STDs May Change Stance on Circumcision

"It's definitely true that the cost is important, especially if you think of Medicaid," said Arleen Leibowitz, professor of public policy at the University of California in Los Angeles.

This January, Leibowitz published a large study investigating circumcision choice, insurance coverage, common cultural choices, and economic status of young parents. Without coverage, Leibowitz said, a circumcision will cost $300, and that made a difference to some parents.

"If you're controlling for all sorts of things that influence circumcision -- race, economic standing, culture -- the study still shows babies who are not covered are less likely to be circumcised," said Leibowitz.

Which Parents Decide for Circumcision?

Yet, outside of costs, Leibowitz can't say whether parents would choose circumcision for any newfound benefits in preventing sexually transmitted infections.

"I think that we already knew from observational studies in the U.S. that HPV was lower in circumcised men," said Leibowitz. "I think we knew that, but I think it's nice to have it confirmed in a randomized trial.

"Whether individuals may relate this information to this decision-making, I really don't know," she said. "I think increasingly what people do before making the decision is they go to the Net -- they Google."

However, a handful of professors in the wake of the HPV vaccine have tried to study whether parents value cultural and belief systems over efforts that can reduce sexually transmitted diseases.

Although quite different from circumcision, Norman Constantine of the University of California at Berkeley said his research on HPV vaccines and sexual education indicated parents tend to be quite pragmatic.

"Most parents are pragmatic and realize that a large percentage of teens by the time they've reached their 20s are sexually active," said Constantine, the senior research scientist and director at the Center for Research on Adolescent Health and Development.

Constantine and other scientists did a statewide California survey of parental attitudes when the HPV vaccine was first approved by the Food and Drug Administration.

Self-identified Asian, African American, Latino, white, liberal, conservative, religious and secular individuals all were asked. Constantine said 75 percent of parents surveyed supported the HPV vaccine, and 89 percent supported comprehensive sexual education in the classrooms.

"This was remarkably similar across different groups," he said.

Religious groups, liberal people, conservative people, Christians, secular -- all responded with a pragmatic approach, Constantine said.

"We had a very small subset of parents," he said. "Three-point-five percent gave moral values reasons to objecting to vaccination and the comprehensive sex education."

With new evidence supporting circumcision, Constantine said he would consider it as a cost effective public health strategy.

"I think we need support for it, we need coverage, but we have to be careful," he said. "I am in favor of mandating funding, but don't mandate circumcision."

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