Betelihem B. Tobo

Not just a woman's business! Understanding men and women's knowledge of HPV, the HPV vaccine, and HPV-associated cancers

Few studies have included men when assessing differences in knowledge about HPV, and HPV-associated cancers. We examined gender differences in knowledge about HPV, HPV vaccine, and HPV-associated cancers. Multivariable logistic regression models were used to analyze data of 3,677 survey respondents aged 18 years and older from the 2014 Health Information National Trends Survey. Covariates included age, race/ethnicity, marital status, education, income level, regular provider, general health, internet use, and family structure aged 9 to 27 years. Analyses were conducted in 2015. Sixty-four percent of respondents had heard of HPV and the HPV vaccine. Seventy-eight percent of respondents knew HPV causes cervical cancer, but only 29% knew it causes penile cancer, 26% knew it causes anal cancer, and 30% knew it causes oral cancer. In multivariable analyses, males were less likely to have heard of HPV (aOR: 0.33; 95% CI: 0.25-0.45), and less likely to have heard of the HPV vaccine (aOR: 0.24; 95% CI: 0.18-0.32) compared to females. No differences existed between males and females regarding knowledge about HPV-associated cancers. In conclusion, knowledge of HPV, the vaccine, and HPV-associated cancers in both males and females in the United States remains very low, especially among men.

A Comparison of Parent- and Provider-Reported Human Papillomavirus Vaccination of Adolescents

INTRODUCTION There is considerable effort at the state and national levels to monitor human papillomavirus (HPV) vaccine uptake and understand the factors that influence who gets vaccinated. Accurate measurement of vaccination coverage is critical for monitoring HPV vaccination. This study aimed to determine comparability between parent- and provider-reported HPV vaccination status for a sample of adolescents in the U.S. METHODS Data from the 2014 National Immunization Survey-Teen were analyzed in 2016 for 20,827 adolescents. Information on HPV vaccine uptake (initiation [one or more dose] and completion [three or more doses]) was obtained using parental (recall) and provider reports (electronic medical records). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and κ-coefficient were computed to determine how comparable parental and provider (ref group) reports were for HPV vaccination. RESULTS Prevalence of HPV vaccine initiation was comparable between parental and provider report (51.3% vs 50.0%) and for completion (30.7% vs 27.3%). Compared with provider report, parent-reported HPV vaccine initiation had high sensitivity (86.0%), specificity (87.4%), PPV (87.5%), NPV (85.9%), and acceptable κ-coefficient (0.73). Compared with provider report, parent-reported HPV vaccine completion had a sensitivity of 71.5%, specificity of 91.1%, PPV of 78.5%, NPV of 87.6%, and κ-coefficient of 0.64. Similar characteristics-adolescent age, sex, number of doctor visits, and region-were associated with HPV vaccine uptake using parental and provider reports. CONCLUSIONS Parental recall is comparable to provider report in monitoring HPV vaccine uptake for adolescents, although parental recall is less comparable for HPV vaccine completion.

Association Between Head and Neck Squamous Cell Carcinoma Survival, Smoking at Diagnosis, and Marital Status

Importance While the adverse association between smoking and head and neck squamous cell carcinoma (HNSCC) survival has been well described, there are also inconclusive studies and those that report no significant changes in HNSCC survival and overall mortality due to smoking. There is also a lack of studies investigating the association of marital status on smoking status at diagnosis for patients with HNSCC. Objective To examine the association between patient smoking status at HNSCC diagnosis and survival and the association between marital status and smoking in these patients. Design, Setting, and Participants This retrospective cohort study was conducted by querying the Saint Louis University Hospital Tumor Registry for adults with a diagnosis of HNSCC and treated at the university academic medical center between 1997 and 2012; 463 confirmed cases were analyzed. Main Outcomes and Measures Cox proportional hazards regression analysis was used to evaluate association of survival with smoking status at diagnosis and covariates. A multivariate logistic regression model was used to assess whether marital status was associated with smoking at diagnosis adjusting for covariates. Results Of the 463 total patients (338 men, 125 women), 92 (19.9%) were aged 18 to 49 years; 233 (50.3%) were aged 50 to 65 years; and 138 (29.8%) were older than 65 years. Overall, 56.2% of patients were smokers at diagnosis (n = 260); 49.6% were married (n = 228); and the mortality rate was 54.9% (254 died). A majority of patients were white (81.0%; n = 375). Smokers at diagnosis were more likely to be younger (ie, <65 years), unmarried, and to drink alcohol. We found a statistically significant difference in median survival time between smokers (89 months; 95% CI, 65-123 months) and nonsmokers at diagnosis (208 months; 95% CI, 129-235 months). In the adjusted Cox proportional hazards model, patients who were smokers at diagnosis were almost twice as likely to die during the study period as nonsmokers (hazard ratio, 1.98; 95% CI, 1.42-2.77). In the multivariate logistic regression analysis, unmarried patients were 76% more likely to use tobacco than married patients (adjusted odds ratio, 1.76; 95% CI, 1.08-2.84). Conclusions and Relevance Smokers were almost twice as likely as nonsmokers to die during the study period. We also found that those who were married were less likely to be smokers at diagnosis. Our study suggests that individualized cancer care should incorporate social support and management of cancer risk behaviors.

