Abstract
Background
The authors examined adults’ perceptions about the importance of the human papillomavirus (HPV) vaccine in preventing oropharyngeal cancers and dental care providers’ role in HPV prevention and identified associated factors.
Methods
Adults (≥ 18 years) completed a national survey of consumer and patient attitudes, experiences, and behaviors on oral health. Descriptive and multivariable logistic regression models determined associations between perceptions regarding HPV and attitudes toward dental care providers’ role and HPV knowledge, HPV vaccine recommendation, and sociodemographic characteristics.
Results
One in 3 adults (32.8%; n = 5,320) said the HPV vaccine was very important, 1 in 2 said it was somewhat important (48.1%), and 1 in 5 said it was not important (19.1%) in preventing mouth and throat cancers. More than one-half (56.7%) of adults had positive perceptions about dental care providers’ role in HPV education and were comfortable discussing the HPV vaccine with a dental care provider (59.4%). Adults with knowledge about HPV and oral health linkage and those who received HPV vaccine recommendation from a dental care provider had 2.0 to 2.5 times higher odds of reporting positively for all 3 outcomes (P < .001).
Conclusions
Most adults are comfortable discussing HPV and the HPV vaccine with their oral health care provider. Perceptions about the HPV vaccine’s importance in preventing oropharyngeal cancers and the role of dental care providers in HPV prevention can be improved by means of increasing adults’ knowledge about the relationship between HPV and oral health.
Practical Implications
Dental care providers’ engagement in HPV conversations with patients may increase their knowledge about the HPV and oral health linkage and their understanding of the role of the HPV vaccine in preventing oropharyngeal cancers.
Key Words
Abbreviation Key:
HPV (Human papillomavirus), NH (Non-Hispanic), OPC (Oropharyngeal cancer)
Human papillomavirus (HPV): genital HPV infection—basic fact sheet. Centers for Disease Control and Prevention, Division of STD Prevention, National Center for HIV Viral Hepatitis, STD and TB Prevention, Division of STD Prevention. July 2017. Accessed January 2, 2023. https://www.cdc.gov/std/hpv/stdfact-hpv.htm#print
There were more than 43 million HPV infections reported in 2018 alone.
Human papillomavirus (HPV): genital HPV infection—basic fact sheet. Centers for Disease Control and Prevention, Division of STD Prevention, National Center for HIV Viral Hepatitis, STD and TB Prevention, Division of STD Prevention. July 2017. Accessed January 2, 2023. https://www.cdc.gov/std/hpv/stdfact-hpv.htm#print
Although most HPV infections are asymptomatic and generally clear on their own, some people can develop anogenital warts and cancers. Each year, HPV causes 36,000 new cancer cases in the United States, including cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancers.
Cancers associated with human papillomavirus, United States: 2014–2018. USCS Data Brief, no. 26.
,
- Senkomago V.
- Henley S.J.
- Thomas C.C.
- Mix J.M.
- Markowitz L.E.
- Saraiya M.
Oropharyngeal cancers (OPCs) are now the most common cancers of all HPV-related cancers, surpassing cervical cancer rates in the United States.
- Lechner M.
- Liu J.
- Masterson L.
- Fenton T.R.
- Islami F.
- Ward E.M.
- Sung H.
- et al.
OPC makes up 40% of all HPV-attributable cancers and 80% of HPV-attributable cancers among males.
Cancers associated with human papillomavirus, United States: 2014–2018. USCS Data Brief, no. 26.
OPCs are most common among White people, and males are 5 times more likely receive an OPC diagnosis than females.
- Senkomago V.
- Henley S.J.
- Thomas C.C.
- Mix J.M.
- Markowitz L.E.
- Saraiya M.
,
- Liederbach E.
- Kyrillos A.
- Wang C.H.
- Liu J.C.
- Sturgis E.M.
- Bhayani M.K.
The overall 5-year survival rate for OPC was 59% for localized cancer, but drops by more than one-half (28%) if diagnosed at a later stage, with distant metastases. Data from 2009 through 2015 indicate a nearly 20 percentage point difference in 5-year survival rates between Black (51%) and White patients (70%) with OPC.
- Shimabukuro T.T.
- Su J.R.
- Marquez P.L.
- Mba-Jonas A.
- Arana J.E.
- Cano M.V.
,
- Meites E.
- Kempe A.
- Markowitz L.E.
Initially recommended for cervical cancer, the US Food and Drug Administration expanded its approval of the HPV vaccine in 2020 to include prevention of HPV-related OPCs.
