There's Much Yet to be Done: Diverse Perspectives on HPV Vaccination

It has been over 10 y since the first HPV vaccines were licensed and introduced in a number of countries around the world. As only the second vaccine (after hepatitis B) that prevents an infection that can lead to the development of cancer, HPV vaccine occupies an important position in our armamentarium of vaccines yet remains underutilized. The number of national HPV vaccination programs has increased steadily; as of June 2017, 91 countries had introduced national HPV vaccination programs,1 with that number now over 100. Over the past 10+ y, several modifications have been made to the vaccination regimen (e.g., moving from three to two doses if the first dose is administered before age 15 y), in the type of vaccine available (e.g., introduction of the 9-valent vaccine), and in the target of vaccination (e.g., many countries have shifted from female-only to gender-neutral vaccination). There is great variability across the globe in terms of HPV vaccination policies and accompanying barriers to the implementation and/or sustainability of programs. It is well known, for instance, that Japan’s initial success with vaccination was undermined by several factors, leading to a precipitous drop in vaccination rates, with little subsequent recovery.2 Other countries, such as the U.S.,3 have struggled to achieve vaccination goals, and still others have faced setbacks but with good recovery (e.g., Denmark and Ireland).4,5 At the same time, many countries, including China,6 still have not implemented national vaccination programs, with the cost of vaccines presenting a significant obstacle, particularly for those countries that are not eligible for reduced pricing through Global Alliance for Vaccines and Immunisation (GAVI) or other mechanisms. Other countries, such as Malaysia, Rwanda, Australia, and the U.K., have achieved sustained high levels of vaccination.7–10 Unwarranted fears about HPV vaccine and the proliferation of misinformation, particularly via social media, have proven to be significant and widespread obstacles to achieving and maintaining high vaccination rate

Association of state Medicaid expansion status with rates of suicide among US adults

Importance: In the US, suicide is the 10th leading cause of death and a serious mental health emergency. National programs that address suicide list access to mental health care as key in prevention, and more large-scale policies are needed to improve access to mental health care and address this crisis. The Patient Protection and Affordable Care Act (ACA) Medicaid Expansion Program was implemented in several states with the goal of increasing access to the health care system. Objective: To compare changes in suicide rates in states that expanded Medicaid under the ACA vs states that did not. Design, Setting, and Participants: In this cross-sectional study, state-level mortality rates were obtained from the National Center for Health Statistics for US individuals aged 20 to 64 years from January 1, 2000, to December 31, 2018. Data analysis was performed from April 18, 2021, to April 15, 2022. Exposures: Changes in suicide mortality rates among nonelderly adults before and after Medicaid expansion in expansion and nonexpansion states were compared using adjusted difference-in-differences analyses via hierarchical bayesian linear regression. Main Outcomes and Measures: Suicide rates using death by suicide as the primary measure. Results: Of the total population at risk for suicide, 50.4% were female, 13.3% were Black, 79.5% were White, and 7.2% were of other races. The analytic data set contained suicide mortality data for 2907 state-age-year units covering the general US population. A total of 553 912 deaths by suicide occurred during the study period, with most occurring in White (496 219 [89.6%]) and male (429 580 [77.6%]) individuals. There were smaller increases in the suicide rate after 2014 in Medicaid expansion (2.56 per 100 000 increase) compared with nonexpansion states (3.10 per 100 000 increase). In adjusted difference-in-differences analysis, a significant decrease of -0.40 (95% credible interval, -0.66 to -0.14) suicides per 100 000 individuals was found, translating to 1818 suicides that were averted in 2015 to 2018. Conclusions and Relevance: In this cross-sectional study, although suicide rates increased in both groups, blunting of these rates occurred among nonelderly adults in the Medicaid expansion states compared with nonexpansion states. Because this difference may be linked to increased access to mental health care, policy makers should consider suicide prevention as a benefit of expanding access to health care

