Jimmy T. Efird, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): In contrast to the anogenital area, where the persistence of human papillomavirus (HPV) is an important prerequisite for the development of most cervical intraepithelial neoplasia and cancer, very little is currently known about the infection, persistence, or clearance of human papillomavirus (HPV) infection in the oral cavity of women. HPV is spread in a non-hematogenous fashion without a viremic phase, and is believed to occur in the oral cavity in measurable amounts as a consequence of persistent cross-infection or auto- inoculation with genital HPV types. Given the histologic similarity between the anogenital and oral cavity regions, the continuous presence of high-risk HPV types in the oral cavity is likely a strong marker for progression of intraepithelial disease in certain areas of the oral cavity. However, convincing evidence in support of this premise remains elusive in the literature. Even in the case of basaloid-type tumors of the tonsillar region, which have been the focus of several studies in recent years, other factors may underlie increased oral HPV rates in affected individuals. These include impaired immunity consequent of the extended cancer process or treatment, and cancer-related bias in sampling and detection of the virus. The major goal of this proposal is to characterize etiologic determinants of infection, clearance and persistence of HPV infection in the oral cavity. This will be accomplished by conducting secondary analysis of data previously collected through the National Institute of Allergy and Infectious Disease's Women's Interagency HIV Study (WIHS) program and the intraepithelial dysplasia clinic at the University of California, San Francisco. Similar to the anogenital region, HPV-related disease in the oral cavity may be preventable with appropriate screening and knowledge of risk factors for this infection in women. The underlying strength of the proposed analyses over previously published studies is the opportunity to answer important questions on the temporal interrelation of oral, cervical and anal HPV infection and natural history, since within-person data was concurrently collected at each of these sites. Extensive individual epidemiologic and behavioral risk factor information is available for detailed analysis in this large dataset. Knowledge gained from this study will provide important information about the role of HPV in oral disease, help explain inconsistencies in results from earlier HPV oral studies, which were constrained by size and exposure data, and aid public health response in intervention and education. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Our long-term goal is to improve the oral health and reduce disparities of children in Hawai'i. We hypothesize that the reach, and impact, of effective school-based caries prevention programs can be quantitatively increased by leveraging social networks to target behavioral change. 1. Significance: 10 million children (>20%) of U.S. elementary school age children have untreated dental decay. The disparity in health is notable, rising to 72% for American Indians/Native Americans. Effective school-based preventions are available but underutilized or unavailable. In Hawai'i there are: an abundance of dentists, but few accepting Medicaid;caries rates exceeding national averages;and no school-based caries prevention programs. 2. Innovation:Integrating social network analysis, behavior change and caries prevention has not before been attempted. If successful, a state-wide caries prevention could facilitate exceeding the goals of Healthy People 2020 prior to 2020. 3. Approach: Generate MOP and preliminary data. The specific aims are to: Create a manual of procedures (MOP) for pilot program, based on the NIDCR model, and modified from the PI's current successful, but independent, programs focusing social network analysis, behavioral change, and caries prevention. Carry out pilot program to generate and analyze preliminary data, working with two after school organizations. We will determine the social network and behavioral intent of all site coordinators (~100), and both parents and children in 4 pilot schools (~400 parents and children). Two sets of school's directors, parents, and children will receive targeted behavior change (experimental);the other two sets will receive no behavior change (control). Children in all four schools will receive comprehensive caries prevention. The primary outcome will be program impact, defined by RE-AIM. Prepare U01 application. We will use outcomes, RE-Aim, Markov Chain/Monte Carlo modeling, economic assessments, and power calculations to generate predictive models. These will allow us to revise the MOP and prepare a U01 application for implementation across the Hawai'ian Islands. 4. Investigators: Four experts in unique content areas will collaborate in this team science program, coordinating expertise in social network analysis, behavioral intent and change, caries prevention, and statistical and economic analysis. 5. Environment: Hawai'i is a small state with substantial health care needs and no school-based caries prevention program. The proposed program therefore coalesces an environment with high need, and investigators from institutions with extraordinary depth. PUBLIC HEALTH RELEVANCE: To improve the oral health and reduce disparities of children in Hawaii, we will implement an effective school-based caries prevention program that leverages social networks to effect social change.

DESCRIPTION (provided by applicant): Our long-term goal is to improve the oral health and reduce disparities of children in Hawai'i. We hypothesize that the reach, and impact, of effective school-based caries prevention programs can be quantitatively increased by leveraging social networks to target behavioral change. 1. Significance: 10 million children (>20%) of U.S. elementary school age children have untreated dental decay. The disparity in health is notable, rising to 72% for American Indians/Native Americans. Effective school-based preventions are available but underutilized or unavailable. In Hawai'i there are: an abundance of dentists, but few accepting Medicaid; caries rates exceeding national averages; and no school-based caries prevention programs. 2. Innovation:Integrating social network analysis, behavior change and caries prevention has not before been attempted. If successful, a state-wide caries prevention could facilitate exceeding the goals of Healthy People 2020 prior to 2020. 3. Approach: Generate MOP and preliminary data. The specific aims are to: Create a manual of procedures (MOP) for pilot program, based on the NIDCR model, and modified from the PI's current successful, but independent, programs focusing social network analysis, behavioral change, and caries prevention. Carry out pilot program to generate and analyze preliminary data, working with two after school organizations. We will determine the social network and behavioral intent of all site coordinators (~100), and both parents and children in 4 pilot schools (~400 parents and children). Two sets of school's directors, parents, and children will receive targeted behavior change (experimental); the other two sets will receive no behavior change (control). Children in all four schools will receive comprehensive caries prevention. The primary outcome will be program impact, defined by RE-AIM. Prepare U01 application. We will use outcomes, RE-Aim, Markov Chain/Monte Carlo modeling, economic assessments, and power calculations to generate predictive models. These will allow us to revise the MOP and prepare a U01 application for implementation across the Hawai'ian Islands. 4. Investigators: Four experts in unique content areas will collaborate in this team science program, coordinating expertise in social network analysis, behavioral intent and change, caries prevention, and statistical and economic analysis. 5. Environment: Hawai'i is a small state with substantial health care needs and no school-based caries prevention program. The proposed program therefore coalesces an environment with high need, and investigators from institutions with extraordinary depth.