Despite clear benefits and recommendations, HPV vaccination rates are suboptimal and are far from the Healthy People 2020 and 2030 goals of 80% up-to-date vaccination.
,
As of 2019, only 54% of adolescents aged 13 through 17 years were up to date with their HPV vaccine, and the vaccination rates for males were nearly 5 percentage points lower (51.8%) than for females (56.8%).
- Elam-Evans L.D.
- Yankey D.
- Singleton J.A.
- et al.
HPV vaccination is routinely recommended at age 11 or 12 years, but it can be started as early as age 9 years, and it is recommended for all people through age 26 years who were not adequately vaccinated earlier. Depending on the initiation age, the vaccination includes either a 2-dose or 3-dose regimen.
- Meites E.
- Kempe A.
- Markowitz L.E.
,
In 2018, the US Food and Drug Administration expanded the approved use of the vaccine among adults aged 27 through 45 years, and the Advisory Committee on Immunization Practices recommends that patients discuss HPV vaccination with their health care providers.
- Meites E.
- Szilagyi P.G.
- Chesson H.W.
- Unger E.R.
- Romero J.R.
- Markowitz L.E.
- Huh W.K.
- Joura E.A.
- Giuliano A.R.
- et al.
With the high occurrence of OPCs, improving HPV vaccination rates and engaging oral health care providers in HPV vaccine conversations with their patients is essential. Provider recommendation is one of the strongest predictors of vaccination for HPV.
- Holman D.M.
- Benard V.
- Roland K.B.
- Watson M.
- Liddon N.
- Stokley S.
With a considerable proportion of adolescents visiting dentists routinely, the potential for dental care provider recommendation and delivery of vaccine in increasing HPV vaccination rates cannot be ignored.
- Cloidt M.
- Kelly A.
- Thakkar-Samtani M.
- et al.
Although dentists routinely administer anesthetic injections in the oral cavity, their involvement in discussing and providing routine vaccinations is minimal.
but their involvement in HPV vaccination remains unexplored. Dentists are well-positioned to educate patients about the importance of HPV vaccinations and increase access to these vaccinations, but they face several challenges, including concerns about how patients or parents of minor patients would perceive dentist-initiated discussions of HPV vaccinations and whether they are comfortable with dentists delivering such vaccinations.
- Walker K.K.
- Jackson R.D.
- Sommariva S.
- Neelamegam M.
- Desch J.
Prior studies have examined the attitudes and behaviors of dental care providers regarding HPV and HPV vaccines, but there is limited information on adults’ perceptions and receptiveness to HPV vaccine from dental care providers, especially at the national level.
- Walker K.K.
- Jackson R.D.
- Sommariva S.
- Neelamegam M.
- Desch J.
,
- Patel S.
- Koskan A.
- Spolarich A.
- Perry M.
- Flood T.
Two state-level limited sample studies, 1 from Minnesota (n = 208) and 1 from Louisiana (n = 81), found that most parents felt dentists were qualified to discuss HPV vaccination.
- Dean T.C.
- Gilliland A.E.
- Cameron J.E.
,
- Stull C.
- Freese R.
- Sarvas E.
Furthermore, there is limited information on adults’ knowledge about the relationship between HPV and oral health. Our aim was to use nationally representative survey data to examine HPV vaccine knowledge and perceptions among adults regarding HPV and oral health.
Methods
Study design and participants
- Tiwari T.
- Kelly A.
- Randall C.L.
- Tranby E.
- Franstve-Hawley J.
This is a nationally representative survey asking adults about their attitudes, experiences, and behaviors related to oral health. CareQuest Institute for Oral Health designed and funded the survey, and NORC (formerly known as the National Opinion Research Center) at the University of Chicago administered it using the AmeriSpeak panel. CareQuest Institute for Oral Health is a nonprofit organization that supports oral health and equity for all through grant making, research, health improvement programs, policy and advocacy, and education (carequest.org). NORC at the University of Chicago is a nonpartisan research organization that works with nonprofit, corporate, and government organizations to conduct research and data analysis (https://www.norc.org/Pages/default.aspx). The AmeriSpeak panel is probability-based and designed to be representative of the US household population. Participants provided consent when they enrolled in the AmeriSpeak panel after being recruited through mail and telephone contact via NORC. The survey was tested on a group of 48 people from the AmeriSpeak panel in December 2021. Data were collected from January through February 2021. US households were selected randomly, sampled using area probability and address-based sampling, and contacted via US mail, telephone, and field interviewers. Each potential participant was sent an initial email invitation and follow-up reminder if they did not respond. In addition, the entire sample was sent a text message reminder to participate. A final sample size of 5,320 was used from an initial sampling unit of 16,986, for a completion rate of 31.3%. All data presented in this article account for appropriate analytical sample weights representing national estimates. The survey covered several domains, including questions on HPV, the HPV vaccine, and its relationship with oral health. Our study uses HPV-related and demographic questions to understand perceptions about HPV and the HPV vaccine, which we will describe. Our study received approval from the WCG Institutional Review Board (DQPSN001).