State public assistance spending and survival among adults with cancer

IMPORTANCE: Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. OBJECTIVE: To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. EXPOSURE: Differential state-level public assistance spending. MAIN OUTCOME AND MEASURE: The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. RESULTS: A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P \u3c .001), particularly for non-Hispanic Black individuals (0.29$100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P \u3c .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49$100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). CONCLUSIONS AND RELEVANCE: This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation

Medical students\u27 knowledge of HPV, HPV vaccine, and HPV-associated head and neck cancer

On the basis of their training, medical students are considered the best case scenario among university students in knowledge of the human papillomavirus (HPV). We evaluated differences in knowledge of HPV, HPV vaccine, and head and neck cancer (HNC) among medical students. A previously validated questionnaire was completed by 247 medical students at a Midwestern university. Outcomes of interest were knowledge score for HPV and HPV vaccine, and HNC, derived from combining questionnaire items to form HPV knowledge and HNC scores, and analyzed using multivariate linear regression. Mean scores for HPV knowledge were 19.4 out of 26, and 7.2 out of 12 for HNC knowledge. In the final multivariate linear regression model, sex, race, and year of study were independently associated with HPV and HPV vaccine knowledge. Males had significantly lower HPV vaccine knowledge than females (β = -1.53; 95% CI: -2.53, -0.52), as did nonwhite students (β = -1.05; 95% CI: -2.07, -0.03). There was a gradient in HPV vaccine knowledge based on the year of study, highest among fourth year students (β = 6.75; 95% CI: 5.17, 8.33). Results were similar for factors associated with HNC knowledge, except for sex. HNC knowledge similarly increased based on year of study, highest for fourth year students (β = 2.50; 95% CI: 1.72, 3.29). Among medical students, gaps remain in knowledge of HPV, HPV vaccine, and HPV-linked HNC. Male medical students have significantly lower knowledge of HPV. This highlights the need to increase medical student knowledge of HPV and HPV-linked HNC

Association of Inventory to Measure and Assess imaGe Disturbance - Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors

Objective: The Inventory to Measure and Assess imaGe disturbance - Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID. Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff. Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of \u3c22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID. Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder

The Alma-Ata declaration: An appraisal of Nigeria's primary oral health care three decades later

Aim This work is a critical appraisal of the state of primary oral health care in Nigeria, the largest Black nation on earth, three decades after the Alma-Ata declaration of primary health care.Methods A review based on published peer-reviewed journals, documents from international organs like the World Health Organization, internet sources and newspapers, which beams a searchlight on the state of health care in Nigeria.Results Results show a lot of decay in the primary health care sector and a lack of proper amalgamation defined by affirmative action of the primary oral health care into the mainstream of primary health care.Conclusion Time for massive action, first by the government, and then by the oral health professionals and the public and all stake-holders to ensure that the dream of Alma-Ata does not remain an illusion in Nigeria's oral health care sector.Alma-Ata declaration Primary health care Primary oral health care Nigeria

Determinants of Health Disparities: The Perennial Struggle against Polio in Nigeria

Polio remains a global public health issue, and even though it has been eradicated from most countries of the world, countries like Nigeria, the largest black nation on earth, threatens the dream of total eradication of polio from the surface of the earth. Transmission of wild polio virus has never been eliminated in Nigeria, but even worse is the number of countries, both in Sub-Saharan Africa and all over the world that has become re-infected by polio virus strains from Northern Nigeria in recent past. Although a lot has been documented about the Nigerian polio struggle, one aspect that has received little attention on this issue is ethnic and geographic disparities between the Southern and the Northern parts of Nigeria. Understanding these disparities involved in polio virus transmission in Nigeria, as well as the social determinants of health prevalent in Northern Nigeria will help government and other stakeholders and policy makers to synergize their efforts in the fight against this perennial scourge

Geospatial comparison of incidence of oral and pharyngeal cancers and tobacco and alcohol use in the United States

