Longitudinal trends in perceptions of COVID-19, vaccination, and barriers to COVID-19 vaccination among college students.

OBJECTIVE: To assess changes in perceptions of COVID-19 worry and perceived severity, changes in COVID-19 vaccination status, and barriers to COVID-19 vaccination among college students. PARTICIPANTS: 2,252 participants were recruited from a personal wellness course across four academic semesters at a large public university. METHODS: Participants completed an anonymous online survey. Changes between groups were analyzed to capture changing perceptions and behaviors related to COVID-19. RESULTS: COVID-19 related worry, perceived severity, and vaccination against COVID-19 significantly decreased over time. However, flu vaccination status did not decrease. The top three cited reasons for vaccination hesitation were concerns about side effects, being healthy and young, and at low risk for getting infected. CONCLUSION: Given the likely endemic nature of COVID-19, it is important for universities to continue to provide health education regarding transmission prevention, promote COVID-19 vaccination, and reduce myths regarding side-effects and risk perception.

Exploring Young Adult Comfort with Oral Health Care Providers' Discussions Related to HPV: A mixed methods study.

Purpose: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States and oral healthcare providers (OHPs) have become increasingly focused on preventing oral health outcomes related to HPV through screening for oral cancer and recommending HPV vaccination. The purpose of this study was to explore the comfort of having HPV-related discussions with OHPs among a college-age population.Methods: Students enrolled in an introductory-level, personal health class at a large, public, mid-Atlantic institution were invited to participate in an anonymous survey. Ten items related to participant's perceptions of HPV discussions with an OHP were part of a larger 100 item online survey designed to measure various aspects of college student health. Comfort with an OHPs' discussion of various health issues (including oral cancer, the relationship between oral cancer and HPV, and HPV vaccination) was measured on a 5-point scale with follow up, open-ended questions. Descriptive statistics were used to analyze the data; thematic coding was used to analyze the open-ended items.Results: A total of 3,236 students were invited to participate during the two data collection waves; 2,198 surveys were fully completed, representing a 67.9% response rate. Participants reported having the greatest level of comfort discussing oral health prevention behaviors such as tooth brushing and flossing and the least comfort discussing HPV-related topics with OHPs. Among those expressing low levels of comfort, qualitative responses highlighted participants limited knowledge related to HPV and the HPV vaccination along with the belief that these discussions were better suited for physicians.Conclusions: Results from this study demonstrated that college-age students may be uncomfortable with HPV-related discussions in a dental care setting. However, given the relationship between HPV infection and poor oral health outcomes, it is important that this population be informed about the oral-systemic HPV relationship and of the HPV vaccination as means for primary prevention. These findings highlight the need to address the public's perceptions regarding the role that OHPs play in educating the public about oral-systemic health.

Exploring the Impact of Instruction on College Students' Health Insurance Literacy.

Student health insurance literacy is an area of limited prior knowledge, and investigations into this topic have the potential to impact students' self-care strategies, self-efficacy, decision-making, and quality of life. The purpose of this study was to examine factors associated with health insurance literacy and knowledge among undergraduate students. In this study, undergraduate students at one mid-Atlantic public university in the United States who did and did not receive instruction on health insurance were surveyed. Students were recruited from a course that offers formal instruction about health insurance and students in a comparison group at the same university were recruited from a general education participant pool. Participants (n = 364) completed an online anonymous survey that included demographics, experience with health insurance, health insurance knowledge, and health insurance literacy self-efficacy. Hierarchical multiple regression results indicated participants in the course who received health insurance instruction scored higher on a measure of health insurance knowledge. Higher levels of health insurance self-efficacy was also associated with receiving instruction related to health insurance. Female gender and higher parental education were associated with a lower self-efficacy. Improving health insurance knowledge and self-efficacy among undergraduates is an important aspect of preparing students for post-graduate life where decisions about health insurance coverage and healthcare utilization will increase. Furthermore, increasing health insurance literacy may contribute to raising standards of health literacy, health care, and health care seeking across communities.

