Oral human papillomavirus (HPV) infection is the cause of 40% to 80% of oropharyngeal cancers; yet, no published study has examined the role of oral health in oral HPV infection, either independently or in conjunction with other risk factors. This study examined the relation between oral health and oral HPV infection and the interactive effects of oral health, smoking, and oral sex on oral HPV infection. Our analyses comprised 3,439 participants ages 30 to 69 years for whom data on oral HPV and oral health were available from the nationally representative 2009-2010 National Health and Nutrition Examination Survey. Results showed that higher unadjusted prevalence of oral HPV infection was associated with four measures of oral health, including self-rated oral health as poor-to-fair [prevalence ratio (PR) ¼ 1.56; 95% confidence interval (CI), 1.25-1.95], indicated the possibility of gum disease (PR ¼ 1.51; 95% CI, 1.13-2.01), reported use of mouthwash to treat dental problems in the past week (PR ¼ 1.28; 95% CI, 1.07-1.52), and higher number of teeth lost (P trend ¼ 0.035). In multivariable logistic regression models, oral HPV infection had a statistically significant association with self-rated overall oral health (OR ¼ 1.55; 95% CI, 1.15-2.09), independent of smoking and oral sex. In conclusion, poor oral health was an independent risk factor of oral HPV infection, irrespective of smoking and oral sex practices. Public health interventions may aim to promote oral hygiene and oral health as an additional measure to prevent HPV-related oral cancers. Cancer Prev Res; 6(9); 917-24. Ó2013 AACR.
Adolescents and young adults account for over 10 million HIV infections worldwide. Prevention of secondary transmission is a major concern as many HIV-positive youth continue to engage in risky sexual behavior. This study pilot-tested "+CLICK", an innovative, web-based, sexual risk reduction intervention for HIV-positive youth as an adjunct to traditional clinic-based, self-management education. The theory-based application, developed for perinatally and behaviorally infected youth 13-24 years of age, provides tailored activities addressing attitudes, knowledge, skills, and selfefficacy related to sexual risk reduction. HIV-positive youth (N = 32) pilot-tested "+CLICK" to assess usability (ease of use, credibility, understandability, acceptability, motivation) and short-term psychosocial outcomes (importance and self-efficacy related to abstinence and condom use) using a single group, pre-/post-test study design in a hospital-based pediatric clinic and community locations. A subsample of participants (n = 20) assessed feasibility for clinic use. Participants were 62.5% female, 68.8% Black, and 28.1% Hispanic. Mean age was 17.8 years (SD = 2.55), 43.8% were infected behaviorally, 56.2% perinatally, and 68.8% were sexually experienced. Usability ratings were high: 84.4% rated the application very easy to use; 93.8% perceived content as trustworthy; 87.5% agreed most words were understandable; 87.5% would use the application again. Short-term psychosocial outcomes indicate a significant increase in condom use self-efficacy (p = 0.008) and positive trends toward importance (p = 0.067) and self-efficacy (p = 0.071) for waiting before having sex. Regarding feasibility, participants accessed "+CLICK" during waiting periods (average time, 15 minutes) in their routine clinic visit. Clinic staff rated "+CLICK" highly in providing consistent, confidential, and motivational sexual health education without significant disruption to clinic flow. Results suggest that the application is a feasible tool for use in the clinic and has the potential to affect psychological antecedents to sexual behavior change. Further research on long-term and behavioral effects is indicated prior to broader dissemination into clinical practice.
Youth account for almost half of all new HIV infections in the United States. Adherence to antiretroviral treatment (ART) is critical for successful management, yet reported adherence rates for youth are often low. This study pilot-tested "+CLICK," an innovative, web-based, adherence intervention for HIV-positive youth as an adjunct to traditional clinic-based, self-management education. The theory-based application, developed for HIV-infected youth, 13-24 years of age, provides tailored activities addressing attitudes, knowledge, skills, and self-efficacy related to ART adherence. HIV-positive youth (N=10) pilot-tested "+CLICK" to assess usability (ease of use, credibility, understandability, acceptability, motivation) and short-term psychosocial outcomes (importance and self-efficacy related to ART adherence) using a single-group, pre-/post-test study design in a hospital-based pediatric clinic (n=8) and home (n=2) location. Youth were mostly female (80%) and Black (80%). Mean age was 17.8 years (SD=2.65, range 14-22). All were infected perinatally and had been living with HIV all their lives. Most learned their HIV status by age 10 years. Sixty percent reported an undetectable viral load, whilst 10% reported a viral load of over 50,000. Half (50%) reported a normal CD4 count, whilst 20% reported having low CD4 (<200). Usability ratings indicated "+CLICK" was very easy to use (70%), trustworthy, and understandable (both>90%). Most (70%) indicated they would use "+CLICK" again. Short-term psychosocial outcomes indicate significant increase in medication adherence self-efficacy (p<0.05), perceived importance of taking antiretroviral medicine close to the right time every day (p<0.05), and knowledge about HIV and adherence (p<0.01). Other psychosocial variables and behavioral intentions were not significantly impacted. Results suggest that "+CLICK" has the potential to affect psychological antecedents to ART adherence. Further research on long-term and behavioral effects is indicated prior to broader dissemination into clinical practice.
The very few studies that have examined the association between vaginal douching and genital human papillomavirus (HPV) infection have found contrary results. We investigated the associations between douching and numbers of HPV genotypes infecting 1271 participants aged 20-49 years in the 2003-2004 US National Health and Nutrition Examination Survey. After controlling for relevant covariates, douching in the past 6 months was significantly associated with infection by higher numbers of all genital HPV types (relative risk ratio, 1.26; 95% confidence interval, 1.03-1.54) and HPV high-risk types (1.40; 1.09-1.80).
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