Classification Tree Analysis of Factors Associated with Oral Cancer Exam.

Objective: In this study, we performed a classification tree analysis (CTA) to identify population subgroups that are less likely to have an oral cancer examination (OCE). Methods: We conducted telephone surveys (N = 2401) of adults residing in north Florida to collect data on OCE status and potential OCE predictors including demographics, medical and dental experience, and psychosocial factors. The CTA algorithm exhaustive chi-square automatic interaction detector (E- CHAID) was employed to determine the relationships between OCE status and the predictors. Results: The overall OCE rate was 46.8% in our sample. Participants' rating of the dentist was the first level splitting variable, leading to 15 unique participant subgroups: (1) high dentist rating (N = 1269) led to 5 splits and 11 subgroups; (2) low dentist rating (N = 308) led to zero splits; and (3) no regular dentist (N = 824) led to 2 splits and 3 subgroups. Conclusions: The CTA has identified unique population subgroups that could be targeted in future tailored public health interventions. Among underserved populations, it is important to develop and implement community-based interventions that encourage regular dental visits and provide oral cancer self- examination education..

Impact of the promotora model on the improvement of oral health knowledge of caregivers / Impacto del modelo promotora en el mejoramiento del conocimiento sobre salud oral de los cuidadores

ABSTRACT Objective The objective of this quasi-experimental study was to determine the impact of the Promotora Model (PM) as an educational strategy to increase oral health knowledge in parents/caregivers of children aged 2-5 years at high risk for dental caries. Materials and Methods Sixty-three caregivers who provided informed consent were included in the study. A structured 37-item survey was administered prior to conducting the Promotora educational intervention (PEI) that covered oral health topics and behaviors. Three (3) months after the PEI session, during their child's next dental visit, the same instrument was administered to 46 of the parents/caregivers that had completed the first instrument. Results Most caregivers were Hispanic (73.9%) and 50% reported completing high school. Before PEI, 56.5% of participants scored as having "good" general knowledge. Three months after PEI, 82.6% achieved that score (paired sample T-test, p< 0.00001). Conclusion Based on the results, it was concluded that the PM significantly increased caregivers' oral health knowledge.(AU)

RESUMEN Objetivo El propósito de este estudio cuasi-experimental fue determinar el impacto del Modelo Promotora (MP) como estrategia educacional para mejorar el conocimiento sobre salud oral de los padres y/o cuidadores de niños con edades comprendidas entre 2-5 años con alto riesgo de sufrir caries dental. Métodos Sesenta y tres padres y/o cuidadores quienes dieron el consentimiento fueron incluidos en el estudio. Se administró un cuestionario estructurado de 37 preguntas antes de la intervención educativa (IE) con el Modelo Promotora (IEP) el cual cubría tópicos sobre salud oral y conductas. Tres (3) meses después de la sesión de IEP, en la próxima visita dental del niño, el mismo cuestionario fue administrado a 46 padres y/o cuidadores que habían completado el primer cuestionario. Resultados La mayoría de los padres y/o cuidadores eran Hispanos (73,9%) y 50% reporto tener bachillerato completo. Antes del IEP, 56,5% de los participantes presentó un nivel general de conocimiento "Bueno." Tres meses después de la aplicación del IEP, 82,6% obtuvieron el mismo nivel de conocimiento (T-test, p<0.00001). Conclusión Se concluye que el MP mejora considerablemente el conocimiento sobre salud bucal de los padres y/o cuidadores.(AU)

Impact of the promotora model on the improvement of oral health knowledge of caregivers.

