Human papillomavirus (HPV) is a sexually transmitted infection contributing to 70% of oropharyngeal cancers in the United States. The incidence of HPV-related oropharyngeal cancers is greater in Kentucky's population than in any other state. Research has demonstrated the cost of treating oropharyngeal cancer on a national level, but little information exists as to state-specific costs. The purpose of this quantitative study was to examine radiation therapy costs for treating HPV-related oropharyngeal cancer in Kentucky in relation to age, gender, race, and insurance. A theory by Aday and Andersen was applied to explain the relationship between the independent and dependent variables. Cluster sampling was used to randomly select 130 de-identified men and women age 40-65 years who had been diagnosed with oropharyngeal cancer. The data were collected from an existing database. The study used descriptive analysis with correlational, longitudinal data to examine the relationship of categorical and continuous variables. The mean cost for radiation therapy treatment was $123,629.14 (SD= $58,697.36). The multiple regression indicated that the null hypothesis was accepted showing that the independent variables were not statistically significant predictors of the z Score of Cost Difference [F (4,122) = 0.972, p = 0.425]. The results showed no significant independent predictor variables (p > 0.05); gender [t (127) = -0.943, p = 0.348], race [t (127) = 1.378, p = 0.171], insurance type [t (127) = -1.512, p = 0.133], and age group [t (127) = -0.230, p = 0.818]). The results may contribute to positive social change in the development of cancer prevention strategies and policies.

Human Papillomavirus (HPV) is one of the most common causes of sexually transmitted disease worldwide. Infections by high-risk HPVs, such as HPV-18, have been associated etiologically with cervical cancer. The successful development of HPV vaccines may be beneficial to the HPV-na??ve population, but women that have already been exposed to the virus are still at risk of developing HPV-associated malignancies. A need for a systemic cure for HPV-infection therefore still exists. Gene therapies using tissue-specific promoters have been reported to be a promising tool for treating cancers; however, few studies have explored this possibility for cervical cancer. The aim of this project is to construct a gene expression vector that can specifically target HPV-infected cervical cancer cells, by making use of the activity and selectivity of the P105 promoter which is determined by transcription control elements within the HPV-18 long control region (LCR). The first part of this study involved the construction of LCR deletion plasmids, and examining the subsequent level of gene expression induced within different mammalian cell lines. The results suggest the LCR to be capable in achieving cervical cancer-specific gene expression. The 3′-end of the viral L1 gene upstream of the LCR appeared to have a repressive effect on the promoter and therefore should be excluded for maximum LCR promoter activity. The second part of the project involved site-directed mutagenesis studies performed on selected transcription factor binding sites with an attempt to further increase the level of LCR promoter activity and specificity towards HPV-infected cervical cancer cells. The results suggest that a GRE/YY1 mutation may significantly enhance promoter activity. In terms of promoter regulation, the E2BSs appeared to be responsible for promoter activation in the absence of viral E2 proteins. The findings of this study suggest a possible gene therapy approach towards the treatment of cervical cancer. By making use of the activity and specificity of the HPV-18 P105 promoter to induce cervical carcinoma-specific expression of appropriate therapeutic genes, suicidal phenotypes can be introduced selectively within HPV-positive cervical cancer cells while normal HPV-negative cells are unaffected.

Human papillomavirus (HPV) is a double-stranded DNA virus, typically infecting mucosal or cutaneous epithelial keratinocytes. Today, more than 118 different HPV types have been formally described. Sexual transmission of mucosal HPVs is very common and generally asymptomatic, but HPV infection can be associated with benign lesions such as condylomata acuminata or, in rare cases, with malignant lesions such as cervical cancer. Two prophylactic vaccines are currently available in Europe, protecting against HPV-16 and HPV-18 (Cervarix) or against HPV-6, HPV-11, HPV-16 and HPV-18 (Gardasil). In order to assess the impact of the vaccination program, it is mandatory to obtain geographically widespread date on the baseline HPV prevalence and type distribution in cervical samples from women, presenting or not, normal or abnormal cytologic or histologic results. We undertook an epidemiological study in the Capital Region of Brussels to determine the HPV prevalence and type-distribution in 1526 cervical samples of women presenting a cytology within normal limits (WINL), atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intra-epithelial lesions (LSIL), high-grade squamous intra-epithelial lesions (HSIL) or invasive cervical cancer (ICC). The HPV prevalence was 10.8% (95%CI: 8.8-12.8) for NILM, 34.5% (95%CI: 28.3-40.8) for ASC-US, 54.0% (95%CI: 47.4-60.6) for LSIL and 100% for HSIL and ICC. With an HPV-16 and HPV-18 prevalence of 63.3% (95%CI: 44.1-67.7) and 73.5% (95%CI: 63.0-84.0) in mono-infected HSIL and ICC, respectively, HPV 16/18 L1 VLP vaccines would be expected to significantly reduce the management and treatment of women suffering from HSIL and ICC in the Capital Region of Brussels. We also detected HPV-30, HPV-53, HPV-66 and HPV-68 in mono-infected HSIL and ICC samples, possibly providing arguments for the reconsideration of the carcinogenicity of these types. Vertical transmission of HPV was also previously reported, but in most cases one could not exclude a placental contamination by HPV positive cells from an infected birth canal. In order to confirm that the placenta can be infected with HPV, we analysed residual cells from 35 transabdominally obtained placental samples from pregnant women undergoing chorionic villous sampling for screening of suspected foetal abnormalities and found that two samples were positive for HPV-16 and HPV-62, respectively. The clinical importance of these results remains to be elucidated, but the previously observed association between placental HPV infection and pregnancy loss might gain further in importance. HPV gene regulation in placental trophoblastic cells has not been studied so far. We studied the HPV-16 early gene expression regulation in transiently transfected monolayer cultured trophoblastic cells with an HPV-16 long control region (LCR) driven reporter plasmid. We observed important differences in constitutive HPV-16 LCR activities between trophoblastic cell lines and could identify progesterone as an important inducer of HPV-16 early gene expression. Steroid hormones are induced during pregnancy and could therefore lead to an enhanced expression of the E5, E6 and E7 proteins upon placental HPV infection. Since these proteins were previously shown to affect trophoblast adhesion, survival, migration and invasion, their enhanced expression might eventually contribute to pregnancy loss. We furthermore found that the transcription of episomally maintained HPV-16 is not regulated by E2 or E1, but by E5, E6 and/or E7.