Discussing HPV and oropharyngeal cancer in dental settings: gender and provider-type matter.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and the leading cause of oropharyngeal cancer (OPC), an oral cancer most often identified by dental providers. Given the rise in HPV-associated OPC and recent Food and Drug Administration (FDA) approval of the HPV vaccine to prevent OPC, dental providers have a unique role in HPV prevention. This study assessed US adults' comfort levels discussing HPV and OPC with dental providers. An online survey platform was used to recruit a nationally representative sample of US adults (n = 300). The questionnaire assessed participants' knowledge, acceptability, and comfort discussing HPV-related topics with dental providers. SPSS 24 was utilized for data analyses. In general, participants reported feeling comfortable discussing HPV and OPC with dental providers. Participants reported feeling more comfortable with dentists than dental hygienists when discussing (t = 2.85, p < .01) and receiving recommendations about the HPV vaccine (t = 2.09, p < .05). Participants were less comfortable discussing HPV as a risk factor for OPC compared to non-HPV related risk factors (t = 2.94, p < .01). Female participants preferred female providers, whereas male participants had no preference. Previous research has indicated dental providers recognize their role in HPV prevention, but research is needed to understand patients' perceptions of dental providers' role in HPV prevention. Findings demonstrate that US adults are comfortable discussing HPV and OPC with dental providers, which may be key to OPC-HPV prevention. Future research is needed to facilitate HPV communication between patients and dental providers.

Monogamy as a Barrier to Human Papillomavirus Catch-Up Vaccination.

Background: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) in the United States. Although a vaccine to prevent HPV infection exists, only 53.7% of females 13-17 years of age were up-to-date on the HPV vaccination series in 2018. There is a catch-up period of vaccination for females 18-26 years of age that shows consistent underparticipation. A potential barrier to vaccination is relationship status, as long-term relationships may negatively impact HPV risk perception. This study examined monogamy as a risk factor for nonvaccination and explored how risk perception may influence this association. Materials and Methods: An electronic survey was distributed to females 18-26 years of age who attended a large public university in the mid-Atlantic region (n = 629). Multivariable and descriptive statistics were estimated using SAS 9.4 to explore the likelihood of vaccination during the catch-up period by relationship status. Results: Most participants had received the HPV vaccine, a small proportion of whom received it during the catch-up period. After adjusting for confounders, women who were in monogamous relationships were significantly less likely to have participated in HPV catch-up vaccination compared to women who were single and dating (adjusted odds ratio: 0.36, 95% confidence interval: 0.15, 0.87). Women in monogamous relationships had a lower average sexually transmitted disease (STD) risk perception compared to women who were single and dating (p < 0.0001). Conclusions: A decreased risk perception may present a barrier to participating in catch-up vaccination for monogamous women. Practitioners and the public health community should focus on communicating HPV risk to women in monogamous relationships, especially given the recently expanded age range for HPV vaccination.

Does Perpetrator Occupation Affect Classification of Sexual Assault?

Classification of sexual assault varies based on the characteristics of the victim, perpetrator, and event. However, most studies focus on the individual characteristics of participants asked to classify the assault, the victims' characteristics, or the event; few have examined variations in the perpetrator. Therefore, this study examined whether the occupation of the perpetrator affected the classification of the event as sexual assault. Participants included a primarily White female sample of undergraduate students (n = 401) at a south-Atlantic university. They completed a paper-and-pencil survey containing an ambiguous sexual assault encounter where the occupation of the perpetrator (athlete, reporter, college student, or politician) was randomly varied. Participants were asked to classify whether the encounter was sexual assault and what an appropriate punishment might be. Additional measures included the Illinois Rape Myth Acceptance Scale (IRMA) and questions about personal experience with sexual assault. Overall, most participants labeled the encounter as sexual assault, indicating that college students are aware of the legal parameters for providing consent. However, this classification occurred differentially based on the occupation of the perpetrator. Participants were most likely to label the athlete as committing sexual assault, followed by the college student, politician, and reporter, respectively. Females and those who reject rape myths were more likely to label the scenario as sexual assault. A "personal apology" and a "sexual rehabilitation program" were the most common punishments selected for the perpetrator. These findings highlight potential concerns and the need for additional training when college students adjudicate sexual assault reports and determine appropriate consequences.

Women's Empowerment as a Mitigating Factor for Improved Antenatal Care Quality despite Impact of 2014 Ebola Outbreak in Guinea.

Improving maternal outcomes and reducing pregnancy morbidity and mortality are critical public health goals. The provision of quality antenatal care (ANC) is one method of doing so. Increasing women's empowerment is associated with positive women's health outcomes, including the adequate timing and amount of ANC use. However, little is known about the relationship between women's empowerment and quality ANC care. Despite a history of political instability, low women's equality and poor maternal health, the Republic of Guinea has committed to improving the status of women and access to health. However, the 2014 Ebola outbreak may have had a negative impact on achieving these goals. This study sought to examine factors in the relationship between women's empowerment and the receipt of quality ANC (indicated by the number of health components) within the context of the Ebola outbreak. This study conducted multiple logistic regressions examining associations between covariates and the number of ANC components received using data from the 2012 and 2018 Guinea Demographic Health Surveys. Several aspects of women's empowerment (healthcare decision-making, literacy/access to magazines, monogamous relationship status, contraceptive use, socio-economic status/employment) were significantly linked with the receipt of a greater number of ANC components, highlighting the importance of women's empowerment in accessing quality maternity care.