Correlates of health information seeking between adults diagnosed with and without cancer

Purpose To examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without. Methods Cross-sectional data from the Health Information National Trends Survey 4 Cycles 1–3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking. Results Cancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis. Conclusions Respondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.

Pineal Gland Calcification in Kurdistan: A Cross-Sectional Study of 480 Roentgenograms.

Objective The goal of this study was to compare the incidence of Pineal Gland Calcification (PGC) by age group and gender among the populations living in the Kurdistan Region-Iraq. Methods This prospective study examined skull X-rays of 480 patients between the ages of 3 and 89 years who sought care at a large teaching public hospital in Duhok, Iraq from June 2014 to November 2014. Descriptive statistics and a binary logistic regression were used for analysis. Results The overall incidence rate of PGC among the study population was 26.9% with the 51–60 age group and males having the highest incidence. PGC incidence increased after the first decade and remained steady until the age of 60. Thereafter the incidence began to decrease. Logistic regression analysis revealed that both age and gender significantly affected the risk of PGC. After adjusting for age, males were 1.94 (95% CI, 1.26–2.99) times more likely to have PGC compared to females. In addition, a one year increase in age increases the odds of developing PGC by 1.02 (95% CI, 1.01–1.03) units after controlling for the effects of gender. Conclusion Our analysis demonstrated a close relationship between PGC and age and gender, supporting a link between the development of PGC and these factors. This study provides a basis for future researchers to further investigate the nature and mechanisms underlying pineal gland calcification.

Abstract A51: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine in a national sample of U.S. adults

Background: Nearly 80 million people in the U.S. are currently infected with at least one of two strains of human papillomavirus (HPV), which is associated with 70% of cervical, and more than 90% of oropharyngeal, cancers. Racial/ethnic disparities in cervical cancer are pervasive, with non-Hispanic Black and Hispanic women experiencing disproportionately higher incidence and mortality rates than other racial or ethnic groups. Further, although it has been almost 10 years since the approval of the first of three HPV vaccines for boys and girls, disparities in knowledge and awareness about HPV and the HPV vaccine persist, and vaccination rates are suboptimal. The goal of this study was to assess racial/ethnic and gender disparities in the knowledge and awareness of HPV and the HPV vaccine among US adults. Methods: Cross-sectional data were obtained from the Health Information National Trends Survey Cycles 3 and 4 (HINTS; N=6,862). Descriptive statistics and multivariable logistic regression were used to assess racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness. Results: Sixty-six percent of Americans had heard of HPV and the HPV vaccine; and seventy percent knew that HPV causes cervical cancer. However, we found racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine. In multivariate analyses, females were 3.28 times (95% CI: 2.62 – 4.09) more likely to have heard of HPV, and 3.86 times (95% CI: 3.11 – 4.79) more likely to have heard of the HPV vaccine compared to males. Non-Hispanic Blacks were 33% (95% CI: 0.47 – 0.96) and 44% (95% CI: 0.39 – 0.81) less likely than non -Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. There was no significant difference between Hispanics and non-Hispanic Whites regarding HPV knowledge; however, Hispanics were 53% (95% CI: 0.34 – 0.64) less likely than non-Hispanic Whites to have heard of the HPV vaccine. Females were more likely than males to know that HPV causes cervical cancer (OR = 1.49, 95% CI: 1.13 – 1.96). Non-Hispanic Blacks were 48% (95% CI: 0.35 – 0.76) less likely to know that HPV causes cervical cancer compared to non-Hispanic Whites. However, there was no statistically significant difference between Hispanics and non-Hispanic Whites regarding awareness that HPV causes cervical cancer. Forty-six percent of Americans were aware that HPV often clears on its own without treatment. Conclusions: Non-Hispanic Blacks and males suffer the greatest disparities associated with knowledge and awareness of HPV and the HPV vaccine. Increasing awareness about the HPV vaccine may help improve vaccination uptake, especially among males and minority populations. Thus, future interventions targeting males and minority populations, for whom knowledge gaps currently exist, are needed. There is also a need to improve physician-patient communications to maximize physician discussion of the HPV vaccine with patients and parents of children eligible for the HPV vaccine. Citation Format: Eric Adjei Boakye, Betelihem B. Tobo, Nosayaba Osazuwa-Peters. Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine in a national sample of U.S. adults. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A51.

Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer-Results from a national study

Depression is a significant problem for patients with head and neck cancer (HNC). This study explored the prevalence of and sociodemographic and clinical factors associated with depression, among patients with HNC.

Correlates of Human Papillomavirus (HPV) vaccination initiation and completion among 18–26 year olds in the United States

ABSTRACT Purpose: To examine correlates of HPV vaccination uptake in a nationally representative sample of 18–26-year-old adults. Methods: Young adults aged 18–26 years were identified from the 2014 and 2015 National Health Interview Survey (n = 7588). Survey-weighted multivariable logistic regression models estimated sociodemographic factors associated with HPV vaccine initiation (≥1 dose) and completion (≥3 doses). Results: Approximately 27% of study participants had initiated the HPV vaccine and 16% had completed the HPV vaccine. Participants were less likely to initiate the vaccine if they were men [(adjusted odds ratio) 0.19; (95% confidence interval) 0.16–0.23], had a high school diploma (0.40; 0.31–0.52) or less (0.46; 0.32–0.64) vs. college graduates, and were born outside the United States (0.52; 0.40–0.69). But, participants were more likely to initiate the HPV vaccine if they visited the doctors office 1–5 times (2.09; 1.56–2.81), or ≥ 6 times (1.86; 1.48–2.34) within the last 12 months vs. no visits. Odds of completing HPV vaccine uptake followed the same pattern as initiation. And after stratifying the study population by gender and foreign-born status, these variables remained statistically significant. Conclusions: In our nationally representative study, only one out of six 18–26 year olds completed the required vaccine doses. Men, individuals with high school or less education, and those born outside the United States were less likely to initiate and complete the HPV vaccination. Our findings suggest that it may be useful to develop targeted interventions to promote HPV vaccination among those in the catch-up age range.

Foreign-born blacks no different from whites for odds of stroke

Background Blacks have higher risk for stroke than whites. However, combining foreign-born and US-born blacks could mask important health differences. We examined the relationship between nativity and stroke risk in US adults. Methods Data were obtained from the National Health Interview Survey, 2006–2014. Study population (n=189, 409) included non-Hispanic whites and non-Hispanic blacks born in the Caribbean, and non-Hispanic blacks born in Africa. Logistic regression models were used to assess the association between stroke and race/nativity, adjusting for covariates such as insurance status, hypertension, age and duration of US residence. Results Foreign-born blacks had similar odds of stroke (95% CI 0.58 to 1.60 for non-Hispanic blacks from the Caribbean, and 95% CI 0.17 to 1.10 for blacks from Africa), while US-born blacks had increased odds of stroke (95% CI 1.22 to 1.46) compared with non-Hispanic whites. When compared with US-born blacks, both non-Hispanic blacks from the Caribbean and Africa showed reduced odds of stroke: 95% CI 0.50 to 0.94 and 95% CI 0.21 to 0.75, respectively. After adding a race/nativity × age interaction term to the model however, compared with non-Hispanic whites, blacks from Africa aged <65 years had lower odds of stroke (95% CI 0.13 to 0.72) while blacks from the Caribbean had similar odds of stroke at all ages. Conclusions Homogenising ‘Blacks’ may mask important differences based on nativity. Public health prevention efforts should consider the heightened risk of stroke among younger US-born blacks and focus on primary prevention for immigrant blacks. Also, national surveys should incorporate more ethnicity-related variables.

Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine

ABSTRACT   Purpose: Gaps remain in the publics knowledge of the human papillomavirus (HPV). We assessed racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine among US adults. Methods: Data from the Health Information National Trends Survey 4 Cycle 3 (September – December 2013) and Cycle 4 (August – November 2014) were analyzed for 6,862 respondents aged 18 years and older. Weighted multivariable logistic regression models were used to estimate racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness. Results: Sixty-six percent of respondents had heard of HPV and the HPV vaccine (57% of men vs. 75% of women). In multivariable analyses, compared with men, women were 225% (95% CI: 2.60 – 4.07) more likely to have heard of HPV, and 281% (95% CI: 3.06 – 4.74) more likely to have heard of the HPV vaccine. Non-Hispanic Blacks were 33% (95% CI: 0.47 – 0.96) and 44% (95% CI: 0.39 – 0.81) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% (95% CI: 0.52 – 1.02) and 53% (95% CI: 0.34 – 0.64) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Conclusions: There was evidence of disparities in HPV and HPV vaccine awareness among men compared with women and non-Hispanic Blacks and Hispanics compared with non-Hispanic Whites. To foster improvements in HPV vaccine uptake and reduce disparities in HPV associated cancers, future interventions must target men and minority populations, for whom knowledge gaps exist.