Doctor of Philosophy in Health Sciences, Youngstown State University, 2024, Department of Graduate Studies in Health and Rehabilitation Sciences

The HPV vaccination has been effective in preventing HPV-related diseases and cancers, but a large portion of the US population remains unvaccinated. The dissertation explores the sociodemographic disparities in HPV vaccination uptake and coverage in different categories of the US population. Additionally, it investigates the nature and pattern of HPV misinformation and its relationship with extremism, conspiracism, and religious ideologies in online forums. The first two studies used national survey data to analyze HPV vaccine initiation and completion among US adolescents and adults. Descriptive statistics and logistic regression were adopted to estimate disparities in HPV vaccination uptake. The third study analyzed online forum posts related to HPV vaccination discourse and misinformation through purposive sampling, utilizing automated text mining and statistical analysis to assess the association with conspiracy theories, extreme ideologies, and extremist activities. HPV vaccine initiation and completion increased among older adolescents, and there are lower odds of HPV vaccination among adults aged 45 and above. The nature of discussions about HPV vaccination in online forums is primarily analytical, with moderate to low clout and emotional tone. Discourse and misleading narratives about the HPV vaccine among faith communities, including the prevalence of extreme theories and ideologies, potentially escalate into extremist activities. There is a need for initiatives to address HPV vaccination uptake among boys and expand the vaccine recommendations to include all US adults. Online engagement of community forums, experts, and evidence-based communication to promote HPV vaccine uptake.

Committee: Nicolette Powe PhD (Advisor); Ken Learman PhD (Committee Member); Richard Rogers PhD (Committee Member); Heather Hefner PhD (Committee Member) Subjects: Biostatistics; Demographics; Health; Health Sciences; Public Health; Public Health Education

Master of Science, The Ohio State University, 2023, Dentistry

Purpose: The aim of this pre-post design study was to determine the usability and feasibility of a virtual simulation-based learning experience to educate pediatric dental providers regarding human papilloma virus (HPV) and the HPV vaccine. Methods: Sixteen residents at one pediatric dental residency program were recruited. All residents completed a pre-simulation survey to assess their baseline knowledge, skills, and attitudes toward discussing HPV with patients. Participants then completed a telehealth standardized patient encounter where they were tasked with discussing HPV and the HPV vaccine with a teenage patient and their parent. All participants then completed an online learning experience. Following this exercise, participants repeated the same standardized patient encounter and then completed a post-simulation survey to assess changes from baseline. Results: There was a significant difference between pre and post survey responses for eight of eleven questions (p<0.05) and pre and post standardized patient encounter performance for two of twelve vaccine discussion elements (p<0.05). Participants reported increased knowledge regarding discussing HPV and its connection to overall and oral health, as well as increased confidence in discussing common side effects and safety of the vaccine. Participants showed improved performance in communicating the safety and efficacy of the vaccine as well as sharing age-based dosing recommendations. Most participants reported the simulation equipped them with new knowledge and that they plan on applying at least one new thing they learned into their future clinical practice. Conclusions: Standardized patient encounters and virtual learning experiences are an accessible and effective way to increase knowledge regarding HPV and the HPV vaccine that exists among dental trainees and help dental providers feel confident aligning their recommendation for the HPV vaccine with the guidelines set by dental professional organizations (open full item for complete abstract)

Committee: Homa Amini DDS, MPH, MS (Advisor); Janice Townsend DDS, MS (Committee Member); Erin Gross DDS, PhD, MS (Committee Member) Subjects: Dentistry; Education; Health Education

