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Try out PMC Labs and tell us what you think. Learn More. Dance Jr. Analyzed the data: GD. Multivariate logistic regression was used to evaluate predictors of oral sexual behavior and oral HPV16 infection. Differences in oral sexual behavior were observed by gender, age-cohort and race. Most men Prevalence ratios PR of ever oral sex in men vs.
In multivariate analysis, gender, age-cohort, and race were ificant predictors of oral sexual behavior. Oral sexual behavior was the primary predictor of oral HPV16 infection; once this behavior was adjusted for, age-cohort and race were no longer associated with oral HPV There are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups.
In recent decades sexual behaviors have changed; the age of sexual initiation has decreased, and the lifetime of sexual partners has increased. Therefore, we examined differences in sexual behaviors by gender, age-cohort, and race in a nationally representative sample, to explore whether the observed epidemiologic differences in oral HPV infection and OSCC rates reflect differences in sexual behaviors across these groups.
Demographic data was collected using an interviewer administered survey. of lifetime partners for any kind of sex, vaginal sex, and performing oral sex, were each collected separately. of lifetime partners reported in this paper is a sum of both male and female partners.
Analysis for this study was restricted to individuals 20—69 yo, as the ACASI was not administered to older individuals. Weighted prevalence estimates were reported. The primary outcomes of interest were history of ever performing oral sex and of lifetime oral sex partners.
Wald F p-values were used to compare weighted prevalence between groups. For continuous variables, weighted means were compared using analysis of variance with Wald F p-values. The association of gender, age-cohort and race with odds of ever having performed oral sex was explored using multivariate logistic regression.
With the exception of age-cohort, gender, and race, only covariates that were statistically ificant were retained in the final multivariate models. Data from 2, men and 2, women between the ages of 20 and 69 were included in this analysis Table S1 in File S1. Participants were primarily heterosexual Sexual behaviors of interest were first compared by gender Table 1. The overwhelming majority of men Similarly, prevalence of oral HPV16 2. Middle aged individuals 45—59 yo were ificantly less likely than adults 30—44 yo to report ever performing oral sex Given the behavioral differences observed between men and women, additional age-cohort analyses were stratified by gender Table 2.
While the majority of individuals in each age-cohort, including seniors, reported ever performing oral sex, seniors were ificantly less likely to have ever performed oral sex than adults males For both genders and all age-cohorts, the majority of individuals had fewer lifetime oral than vaginal sexual partners. The of lifetime sexual and oral sex partners and age of first sex varied considerably between racial and ethnic groups Table 3.
Similar differences were observed between white and black women Table 3and when comparing white women with Mexican-American, Hispanic, women of other race Table 3. Reporting fewer lifetime oral than vaginal sexual partners was ificantly more common among blacks than whites men When examining prevalence ratios by age-cohort, older men were moderately less likely to report oral sexual behaviors PRs 0. When comparing white and black men, differences in sexual behaviors were consistent with the differences observed in oral HPV16 infection and cancer.
To further understand the contribution of these differences in oral sexual behaviors to the demographic differences in oral HPV16 prevalence, multivariate analyses were performed. We first evaluated the association between demographic characteristics of interest and oral sexual behaviors Table 5. Younger age-cohort and white race were each independently associated with increased odds of ever having oral sex Table 5.
Therefore, gender, age-cohort and race were each independent predictors of oral sexual behavior Table 5. By contrast, when evaluating the association between these demographic characteristics and prevalent oral HPV, after ing for oral sexual behavior, age-cohort and white race were not associated with increased odds of oral HPV16 or any oral HPV Table 5.
Similar were observed when examining predictors of any oral HPV infection Table 5. of these multivariate analyses were similar when stratified by gender and including all individuals 20—69 and adjusting for ever oral sex Table S3 in File S1. S population. These data reveal that there are differences in oral sexual behaviors when considering gender, age-cohort and race. This suggests that the observed epidemiologic differences in infection are a result of differences in oral sexual behavioral, and not by age-cohort or race differences.
This study is the first to explore whether differences in sexual behaviors across gender, age-cohort, and race for differences in oral HPV16 infection and OSCC in these same groups. The relative differences in prevalence of oral sexual behaviors, oral HPV16 infection, and OSCC incidence are dramatic when considering gender Table 4.
Males, independent of age and race, have more oral sexual partners as compared with females. Further, male gender is associated with oral HPV16 prevalence, even after ing for oral sexual behavior.
This suggests that in addition to the behavioral differences between men and women, namely higher cumulative exposure to oral HPV16 infection, additional gender-specific factors may for the increased prevalence of oral HPV16 infection or incidence of OSCC in men compared to women. A potential explanation for male gender being an independent risk factor for oral HPV16 infection is that performing oral sex on a woman might have higher infection risk than performing oral sex on a man. Notable age-cohort differences in oral sexual behaviors were observed.
Our finding that oral sex was ificantly more common among young adults than older adults is consistent with prior data. In recent decades, the age of sexual debut has decreased and the of lifetime sexual partners has increased. It appears that oral HPV16 infection varies as a function of oral sexual behaviors. While these oral sexual behaviors differ ificantly by age-cohort, age does not appear to independently influence the presence of oral HPV16 infection i.