OBJECTIVE: The objective of this quasi-experimental study was to determine the impact of the Promotora Model (PM) as an educational strategy to increase oral health knowledge in parents/caregivers of children aged 2-5 years at high risk for dental caries. MATERIALS AND METHODS: Sixty-three caregivers who provided informed consent were included in the study. A structured 37-item survey was administered prior to conducting the Promotora educational intervention (PEI) that covered oral health topics and behaviors. Three (3) months after the PEI session, during their child's next dental visit, the same instrument was administered to 46 of the parents/caregivers that had completed the first instrument. RESULTS: Most caregivers were Hispanic (73.9%) and 50% reported completing high school. Before PEI, 56.5% of participants scored as having "good" general knowledge. Three months after PEI, 82.6% achieved that score (paired sample T-test, p< 0.00001). CONCLUSION: Based on the results, it was concluded that the PM significantly increased caregivers' oral health knowledge.

Dental Visits Mediate the Impact of Smoking on Oral Health.

OBJECTIVES: We explored the mediational relationships among smoking, dental visits, and oral health in a longitudinal study. METHODS: We selected a sample of adult residents of rural communities of North Central Florida and followed them for 3 years (final N = 1170). We examined the impact of smoking on oral health across time and conducted mediation analysis to quantify the effect of dental visits on the relationship between smoking and poor oral health. RESULTS: Our results showed that oral health declined across time for smokers but not for nonsmokers. The mediation analysis found that 18.3% of the difference in followup oral health between smokers and non-smokers was explained by smokers not having any dental visits in the last year. CONCLUSIONS: Our findings suggest that, given the low success rate of quitting smoking, promoting dental visits can help limit the negative effects of smoking on oral health. Future community prevention studies could encourage dental visits among smokers and provide educational materials that aim to increase knowledge of oral self-care.

Addressing Oral Health Disparities Via Educational Foci on Cultural Competence.

An ever-present challenge for the oral health profession is to reduce the extent of oral disease among racial and ethnic minority populations. Adding to this complex dilemma is the linkage between oral health and systemic health. We describe enhanced cultural competency, in the context of individual cultural beliefs, values, language, practice, and health behaviors, among dental professionals, as one approach to meeting the dental care needs of the underserved. An overview and examples of teaching methods used by University of Florida dental educators to enhance student cultural competency is provided. Evidence-based evaluation results provide evidence of methodology efficacy. We conclude by describing actions that can be implemented by academic dental institutions to facilitate development of culturally competent practitioners.

The reliability of psychological instruments in community samples: A cautionary note.

Although researchers norm and validate measures of psychological constructs largely on educated samples, they often use these instruments more broadly, assuming generalizability. We examined whether the assumption of generalizability is warranted. We administered three commonly used psychological measures-the Behavioral Activation/Behavioral Inhibition Scale, the Regulatory Focus Questionnaire, and the Need for Cognition Scale-to a community sample (N = 332) with limited education. For the three instruments, five of seven scales/subscales had unsatisfactory reliabilities. Internal consistency was lowest among participants with less education. The results suggest that instruments normed on educated samples may not generalize to uneducated samples.

Trends in dental-related use of hospital emergency departments in Florida.

OBJECTIVES: The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care. METHODS: Data for this study were drawn from ambulatory ED discharge records compiled by Florida's Agency for Health Care Administration for 2005-2014. Visits for dental-related reasons in Florida were defined by the patient's reported reason for seeking care or the ED physician's primary diagnosis using ICD-9-CM codes. We calculated frequencies, age-specific and age-adjusted rates per 100,000 population, and secular trends in dental-related ED visits and their associated charges. RESULTS: The number of dental-related visits to Florida EDs increased each year, from 104,642 in 2005 to 163,900 in 2014; the age-adjusted rate increased by 43.6 percent. Total charges for dental-related ED visits in Florida increased more than threefold during this time period, from $47.7 million in 2005 to $193.4 million in 2014 (adjusted for inflation). The primary payers for dental-related ED visits in 2014 were Medicaid (38 percent), self-pay (38 percent), commercial insurance (11 percent), Medicare (8 percent), and other (5 percent). CONCLUSIONS: Dental-related visits to hospital EDs in Florida have increased substantially during the past decade, as have their associated charges. Most patients did not receive definitive oral health care in EDs, and this trend represents an increasingly inefficient use of health care system resources.