Variables
Dependent Variables
- 1.
HPV vaccine importance in OPC prevention: “How important do you think the human papillomavirus (HPV) vaccine is for preventing cancers of the mouth and throat?” (very important, somewhat important, not important)
- 2.
role of the dental care provider in HPV education: “Do you think a dentist or other oral health care provider, such as a dental hygienist, is qualified to educate patients about the HPV vaccine?” (yes or no)
- 3.
role of the dental care provider in HPV vaccine discussion: “Are you comfortable with a pediatric dentist/dentist or other oral health care provider discussing HPV and the HPV vaccine with you and your children?” (yes or no)
Independent Variables
Participants were asked whether they thought HPV was linked to the health of their teeth, mouth, and gums (HPV knowledge, yes or no) and whether their oral health care provider ever mentioned getting an HPV vaccine to them (HPV vaccine recommendation, yes or no).
- Sørensen K.
- Van den Broucke S.
- Fullam J.
- et al.
Health literacy and public health: a systematic review and integration of definitions and models.
Similarly, provider recommendation is strongly associated with vaccination and could positively influence perceptions about the provider’s role; thus, it was also included in our analyses.
Other Variables
- Holman D.M.
- Benard V.
- Roland K.B.
- Watson M.
- Liddon N.
- Stokley S.
,
- Walker K.K.
- Jackson R.D.
- Sommariva S.
- Neelamegam M.
- Desch J.
These included age group (18-29 years, 30-44 years, 45-59 years, ≥ 60 years), sex (male, female), education (
Statistical methods
We examined the distribution of the study population using unweighted sample sizes and weighted percentages. Stratified analyses were used to examine the relationships between each outcome and included variables using χ2 tests. A multiple logistic regression model was calculated using a stepwise method for each outcome, adjusting for covariates including sex, age, race or ethnicity, education, income, metropolitan area resident status, HPV knowledge, and HPV vaccine recommendation. The HPV vaccine importance in OPC prevention outcome was categorized as very important, somewhat important, or not important and was modeled using an ordered logistic regression model. This model estimates a single regression coefficient over the ordinal dependent variable levels, and the probabilities modeled are cumulated over the lower-ordered values. For the other 2 outcomes, binary logistic regression models were used to estimate the odds of positive perceptions of the dental care provider role. Odds ratios (ORs) and corresponding 95% CIs were calculated from all regression models. Interaction terms were tested between the primary independent variables and demographic variables, and no systematic significant moderating effects were found. Results of diagnostics showed that each model had an acceptable fit to the data, and estimates were not biased by means of unbalanced dependent variables or multicollinearity in the independent variables. All analyses were weighted using sample weights and performed using SAS Enterprise Guide, Version 7.1, using SAS survey procedures accounting for complex survey design. P values less than .05 were considered significant unless specified otherwise.
Results
Table 1Characteristics of study participants from the national survey (n = 5,320).
HPV: Human papillomavirus.
outcomes and included characteristics.
HPV vaccine importance in OPC prevention
Among the study population, one-third of adults (32.8%) reported HPV vaccines are very important, 48.1% reported they were somewhat important, and 19.1% reported they were not important in preventing mouth and throat cancers. A higher percentage of adults who had knowledge about HPV and oral health (55.3%) and had received HPV vaccine recommendation (47.1%) reported HPV vaccines as very important compared with their counterparts (30.5% and 32.1%, respectively). Perceived importance differed according to race and ethnicity and metropolitan residence. Only 28.2% of NH White participants reported that HPV vaccines are very important in preventing oral cancers compared with 43.5% of NH Black participants. A higher percentage of metropolitan residents (32.8%) reported HPV vaccines as very important for oral cancer prevention compared with nonmetropolitan residents (25.0%).