This thesis examined the evidence, policy decision-making, and implementation of HPV vaccination in Canada as a case study to explore normalization versus individualized decision making in public health programs. Mixed methods were used: a systematic review, content analyses and policy document analysis. Overall, the scientific evidence supported an effect of vaccination against HPV infection and precancerous cervical lesions, but evidence regarding cervical cancer incidence or mortality is lacking. Scientific and medical communities appeared optimistic about the vaccine, but cautious about its readiness for routine implementation. Policy decision-making was initially cautious, but shifted towards active program implementation, possibly related to the availability of federal funding. The educational materials and media coverage both sent clearly normalizing messages about HPV vaccination. The discussion suggests that HPV vaccination might be more suited to an individualized than population approach, but many factors coincided to promote its implementation, in Canada, within a traditional public health model.

Thesis (Ph.D. in Molecular Biology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 96-117). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Introduction: The incidence of anal cancer, whose primary cause is human papillomavirus (HPV) infection, has increased in United States (US) men almost three-fold in three decades; however, little is known about the epidemiology of anal HPV, especially in heterosexual men. Furthermore, advancements in knowledge about the epidemiology of anal HPV may be hampered by measurement error in the collection of sexual behavior data. Methods: From two US cities, behavioral data and anal biological specimens were collected from 253 men who acknowledged sexual intercourse with a woman in the previous year. PCR and genotyping were used to assess the presence of HPV DNA. In addition, two HPV questionnaires were assessed for test-retest reliability: the first was a self-administered questionnaire associated with the collection of the biological specimens while the second was a computer-assisted self-interview (CASI) with 1069 men in Brazil, Mexico, and the US. Results: Based on DNA analysis, overall anal HPV prevalence was 24.8% in 222 men who acknowledged no prior sexual intercourse with men. Risk factors independently associated with anal HPV were lifetime number of female sexual partners and frequency of sex with females in the past month. Based on kappa and intraclass correlation coefficients (ICC), both HPV questionnaires were found to be highly reliable with low refusal rates; however, three discrete measures in the multi-national interview asking for the number of sexual partners had lower reliability. The ICC of these questions increased to greater than or equal to 0.79 when a small number of extreme outliers (less than or equal to 3) were removed. Predictors of unreliable reporting were age and lifetime number of female sexual partners while years of education was inversely associated with unreliable reporting. Discussion: These results suggest anal HPV is common in heterosexual men. Risk factors associated with anal HPV did not explain how HPV was transmitted to the anal region. Both instruments used to collect sexual behavior data were highly reliable including the CASI instrument used in three culturally and linguistically distinct countries; however, caution is warranted with discrete measures that ask participants to report the number of sexual partners.

Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection and causes 529.000 cases of cervical cancer every year. Nowadays, there are vaccines available to prevent infection. Knowledge of HPV influence the attitude towards the vaccine and is therefore a factor of accepting the vaccine. Aim: The aim of this study was to examine the knowledge of HPV and attitudes towards HPV-vaccine among Thai female university students. Method:  Descriptive and cross-sectional study with quantitative method using a questionnaire. Purposive sampling was used. The sample consisted of students from two different universities in Bangkok, Thailand and out of the 201 students whom filled in the questionnaire, 192 questionnaires were used. Result: There were 64.6% of the participants that had heard of HPV previously. Of these, the most common source of information was health professionals. The HPV-vaccine was known by 42.6% of the participants and 17.4% had taken the vaccination. Over 90% of the participants had a poor or moderate knowledge of HPV. In total, most of the participants in the sample were found to have a positive level of attitude towards the vaccine (72.4%). Almost all participants wanted to know more about HPV and the HPV-vaccine and 88.5% thought it was necessary for them to get the vaccination. Conclusion: As some gaps in knowledge among the participants were shown, the information to young women should be improved and aim to increase the motivation towards the use of preventive methods, such as taking the HPV-vaccine.