Exploring college students' sexual and reproductive health literacy.

Objective: To assess college students' sexual and reproductive health (SRH) literacy experiences, specific to contraception use and STI prevention. Participants: In Spring 2015, participants (n = 43) from a large institution participated in six focus groups (two male and four females groups). Methods: Focus groups were guided by the health literacy domains (access; understand; appraise; apply); data were analyzed in MaxQDA using the constant comparative method. Results: The Internet was the most commonly accessed source for SRH information. Participants discussed facilitators (eg, use of visuals) and barriers (eg, medical jargon) to understanding information; and personal lifestyle, advice from family/friends, symptoms, and sexual partners as appraisal factors. Participants applied information by communicating with friends/providers and seeking healthcare. However, findings were not linear nor mutually exclusive, representing the interaction of health literacy skills. Conclusion: Findings suggest that a patient-centered intervention capitalizing on technology and trusted individuals (providers/peer educators) may facilitate college students' SRH literacy.

"I Didn't Know": Pregnant Women's Oral Health Literacy Experiences and Future Intervention Preferences.

OBJECTIVE: This study explored women's 1) experiences in accessing, understanding, appraising, and applying oral health information and services, and 2) preferences regarding oral health promotion during pregnancy. METHODS: Pregnant women ages 18 to 45 were recruited from an obstetrics and gynecology clinic at a large university hospital. Focus groups were conducted using the four domains of the integrated model of health literacy (access, understand, appraise, apply) and were audio-recorded and professionally transcribed. Thematic analysis was employed using Atlas.ti. RESULTS: Participants (n = 17) were Hispanic (53%), married (67%), college educated (87%), employed (80%), and insured (100%). Most participants reported not accessing or receiving oral health information during pregnancy, with limited information received from less trustworthy sources (Internet; friends/family) and focusing on symptoms or myths. Participants revealed gaps in basic oral health understanding and demonstrated limited ability to evaluate or apply information, such as engaging in positive oral health behaviors, according to their needs and personal health status. Participants strongly desired that oral health promotion be integrated into prenatal care. CONCLUSIONS: Participants described missed opportunities to improve oral health literacy and desire future health messages that facilitate patient-provider communication on oral health during prenatal care visits. Future health interventions should convey the importance and associated risks, be time efficient and patient centered, and include patient activation to prompt oral health-seeking behaviors during pregnancy.

Exploring Women's Experiences in Accessing, Understanding, Appraising, and Applying Health Information During Pregnancy.

INTRODUCTION: This study explored pregnant women's experiences in accessing, understanding, evaluating, communicating, and using health information and services during pregnancy. METHODS: Pregnant participants (aged 18-45 years) were recruited from an obstetrics and gynecology department of a large urban training hospital. Focus groups were facilitated by a moderator's guide developed from health literacy domains (access, understand, evaluate, and communicate and use), audio recorded, transcribed, and uploaded into ATLAS.ti. Constant comparative and thematic analysis were employed. RESULTS: Participants (N = 17) were predominantly Hispanic (53%), married (67%), college educated (87%), employed (80%), insured (100%), and nulliparous (59%). Health care providers and online and digital sources were preferred sources of information. Participants' understanding was facilitated by plain language, pictures and other visuals, numbers and statistics, and tailored information. Participants evaluated information credibility by source (health care provider, advertisement, multiple sources) and personal circumstances (eg, health history, gestational age). In addition, these women used the information to communicate with health care providers, family, and partners and to change health-related behaviors. DISCUSSION: Participants described rich, contextual health literacy experiences. Future interventions that maximize access to health care providers and online and digital sources, while ensuring materials are easy to understand, convenient, and patient centered, could facilitate informed decision making during this critical period. Future prenatal education and counseling interventions could be developed and evaluated using established health literacy principles to ensure that information is accessible, understandable, and actionable.

Dental opinion leaders' perspectives on barriers and facilitators to HPV-related prevention.

