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Ogden SN, Leskinen EA, Sarma EA, Wainwright JV, Rendle KA. Effects of Message Framing on Cervical Cancer Screening Knowledge and Intentions Related to Primary HPV Testing. Cancer Prev Res (Phila) 2021; 14:839-844. [PMID: 33846214 DOI: 10.1158/1940-6207.capr-20-0622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022]
Abstract
Numerous national guidelines now include primary human papillomavirus (HPV) testing as a recommended screening option for cervical cancer in the United States yet little is known regarding screening intentions for this specific screening strategy or interventions that may increase uptake. Gain- and loss-framed messaging can positively impact health behaviors; however, there is mixed evidence on which is more effective for cervical cancer screening, with no published evidence examining HPV testing. To help address this gap, this study compared the effects of message framing on screening knowledge and intentions related to primary HPV testing. We randomized females aged 21-65 (n = 365) to receive brief messaging about cervical cancer screening with either gain- or loss-framing. In January-February 2020, participants completed pretest and posttest measures evaluating cervical cancer knowledge, beliefs, and intentions to be screened using HPV testing. We used generalized estimating equations to model message and framing effects on screening outcomes, controlling for age, education, race, and baseline measures. In comparison to pretest, messaging significantly increased HPV-related screening intentions [adjusted OR (aOR): 2.4 (1-3.5)] and knowledge [aOR: 1.7 (1.2-2.4)], perceived effectiveness of HPV testing [aOR: 4.3 (2.8-6.5)], and preference for primary HPV screening [aOR: 3.2 (1.2-8.5)], regardless of message framing. For all outcomes, no significant interaction by message framing was observed. Brief public health messaging positively impacted HPV-related screening intentions, knowledge, and beliefs, independent of message framing. In conjunction with other strategies, these results suggest that messaging could be an effective tool to increase uptake of primary HPV testing. PREVENTION RELEVANCE: Primary HPV tests are more sensitive and offer greater reassurance than Pap tests alone yet use for routine cervical cancer screening remains low. Brief public health messaging can positively impact awareness, knowledge, and screening intention regarding primary HPV testing. Messaging campaigns paired with other strategies can increase uptake across populations.See related Spotlight, p. 823.
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Affiliation(s)
- Shannon N Ogden
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Emily A Leskinen
- School of Social Science and Human Services, Ramapo College of New Jersey, Mahwah, New Jersey
| | - Elizabeth A Sarma
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jocelyn V Wainwright
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. .,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Mings J, Soto Mas F. Barriers to Pap Smear Among Homeless Women at Albuquerque Healthcare for the Homeless. J Community Health 2020; 44:1185-1192. [PMID: 31313028 DOI: 10.1007/s10900-019-00704-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this cross-sectional survey study was to explore common barriers to adequate Pap smear utilization among homeless women, and the factors that may relate to cervical cancer testing in this population. Participants consisted of adult women recruited at a healthcare facility for the homeless. Data were collected through a self-completed questionnaire on knowledge, attitudes and intentions about Pap smears and cervical cancer. Analyses included descriptive and inferential statistics. Sixty participants who had experienced homelessness within the past year completed the study. The most frequently mentioned barrier to testing was not having enough time to obtain a Pap smear (n = 33; 55%). Linear regression found that there were no significant relationships between knowledge and attitudes about cervical cancer and intention to get a Pap smear. However, the study did find that women with a positive previous Pap smear experience had more positive attitudes about the process and outcomes of Pap smears (p = 0.011, p = 0.00, respectively). Participants with more knowledge about cervical cancer were less negative about Pap smear outcomes (p = 0.05), and that women with negative attitudes about Pap smear outcomes were less likely to have obtained a Pap smear in the past (p = 0.033). Interventions that promote positive attitudes about testing and outcomes, minimizing stress and inconvenience during the test, as well as increasing the ease of scheduling an appointment may help break down barriers to cervical cancer screening among homeless women.
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Affiliation(s)
- Jennifer Mings
- College of Population Health, 1 University of New Mexico, MSC09 5070, Albuquerque, NM, 87131-0001, USA
| | - Francisco Soto Mas
- College of Population Health, 1 University of New Mexico, MSC09 5070, Albuquerque, NM, 87131-0001, USA.
