Sexual Behavior and Perceived Risk for Oropharyngeal Cancer Among Men Who Have Sex With Men: A Psychometric Scale Validation.

BACKGROUND: Men who have sex with men (MSM) are at increased risk for human papillomavirus-associated oropharyngeal cancer (HPV-OPC). The objective of this analysis was to create a psychometrically validated scale to measure perception of risk for HPV-OPC. METHODS: We conducted an exploratory and a confirmatory factor analysis to determine and confirm the latent factor structure. We used a path diagram to evaluate the relationship between the validated scale and perceived risk for HPV-OPC. The model was determined to be a good fit if it met all criteria: root mean square error of approximation ≤0.06, standardized root mean residual ≤0.08, Comparative Fit Index ≥0.90, and Tucker-Lewis Index ≥0.90. We report standardized estimates and 95% confidence intervals. RESULTS: This cross-sectional study recruited 1315 MSM. A majority (73.33%) of MSM had performed fellatio on ≥20 partners, 36.98% had rimmed ≥20 partners, and 5.31% had performed cunnilingus on ≥10 partners in their lifetime.Six sexual history survey items loaded onto 2 latent factors: sexual risk behaviors: class 1 and sexual risk behaviors: class 2. The final model statistics indicated good fit: root mean square error of approximation = 0.064, standardized root mean residual = 0.059, Comparative Fit Index = 0.996, and Tucker-Lewis Index = 0.993. Sexual risk behaviors: class 1 was associated with greater perceived risk for HPV-OPC (0.217; 95% confidence interval, 0.138-0.295). Age, HIV status, HPV vaccination status, and sexual risk behaviors: class 2 were not associated with perceived risk for HPV-OPC. CONCLUSION: Men who have sex with men assessed risk for HPV-OPC based on their lifetime number of cisgender male sexual partners, rimming partners, and fellatio partners but not other sexual behaviors. Men who have sex with men may be responsive to future HPV-OPC educational interventions and opportunities for screening.

Examining the influence of professional identity formation on the attitudes of students towards interprofessional collaboration.

An expectation of introductory interprofessional education (IPE) is improvement in attitudes towards other professions. However, the theory surrounding professional identity formation suggests this expectation may be premature. The objective of this study was to quantify first-year health professional students' attitudes towards their own and other professions and to investigate the relationship between strength of professional identity and attitudes towards other professions and interprofessional learning. Using a pre/post-test design, researchers administered the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS) to 864 first-year healthcare students in the Academic Health Center (AHC) at the University of Minnesota. The findings showed a decline in student attitudes towards their own and other professions. Additionally, a positive correlation between a weakened professional identity and readiness for interprofessional learning was demonstrated. This study found that an introductory IPE course did not positively affect student attitudes towards other professions, or strengthen professional identity or readiness for interprofessional learning. Analysis of the findings support the successive stages of professional identity formation.

Using Low-cost Videoscopes to Obtain Accurate Video "Oral Selfies" as Screening for HPV-associated Oropharyngeal Cancer: A New Screening Technology?

Human papillomavirus (HPV)-related oropharyngeal cancers associated with sexual contact are increasing, with high rates in men who have sex with men. HPV-related cancers have the advantage of being frequently detectable through oropharyngeal visual examination and having much higher survival rates than classic oropharyngeal cancers. It has been demonstrated that gay and bisexual men can take smartphone oropharyngeal "selfies" of sufficient quality for screening. However, there is an issue with the inability to move the tongue to allow a clear view of the palatine tonsils, where a majority of oropharyngeal cancer cases occur. We attempted to investigate the feasibility of using commercially available videoscopes to visualize the oropharynx. Fourteen healthy volunteers used a provided low-cost commercial endoscope to video their oropharynx. Participants used the videoscope connected to a laptop and could visualize the oropharynx on the screen. Attempts were observed, and the process was noted. A focus group of participants was carried out immediately afterwards to ascertain barriers and facilitators to using the videoscopes. All participants were able to use the videoscope and obtain videos of sufficient clarity to note major oropharyngeal landmarks. The palatine tonsils were initially difficult to visualize because the tongue could not be sufficiently controlled. Participants were given time to practice using visual cues to control the position of the tongue, which helped in obtaining good videos. Videoscopes can be used effectively with minimal instruction and provide a better view than still images, as they illuminate and magnify the site. Low-cost commercially available videoscopes may be an improvement over smartphone "selfies".