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

Background: Human papillomavirus (HPV), the most common sexually transmitted infection in the United States, results in significant morbidity and mortality. Pediatric and adolescent cancer survivors' vulnerability to second malignancies leaves this under-immunized population at increased risk. Methods: Guided by the Health Belief Model (HBM) and using quality improvement methodology, a HPV Cancer Prevention video was created and implemented during a routine survivorship appointment. The purpose was to 1) explore feasibility of a video implementation process, 2) improve provider recommendation/endorsement of HPV vaccine, 3) explore satisfaction, knowledge gain, and rationale for immunization and 4) measure initiation and completion rates. Results: The HPV Cancer Prevention video supplemented provider education and endorsement, successfully increasing HPV initiation and completion rates in a vulnerable survivorship population. Eighty percent of survivors and 73% of parents either strongly agreed or agreed that the video provided them with new information about HPV. Satisfaction rates for receiving HPV information in video format were similarly high, with 90% of survivors and 87% of parents satisfied, or very satisfied. Provider endorsement of immunization, a strong predictor of immunization, improved over historical baseline to 95% of the population. Immunization initiation and completion rates of 68% and 40.4% (respectively) were higher in this cohort of 59 survivors (33 males, 26 females) than for other cancer survivor populations. The most commonly reported rationale for uptake related to perceived susceptibility, reported as “cancer prevention”; cues to action such as provider recommendations and familial experience with HPV associated cancers were important; lack of perceived susceptibility featured themes about the lack of sexual activity. Other rationale included lack of research about the vaccine and religious justification. The decline to vaccinate rate (open full item for complete abstract)

Committee: Susan Allen PhD, RN-BC (Committee Chair); Patricia McMahon DNP, NP-C, RN (Committee Member) Subjects: Health; Health Care; Public Health

PhD, University of Cincinnati, 2023, Medicine: Cancer and Cell Biology

Human papillomavirus is the most common sexually transmitted pathogen in the US and drives benign and malignant diseases, namely high-risk (e.g. HPV16) and low-risk (e.g. HPV6; HPV11) strains. High-risk HPV strains are responsible for 5% of cancers worldwide while low risk strains cause benign tumors including those in recurrent respiratory papillomatosis (RRP). HPV specifically infects the stratified squamous epithelium, where the virus can either remain latent, thus avoiding immune detection, or actively replicate and express viral genes in synchrony with epithelial differentiation. Despite decades of research, no antivirals exist to clear HPV infection and it remains unknown which specific epithelial cell subpopulation(s) support disease formation and/or persistence. Single-cell RNA sequencing technologies enable a granular understanding of distinct cell types and subpopulations within complex tissues. Thus, we applied scRNAseq to epithelial tissues to (1) identify the transcriptomes of keratinocyte subpopulations and (2) discover HPV reprogramming and viral-driven disease phenotypes in infected epithelium. In Part One, we utilized 3D organotypic epithelial rafts, a model of stratified squamous epithelium, to compare isogenic HPV16+ versus HPV16-naive tissue. We identified twelve transcriptomically distinct keratinocyte clusters and spatially mapped select subpopulations, including actively replicating cells and those that comprise basal and differentiated layers. HPV16-driven reprogramming was evidenced by changes in gene signatures of defined subpopulations (e.g. basal cells), in the localization of replicating cells, and in the overall composition of the epithelium wherein we discovered an HPV-induced differentiated subpopulation. This subpopulation, termed HPV-induced differentiation dissonant epithelial nonconventional (HIDDEN) cells, was further determined to be driven by the transcription factor ELF3 and to be enriched in stages of HPV+ car (open full item for complete abstract)

Committee: Susanne Wells Ph.D. (Committee Chair); S. Steven Potter Ph.D. (Committee Member); Joseph Qualls Ph.D. (Committee Member); Kathryn Wikenheiser-Brokamp M.D. (Committee Member); David Smith M.D. Ph.D. (Committee Member); Daniel Starczynowski Ph.D. (Committee Member); Marc Rothenberg M.D. Ph.D. (Committee Member) Subjects: Cellular Biology

PhD, University of Cincinnati, 2020, Education, Criminal Justice, and Human Services: Educational Studies

This dissertation explores how participatory research, in partnership with community-based organizations, co-constructs knowledge and action in ways that amplify community and stakeholder voice. The first chapter defines research engagement and the related concepts of community and stakeholders then outlines the benefits of participatory research and research in partnership with community-based organizations. The next chapters are research and method reports that highlight how having a participatory mind-set when partnering with community-based organizations can increase community engagement. Chapter 2 reports on a community assessment to better understand stressors, protective factors and resilience in the Cincinnati, Ohio area. The study used group-level assessment (n= ~90) and two types of interviews (n= 61 total interviews). Findings include: 1) mental health is at the root of individual stressors; 2) external and community stressors are systemic; 3) coping techniques are varied and highly individualized; 4) community solutions focus on connection and relationships; 5) hope and optimism contribute to resilience. Community partners in this study included Joining Forces for Children (a coalition of educators, nonprofits and health care professionals focused on preventing childhood traumas and mitigating the effects of trauma and toxic stress on youth) and several churches, school and community organizations. Chapter 3 is a research report to explore knowledge, belief, and behaviors about human papillomavirus vaccination (HPVV) with the aim of developing health promotion messaging. This study focused on Ohio in an effort to understand the geographic and contextual factors that may affect vaccine uptake. More than 250 parents/caregivers and youth were interviewed at health fairs, clinics, fairs and other community events. Five personas or fictional composites of common patterns across the data were developed: Hesitant, Against, Data-Driven, All Positive and Ne (open full item for complete abstract)