Role of dental care provider in HPV education
More than one-half of the respondents (56.7%) agreed that dental care providers are qualified to educate patients about the HPV vaccine. Nearly 73% of adults with HPV knowledge and an HPV vaccine recommendation approved dental care providers’ role in HPV education compared with 55% of their counterparts. This was true for demographic characteristics, except for metropolitan residence. A higher percentage of men (62.4%), adults 60 years or older (63.7%), those with postgraduate education (67.9%), and those with an annual household income of $100,000 or more (64.9%) responded positively regarding dental care providers’ role in HPV education. Hispanic adults (48.0%) had the lowest percentage of dental care provider approval for dental care providers’ role in HPV education compared with other racial and ethnic groups.
Role of dental care provider in HPV vaccine discussion
Most of the adults (59.4%) reported feeling comfortable discussing the HPV vaccine with a dental care provider. Among those with HPV knowledge and an HPV vaccine recommendation, the percentage reporting comfort increased to nearly 75%. Comfort level was also associated with sex, education, household income, and metropolitan residence. A higher percentage of men than women (66.0% vs 53.1%), adults with a postgraduate education than a high school education (69.6% vs 55.0%), and adults with annual household incomes $100,000 or higher than those with incomes from $30,000 through $59,999 (66.5% vs 55.7%) were comfortable discussing HPV vaccine with a dental care provider.
HPV: Human papillomavirus.
outcomes (n = 5,320).
Importance of HPV vaccine in OPC prevention
According to the adjusted ordered logistic regression model, adults who were knowledgeable about the relationship between HPV and oral health had 2.48 times higher odds of reporting high HPV vaccine importance in OPC prevention (very important) than the combined middle and low categories (somewhat important and not important, respectively) (OR, 2.48; 95% CI, 2.08 to 2.96). Because of the proportional odds assumption, the same increase, 2.48 times, is found between the combined middle and high categories and low HPV vaccine importance. Similarly, receipt of HPV vaccine recommendation (OR, 2.29; 95% CI, 1.71 to 3.06) was positively associated with adults’ report of HPV vaccine being very important in preventing mouth and throat cancer compared with those reporting somewhat important or not important. NH Asian, NH Black, and Hispanic adults compared with NH White and metropolitan residents compared with nonmetropolitan residents were more likely to report the HPV vaccine as very important in preventing mouth and throat cancers.
Dental care provider’s role in HPV education
Dental care provider’s role in HPV vaccine discussion
Discussion
In this nationally representative study, we found that most adults have positive perceptions of dental care providers’ role in HPV prevention dialogue, are comfortable discussing the HPV vaccine with them (59.4%), and agree that dental care providers are qualified to educate about HPV (56.7%). Although only 32.8% of adults thought that the HPV vaccine was very important in preventing cancers of the mouth and throat, it is promising to see that 48.1% reported that it was somewhat important and only 20% reported that it was not important. Knowledge of the relationship between HPV and oral health and receiving an HPV vaccine recommendation from a dental care provider were strongly associated with positive perceptions of HPV vaccine’s importance and dental care providers’ role in HPV education and HPV vaccine discussion.
- Patel Murthy B.
- Zell E.
- Kirtland K.
- et al.
,
- Fridman A.
- Gershon R.
- Gneezy A.
The rates of OPCs are increasing and, unlike a Papanicolaou test, there are no specific screening tests available to detect OPCs in their precancerous stages. Researchers have reported that increasing HPV vaccination rates to meet national goals of 80% is cost-effective and can reduce OPC cases among males by 50% over the course of their lives.
- Choi S.E.
- Choudhary A.
- Huang J.
- Sonis S.
- Giuliano A.R.
- Villa A.
The American Academy of Pediatric Dentistry recommends a dental examination every 6 months based on oral health status,
Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents.
and more than 70% of children and adolescents reported having a dental visit in the past 6 months.
National Health Interview Survey. Table C-11a. Age-adjusted percent distributions (with standard errors) of unmet dental need due to cost in the past 12 months and of length of time since last visit with a dentist or other dental health care professional for children aged 2-17 years, by selected characteristics: United States, 2018. Accessed November 18, 2022. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_C-11.pdf
Dental practitioners are therefore likely to interact with adolescents and their parents more than medical providers and can play a crucial role in educating and counseling them about the link between HPV and oral health and the role of the HPV vaccine in preventing OPCs. Dental care providers also routinely conduct oral cancer screenings and have an opportunity to discuss the relationship between HPV, oral health, and cancers during the screenings as well. With disparities in HPV-attributable cancer rates and HPV vaccination, dental care providers’ engagement in HPV education and discussion is crucial.