HPV-related oropharyngeal cancer early detection in gay and bisexual men is an "orphan" practice: A qualitative analysis among healthcare providers.

Introduction: Among US men, oropharyngeal cancer (cancer of the back of the mouth and throat) is the 8th most common cancer. If detected early, human papillomavirus (HPV)-16-associated oropharyngeal cancer has a high 5-year survival rate. Risk factors such as high numbers of oral sex partners, disparities in smoking and drinking, and low rates of HPV vaccination may put gay and bisexual men at even higher risk for oropharyngeal cancer. Methods: We recruited 21 healthcare providers in Minneapolis-St. Paul, Minnesota and Houston, Texas to participate in semi-structured interviews. Nurses, physician assistants, dental hygienists, and dentists were asked about their clinical experiences serving gay and bisexual men and opinions on potential interventions for the early detection of oropharyngeal cancer. Results: Providers typically did not tailor health screenings and examinations for gay and bisexual men. Participants lacked confidence in their ability to effectively implement routine screening for oropharyngeal cancer. The extent to which oropharyngeal cancer screening was incorporated into clinical practice varied by specialty, and practices necessary to detect it were scattered across clinical environments. HIV- and LGBTQ-focused healthcare providers were more aware of HPV-associated oropharyngeal cancer in gay and bisexual men, and appeared readier to act and lead on this issue. Discussion: Further studies should (1) evaluate protocols for oropharyngeal cancer detection; (2) identify and assess the acceptability of screening in the community; and (3) study how to best close gaps in health services for gay and bisexual men which might contribute to low early detection rates of oropharyngeal cancer.

Brief Motivational Interviewing: Evaluation of a skills-based education program.

Purpose: Oral health care providers have been charged with recommending the human papillomavirus (HPV) vaccine for the prevention of HPV oropharyngeal cancers (OPC). The purpose of this study was to determine dental hygiene student competency of the application of brief motivational interviewing (BMI) and the accuracy of HPV vaccine information for the prevention of HPV OPC.Methods: A convenience sample of 59 senior dental hygiene (DH) students from the class of 2020 (n=31) and the class of 2021 (n=28) participated in the HPV OPC curriculum and skills-based BMI training at the University of Minnesota School of Dentistry. Students completed two audio-recorded patient interactions and one Objective Structured Clinical Examination (OSCE). Student self-assessment and faculty evaluation scores were determined by a standardized BMI HPV rubric. Descriptive statistics were used to analyze the data.Results: Class of 2021 self-assessment ratings were higher than the class of 2020 in all components of the BMI HPV rubric at all three time points. Faculty evaluation achieved statistically significant improvement for the class of 2021 from patient Interaction 1 (evocation p<0.01; summary p<0.01) to the OSCE (evocation p<0.05; summary p<0.01). Both classes rated themselves as competent (≥70%) for most BMI subcategories.Conclusion: Dental hygiene student competence in demonstrating the components of the Spirit of MI to the accuracy of HPV and HPV vaccine information was achieved through the implementation of the skills-based BMI HPV training. Outcomes of student self-assessment and faculty evaluation highlighted the Kirkpatrick Model as a framework to evaluate BMI skills-based training.

Human Papillomavirus Content Inclusion in Dental Hygiene Program Curricula in the United States.