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Head KJ, Johnson NL, Scott SF, Zimet GD. Communicating Cervical Cancer Screening Results in Light of New Guidelines: Clinical Practices at Federally Qualified Health Centers. HEALTH COMMUNICATION 2020; 35:815-821. [PMID: 30945950 DOI: 10.1080/10410236.2019.1593079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New guidelines for cervical cancer screening (CCS) incorporate both HPV and Pap tests, and there is a need to understand communication of these cotesting results to patients, especially in at-risk populations disproportionally affected by cervical cancer. This study used computer-assisted telephone interviews in 2017 at 51 federally qualified health centers (FQHCs) in Indiana to evaluate the characteristics of clinical communication CCS results to women. Results revealed that clinical communication practices varied on channel, timing, and content. Almost half of the clinics (n = 23, 45%) communicate results to patients by phone. Most clinics (n = 47, 92%) notify patients of results in two weeks or less. For cotesting, 70% (n = 36) always communicate Pap/HPV results at the same time. The majority of clinics (n = 42, 82%) explain the type of abnormal Pap test, while only 43% (n = 22) discuss the cervical cancer risk as indicated by the HPV test result. Even though 98% (n = 48) of participants rated their communication strategy as effective, qualitatively participants acknowledged difficulties in communicating cotesting results with their often transient and low health literate patients populations. These results indicate considerable variation and potential deficits in clinical communication of cotesting results in FQHCs, but several promising communication strategies were identified that may inform improved screening communication for other clinics.
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Affiliation(s)
- Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Nicole L Johnson
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Susanna Foxworthy Scott
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
- Division of Clinical Pharmacology, Indiana University School of Medicine
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine
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Tatar O, Thompson E, Naz A, Perez S, Shapiro GK, Wade K, Zimet G, Gilca V, Janda M, Kahn J, Daley E, Rosberger Z. Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis. Prev Med 2018; 116:40-50. [PMID: 30172799 DOI: 10.1016/j.ypmed.2018.08.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023]
Abstract
Primary screening for cervical cancer is transitioning from the longstanding Pap smear towards implementation of an HPV-DNA test, which is more sensitive than Pap cytology in detecting high-risk lesions and offers greater protection against invasive cervical carcinomas. Based on these results, many countries are recommending and implementing HPV testing-based screening programs. Understanding what factors (e.g., knowledge, attitudes) will impact on HPV test acceptability by women is crucial for ensuring adequate public health practices to optimize cervical screening uptake. We used mixed methods research synthesis to provide a categorization of the relevant factors related to HPV primary screening for cervical cancer and describe their influence on women's acceptability of HPV testing. We searched Medline, Embase, PsycINFO, CINAHL, Global Health and Web of Science for journal articles between January 1, 1980 and October 31, 2017 and retained 22 empirical articles. Our results show that while most factors associated with HPV test acceptability are included in the Health Belief Model and/or Theory of Planned Behavior (e.g., attitudes, knowledge), other important factors are not encompassed by these theoretical frameworks (e.g., health behaviors, negative emotional reactions related to HPV testing). The direction of influence of psychosocial factors on HPV test acceptability was synthesized based on 14 quantitative studies as: facilitators (e.g., high perceived HPV test benefits), barriers (e.g., negative attitudes towards increased screening intervals), contradictory evidence (e.g., sexual history) and no impact (e.g., high perceived severity of HPV infection). Further population-based studies are needed to confirm the impact of these factors on HPV-based screening acceptability.
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Affiliation(s)
- Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Erika Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie, Blvd., EAD 709M, Fort Worth, TX 76107-2699, USA.
| | - Anila Naz
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Samara Perez
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Gilla K Shapiro
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
| | - Kristina Wade
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada.
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA.
| | - Vladimir Gilca
- Institut National de Santé Publique du Québec, 945 Wolfe Avenue, Québec, Quebec G1V 5B3, Canada.
| | - Monika Janda
- Queensland University of Technology, Faculty of Health, Brisbane, Australia.
| | - Jessica Kahn
- University of Cincinnati (Ohio), Division of Adolescent and Transition Medicine, MLC 4000, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
| | - Ellen Daley
- University of South Florida, Department of Community and Family Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, Quebec H3T1E4, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec, Canada.