Oral and pharyngeal cancers (OPCs) together, are the 6th most common cancers worldwide Accounts for 3% of all cancers in the United States 13th most common cancers in the United States 300,000 cases reported between 1999 and 2008 Tobacco and alcohol act independently and synergistically as major risk factors. This project asks if there a similarity in distribution of OPC and adult smoking levels across states; is there a similarity in distribution of OPC and alcohol consumption across the states; is there a high density of OPC incidences in areas with high levels of both alcohol consumption and smoking.https://openscholarship.wustl.edu/gis_poster/1145/thumbnail.jp

There's Much Yet to be Done: Diverse Perspectives on HPV Vaccination

It has been over 10 y since the first HPV vaccines were licensed and introduced in a number of countries around the world. As only the second vaccine (after hepatitis B) that prevents an infection that can lead to the development of cancer, HPV vaccine occupies an important position in our armamentarium of vaccines yet remains underutilized. The number of national HPV vaccination programs has increased steadily; as of June 2017, 91 countries had introduced national HPV vaccination programs,1 with that number now over 100. Over the past 10+ y, several modifications have been made to the vaccination regimen (e.g., moving from three to two doses if the first dose is administered before age 15 y), in the type of vaccine available (e.g., introduction of the 9-valent vaccine), and in the target of vaccination (e.g., many countries have shifted from female-only to gender-neutral vaccination). There is great variability across the globe in terms of HPV vaccination policies and accompanying barriers to the implementation and/or sustainability of programs. It is well known, for instance, that Japan’s initial success with vaccination was undermined by several factors, leading to a precipitous drop in vaccination rates, with little subsequent recovery.2 Other countries, such as the U.S.,3 have struggled to achieve vaccination goals, and still others have faced setbacks but with good recovery (e.g., Denmark and Ireland).4,5 At the same time, many countries, including China,6 still have not implemented national vaccination programs, with the cost of vaccines presenting a significant obstacle, particularly for those countries that are not eligible for reduced pricing through Global Alliance for Vaccines and Immunisation (GAVI) or other mechanisms. Other countries, such as Malaysia, Rwanda, Australia, and the U.K., have achieved sustained high levels of vaccination.7–10 Unwarranted fears about HPV vaccine and the proliferation of misinformation, particularly via social media, have proven to be significant and widespread obstacles to achieving and maintaining high vaccination rate

1428P Suicidal outcomes among cancer survivors: Examining associations with depression and non-medical pain prescriptions

Background: A cancer diagnosis results in significant distress and adverse psychosocial sequelae, including suicide, the 10th leading cause of death in the United States. Primary risks for death by suicide include depression, and opioid abuse, which are prevalent amongst cancer survivors. Yet, it remains unclear whether they are also associated with other suicidal outcomes, such as ideation, planning, and suicidal attempt. This study examined associations between suicide-related outcomes, depression and non-medical use of pain prescriptions among cancer survivors in the United States. Methods: We used cross-sectional data from the National Survey on Drug Use and Health (NSDUH; 2015-2019), a nationwide study in the United States that provides data on mental health and other health concerns. Outcomes of interest were patient-reported suicidal ideation, suicidal planning, and suicidal attempt. Participants were grouped as: individuals with a history of cancer, individuals without a history of cancer, but with fair/poor health, and individuals without a history of cancer but with excellent/very good/good health. Results: Weighted logistic regression analyses that adjusted for sociodemographics and substance use showed associations between a history of cancer and suicidal ideation (aOR = 1.32, 95% CI 1.10, 1.58). Among individuals with a history of cancer, depression and non-medical use of pain prescriptions were consistently associated with suicidal ideation (aORdepression = 7.37, 95% CI 4.52, 12.03; aORpain prescriptions = 3.36, 95% CI 1.27, 8.91, planning (aORdepression = 10.31, 95% CI 5.79, 18.34; and aORpain prescriptions = 3.77, 95% CI 1.20, 11.85), and attempt (aORdepression = 4.29, 95% CI 1.41, 13.06). Conclusions: Individuals with a history of cancer are at increased odds of adverse suicidal outcomes, driven by depression and non-medical pain prescription. Routinely assessing for depression and non-medical use of pain prescriptions may be a crucial suicide prevention strategy in oncology