Purpose: Human papillomavirus (HPV)-related oropharyngeal cancers (OPC) have significantly increased over the past three decades despite vaccine availability to prevent carcinogenic HPV types. Dental hygienists are well-positioned to provide HPV counsel to patients; however, most do not feel prepared to do so. The purpose of this study was to examine HPV content inclusion in dental hygiene program curricula in the United States (US).Methods: Dental hygiene program directors in the US were invited to participate in an electronic survey (n=309). The 20-item survey assessed the curricular content related to HPV as well as the faculty training in this area. Descriptive statistics were used to analyze the data.Results: Ninety surveys were returned for a response rate of 29%. Most programs spent up to 2 hours on HPV content. Students across all institutional settings received education on OPC risk factors (66.3%); HPV screening, referral, and management (78.7%); HPV vaccine knowledge (79.8%); and communication skills about HPV (77.5%). The majority of HPV-related content was taught by dental hygiene faculty, although dentists, oral pathologists or medical specialists were involved across all institutional settings.Conclusion: Results indicate that dental hygiene programs, regardless of institutional setting, provide two hours or less of HPV didactic content and clinical application. More research is needed to confirm the adequate time and teaching strategies required to assure that dental hygienists are well-prepared to address HPV preventive strategies.

Preliminary evaluation of dental hygiene curriculum: Assessment and management of peri-implant conditions and diseases.

OBJECTIVE: The purpose of this study was to investigate dental hygiene (DH) educational programs' didactic and clinical curriculum in the management of peri-implant diseases and conditions. The specific aims were (1) assess if evidence-based content for peri-implant diseases and conditions are currently included in didactic and clinical DH curriculum and (2) determine if DH education programs are currently preparing students at a level of clinical competency for the assessment and management of peri-implant diseases and conditions. DESIGN: A cross-sectional study of DH faculty member(s) from 331 United States entry-level programs responsible for didactic and clinical curriculum for peri-implant diseases and conditions were surveyed. The survey was disseminated electronically via Qualtricsxm August 2019 for a response rate of 26%. RESULTS: The results showed didactic courses taught DH students the etiology of peri-mucositis and peri-implantitis (98%), clinical characteristics (98%), and risk factors contributing to these implant diseases (96%). Evaluation methods to determine student level of competency in a didactic setting included quizzes/examinations (98%), case-based examinations (63%), and written essays (6%). Eighty-five percent reported DH students are not required in a clinical setting to provide care for patients with peri-implant diseases and conditions. CONCLUSIONS: Study results suggest DH education programs may need to revise didactic and clinical curriculum to ensure students graduate at a level of clinical competency for assessing and managing peri-implant conditions and diseases. DH educational programs should consider requiring clinical patient experiences for the assessment and management of peri-mucositis and peri-implantitis to prepare students for their professional role.

Knowledge, Attitudes and Practices Regarding Human Papilloma Virus Communication and Vaccine Advocacy Among Minnesota Dentists and Dental Hygienists.

Purpose: Recent increases in oropharyngeal cancer (OPSCC) have been attributed to Human Papillomavirus (HPV) infections. Vaccinations for HPV have been available since 2006, however, vaccine uptake in the United States has been poor. Dental hygienists and dentists have the opportunity to increase vaccine uptake through patient education. The purpose of this study was to ascertain the knowledge, attitudes, and practices of Minnesota dentists and dental hygienists toward conversations regarding HPV infections and vaccine advocacy.Methods: A paper survey was mailed to a random sample of dentists and dental hygienists licensed in the state of Minnesota. Descriptive statistics were used to summarize the data. Two group t-tests or analysis of variance (ANOVA) was used to compare mean knowledge and attitude scores between question responses. Pearson correlation coefficient was calculated for the knowledge and attitude scores.Results: The overall response rate was 21% (dentists n= 750; dental hygienists n=750). Less than half (44%) of the respondents discuss risk factors for oropharyngeal cancer with their patients, and fewer than one quarter (21%) specifically discuss HPV as a risk factor. HPV vaccination was discussed by 9% of the respondents. Barriers to patient education on HPV included discomfort in sensitive conversations (66%) and feeling unqualified (35%). Over three fourths (80%) of the respondents were in favor of receiving training regarding HPV discussions.Conclusion: Barriers preventing dental providers from discussing the HPV with patients, included a lack of knowledge and discomfort in discussing a sexually transmitted infection. Minnesota dentists and hygienists are interested in seeking guidance, including communication tools to discuss HPV infections and the HPV vaccine.