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Luque JS, Tarasenko YN, Chen C. Correlates of Cervical Cancer Screening Adherence Among Women in the U.S.: Findings from HINTS 2013-2014. J Prim Prev 2018; 39:329-344. [PMID: 29876723 PMCID: PMC10878428 DOI: 10.1007/s10935-018-0513-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21-65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years. Correlates of guideline adherent cervical cancer screening included socio-demographic and health-related characteristics and HPV/cervical cancer-related beliefs and knowledge items. Multivariable logistic regression analyses were used to estimate prevalence of guideline adherent screening. An estimated 81.3% of women aged 21-65 years reported being screened for cervical cancer within the last 3 years. Controlling for sociodemographic and health-related characteristics and survey year, women aged 46-65 years were less likely to be guideline adherent than those aged 21-30 years (aPR = 0.89; 95% CI 0.82-0.97). The adjusted prevalence of adherence was significantly higher among married/partnered than among not married women (aPR = 1.13; 95% CI 1.05-1.22), and those with one to three medical visits (aPR = 1.30; 95% CI 1.14-1.48), and four or more visits in the past year (aPR = 1.26; 95% CI 1.09-1.45) compared to those with no medical visits. Differences in unadjusted prevalence of guideline adherent screening depending on women's beliefs and knowledge about HPV and cervical cancer were not significant in adjusted analyses. Lack of interaction with a healthcare provider, being not married/partnered and increasing age continue to be risk factors of foregoing guideline adherent cervical cancer screening.
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Affiliation(s)
- John S Luque
- Institute of Public Health, Florida A&M University, 1515 South MLK Blvd., Ste. 207B, Tallahassee, FL, 32307, USA.
| | - Yelena N Tarasenko
- Department of Health Policy and Management, Georgia Southern University, Statesboro, GA, USA
- Department of Epidemiology, Georgia Southern University, Statesboro, GA, USA
| | - Chen Chen
- College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN, USA
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Rendle KA, Schiffman M, Cheung LC, Kinney WK, Fetterman B, Poitras NE, Lorey T, Castle PE. Adherence patterns to extended cervical screening intervals in women undergoing human papillomavirus (HPV) and cytology cotesting. Prev Med 2018; 109:44-50. [PMID: 29288782 DOI: 10.1016/j.ypmed.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/03/2023]
Abstract
Although guidelines have recommended extended interval cervical screening using concurrent human papillomavirus (HPV) and cytology ("cotesting") for over a decade, little is known about its adoption into routine care. Using longitudinal medical record data (2003-2015) from Kaiser Permanente Northern California (KPNC), which adopted triennial cotesting in 2003, we examined adherence to extended interval screening. We analyzed predictors of screening intervals among 491,588 women undergoing routine screening, categorizing interval length into early (<2.5years), adherent (2.5<3.5years), or late (3.5<6.0years). We also examined repeated early screening in a subgroup of 50,691 women. Predictors examined included: cohort year (defined by baseline cotest, 2003-2009), race/ethnicity, and baseline age. Compared to the 2003 cohort, women in the 2009 cohort were significantly less likely to screen early (aOR=0.22, 95% CI=0.21, 0.23) or late (aOR=0.47, 95% CI=0.45, 0.49). African American (AA) and Hispanic women were less adherent overall than Non-Hispanic White women, with increased early [(AA: aOR=1.21, 95%CI=1.17, 1.25) (Hispanic: aOR=1.08, 95%CI=1.06, 1.11)] and late screening [(AA: aOR=1.23, 95%CI=1.19, 1.27) (Hispanic: aOR=1.06, 95%CI=1.03, 1.08)]. Asian women were slightly more likely to screen early (aOR=1.03, 95%CI=1.01, 1.05), and less likely to screen late (aOR=0.92, 95% CI=0.90, 0.94). Women aged 60-64years were most likely to screen early for two consecutive intervals (aOR=2.09, 95%CI=1.91, 2.29). Our study found that widespread and rapid adoption of extended interval cervical cancer screening is possible, at least in this managed care setting. Further research examining multilevel drivers promoting or restricting extended interval screening across diverse healthcare settings is needed.
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Affiliation(s)
- Katharine A Rendle
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States.
| | - Mark Schiffman
- Clinical Genetics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Li C Cheung
- Biostatistics Branch, Division of Clinical Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Walter K Kinney
- Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA, United States.
| | - Barbara Fetterman
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Nancy E Poitras
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Thomas Lorey
- Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA, United States.