Committee: Lisa Vaughn Ph.D. (Committee Chair); Farrah Jacquez Ph.D. (Committee Member); Robert Shapiro (Committee Member) Subjects: Public Health

Doctor of Philosophy, The Ohio State University, 2020, Public Health

Compared to the rest of the United States (U.S), Appalachia experiences significant health and economic disparities. Appalachian women are at increased risk for many chronic diseases, including cervical cancer. Prior research has suggested that the prevalence of risk factors for cervical cancer, including high-risk human papillomavirus (HPV) infection, is high among Appalachian women. Prior research also suggests that Appalachian women mostly perceive themselves to be at average risk of cervical cancer. One goal of this research was to compare an objective measure of cervical cancer risk to a woman's perceived risk of cervical cancer to determine misperceptions of risk. The main interest in misperception is to determine if there is an association of socioeconomic status (SES) at an individual as well as county-level with cervical cancer risk misperceptions. Considering that there is no published research investigating cervical cancer risk misperceptions, this dissertation will present novel findings in the domain of cervical cancer risk misperception research. Additionally, it is of interest to determine if cervical cancer risk misperception mediates the relationship between an individual's socioeconomic status and their adherence to cervical cancer screening guidelines. Lastly, this research will examine the association between individual and county-level SES with the outcomes of high-risk HPV infection and current abnormal Pap smear. Data for these studies were drawn from the Community Awareness Resources and Education (CARE) 1 project 3 study, a case-control study designed to determine variables associated with cervical cancer abnormalities among Ohio Appalachian women. HPV status was determined by biological specimen, and information regarding risk factors for cervical cancer were obtained from study surveys to construct an index for cervical cancer risk. Participants were categorized as low, average, or high risk for cervical cancer and this objective classi (open full item for complete abstract)

Committee: Electra Paskett (Advisor); Tasleem Padamsee (Committee Member); Michael Pennell (Committee Member); Paul Reiter (Committee Member) Subjects: Epidemiology; Public Health

Doctor of Philosophy, University of Toledo, 2019, Psychology - Experimental

The current research explored whether positive and negative affective associations were related to HPV vaccination status and intentions, and tested whether affective associations are a better predictors of HPV vaccination status and intentions in comparison to previous established cognitive predictors. The project included three correlational studies (Pilot Study, Study 1, and Study 2) and one experimental study (Study 3) to investigate the involvement of affective associations in HPV vaccination status and intentions. Among undergraduate students, the Pilot Study indicated that several individual items of positive affective associations were significantly higher among participants who had received the HPV vaccination in comparison to those who had not received the HPV vaccination. Study 1 results indicated that, again among undergraduate students, both positive and negative affective associations were predictive of HPV vaccination uptake, however when all predictors were considered in the model only instrumental attitudes and cognitive barriers were predictive of HPV vaccination uptake. Study 2 specifically targeted young adults on Amazon's Mechanical Turk who had not received the HPV vaccination. Both positive and negative affective associations were predictive of HPV vaccination intentions when considered alone, but neither were significant predictors when considered with cognitive measures and exploratory measures. Finally, Study 3 experimentally explored whether manipulating affective associations and cognitive barriers might be useful for changing HPV vaccination intentions among college students. Results found that there was no main effect of affect or barriers manipulations on the key dependent measures. Analyses within this study again found a main effect of self-reported vaccination uptake on positive affective associations, instrumental attitudes, cognitive barriers, and various exploratory measures including positive anticipated affective response. Two (open full item for complete abstract)

Committee: Andrew Geers Ph. D. (Committee Chair); Jason Rose Ph. D. (Committee Member); John Jasper Ph. D. (Committee Member); Matt Tull Ph. D. (Committee Member); Kimberly McBride Ph. D. (Committee Member) Subjects: Experimental Psychology; Psychology