- Walker K.K.
- Jackson R.D.
- Sommariva S.
- Neelamegam M.
- Desch J.
,
- Shukla A.
- Welch K.
- Villa A.
,
- Arnell T.L.
- York C.
- Nadeau A.
- et al.
The results from our national study align with the findings from the 2 small-scale state-based studies and confirm that adults are open to HPV-related discussions with their dental care providers.
- Dean T.C.
- Gilliland A.E.
- Cameron J.E.
,
- Stull C.
- Freese R.
- Sarvas E.
Our results also provide national-level estimates for adults’ perceptions about the importance of the HPV vaccine in OPC prevention and identify factors that can help improve those perceptions. These findings are valuable to dental care providers, professional organizations, and oral health and HPV vaccine stakeholders in supporting dental care providers’ engagement in increasing HPV vaccine uptake. Building on our findings, future work can examine various methods and best practices to engage dental care providers in HPV prevention in different settings, such as private, public, and community health centers.
Some unexpected associations included the relationship of age and sex with perceptions about dental care providers’ role. Although both men and women and all age groups had no significant differences in the perception that the HPV vaccine is important in preventing OPCs, younger adults and women were less likely than their counterparts to have positive perceptions about dental care providers’ role in HPV education (OR, 0.63; 95% CI, 0.53 to 0.76 and OR, 0.59; 95% CI, 0.52 to 0.66, respectively) and HPV vaccine dialogue (OR, 0.77; 95% CI, 0.65 to 0.93 and OR, 0.54; 95% CI, 0.48 to 0.61, respectively). Future work is warranted to disentangle these findings and understand the differences and reasons between groups.
To our knowledge, this is the first national study to examine adults’ perceptions about HPV vaccine importance and the role of the dental care provider in HPV and HPV vaccine dialogue; however, there are a few limitations. These self-reported cross-sectional survey data were collected in early 2021, amid the COVID-19 pandemic, during which the topic of vaccines was highly sensitive and may have led to reporting bias. As a result, we expect the estimates to be more conservative than an overestimate due to the timing. Self-reported data are subject to social desirability and recall bias, but because the data were collected without identifiers and we were interested in knowing adults’ perceptions, these limitations should have minimal impact on our findings. Lastly, the cross-sectional nature of data does not allow us to examine the temporality of events; thus, we could estimate associations only.
Conclusions
There is a need to improve public understanding of the HPV vaccine’s role in preventing OPCs. One in 3 adults in the United States understands the importance of the HPV vaccine in the prevention of OPCs, and more than one-half of the adults agreed that dental care providers are qualified to educate about HPV and report that they are comfortable having HPV vaccine discussions with their dental care providers. Perceptions about the HPV vaccine’s importance in preventing OPC and dental care providers’ role in HPV prevention can be improved by means of increasing knowledge about HPV and oral health and engaging dental care providers in HPV discussions.
Reference
Human papillomavirus (HPV): genital HPV infection—basic fact sheet. Centers for Disease Control and Prevention, Division of STD Prevention, National Center for HIV Viral Hepatitis, STD and TB Prevention, Division of STD Prevention. July 2017. Accessed January 2, 2023. https://www.cdc.gov/std/hpv/stdfact-hpv.htm#print
Cancers associated with human papillomavirus, United States: 2014–2018. USCS Data Brief, no. 26.
Centers for Disease Control and Prevention, US Department of Health and Human Services,
2021Human papillomavirus-attributable cancers: United States, 2012-2016.
MMWR Morb Mortal Wkly Rep. 2019; 68: 724-728
HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management.
Nat Rev Clin Oncol. 2022; 19: 306-327
Annual report to the nation on the status of cancer, part 1: national cancer statistics.
J Natl Cancer Inst. 2021; 113: 1648-1669
The national landscape of human papillomavirus-associated oropharynx squamous cell carcinoma.
Int J Cancer. 2017; 140: 504-512
Survival rates for oral cavity and oropharyngeal cancer. American Cancer Society. Accessed November 18, 2022. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/survival-rates.html#references
Oral cavity and oropharyngeal cancer disparities in Alabama and the United States: a review.
J Oral Maxillofac Surg. 2021; 79: e81-e82
Safety of the 9-valent human papillomavirus vaccine.