Assessing Oral Cancer Awareness Among Rural Latino Migrant Workers.

Latino migrant farm workers suffer significant health disparities, including poor oral health. The purpose of this research was to assess Latino migrant farm workers' OC awareness, including knowledge and care-seeking behaviors. A 42-item survey was developed. Trained, bilingual researchers verbally administered the survey to migrant farm workers in Hillsborough County, Florida. Frequencies and descriptive statistics were generated to report baseline data. The sample consisted of 53.7 % female respondents. The mean age for males and females respectively was 38.7 and 39.2. Most respondents had attended grade school; 6.7 % never attended school. Perceptions of cancer susceptibility were present; knowledge of OC risk factors, signs and symptoms was low. Participants were unlikely to seek preventive care. The results contribute to the limited studies regarding Latino migrant farm workers and oral cancer risk factor awareness and knowledge. Findings highlight factors influencing motivation and care-seeking behaviors, as well as provide guidance for development of educational materials.

Determinants of First-Time Cancer Examinations in a Rural Community: A Mechanism for Behavior Change.

OBJECTIVES: After conducting a media campaign focusing on the importance of oral and pharyngeal cancer (OPC) examinations, we assessed mechanisms of behavior change among individuals receiving an OPC examination for the first time. METHODS: We used data from 2 waves of telephone surveys of individuals residing in 36 rural census tracts in northern Florida (n = 806). The second survey occurred after our media intervention. We developed media messages and modes of message delivery with community members via focus groups and intercept interviews. We performed a mediation analysis to examine behavior change mechanisms. RESULTS: Greater exposure to media messages corresponded with heightened concern about OPC. Heightened concern, in turn, predicted receipt of a first-time OPC examination, but only among men. CONCLUSIONS: We extended earlier studies by measuring an outcome behavior (receipt of an OPC examination) and demonstrating that the putative mechanism of action (concern about the disease) explained the link between a media intervention and engaging in the target behavior. Improving the quality of media campaigns by engaging community stakeholders in selecting messages and delivery methods is an effective strategy in building public health interventions aimed at changing behaviors.

Assessing Specific Sexual Behavior: Instrument Development and Validation Techniques.

Through the use of multi-modal methods, the purpose of this study was to develop and assess measurement properties of an instrument evaluating specific sexual behaviors of college students and the role alcohol intoxication plays in one's intention to participate in these behaviors. A modified version of N. Krause's instrument development process was applied to create a behavior-specific instrument assessing oral, vaginal, and anal sex behaviors. The process included a review by expert scholars in relevant fields, cognitive interviews with the target population using screen-capture program Camtasia, piloting to assess measurement scales, and a formal investigation. The applied instrument development process employed screen capture software and web-based surveying in a cost-effective format suitable for mixed-method measurement development. The development and application of the instrument provides a clearer understanding of the relationship between alcohol use and sexual activity and aids in the development of effective public health interventions and policies.

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

BACKGROUND: An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. METHODS: Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. RESULTS: Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. CONCLUSIONS: Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed.

Sexual behaviors and other risk factors for oral human papillomavirus infections in young women.