BS, Kent State University, 2018, College of Arts and Sciences / Department of Psychological Sciences

Objective. The Human Papillomavirus or HPV is the most common sexually transmitted infection in the United States. When healthcare professionals campaign to get people to participate in a particular health behavior, like getting vaccinated for HPV, they use educational messages to explain the importance. Although the general information may be the same, the messages can be framed in two different ways, gain-frame and loss-frame. The present study seeks to examine the effect message frame has on intentions and attitudes to get vaccinated as well as the potential mediating factors of culture and motivational orientation. Design. Males and females (N=72) were recruited from two university campuses and randomly assigned to watch a video either describing the benefits of getting vaccinated (gain-frame) or the consequences of not getting vaccinated (loss-frame). After the video, participants indicated their intentions to get vaccinated and their attitudes towards the vaccination. Results. The type of message frame was not associated with an increase or decrease in attitudes or intentions. Furthermore, neither culture nor motivational orientation appeared to moderate the effect of message frame on attitudes or intentions. Conclusion. Although we were unable to support our hypothesis, the present study's aim to make HPV-vaccine-campaign messages more effective is essential to making preventative health behaviors a priority for all cultures.

Committee: John Updegraff Ph.D. (Advisor) Subjects: Health Education; Psychology; Public Health

Doctor of Philosophy, The Ohio State University, 2017, Chemical Engineering

Cancer is a disease affecting the global population. Especially, cancer becomes truly deadly and unstoppable when it metastasizes. Various cancer biomarkers are being developed and applied into clinical practices, but there are still many different obstacles and challenges in the field that need to be overcome. In this study, two different technologies are used to detect, characterize, and separate cancer cells and various types of cells and organisms. First one is circulating tumor cell (CTC) technology, which is composed of red blood cell lysis, negative depletion method, and integrated staining of immunocytochemical staining and RNA in situ hybridization. The second technology is single cell magnetophoresis (SCM), which measures and analyzes the magnetophoretic mobility induced by the external magnetic field created by the specially-designed magnet. First technology enables us to assess many different markers at once at protein and nucleic acid levels on a single cell basis, whereas the second technology enables us to utilize the intrinsic magnetic susceptibility of the individual cell and use the characteristics in various applications. Applying the CTC technology developed and optimized in our lab, HPV 16 expressions are characterized in HPV-positive squamous cell carcinoma of the head and neck, and the effects of different PARP-inhibitor dosing levels are investigated in triple negative breast cancer (TNBC) patients. Understanding CTCs, the major key players in metastasis, and using those discoveries as a form of biomarker is important because it can help us understand more about metastasis and cancer and also provide guidance in decision-making and evaluation. Applying the SCM technology, intrinsic magnetic susceptibility of algae and cancer cells are quantitatively analyzed to understand iron and glucose metabolism in cancerous cells. Furthermore, based on the differences in iron regulation in stem-like cells and non-stem tumor cells, label- (open full item for complete abstract)

Committee: Jeffrey Chalmers (Advisor) Subjects: Chemical Engineering

PhD, University of Cincinnati, 2017, Medicine: Cancer and Cell Biology

The DEK oncogene is currently under investigation as a therapeutic target and clinical biomarker for tumor progression, chemotherapy resistance and poor outcomes for multiple types of malignancies. With regard to most cancer types, the degree of DEK overexpression correlates with higher stage tumors and worse patient survival, marking this molecule as a promising prognostic factor. Prior to this work, the utility of DEK as a biomarker had not been assessed in oropharyngeal squamous cell carcinoma (OPSCC), an aggressive disease characterized by poor survival and high rates of treatment comorbidities. As discussed in chapter 1, OPSCC is comprised of two subtypes based on the presence or absence of human papillomavirus (HPV) infection. Overall, HPV+ OPSCCs have improved therapy response and an overall better prognosis than their HPV- counterparts. This treatment sensitivity may be due in part to the HPV oncogenes, which inactivate and degrade tumor suppressors as discussed in chapter 2, removing the need for the development of mutations that promote radiation and chemotherapy resistance. Due to improved therapy response, clinical trials are now testing de-intensified regimens for the HPV+ OPSCC subset to prevent unnecessary morbidity from aggressive treatment. However, there is a population of HPV+ tumors that have poor outcomes from standard treatment and may not respond to de-intensified therapy. Since current staging tools do not fully account for therapy response, it is unclear which HPV+ OPSCC patients will not benefit from de-intensified treatment, but biomarkers, such as DEK, may play a critical role in identifying such patients. Chapter 3 describes the biochemical and cellular functions of the DEK oncogene and focuses on how DEK can promote chemotherapy/radiation resistance through DNA repair. Chapter 4 provides new experimental evidence demonstrating that DEK is strictly required for homologous recombination (HR) repair of DNA breaks. DEK was found to b (open full item for complete abstract)