HPV vaccine school entry mandates and vaccine funding by state was examined using the Diffusion of Innovations (DOI) theory. The DOI was applied to HPV immunization policy to evaluate the rate of vaccine adoption and to determine whether associations existed between an empirical need for vaccine adoption and action by the states. State-level data on political characteristics, health and policy were collected from several secondary sources. Data analyses were performed utilizing SPSS logistic regression models. Odds rations were used to evaluate the associations between the independent and dependent variables to determine whether there was a statistical significance level of .05. Cervical Cancer incidence in a state was significantly associated with HPV school entry mandates (proposed or enacted), but it did not show a significant association with HPV vaccine funding. Diffusion of vaccine innovation is slow, which may offer additional opportunities to evaluate effective policy strategies for coverage and use of the HPV vaccine.

In Canada, parental acceptance and uptake of the HPV vaccine has been low. There is a need for more effective HPV vaccination health messages for parents. Whether a message is framed in terms of the benefits of engaging in the behaviour (gain frame), the costs of failing to engage in the behaviour (loss frame) or both the benefits and the costs (mixed frame) has potential to impact parents’ decision making. The appropriate frame of a message may depend on the recipient’s sex and involvement with the health issue. The purpose of this study was to investigate the persuasiveness of gain-, loss- and mixed-framed messages on mothers’ and fathers’ intentions to have their young son or daughter vaccinated against HPV. The study used a 3 Frame x 2 Sex of Parent x 2 Sex of Child design. We randomly assigned participants (n=367) to read a framed message and then complete a 29-item questionnaire assessing theoretical determinants of parental consent for vaccination. ANCOVAs revealed a three-way interaction for intentions to speak to a doctor about the HPV vaccine, F(2, 342)=3.66, p =.03, perceived severity of HPV, F(2, 347) = 3.10, p = .05, and for anxiety about their child contracting HPV, F(2, 342)=3.58, p=.02. Effect size comparisons revealed that gain-framed messages seem to persuade parents who are the opposite sex to the child for whom they are considering the vaccine. In turn, loss- and mixed-framed messages may persuade parents who are the same sex as the child for whom they are considering the vaccine. Perceived severity of HPV and anxiety about HPV mediated the relationship between message frame and intentions for some parent-child dyads. Findings have implications for constructing effective messages encouraging parents to consider having their child vaccinated against HPV. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2010-07-07 23:06:25.757

The quadrivalent (q-) human papillomavirus (HPV) vaccine is praised for its near perfect efficacy of 98% in the per-protocol population and minimal safety concerns. Adherence to the dosing schedule of 0, 2 and 6 months outside clinical trials has not yet been described. Furthermore, clinical trials were underpowered to detect rare, but serious, adverse events including convulsions, seizures and epilepsy in young girls targeted by American and Canadian national advisory committees. This retrospective cohort study followed Grade 8 girls eligible for Ontario’s HPV immunization program during the 2007/08 to 2010/11 campaign years. Using Ontario’s immunization and health databases, baseline characteristics, qHPV vaccination, dates of qHPV vaccination and diagnoses of serious neurological events were identified for each cohort member. The proportions of girls who initiated and completed the qHPV vaccine program were determined. Adherence to the recommended dosing intervals and for ‘time-to-series completion’ was calculated as the proportion of eligible girls whose number of days between doses complied with the recommended dosing interval. A self-matched, case only approach was used to estimate the age-adjusted rate ratio (RR) of neurological events in the 0-30 day period following qHPV vaccination. The primary study endpoint was a composite of the first occurrence of a convulsion, seizure or epilepsy. Secondarily, an epileptic seizure only endpoint was assessed, as were the influence of a number of predisposing risk factors. An overall uptake of 50.24% was observed, of which, 87.02% received at least three doses. Adherence to the recommended dosing interval was most difficult in scheduling of the second dose (70.80%). There was no increased risk observed for the primary endpoint in the 0-30 days following qHPV vaccination (RR 1.01, 95% CI 0.92-1.10). However, this association was modified in girls with predisposing risk factors for epilepsy. There was an increased risk observed for the epileptic seizure only endpoint (RR 1.64, 95% CI 1.28-2.10). In Ontario, the overall uptake of the qHPV vaccine is low. Once initiated, series completion is high, with the majority receiving the vaccine in a timely manner. A risk for epileptic seizures following vaccination may be limited to girls with predisposing risk factors. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-28 17:56:59.608