Evidence suggests a causal connection between the Human Papillomavirus (HPV) and oropharyngeal cancers. HPV-related oropharyngeal cancers are increasing and are the most common HPV-associated cancer. Previous research suggests that dental professionals recognize a role in the prevention of HPV and oropharyngeal cancers. As an initial step to investigating effective mechanisms of incorporating HPV prevention into dental practices, including the HPV vaccine, this qualitative study explored dental opinion leaders' perspectives on barriers and facilitators to HPV-related prevention in the dental profession. Dental opinion leaders were identified through: (1) national professional organizations and advocacy groups, (2) by indication of an expert panel, and (3) focus groups conducted with oral health providers. Thirteen participants representing 11 organizations were interviewed via telephone. Interview recordings were transcribed verbatim and thematically coded using a priori and emergent codes. Opinion leaders described multi-level factors influencing dental providers' HPV-related prevention practice behaviors. Barriers included HPV as a sensitive topic and the need for HPV-related education and skills. Facilitators included perceptions of HPV prevention as part of the dental providers' role and the potential development of passive educational methods to provide HPV-related information to patients. Opinion leaders reported dental providers have a role in the prevention of HPV and oropharyngeal cancer; yet, to fully incorporate this topic into their practice, dental providers need further education and skill-based training. Opinion leaders have significant role in shaping this topic as a priority and identifying potential interventions to assist dental providers' HPV-related prevention. Future research should maximize the role of opinion leaders as key change agents.

The Role of Dental Providers in Preventing HPV-Related Diseases: A Systems Perspective.

Successfully educating dental providers and patients about the link between human papillomavirus (HPV) and oropharyngeal cancer requires coordinated efforts to increase HPV-related prevention practices. The aim of this study was to identify, using a systems perspective, the multi-level determinants related to how dental providers can promote HPV prevention in dental practices. Data for this qualitative study were collected in 2015-16 from focus groups with dentists (four focus groups, n=33), focus groups with dental hygienists (four focus groups, n=48), and in-depth interviews with dental opinion leaders (n=13). Results were triangulated and mapped along micro, meso, and macro system levels. At the micro level, participants identified patient characteristics and low self-efficacy as influential determinants when discussing HPV prevention. At the meso level, relationships among dentists, dental hygienists, and the physical practice environment were factors affecting dental providers' HPV prevention efforts. At the macro level, professional organizations impacted how dental providers interacted with their patients on this topic. These results suggest that improving HPV prevention among dental providers requires a multi-level approach that considers the distinctive context of dental settings, dental training, and perceptions of professional roles. The findings suggested that the macro- and meso-level determinants may be challenging to modify due to the distinctive culture and practice models of dentistry. Nevertheless, the association between HPV and oral cancer requires an expansion of prevention strategies used in dental practices. Improving dental providers' self-efficacy to communicate HPV prevention through continuing education and integration of skill-guided training in dental and dental hygiene curricula could facilitate this process.

Are dental providers the next line of HPV-related prevention? Providers' perceived role and needs.

The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance "primordial prevention," or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists' perceived roles and needs regarding HPV-related primordial prevention. We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests. Participants affirmed dental professionals' roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention. Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers' professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers' needs for following professional organizations' guidance to advance prevention efforts and reduce HPV-related cancer incidence.

HPV-Related Knowledge Among Dentists and Dental Hygienists.

Dental providers, such as dentists and dental hygienists, play an important role in HPV-related oropharyngeal cancer prevention. Dental professional organizations recommend dental providers educate patients about HPV and oral cancers. The objective of this study was to assess HPV knowledge among dental providers. Dentists (n = 36) and dental hygienists (n = 146) attending a professional conference completed a continuing education post-test survey, which included socio-demographics, an HPV knowledge scale, and measure of HPV discussion with patients ("no," "yes," and "yes, but only with some patients"). Chi-square tests, t tests, and ANOVA tests were used for this analysis. Although dental hygienists (35.4%) reported less discussion with patients about HPV than dentists (52.8%), these differences were not significant. The mean knowledge score was 24.7 (SD = 3.8) with no significant differences by profession. Among dentists, knowledge did not significantly differ by discussion category (p = 0.28). In contrast, dental hygienists who did not discuss HPV with patients had significantly lower mean knowledge scores (mean = 23.4) than those who discussed with patients (mean = 26.5, p < 0.01) or discussed only with some patients (mean = 26.0, p = 0.01). Knowledge deficits included outcomes associated with HPV, HPV in men, and curability. Specifically, participants incorrectly answered that HPV can affect a women's ability to get pregnant (81.9%), that one can never get rid of HPV once they have it (69.2%), and that HPV can cause herpes (43.4%). This study identified HPV knowledge deficits among dental providers. Given the recommendation for dental providers to discuss HPV prevention with their patients, additional education and training on this emerging topic may benefit these professionals.