Committee: Susanne Wells Ph.D. (Committee Chair); Paul Andreassen Ph.D. (Committee Member); Nancy Ratner Ph.D. (Committee Member); Peter Stambrook Ph.D. (Committee Member); Kathryn Wikenheiser-Brokamp M.D. Ph.D. (Committee Member) Subjects: Cellular Biology

Doctor of Philosophy, The Ohio State University, 2017, Communication

Human papillomavirus (HPV), the most common newly acquired sexually transmitted infection (STI) in the United States (U.S.), is a well-established and accepted cause of a number of cancers in women and men (Centers for Disease Control and Prevention, 2016). Because of pervasive cervical cancer disparities, a focus has been placed on pushing for adolescent vaccination in low income and ethnic minority populations. As a framework for this study, we drew upon the Identity-Based Motivation Theory (Oyserman, Fryberg, & Yoder, 2007) to explore the potential role of ethnic identity (ID) in HPV vaccine decision-making among Somali and African-American parents. We examined whether the HPV vaccine is viewed as congruent with ethnic-ID, and how this in turn influenced vaccine uptake. In cases of incongruence, we examined how provider trust, health care provider (HCP) communication during the vaccine offer, and perceptions of the vaccines efficacy interact with ethnic-ID to influence parental decision-making. A cross-sectional survey was administered to 211 parents (100 African American and 111 Somali) of children who had been previously offered the vaccine. Participants self-labeled and rated the importance of their ethnic-ID, rated the frequency of general health behaviors, and indicated their current HPV vaccine decision. Participants then indicated the degree to which HPV vaccination and general health behaviors are typical (congruent) of people who share their ethnic-ID. Finally, parents were asked about the degree to which they trust their child's HCP, their perceptions of the vaccine's response efficacy and provider communication about the vaccine. In addition, a small sub-set (n = 5) of in-depth interviews were conducted with Somali mothers to explore alternate identities that were salient during HPV vaccine decision-making. Results showed moderate HPV vaccine uptake and vaccine series completion rates among African American and Somalis. Completion rates were hi (open full item for complete abstract)

Committee: Shelly Hovick PhD (Advisor); Osei Appiah PhD (Committee Member); Siyue Li PhD (Committee Member) Subjects: Communication

Doctor of Philosophy, The Ohio State University, 2017, Biomedical Sciences

Head and neck squamous cell carcinoma (HNSCC) is sixth in cancer incidence worldwide. Human papillomavirus (HPV) accounts for ~5% of the world's cancer burden, including a distinct subset of oropharyngeal HNSCCs rising in incidence in numerous developed countries. The transforming ability of HPV is primarily attributed to the viral oncoproteins E6 and E7 which inactivate the tumor suppressor proteins p53 and pRb, respectively. While E6 and E7 expression are sufficient for immortalization, poorly defined, secondary genetic events are necessary for cellular transformation. Whole genome sequencing of HPV-positive HNSCC cell lines and primary tumors demonstrated a direct association between HPV integrants and focal host genomic instability, including amplification, rearrangement, deletion, and translocation. HPV integrants frequently disrupted expression of host genes with established roles in cancer pathogenesis. We hypothesized that host genomic alterations caused by HPV integration are critical secondary genetic events necessary for the pathogenesis of HPV-caused cancers and that identification of HPV integration sites can serve as a tool for discovery of candidate driver genes targetable for HNSCC therapeutics. To test this hypothesis we extensively characterized two integration events at TP63 and PIM1genes in UM-SCC-47 and UPCI:SCC090, respectively. Both genes were candidates due to their extensive links to cancer. In UM-SCC-47, HPV integration resulted in disruption of wild-type p63 transcripts and detection of unique fusion transcripts that served as a template for translation of a novel truncated p63 protein (p63T). Although morpholino mediated knockdown of p63T did not affect UM-SCC-47's growth and viability, p63T displayed novel localization in the cytoplasm indicative of possible new protein interactions not previously characterized. Furthermore, its stability was shown to be modulated by p53 and the proteasome. In UPCI:SCC090, HPV integratio (open full item for complete abstract)