BACKGROUND: Oral human papillomavirus (HPV) is associated with a rising incidence of certain head and neck cancers, and oral sex has been associated with oral HPV. This study sought to identify more specific patterns of oral sexual activity, including self-inoculation, that are associated with oral HPV infections in young women. METHODS: A total of 1010 women attending a large university completed a computer-based questionnaire and provided oral specimens that were tested for any oral HPV using a Linear Array assay that detects any HPV as well as 37 HPV genotypes. Twenty-seven women provided additional samples up to 12 months after enrollment. Bivariable and multivariable analyses were conducted to identify oral sexual patterns and other risk factors associated with prevalent oral HPV. RESULTS: Nineteen women had prevalent oral HPV (1.9%), with 10 women (1%) having a type-specific infection. Oral HPV was significantly associated with lifetime coital sex partnership numbers (P = 0.03), lifetime and yearly oral sex partnership numbers (P < 0.01), and hand and/or sex toy transfer from genitals to mouth (P < 0.001). Oral HPV was also associated with greater use of alcohol, cigarettes, marijuana, and sharing of smoking devices, lipstick, or toothbrushes (P < 0.05 for each), with an apparent dose-response for alcohol use and smoking behavior, stratified by number of sexual partners. Of 7 women with prevalent HPV who provided follow-up samples, none had evidence of a persistent type-specific infection. CONCLUSIONS: These data provide additional evidence of transmission of oral HPV from oral sexual activity and also suggest possible transmission from self-inoculation or sharing of oral products.

Health literacy: a pathway to better oral health.

OBJECTIVES: We examined whether health literacy was associated with self-rated oral health status and whether the relationship was mediated by patient-dentist communication and dental care patterns. METHODS: We tested a path model with data collected from 2 waves of telephone surveys (baseline, 2009-2010; follow-up, 2011) of individuals residing in 36 rural census tracts in northern Florida (final sample size n = 1799). RESULTS: Higher levels of health literacy were associated with better self-rated oral health status (B = 0.091; P < .001). In addition, higher levels of health literacy were associated with better patient-dentist communication, which in turn corresponded with patterns of regular dental care and better self-rated oral health (B = 0.003; P = .01). CONCLUSIONS: Our study showed that, beyond the often-reported effects of gender, race, education, financial status, and access to dental care, it is also important to consider the influence of health literacy and quality of patient-dentist communication on oral health status. Improved patient-dentist communication is needed as an initial step in improving the population's oral health.

Utilization of information and communication technology (ICT) among sexually transmitted disease clinics attendees with coexisting drinking problems.

BACKGROUND: Alcohol misuse remains a major risk factor for contracting sexually transmitted diseases (STDs) not typically addressed in STD clinic settings. Information and communication technology (ICT) can offer new avenues to deliver evidence-based screening and treatment for problematic drinking, however, few data exists regarding the utilization of ICT among STD clinic attendees with coexisting drinking problems. The objectives of this study are to identify STD clinics attendees with hazardous drinking, to examine socio-demographic factors associated with ICT use, and to explore individuals' interests in engaging in ICT-based health interventions. METHODS: Cross-sectional questionnaires examining alcohol consumption and ICT use were administered to 396 persons attending two non-urban STD clinics. Descriptive statistics for ICT use were calculated for both hazardous drinkers and the entire sample. Multivariable logistic regression models among hazardous drinkers identified factors significantly associated with use of each kind of ICT. RESULTS: The mean age of the 396 participants was 25 years, 66% were females and 60% were African-Americans. One third of the sample met the criteria of hazardous drinking. ICT use in hazardous drinkers included 94% reporting having internet access at least monthly, 82% reporting having an email account, 85% reporting currently owning a cell phone, and 91% reporting use of any cell phone application. More than two thirds (73%) of hazardous drinkers were willing to play health-related video games during clinic waiting time, slightly higher than the entire sample (69%). Multivariable analyses indicated that younger age were significantly related to monthly internet use, and multifunction cell phone use, while being males and younger age were significantly associated with monthly video game playing. CONCLUSIONS: Our study demonstrates commonality of ICT use among STD clinic attendees with hazardous drinking, indicating the viability of using ICT to assist screening and behavioural intervention for alcohol misuse in STD clinic settings. Future research is needed to demonstrate the effectiveness of ICT-based health behavioural interventions in the STD clinic settings or other venues that serve populations at high risk for substance abuse, HIV or other STDs.

Demographic and practice characteristics of Medicaid-participating dentists.