This finding may be due to the age-categorization used, as the presence of a bimodal relationship of age and oral HPV prevalence has been suggested when this NHANES data was modeled. However, it is important to recognize that cancers across anatomic sites increase with age, and that this question was not directly examined in this dataset. This study also describes differences in oral sexual behaviors among blacks and whites in the U.
Whites were ificantly more likely than other races to report oral sexual behaviors, even after ing for other important risk factors including age and gender. Yet, white race was not independently associated with oral HPV16 after adjusting for oral sexual behavior. Similar to age-cohort differences in oral sexual behavior, racial differences in oral sexual behaviors explain the racial disparities observed in unadjusted oral HPV16 prevalence and possibly HPV-OSCC incidence although this was not assessed in this study.
Interestingly, while oral HPV16 infection was less common in blacks than whites, prevalence of any oral HPV was ificantly more common in blacks than whites; it is unclear why this difference was observed. However, it remains unlikely that these relative differences would be larger than the 1. In our analysis, we show that oral sexual behaviors vary by gender, age-cohort and race. However, after ing for oral sexual behavior, we learn that the age and race do not independently affect the odds of oral HPV16 infection.
After controlling for of oral sexual partners, gender remained associated with oral HPV prevalence, and was elevated but not statistically ificantly associated with oral HPV16 prevalence; this suggests that while of oral sexual partners may be the primary risk factor for oral HPV infection there may be other sexual factors such as performing oral sex on a women compared to a man, or site of first HPV exposure genital vs. While this study suggests that changes in oral sexual behavior likely contribute to the observed increases in HPV-OSCC, there may be other unknown factors that may also contribute to these epidemiologic differences.
This study has several limitations and strengths. Study limitations include the lack of some sexual data in 60—69 yo, the lack of temporal data, and the limited of individuals with oral HPV16 infection. Strengths of this study include the large overall sample size with a wide range of ages and ificant representation of blacks and other minority populations, as well as the availability of oral HPV prevalence data.
SEER data provides population based cancer incidence estimates. These data are a ificant contribution to the small but growing body of literature which examines the contribution of HPV to temporal changes in HPV-OSCC and the role of gender and race in these cancers.
This data provide an important context regarding changing sexual behaviors and the role these behaviors may play in the increasing incidence of HPV-OSCC. We learn from this data that oral sexual behaviors are common and that males, younger age groups, and whites report increased oral sexual behaviors, and thus likely have a higher exposure to oral HPV infections. However, age-cohort and race are not independent predictors of oral HPV infections, but rather affect the odds of oral HPV infection through differences in oral sexual behaviors.
Similar to U. Recent research suggests HPV vaccination is likely effective in preventing oral HPV infection among women, with efficacy expected among men as well. Table S1. Table S2. Sexual behavior and oral HPV prevalence by age-cohorts. Table S3. Multivariate risk factors associated with ever oral sex, oral HPV infection, when controlling for ever performing oral sex, among 20—69 year olds, and stratified by gender.
The authors thank Timothy S. National Center for Biotechnology InformationU. PLoS One. Published online Jan Xuefeng Liu, Editor. Author information Article notes Copyright and information Disclaimer.
Competing Interests: The authors have declared that no competing interests exist. Received Sep 26; Accepted Dec 4. This is an open-access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. This article has been cited by other articles in PMC. Conclusion There are differences in oral sexual behaviors when considering gender, age-cohort and race which explain observed epidemiologic differences in oral HPV16 infection across these groups.
Behavioral Data Demographic data was collected using an interviewer administered survey. Statistical Analysis Analysis for this study was restricted to individuals 20—69 yo, as the ACASI was not administered to older individuals. Differences in Behavior by Gender Sexual behaviors of interest were first compared by gender Table 1. Table 1 Sexual behavior and oral HPV prevalence, overall and gender stratified. Open in a separate window. Figure 1. Table 2 Sexual behavior and oral HPV prevalence, by age-cohort and gender.
Multivariate Analysis of Risk Factors for Oral Sex To further understand the contribution of these differences in oral sexual behaviors to the demographic differences in oral HPV16 prevalence, multivariate analyses were performed. DOCX for additional data file. Acknowledgments The authors thank Timothy S. Funding Statement The authors have no support or funding to report. References 1. N Engl J Med : — J Clin Oncol 26 : — J Clin Oncol 29 : — J Natl Cancer Inst : — Ramqvist T, Dalianis T Oropharyngeal cancer epidemic and human papillomavirus. Emerging infectious diseases 16 : — AIDS 24 : — Herlitz C Sexual risk-taking in the general population of Sweden — Sexual health 6 : — Sexually transmitted diseases 34 : — Sexually transmitted diseases 32 : — Sexually transmitted diseases 22 : — The journal of sexual medicine 7 Suppl — J Infect Dis : — Department of Health and Human Services.
N Engl J Med : 24— Laryngoscope : — Cancer prevention research Philadelphia, Pa 2 : — Jama : — Hyattsville, MD: U. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. Cancer : —Black girls 4 best oral you ever had
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