Committee: Maura Gillison (Advisor); Quintin Pan (Committee Member); Dawn Chandler (Committee Member); Nyla Heerema (Committee Member) Subjects: Biomedical Research

PhD, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Health Education

The Human Papillomavirus (HPV) can cause some types of cancer and is the most common sexually transmitted infection in the US. Because most people turn to the internet for health information, this study analyzed HPV information found online. A content analysis was conducted on 69 web search results (URLs) from Google, Yahoo, Bing and Ask. The content was analyzed for source, tone, presence of science-based content and presence of theory (constructs of the Health Belief Model). In Chapter 1, relationships between these aspects of the URL content were examined. The majority of URLs were pro-HPV vaccine (62.3%) followed by neutral (23.2%) and anti (14.5%). Government and medical sites had the most pro-HPV vaccine sites with 32.6% and 23.3% respectively. Only three types of sites contained anti-HPV vaccine information, news agencies (50%), non-profits (30%) and medical advice (20%). No statistically significant relationship was found between source of URL and tone (χ2(14) = 87.28, p=0.058) or tone and number of scientific citations (χ2(4)) = 62.81, p=0.655). However, a statistically significant relationship was found between tone and theory (χ2(4) = 106.90, p=0.002). There were no statistically significant interaction or main effects found between tone of URL and both science and theory. In Chapter 2, differences in results were analyzed based on the search engines and eight search terms. Descriptive statistics were reported on the 69 URLs included in the study. Google yielded the most “good” searches at 29 (42%). For Google and Yahoo, the highest returns were from medical advice sites, 31.0% and 38.5% respectively. Bing had the highest search returns from government agencies at 50.0%. Ask was the only engine to return a pharmaceutical company (n=1). For tone, Google, Bing and Ask returned the highest percentages of Pro-HPV sites (75.9%, 72.7% and 50.0% respectively) while Yahoo returned the highest percentage of neutral (46.2). Ask had the second highest neutral retur (open full item for complete abstract)

Committee: Amy Bernard Ph.D. (Committee Chair); Nancy Jennings Ph.D. (Committee Member); Keith King Ph.D. (Committee Member) Subjects: Health Education

MS, University of Cincinnati, 2016, Education, Criminal Justice, and Human Services: Health Education

Human Papillomavirus (HPV) is the most common Sexually Transmitted Infected (STI) in the US with more than 90% and 80% of all sexually active men and women, respectively, becoming infected with HPV at some point in their lives. HPV is associated with cancer of the cervix, vulva, vagina, penis, or anus and genital warts, and cancer in the throat, including the base of the tongue and tonsils (CDC, 2016). Due to the morbidity and mortality of HPV-related diseases, recommendations by the Advisory Council on Immunization Practices (ACIP) are to routinely vaccinate boys and girls at age 11 or 12 against HPV (Markowitz, et al, 2014). Unfortunately, vaccine rates in adolescents receiving the first of three doses is an estimated 60% in females and 41.7% in males. The vaccine rates in adolescents receiving all three doses is an estimated 39.7% in females and 21.6% in males (Reagan-Steiner et al., 2015). The purpose of this study was to examine: 1) characterize school nurses' a) knowledge of HPV and the vaccine, b) self-efficacy to provide HPV vaccine information, c) intention to recommend the HPV vaccine and d) professional practice of providing HPV vaccine education and information, and 2) determine associations between school nurses' age, the number of years in school environment, geographical location and serving specific grade levels with the following variables: a) knowledge of HPV and the vaccine, b) self-efficacy to provide HPV vaccine information, c) intention to recommend the HPV vaccine and d) professional practice of providing HPV vaccine education and information. Results from this study suggest school nurses reported limited HPV and vaccine knowledge, moderate levels of self-efficacy, low intentions to regularly encourage parents to get their child vaccinated against HPV and lack engagement of professional practice in providing parents and students with HPV vaccine education and information. Despite empirical evidence of the HPV vaccine's efficacy and safety, (open full item for complete abstract)