Assessing dentists' human papillomavirus-related health literacy for oropharyngeal cancer prevention.

BACKGROUND: Oropharyngeal cancers related to human papillomavirus (HPV) are on the rise. Dentists may be the next group of providers participating in the prevention of HPV. The aim of this study was to assess dentists' health literacy regarding the connection of HPV and oropharyngeal cancer. METHODS: The authors conducted 4 focus groups with dentists (N = 33) during a regional dental conference in 2016. Guided by the health literacy competencies (that is, access, understand, appraise, and apply), the authors used constant comparison methods for data analysis. RESULTS: Dentists mentioned a variety of informational sources (for example, dental journals and colleagues). Knowledge about the link between HPV and oropharyngeal cancer varied among participants. Participants appraised multiple patient and practice factors when deciding to have the discussion with patients. Some dentists discussed the HPV and oropharyngeal cancer connection with patients, and most conducted secondary screenings. CONCLUSIONS: Findings indicate areas for intervention, including creating awareness of trusted informational sources, as well as increasing HPV knowledge and understanding the multiple patient (for example, age) and practice (for example, open operatories) appraisal factors. Moreover, enhancing the communication skills of dentists with patients is needed to improve HPV-related cancer prevention education. PRACTICAL IMPLICATIONS: Addressing dentists' HPV-related health literacy has the potential to improve dentists' HPV-related prevention practices, including expanding patient education about this topic and increasing HPV vaccination knowledge, ultimately contributing to the reduction of oropharyngeal cancers.

Health Literacy Approaches to Improving Communication between Dental Hygienists and Patients for HPV-Related Oral Cancer Prevention.

Purpose: Human Papillomavirus (HPV) has been identified as a causal agent for oropharyngeal cancers, suggesting a new role for dental hygienists in HPV-related cancer prevention strategies. Health literacy assessment is an approach that can be used to understand providers' informational assets and needs for educating and discussing HPV prevention with patients. This study aimed to understand dental hygienists' level of health literacy regarding HPV-related oropharyngeal cancers.Methods: Four focus group sessions with dental hygienists (n=48) were conducted at a national conference. The constant comparison method, with a priori codes for health literacy competencies (i.e., access/understand/appraise/apply), was utilized for this qualitative study.Results: Participants mentioned a variety of modes (e.g., magazines, journals) for accessing HPV-information; however, descriptions of understanding HPV and its relationship to oropharyngeal cancer varied. Participants considered patients' personal characteristics, the dental practice environment, and professional factors to appraise HPV-related information. Additionally, participants self-described themselves as being "prevention specialists." These factors influenced how dental hygienists applied primary and secondary prevention of HPV-related care issues with their patients (e.g., education and oral-cancer screenings).Conclusions: Dental hygienists recognized the importance of HPV and oropharyngeal cancer prevention efforts, including oral-cancer screenings and promotion of the HPV vaccine. The study findings identified opportunities for intervention focusing on primary prevention.

The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation.

Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.

Do Physical Activity Patterns Across the Lifecourse Impact Birth Outcomes?

The significant impact of physical activity during, or immediately prior to pregnancy on a range of pregnancy and birth outcomes has been established. However, lifecourse theory posits that the antecedents of poor outcomes occur across a larger trajectory of time. The objective of this study was to examine whether physical activity patterns over the lifecourse impact birth outcomes. The sample (n = 1,713) was derived from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health and limited to women who had their first, singleton live birth between Waves III and IV; respondents who had missing data were excluded. Outcome variables included preterm birth (<37 weeks) and low birth weight (<5.5 pounds). Physical activity was categorized as follows: long-term physically active (active at Waves I and III); short-term physically active (active at only Wave I or III); and not physically active (not active at Waves I and III). Survey-weighted logistic regression controlled for socio-demographic and established predictors of poor birth outcomes. Women categorized as long-term physically active had lower rates of preterm births (12.2 vs. 18.7 %) and low birth weight (9.1 vs. 11.1 %) compared to women categorized as not physically active. However, when controlling for covariates, adjusted analysis revealed that physical activity consistency only predicted preterm birth (aOR = 0.55, 95 % CI = 0.33-0.91). Findings suggest that physical activity patterns across the lifecourse may decrease risk of preterm birth. Implications include efforts supporting patterns of physical activity over longer periods of time prior to pregnancy.