OBJECTIVES: The challenges entailed in dental Medicaid programs are well documented. To increase our understanding of Medicaid participation, we surveyed Florida dentists to determine the demographic and practice characteristics of Medicaid-participating dentists. METHODS: Our target population was practicing Florida dentists who treat children, including those who do not currently accept Medicaid as well as those who do. The final sample (n = 882) included (1) pediatric dentists and (2) general dentists who self-reported that they treat children. Participants completed a survey concerning their Medicaid participation. Analyses included survey-sample weighted chi-square tests and multivariable logistic regression. RESULTS: More than two-thirds of the sample dentists are not participating in Medicaid and will not consider doing so. Key findings are that Black dentists across the state and Hispanics in South Florida are more likely to participate in Medicaid than other groups of Florida dentists. Pediatric dentists are more likely to be Medicaid participants than general dentists, but nearly one-fifth of the pediatric dentists might quit participation. Non-Medicaid providers are more likely to report not being busy enough in their practice than Medicaid providers. CONCLUSIONS: If we are to address the shortage of Medicaid dental providers, increasing our understanding of how to capture the excess capacity among general dentists (the reported lack of busyness) in a way acceptable to dentists and to the State of Florida is an important first step. In addition, dental schools should consider implementing a track dedicated to training students for practice success within communities of highest dental need and to seek to increase the number of Black dental students.

The burden of chronic diseases in a rural North Florida sample.

BACKGROUND: The degree of health disparities present in rural communities is of growing concern and is considered "urgent" since rural residents lag behind their urban counterparts in health status. Understanding the prevalence and type of chronic diseases in rural communities is often difficult since Americans living in rural areas are reportedly less likely to have access to quality health care, although there are some exceptions. Data suggest that rural residents are more likely to engage in higher levels of behavioral and health risk-taking than urban residents, and newer evidence suggests that there are differences in health risk behavior within rural subgroups. The objective of this report is to characterize the prevalence of four major and costly chronic diseases (diabetes, cardiovascular disease, cancer, and arthritis) and putative risk factors including depressive symptoms within an understudied rural region of the United States. These four chronic conditions remain among the most common and preventable of health problems across the United States. METHODS: Using survey data (N = 2526), logistic regression models were used to assess the association of the outcome and risk factors adjusting for age, gender, and race. RESULTS: Key findings are (1) Lower financial security was associated with higher prevalence of cardiovascular disease, arthritis, and diabetes, but not cancer. (2) Higher levels of depressive symptoms were associated with higher prevalence of cardiovascular disease, arthritis, and diabetes. (3) Former or current smoking was associated with higher prevalence of cardiovascular disease and cancer. (4) Blacks reported higher prevalence of diabetes than Whites; Black women were more likely to report diabetes than all other groups; prevalence of diabetes was greater among women with lower education than among women with higher education. (5) Overall, the prevalence of diabetes and arthritis was higher than that reported by Florida and national data. CONCLUSIONS: The findings presented in this paper are derived from one of only a few studies examining patterns of chronic disease among residents of both a rural and lower income geographic region. Overall, the prevalence of these conditions compared to the state and nation as a whole is elevated and calls for increased attention and tailored public health interventions.

The decision to counsel adolescents about HPV.

OBJECTIVES: To examine factors influencing dentists' intentions to counsel adolescents. METHODS: Florida dentists (N = 929) responded to 3 descriptions of an office visit by an adolescent patient. In the standard-of-care condition the patient consumed excessive sugar. In the other 2 conditions, a reliable source or patient's mother revealed the patient was sexually active and exposed to HPV. RESULTS: Dentists expressed lower intentions to counsel about HPV than sugar consumption. In the 2 HPV conditions, dentists reported higher intentions to counsel when the mother, rather than another reliable source, disclosed the sexual activity. Perceived social pressure against counseling explained differences between conditions in intention to counsel. CONCLUSIONS: Parent /public approval were primary barriers to HPV-counseling.