Committee: Amy Bernard Ph.D. (Committee Chair); Brittany Rosen Ph.D. (Committee Chair) Subjects: Health Education

PhD, University of Cincinnati, 2015, Medicine: Cancer and Cell Biology

Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignancies worldwide with over 50,000 new cases in the United States each year. For many years tobacco and alcohol use were the main etiological factors; however, it is now widely accepted that human papillomavirus (HPV) infection accounts for at least one-quarter of all HNSCCs. HPV+ and HPV- HNSCCs are studied as separate diseases as their prognosis, treatment, and molecular signatures are distinct. Five-year survival rates of HNSCC hover around 40-50%, and novel therapeutic targets and biomarkers are necessary to improve patient outcomes.

Committee: Susanne Wells Ph.D. (Committee Chair); Keith Andrew Casper M.D. (Committee Member); Ronald Waclaw Ph.D. (Committee Member); Peter Stambrook Ph.D. (Committee Member); Susan Waltz Ph.D. (Committee Member); Kathryn Wikenheiser-Brokamp M.D. Ph.D. (Committee Member) Subjects: Cellular Biology

PHD, Kent State University, 2014, College of Arts and Sciences / Department of Sociology and Criminology

The HPV vaccine has been controversial because it protects against a sexually transmitted infection, the Human Papillomavirus (HPV). Although the HPV vaccine has the potential to reduce rates of HPV-related diseases, most notably cervical cancer, HPV vaccination rates are low and there are gender, race/ethnicity, and socioeconomic disparities in HPV vaccination. This study addresses the factors that influence individuals' decision to get the HPV vaccine (uptake) and two types of attitudes toward the vaccine: willingness to receive the HPV vaccine (acceptance) and the likelihood of getting the vaccine in the upcoming year (intentions). I use the Health Belief Model (HBM) to identify how individuals' perceptions of HPV risk affect their decision whether to get the HPV vaccine. I also utilize fundamental cause theory to highlight the ways in which social inequalities affect the HPV vaccine decision-making process. I argue that one important mechanism through which social inequalities affect HPV vaccine uptake and attitudes is through individuals' perceptions of the trustworthiness of the people and institutions who make risk claims about HPV and the HPV vaccine. Using survey data from a sample of 836 college students at a Midwestern university, I use structural equation modeling to examine the relationships between 1) inequalities based on gender, race/ethnicity, and SES; 2) interpersonal trust in one's doctor; 3) institutional trust in the health care system, pharmaceutical advertising, the federal government, government health agencies, and the news media; 3) three types of risk perceptions; and 4) HPV vaccine uptake/attitudes. I find there are multiple pathways through which inequalities and interpersonal/institutional trust affect HPV vaccine uptake/attitudes, with trust in the news media having a central role in college students' risk perceptions. I also find that the HPV vaccine decision-making process operates differently for women and men. I discuss th (open full item for complete abstract)

Committee: Susan Roxburgh (Committee Co-Chair); Clare Stacey (Committee Co-Chair) Subjects: Sociology

MEd, University of Cincinnati, 2000, Education : Health Promotion and Education

Due to an increase in Human Papillomavirus (HPV) and cervical cancer, health educators were challenged with the task of increasing knowledge, perceived threat and preventive behaviors among college women. It had been implied that cervical cancer was causally related to infection with HPV. During the 1990's HPV infection had become an epidemic due in part to an increase in the number of sexual partners and a decrease in age at initiation of sexual activity. This trend indicated a rising wave of cancer of the cervix, and hence the critical importance of mass cancer screening. Misconceptions about susceptibility, severity and a lack of knowledge increased risk of cervical cancer. The purpose of this study was to assess the relationship among college women's knowledge, perceptions and behaviors regarding human papillomavirus (HPV) and cervical cancer. This study surveyed 430 college women ages 18 through 30 from the University of Cincinnati. Significant findings were determined from this study. The first was that as knowledge increased, perceived severity decreased. This indicated that women who were more informed about cervical cancer believed that cervical cancer was easily cured if found in the early stages. The second was that as the number of sexual partners increased, perceived susceptibility increased; therefore, engaging in risky behavior made women believe they were more susceptible to HPV/cervical cancer. Another significant finding was that as knowledge, perceived susceptibility and perceived severity increased, the percentage of women obtaining a yearly Pap test increased. The results of this study contributed to greater awareness and prevention of HPV /cervical cancer, and established targeted areas for future health promotion and education efforts. . Health education professionals have the opportunity to impact HPV/cervical cancer rates by increasing the amount and quality of education and by continuing to participate in research on this important issue.

