At her college physical in 2007, Vanessa Zarembo said no when a nurse offered her the HPV vaccine. The nurse was not amused.

"She made a face of disapproval mixed with disgust and told me that was irresponsible," Zarembo recalled. "She said I needed to re-evaluate my decision."

But Zarembo had concerns about a lack of research on the new vaccine, and today, six years later, she has not changed her mind. "I have never regretted my choice."

Zarembo reflects a larger trend among young Americans that troubles some public-health officials, who say the HPV vaccine could save thousands lives and prevent dangerous cancers if more young Americans got it.

Only about half of U.S. teenage girls have gotten the vaccine, according to a new report by the U.S. Centers for Disease Control and Prevention — even though the CDC has recommended it since 2006. In 2012, the survey found, 54 percent of girls age 13-17 had received one dose of the vaccine, and 33 percent had received all three recommended doses.

The vaccine protects against the human papillomavirus, which infects the skin, genital area, mouth and throat; it is a principal cause of cervical cancer and can be transmitted through sexual contact. Nationally, about 12,000 cases of cervical cancer occur annually as the result of chronic HPV infections, and about 3,700 women die of cervical cancer. In Minnesota, about 175 women are diagnosed with the disease and about 50 die each year, according to the state Health Department.

Nonetheless, the vaccine remains a subject of debate from family dinner tables to state capitals. Since 2006, at least 41 states have introduced some legislation that would require the vaccine, but only Virginia and D.C. require it.

Following the lead of the CDC and the World Health Organization, many doctors endorse the HPV vaccine enthusiastically.

"This is a normal, common-sense thing," said Alexander Levitan, a retired oncologist who practiced at Unity Hospital in Fridley for 31 years and recommended the vaccine to all his patients. "If I can prevent someone from getting cancer, good lord it is the best thing I can do for them."

Still, many teens and parents harbor doubts — driven by fears of vaccines in general, the high cost (a full dose costs $130, not including the doctor's fee), and concerns that giving the vaccine to teenagers signals tacit approval of sexual activity.

"Many parents don't want their children engaging in behavior that puts them at risk for sexually transmitted infections. So it's hard to give their kids shots that protect them from those behaviors that they are uncomfortable with in the first place," said Laurel Ries, a family physician at HealthEast Clinics, who recommends the vaccine to all her patients when they are due for it.

Some parents decline the vaccine for their sons on the belief that males can't get HPV, Ries said. Others believe the best way to protect their children is to instill values that will reduce their likelihood of sexual activity.

"Parents sometimes say, 'My child isn't having sex, so he/she doesn't need that,' " Ries said.

Mixed opinions

For Niambi Mitchell, 22, a student at St. Catherine University in St. Paul, getting the HPV vaccine was never an option.

Her parents are strongly against vaccines in general, and after she had her required shots for school, an optional vaccine was out of the question.

"When the doctors brought it up, my parents shut it down," Mitchell said.

Emma Fazio, now 26, received the vaccine as a 17-year-old and said she feels lucky to have gotten it relatively early.

"It was a no-brainer for me," said Fazio, who lives in Minneapolis. "I wish that there wasn't a stigma attached to it, since it is just preventing young people from protecting themselves against HPV and cancer."

But for Emily Leabch, a St. Paul mother of five, it took a long conversation with her doctor to make a decision. Cancer runs on both sides of her family, and she felt the vaccine could offer some protection.

But Leabch doesn't think the vaccine will prompt them to have sex earlier. "I refuse to live under the idea that they will not have sex," said Leabch, whose three daughters have been vaccinated.

"I don't see it as encouraging them to have sex any more than having the 'sex talk' does," she added. "It is all in how you present it."