Student Theses, Dissertations and Capstones

Document Type

Thesis - NSU Access Only

Degree Name

Master of Science (M.S.) in Dentistry

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Dental Medicine

First Advisor

Richard Singer

Date of original Performance / Presentation

January 2016

Publication Date / Copyright Date

1-1-2016

Abstract

Introduction: Human Papilloma Virus (HPV) is the most common sexually transmitted disease in the United States, and almost all sexually active men and women will be infected with HPV at some point in their lifetime. HPV is most commonly known as the virus that causes cervical cancer and anogenital warts, but HPV also causes oropharyngeal cancer. There is no current treatment for HPV infection, but the infection is effectively prevented by vaccination prior to infection. As such, the Advisory Committee on Immunization Practices (ACIP) recommends that preteens should be vaccinated before “sexual debut”, at 11 and 12 years of age. Despite the availability of the HPV vaccines and the ACIP recommendations, HPV vaccination rates among U.S. adolescents population remain very low. According to the Centers for Disease Control and Prevention (CDC), more children visited their dentist, including orthodontists, than their pediatrician, within a 12-month period. Moreover, the orthodontic venue is unique to dentistry in that children undergoing orthodontic care visit the orthodontist at regular monthly intervals for as much as two years or more. The frequent contacts between patients and the orthodontic practice provides multiple opportunities within the orthodontic setting to deliver interventions aimed towards educating patients and parents about and recommending HPV vaccination. Therefore, in order to capitalize upon the unique opportunities provided by the orthodontic care setting it is imperative to enlist orthodontists to provide HPV educational interventions. Doing so could provide an important public health service that up to this point has not been utilized. However, effective HPV educational interventions must be based upon determinants that will motivate parents to allow vaccination of their children. Therefore, the goal of this study was to examine, within the context of a university based orthodontic clinic, the determinants of parents’ willingness to allow HPV vaccination of their adolescent children. Methods: Cross-sectional data was collected from 253 parents of adolescent orthodontic patients attending the NSU post-graduate orthodontic clinic. The parents completed a survey instrument that assessed their sociodemographic characteristics, perceptions about HPV and the prophylactic vaccine, as well as, determinants of parents’ willingness to allow their child to receive the HPV vaccine. The Integrated Behavior Model (IBM), a theoretical health behavior model that predicts behavioral intent, and thus, the performance of the behavior, informed the survey instrument. A principle component analysis and multiple logistic regression analyses examined the determinants of parents’ willingness to allow their child to receive the HPV vaccine, and parents’ perception of their child’s susceptibility to HPV infection. Results: The principal component analysis identified four components, composed of groups of variables from the survey data that described common conceptual constructs that followed the domains of the IBM, viz.: perceived norm, personal agency, disease knowledge and salience. Three of those four components, perceived norm, personal agency, and salience of the behavior, were statistically significant determinants of parents’ willingness to allow vaccination of their child against HPV. After controlling for covariates, Each 1-unit increase in perceived norm was associated with almost a 4 times greater likelihood of parents being willing to allow their child to receive the HPV vaccine vs. unwilling (AOR = 3.75, 95% CI 2.12, 6.60). Each 1-unit increase in personal agency accounted for twice the likelihood of parents’ willingness vs. unwillingness to allow HPV vaccination (AOR = 2.37, 95% CI 1.48, 3.80). Lastly, each 1-unit increase in salience was associated with 5.5 times greater odds of parents being willing to allow HPV vaccination of their child (AOR = 5.59, 95% CI 3.27, 9.54) vs. unwilling. Conclusions: The role of the orthodontist is of particular note in these results. In our study, salience was the conceptual construct with the greatest impact on parents’ willingness to allow vaccination of their children. Among the variables clustering in salience, was an orthodontist’s recommendation for parents to allow vaccination of their children. More than half of the parents (59.29%) reported they would be more willing to allow vaccination of their child, if their child’s orthodontist recommended it. Our findings demonstrate the importance that parents place on orthodontists’ recommendations regarding the HPV vaccine. This finding underscores the potential utility of the orthodontic care setting in providing future educational interventions that supplement public health efforts to increase the HPV vaccination rate among the adolescent population. Additionally, our findings identified behavioral domains that are predictive of parents’ willingness to provide HPV vaccination for their child. An educational intervention including these elements in the design based upon the behavioral domains of perceived norm and personal agency, in combination with direct recommendation for vaccination from an orthodontist, is the next step in advancing effective public health measures to increase HPV vaccination among adolescents.

Disciplines

Dentistry

Keywords

adolescent; HPV; orthodontist; parent; Vaccine; willingness

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