Committee: Dr. Randall R. Cottrell (Advisor) Subjects: Education, Health

MS, University of Cincinnati, 2009, Education : Health Promotion and Education

Human papillomavirus (HPV) was one of the most common sexually transmitted infections (STIs) in women of child-bearing age in the U.S. It was estimated that nearly three out of every four Americans between the ages of 15 and 49 would be infected with genital HPV over the course of their lifetime. Human papillomavirus was present in almost 100% of cervical cancers. Despite this growing epidemic, there was little knowledge and awareness of HPV among the general public. HPV was most often detected in abnormal Pap test results. However women undergoing Pap tests lacked basic knowledge about testing, abnormal results, and follow-up procedures. The purpose of this study was to determine women's knowledge of HPV and their perceptions of the education they received from their physician regarding the purpose of a Pap test, explanation of Pap test results, and how effectively the physician explained associations between HPV and cell abnormalities, cervical cancer, risk factors, and preventive measures. This study was needed due to the increased number of Human Papillomavirus infections and the lack of knowledge regarding testing, treatment, risk factors, and preventive measures. This study focused on the educational efforts of physicians and the knowledge levels of patients. This study was different from other studies in that it scored physicians' education efforts as perceived by their patients and measured patients' understanding of such efforts. This study was designed to identify and fill a possible void in the literature regarding HPV and physician education efforts. The results of this study benefited health education professionals and health care professionals by targeting potential gaps in education for future health promotion efforts. Information from this study could be used to help increase and promote dialogue between physicians and their patients. A survey containing 33 questions was completed by 109 women at a social service agency in the summer of 2008. Based (open full item for complete abstract)

Committee: Randall Cottrell PhD (Committee Chair); Judy Murnan PhD (Committee Member) Subjects: Health Education

Doctor of Philosophy, The Ohio State University, 2012, Industrial and Systems Engineering

Cervical cancer is the second leading cause of female cancer mortality worldwide, and it can be prevented effectively with appropriate screening. Infection with an oncogenic strain of the human papillomavirus (HPV) is a necessary cause for cervical cancer and HPV is a very common sexually transmitted infection. Demographic and behavioral risk factors for HPV infection have been identified, but the current screening guidelines for cervical cancer prevention do not make distinctions related to risk factors in their recommendations. Cost-effectiveness analyses have compared the screening strategies approved by current guidelines, but the effect of incorporating each patient's risk for infection into the selection of recommended screening strategies has not been studied. We explore the possibility of implementing risk-specific screening strategies and evaluate their cost-effectiveness with respect to the screening strategies currently used. We develop a model of risk that allows us to estimate the probability of oncogenic HPV infection based on a patient's risk characteristics. We use this to implement risk-specific screening strategies in a simulation model of disease progression and screening, which we use to compare our proposed risk-specific strategies to the traditional screening strategies. We evaluate all strategies in terms of total costs and quality-adjusted life years accumulated in the simulated population. We find risk-specific strategies to be more cost-effective and conclude this to be evidence of the potential benefits of risk-specific screening programs for cervical cancer prevention.

Committee: Julia L. Higle PhD (Advisor); Electra Paskett PhD (Committee Member); Ramteen Sioshansi PhD (Committee Member) Subjects: Industrial Engineering; Operations Research; Public Health

Master of Arts, The Ohio State University, 2009, Communication

Health information is more often than not viewed as an efficient tool in enabling patients to become more active participants in health decision-making processes. This study investigates the effects of information amount on perceptions of patient empowerment (subjective empowerment self-efficacy) and behavioral intention. The proposed relationships are applied within the context of the human papillomavirus (HPV) vaccination decision-making process to assess the effects of information amount on college students' (N = 101) intentions regarding vaccination. Results demonstrated that females have greater intention to discuss HPV vaccination with a physician than males. Participants in general preferred to discuss HPV vaccination with a physician prior to deciding whether to be vaccinated. Implications for understanding the effects of information amount and patient participation are discussed.

Committee: Michael Slater PhD (Advisor); Janice Raup-Krieger PhD (Committee Member) Subjects: Communication; Health