Disparities in knowledge of mouth or throat cancer among rural Floridians.

OBJECTIVE: The aim of this study was to examine risk factors for reduced mouth or throat cancer (MTC) knowledge using a sample of rural North Floridian adults. METHODS: Telephone interviews were conducted across rural census tracts throughout North Florida in 2009-2010, using a survey adapted for cultural appropriateness. The sample consisted of 2,393 individuals (1,059 males and 1,334 females; 1,681 whites and 712 blacks). FINDINGS: Only 9% of the study respondents indicated they had not heard of MTC; however, only 12% endorsed knowing "a lot." Higher education levels and health literacy indicated they had more MTC knowledge. Among female participants, whites had more knowledge than blacks (OR = 1.9). Among black participants, males had more knowledge than females (OR = 1.7). Conversely, greater concern with MTC was associated with lower education levels, health literacy, and financial status, but higher depression scores. Awareness that excessive sun exposure is a risk factor for MTC was lower than for earlier studies using more urban samples. CONCLUSIONS: This study adds to the literature on MTC knowledge and concern because this sample was drawn exclusively from rural populations in North Florida, a group with the highest MTC morbidity and mortality. An unanticipated finding was that blacks were more concerned than their white rural counterparts. This study was also the first to report that depression was associated with increased concern about MTC. The goal is to persuade at-risk groups to obtain MTC screenings with the goal of reducing disparities in MTC whenever they occur.

Perceptions of wellness and burnout among certified athletic trainers: sex differences.

CONTEXT: Athletic trainers are exposed to various stressors, increasing the potential for burnout and decreasing perceived wellness. Burnout and decreased perceived wellness can result from many factors: years of experience, hours per week worked, or decreased levels of physical activity. Another factor that accounts for a portion of the variance is sex differences. OBJECTIVE: To determine the differences in burnout, physical activity, and perceived wellness scores relating to sex in District 9 of the National Athletic Trainers' Association (NATA). DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers who were included in the e-mail directory of NATA District 9 (men = 232, women = 158). INTERVENTION(S): A 19-item questionnaire for burnout, a 36-item questionnaire for perceived wellness, and a 16-item activity questionnaire for physical activity and demographics. MAIN OUTCOME MEASURE(S): The variables included demographics (hours per week worked, years of experience, sex), Copenhagen Burnout Inventory (CBI; scores range from 0-100, and higher scores represent a higher level of burnout), Perceived Wellness Survey (PWS; scores range from 1-36, and scores close to 29 are considered healthy), and Baecke Physical Activity Questionnaire (BPAQ; scores range from 1-15, and higher scores represent more physical activity). RESULTS: Of the 1560 members contacted, 390 responded (response rate = 25%), and 59.5% (n = 232) were male. The mean scores were 38.73 ± 16.9 for men and 46.2 ± 17.1 for women for the CBI, 16.68 ± 2.76 for men and 16.41 ± 2.81 for women for the PWS, and 8.42 ± 1.32 for men and 8.77 ± 1.36 for women for the BPAQ. Men and women worked an average of 55.60 ± 26.03 and 47.86 ± 20.57 hours per week, respectively, and had a mean experience of 14.79 ± 9.86 and 8.92 ± 6.51 years, respectively. Women reported a higher level of burnout (t388 = -4.255, P = .001) and greater levels of physical activity (t388 = -2.52, P = .01) than men. Men reported working more hours (t388 = 3.131, P = .002) and having more years of experience (t388 = 6.568, P = .001) than women. Perceived wellness was not different between sexes (t388 = 0.958, P = .34). CONCLUSIONS: Our results suggest that women experienced moderate to high burnout and men experienced moderate burnout. Interestingly, men reported lower levels of burnout but worked more hours than women. Future researchers should focus on why women experience higher levels of burnout but work fewer hours. These findings may lead to educational interventions that might reduce burnout and increase professional longevity and quality of work.