Pediatrics. 2019; 144e20191791https://doi.org/10.1542/peds.2019-1791
Use of a 2-dose schedule for human papillomavirus vaccination: updated recommendations of the Advisory Committee on Immunization Practices.
MMWR Morb Mortal Wkly Rep. 2016; 65: 1405-1408
US Food and Drug Administration’s Office of Pediatric Therapeutics and Center for Drug Evaluation and Research, Division of Pediatric and Maternal Health and Center for Biologics and Research. FDA Adds Prevention of Oropharyngeal Cancer to HPV Vaccine’s Indication. American Academy of Pediatrics.
AAP News. 2021;
Increase the proportion of adolescents who get recommended doses of the HPV vaccine: IID-08. Office of Disease Prevention and Health Promotion.
Healthy People. Centers for Disease Control and Prevention.
National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years: United States, 2019.
MMWR Morb Mortal Wkly Rep. 2020; 69: 1109
Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices (ACIP).
JAMA. 2020; 323: 468-469
Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices.
MMWR Morb Mortal Wkly Rep. 2019; 68: 698-702
Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial.
Lancet. 2017; 390: 2143-2159
Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature.
JAMA Pediatr. 2014; 168: 76-82
Identifying the utility of dental providers in human papillomavirus prevention efforts: results from the National Health and Nutrition Examination Survey 2015–2018.
J Adolesc Health. 2022; 70: 571-576
US Department of Health and Human Service Expanding the COVID-19 vaccination workforce.
USA dental health providers’ role in HPV vaccine communication and HPV-OPC protection: a systematic review.
Hum Vaccin Immunother. 2019; 15: 1863-1869
Dental professionals’ knowledge, attitudes, and practice behaviors related to human papillomavirus vaccination.
J Public Health Dent. 2020; 80: 61-69
Parents’ receptiveness to oral health clinic-based vaccination.
Vaccine. 2020; 38: 4226-4229
Parent perceptions of dental care providers’ role in human papillomavirus prevention and vaccine advocacy.
JADA. 2020; 151: 560-567
Association between mental health and oral health status and care utilization.
Front Oral Health. 2021; 2732882
Technical Overview of the Amerispeak® Panel: NORC’s Probability-Based Household Panel. NORC at the University of Chicago. Updated February 8, 2022. Accessed November 18, 2022. https://amerispeak.norc.org/content/dam/amerispeak/research/pdf/AmeriSpeak%20Technical%20Overview%202019%2002%2018.pdf
Health literacy and public health: a systematic review and integration of definitions and models.
BMC Public Health. 2012; 12: 80
Impact of the COVID-19 pandemic on administration of selected routine childhood and adolescent vaccinations: 10 US jurisdictions, March-September 2020.
MMWR Morb Mortal Wkly Rep. 2021; 70: 840-845
COVID-19 and vaccine hesitancy: a longitudinal study.
PLoS One. 2021; 16e0250123https://doi.org/10.1371/journal.pone.0250123
Increasing HPV vaccination coverage to prevent oropharyngeal cancer: a cost-effectiveness analysis.
Tumour Virus Res. 2021; 13200234https://doi.org/10.1016/j.tvr.2021.200234
Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents.
Pediatr Dent. 2018; 40: 194-204
National Health Interview Survey. Table C-11a. Age-adjusted percent distributions (with standard errors) of unmet dental need due to cost in the past 12 months and of length of time since last visit with a dentist or other dental health care professional for children aged 2-17 years, by selected characteristics: United States, 2018. Accessed November 18, 2022. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_C-11.pdf
Assessment of the willingness of dentists in the state of Indiana to administer vaccines.
PLoS One. 2022; 17e0267167https://doi.org/10.1371/journal.pone.0267167
The role of the dental community in oropharyngeal cancer prevention through HPV vaccine advocacy.
J Cancer Educ. 2021; 36: 299-304
Biography
Dr. Naavaal is an associate professor, Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA.
Dr. Demopoulos is a professor, Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, Las Vegas, NV.
Ms. Kelly is a biostatistician, PPD, part of Thermo Fisher Scientific, Wilmington, NC.
Dr. Tranby is the director of analytics and data insights, CareQuest Institute for Oral Health, Boston, MA.
Dr. Frantsve-Hawley is an adjunct professor, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA.
Article info
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Published online: February 06, 2023
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Footnotes
Disclosures. None of the authors reported any disclosures.
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DOI: https://doi.org/10.1016/j.adaj.2022.12.006
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© 2022 American Dental Association. Published by Elsevier Inc.
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