| | - Philip E Castle
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
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Clinical, laboratory and epidemiological aspects of HPV infection in a low-income population from South Bahia, Brazil. Epidemiol Infect 2017; 145:3398-3404. [PMID: 29166976 DOI: 10.1017/s0950268817002448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to determine the prevalence and risk factors for human papillomavirus (HPV) infection in the Southern region of the State of Bahia, evaluating the performance of alternative complementary methods for cervical lesion detection. Cervical samples from women who attended healthcare units were collected and diagnosed by visual inspection, cervical cytology and nested polymerase chain reaction (PCR). Moreover, hemi-nested PCR was performed to detect different HPV genotypes. The prevalence of HPV infection was 47·7%, with genotype 16 detected in most cases. Infection was associated with dyspareunia and bleeding (P < 0·001, odds ratio (OR) 5·6, 95% confidence interval (CI) 2·815-11·14) and hormonal contraceptive use (P = 0·007, OR 2·33, 95% CI 1·25-4·34). There was a positive correlation between positive PCR and positive visual inspection, cervical cytology and symptoms reported. Furthermore, visual inspection was twice as specific, and had a greater positive predictive value than cytology. We showed a high prevalence of HPV infection in Southern Bahia, with HPV 16 being the most common type, and visual inspection being most effective at detecting HPV lesions, corroborating the suggestion that it can be applied in routine gynecologic examinations for low-income populations.
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Karimy M, Azarpira H, Araban M. Using Health Belief Model Constructs to Examine Differences
in Adherence to Pap Test Recommendations among Iranian
Women. Asian Pac J Cancer Prev 2017; 18:1389-1394. [PMID: 28612592 PMCID: PMC5555552 DOI: 10.22034/apjcp.2017.18.5.1389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite documented successful Pap tests in routine care of women, screening levels are unfortunately often lower than recommended. This study aimed to assess differences in adherence to Pap test guidelines among a sample of Iranian women using the Health Belief Model (HBM). In this descriptive and analytical study, information was collected from a total of 305 women, (age range of 15-49) from Zarandieh health centers in Iran using a random multistage sampling method. The questionnaire covered demographic characteristics; health belief model constructs were gathered by a self-report method. The results were analyzed using the independent samples t test and logistic regression in SPSS-20. A total 32% of the subjects had a history of a Pap test and the score mean of the whole constructs model (knowledge, susceptibility, severity, benefits, barriers and self-efficacy) in these individuals was higher than those without a positive history. Among the predictive variables of HBM constructs, the highest weights were observed for perceived benefits ß)=0.36), perceived susceptibility =ß) 0.35) and self-efficacy ß)=0.29). Based on our finding of positive relationships for health belief model structures with performance of a pap smear test, designing educational interventions for changing the knowledge levels and beliefs of women is recommended.
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Affiliation(s)
- Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
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Inglehart RC, Taberna M, Pickard RKL, Hoff M, Fakhry C, Ozer E, Katz M, Gillison ML. HPV knowledge gaps and information seeking by oral cancer patients. Oral Oncol 2016; 63:23-29. [PMID: 27938996 DOI: 10.1016/j.oraloncology.2016.10.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/29/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The incidence of human papillomavirus (HPV) positive oral squamous cell carcinoma (OSCC) continues to increase over time, challenging healthcare providers to address their patients' HPV-related concerns. MATERIALS AND METHODS This prospective study assessed health literacy, HPV knowledge, utilization and trust in information sources among patients with incident HPV-positive or HPV-negative OSCC diagnosed at the Ohio State University from 2011 to 2015. Health literacy was assessed with a standardized scale. Additional questions evaluated HPV knowledge (including transmission, prevalence, health consequences and treatment), the frequency and type of information sources sought, and trust in those sources. RESULTS Surveys were collected from 372 OSCC cases (HPV-positive, n=188; HPV-negative, n=184). Despite high mean health literacy scores, only 45.2% of HPV-related knowledge questions were answered correctly. HPV was known to be a sexually transmitted infection and a cause of cervical and anal cancer by 66.0%, 56.5% and 15.2%, respectively. In all domains, cases with HPV-positive OSCC were significantly more informed than HPV-negative cases (for all, p<0.01). Only 52.7% and 56.2% of patients with HPV-positive OSCC felt they knew enough to be comfortable discussing HPV with their doctor or sexual partner, respectively. The most frequently used information source was the internet (80.9%), which ranked 8th in trust of 15 possible sources. Although most (95.5%) patients trusted information from their doctors, only 37.9% used doctors as an information source. CONCLUSIONS Doctors are a highly trusted, but infrequent utilized, information source and should facilitate patient access to high-quality HPV information sources.
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Affiliation(s)
- R C Inglehart
- MSTP Program, The Ohio State University College of Medicine, Columbus, OH, United States
| | - M Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), IDIBELL. L'Hospitalet de Llobregar, Barcelona, Spain; Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Spain
| | - R K L Pickard
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - M Hoff
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - C Fakhry
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD, United States
| | - E Ozer
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, OH, United States
| | - M Katz
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - M L Gillison
- Department of Medicine, The Ohio State University, Columbus, OH, United States.
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