The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) and the leading cause of oropharyngeal cancers (OPC). In the United States, there were about 43 million HPV infections in 2018. Nearly 70% of OPCs are caused by HPV. The number of new cases of OPC in the US has been rising over the last few decades. This webinar will share the findings from the Oral Health Equity survey – a nationally representative survey conducted by the CareQuest Institute for Oral Health in which gathered information about the HPV and HPV vaccine relationship with oral health, vaccine recommendation by the oral health provider, and role of oral health provider in the administration of the HPV vaccine. We will first present the history of HPV and HPV vaccination in the US and the national and state level vaccination trends. This will be followed by the presentation of the main findings from the CareQuest survey. We will share the data on HPV and HPV vaccine knowledge, attitudes and beliefs towards HPV vaccination and the perceptions of US adults about the role of oral health providers in HPV vaccination. In conclusion, we will discuss the implications of survey findings on oral health, gaps in vaccination rates and potential strategies to increase vaccination uptake.
The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) and the leading cause of oropharyngeal cancers (OPC). In the United States, there were about 43 million HPV infections in 2018. Nearly 70% of OPCs are caused by HPV. The number of new cases of OPC in the US has been rising over the last few decades. Each year, about 3,500 new cases of HPV-associated oropharyngeal cancers are diagnosed in women and about 16,200 are diagnosed in men. To prevent HPV infections, safe and effective HPV vaccines are available. However, the uptake for the vaccine remains low nationwide. Thus, it is important to understand the attitudes, beliefs, and knowledge about the HPV vaccine overall and in the context of oral cancers and OPC.
Data from the ‘State of Oral Health Equity in America’ survey was used for this study. It is a nationally representative survey designed by the CareQuest Institute for Oral Health, which collected respondents’ information on attitudes, experiences, and behaviors on oral health. Data was collected in January and February 2021 using the AmeriSpeak panel by the National Opinion Research Center (NORC) at the University of Chicago. Randomly selected US households were sampled using area probability and address-based sampling. Sample households were contacted by US mail, telephone and field interviewers. The survey asked respondents questions about the HPV and HPV vaccine relationship with oral health, vaccine recommendation by the oral health provider, and perceived role of oral health provider in the administration of the HPV vaccine. All estimates were weighted. Chi-square tests were used to examine associations between HPV knowledge and attitudes, and respondent characteristics. The multivariable logistic regression models were used to examine the adjusted associations.
Final sample included 5,320 adults aged 18 years and above. Preliminary findings from the survey suggest that 32% of adults agreed that the HPV vaccine is very important for preventing cancers of throat and mouth, but only 9% thought that HPV was linked to the health of teeth, mouth and gums. Asian race and higher education and income are influencing factors on understanding the importance of the HPV vaccine for preventing cancers of the throat and mouth. Only 10% of adults reported receiving the HPV vaccine recommendation by an oral health provider for their child. Lower education, income and younger age was associated with increased likelihood of an oral health provider recommending the HPV vaccine. Respondents were divided on whether they thought an oral health provider was qualified to provide education on the HPV vaccine. More than half (55%) of respondents reported that an oral health provider was qualified to provide education on the HPV vaccine and that they were comfortable discussing the HPV vaccine (58%) with an oral health provider and consenting to it if the oral health provider recommended it (55%). Respondents who thought HPV was linked to the health of the teeth, mouth and gums were 2.8 times more likely to agree about the importance of the HPV vaccine in preventing cancers of the mouth and throat compared to respondents who didn’t think that HPV was linked to the health of the teeth, mouth and gums. Similarly, respondents whose oral health care provider had mentioned the HPV vaccine to them were 1.7 times more likely to agree about the importance of the HPV vaccine in preventing cancers of the mouth and throat compared to their counterparts.
Findings suggest that knowledge about HPV and oral health linkage among US adults is low but many adults agree that the HPV vaccine can prevent cancers of the throat and mouth. Attitudes about HPV vaccine were associated with HPV knowledge and dental provider recommendation. With the emerging science confirming the association between OPC and HPV, the role of the dental healthcare provider will continue to expand. Integrating effective communication strategies through trusted resources such as oral health providers can build patient awareness of the possible benefits and risks associated with HPV-related OPC and the importance of the HPV vaccine for the prevention of OPC and other cancers. Integrating HPV education into the dental and dental hygiene school curricula will also help prepare future providers in addressing HPV in a dental setting. The next generation of healthcare professionals needs to be well versed in the emerging evidence as it relates to OPC and HPV.
CHRISTINA A. DEMOPOULOS, DDS, MPH, is a faculty member at the UNLV School of Dental Medicine (SDM). She attended the University of Nevada, Las Vegas (UNLV) for her undergraduate and her Master of Public Health (MPH) training. She received her dental degree from the University of Southern California (USC) and her dental public health training from the University of Texas Health Science Center at San Antonio (UTHSCSA).
Dr. Demopoulos is a Course Director for several classes at the UNLV School of Dental Medicine and provides educational experiences relating to HPV and oropharyngeal cancer. She has collaborated with the Nevada statewide immunization coalition (Immunize Nevada), AHEC, American Cancer Society and the National Network for Oral Health Access (NNOHA) to offer continuing education webinars relating to the promotion of the HPV vaccine for healthcare providers. She has also presented on the topic at local, state and national conferences.
Dr. Shillpa Naavaal is an assistant professor and a health services researcher in the Department of Dental Public Health and Policy, Virginia Commonwealth University, School of Dentistry. She is a board-certified diplomate in Public Health Dentistry and serves as a faculty member in the VCU iCubed program and Philips Institute for Oral Health Research. Her primary research interests are in dental-medical integration, oral health disparities, access to health care, and the use of health services among vulnerable populations. As an associate member of the Massey Cancer Center at VCU, her cancer prevention work focuses on addressing oral cancer and screening disparities and examining risk factors, including HPV, HPV vaccination, and tobacco use.
She is a recipient of several internal and external grants and awards and has mentored many undergraduate and graduate students. Her research contributions have been published in various high-ranked peer-reviewed journals, and she has written various reports and professional documents to promote oral health. Dr. Naavaal is actively involved in various national and state-level oral health policy and scientific committees. She co-chairs the Council of Scientific Information at the American Association of Public Health Dentistry.
Before joining VCU, Dr. Naavaal worked as a health scientist and a research fellow at the Office of Smoking and Health and the Division of Oral Health at CDC, Atlanta. She completed her Dental Public Health residency at the CDC Division of Oral Health, Masters in Oral Science, and Masters in Public Health at the University of Illinois at Chicago, and her dental degree and advanced clinical program from the Government Dental College, Nagpur University, India.
ResearchGate profile: https://www.researchgate.net/profile/Shillpa_Naavaal
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