Abstract Background: Oropharyngeal cancer (OPC) disparities exist across race-ethnicity, socioeconomic status, and sociobehavioral characteristics, as well as across different US regions. However, no investigations have interactively assessed these multilevel factors in the polarizing dynamics of region-specific political leanings and affiliated local policies. Methods: This retrospective ecological analysis used the NPCR-SEER database to evaluate county-area-summarized OPC age-adjusted annual mortality rates from 2000-2020 and the CDC-Social Vulnerability Index to assess 15 country-level SDH-vulnerability factors across all 3143 US counties. OPC-mortality rates for White, Black, and all race-ethnic groups were regionally stratified based on the Presidential and midterm (categorized into Democrat, Republican) electoral results of their counties’ respective states for each biannual cycle. These stratified mortality rates were regressed against socioeconomic status, minority-language status, household composition, housing-transportation SDH-vulnerabilities, as well as their total composite. Results: Across the US, yearly age-adjusted OPC-mortality mean rate was 2.94 deaths/100k patients from 2000 to 2020, with counties in Republican-leaning states having higher mortality rates (3.09/100k) compared to Democratic ones (2.72/100k). Mortality rates for Black patients were substantially higher in Republican-leaning areas (4.02/100k) than Democratic ones (3.08/100k). Non-Hispanic white patients also showed lesser increases in mortality in Republican-areas (3.04/100k) compared to Democratic ones (2.68/100k). With increasing total SDH-vulnerability, white populations in Republican-leaning areas suffered 0.27 age-adjusted added deaths/100k annually & 0.22/100k in Democratic ones, whereas black populations in Republican states suffered 0.51/100k annually & 0.34/100k in Democratic ones. For white patients, vulnerabilities in socioeconomic status primarily contributed to these mortality disparities in Democratic-leaning areas while both socioeconomic status and household composition vulnerabilities influenced disparities in Republican ones. For black patients, household composition primarily contributed in Democratic areas, whereas socioeconomic status, housing-transportation, and household composition-vulnerabilities all contributed equivalently in Republican ones. Conclusions: The results of this study showcase multilevel, population effects of political leanings and racial-ethnic demographic makeup in conferring SDH-derived OPC-mortality disparities over the past two decades. In particular, black OPC patients from Republican-leaning areas suffered exacerbated associations of SDH-vulnerability-related disparities driven by varied SDH-types. Through this nuanced modeling of the interactions between geopolitical and sociodemographic factors, targeted public health resource allocation and policy-lobbying can more specifically address local legislature through this systematic, large-data approach. Citation Format: David J. Fei-Zhang, Mary J. Xu, Jeffrey C. Rastatter, Anthony M. Sheyn, Daniel C. Chelius, Jill N. D'Souza, Sandeep Samant, Urjeet A. Patel, Caryn E. Peterson, Olga Garcia-Bedoya, Patrick D. Smith, Kate Klein, Mamoudou Maiga, Warren A. Kibbe, Lifang Hou. Geopolitical and racial-ethnic trends of social vulnerability impact on oropharyngeal cancer mortality in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C004.

• Eviction from rental housing is common throughout the United States and globally. • We synthesize the methods and key findings of recent research on eviction and health. • Most studies found significant links between eviction exposures and poor health. • Some studies found that eviction's impacts were most severe for marginalized groups. • Growing evidence suggests that eviction prevention policies positively impact health.

BACKGROUND:Lesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho's Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers' perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system. METHODS:We conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho's health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization's health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers' perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis. RESULTS:Participants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds. CONCLUSION:Our study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.

BACKGROUND:Poor oral and pharyngeal cancer (OPC) survival among Black men is partially due to their limited knowledge about OPCs, which is exacerbated by dentists' limited training and discomfort in discussing OPC risk factors. The purpose of this study was to assess the attitudes and experiences that Black men have communicating with dentists about OPCs.METHODS:To qualitatively assess these attitudes and experiences, a focus group guide and recruitment strategy were developed using a community engagement approach. Data were analyzed using grounded theory.RESULTS:Twenty-three self-identified Black men participated in three focus groups through the Zoom platform (mean age of 46.1 years). Four main themes emerged, which identified that participants: (1) had little knowledge of OPCs; (2) felt that addressing OPC risk among Black men was not a priority for dentists; (3) stressed the importance of dentists acknowledging the complexity of how race and gender affects Black men's healthcare experiences; and (4) expressed a benefit to receiving information from multiple social networks.CONCLUSION:The focus groups provided context for how dentists might engage with Black men in discussions about OPC prevention and treatment.

Black men are disproportionately impacted by oral and pharyngeal cancer (OPC) mortality. This is in part due to a lack of information received about OPCs and their associated risk factors during health encounters. Discussions between dentists and Black men may improve Black men's knowledge, screening, and treatment uptake. Yet, dentists do not commonly communicate with Black men about OPCs due to their own discomfort. This paper describes the protocol for our research project, which proposes an initiative, grounded in community-based participatory research, to adapt a culturally-specific OPC communication tool. This tool will be adapted using a mixed-methods approach to assess the knowledge, attitudes, and experiences of Black men discussing OPCs and associated risk factors with dental providers. The tool will then be assessed for feasibility and acceptability among Black men, as well as dental students and dental providers in community-based clinical settings.

The purpose of the American Dental Education Association (ADEA) Men of Color in the Health Professions Summit, held in August 2022 at ADEA's headquarters in Washington, DC, was to gather key thought leaders across a myriad of health professions and healthcare organizations and schools to cultivate intentional cross-disciplinary efforts in championing the need to address the low number of men of color entering not only dental, but also medicine, pharmacy, and health-related research careers. A pivotal follow-up step from the inaugural ADEA President's Symposium on Men of Color in the Health Professions at the March 2022 ADEA Annual Session & Exhibition in Philadelphia, the summit brought together academic health professions leaders, government agencies, health professions associations, and other key stakeholders to develop an action plan to support men of color entering the health professions. Moving the needle forward and increasing opportunities for underrepresented men of color in the health professions requires all academic health professions to work together. Highlights of the Summit included a keynote presentation by David Satcher, MD, PhD, the 16th Surgeon General of the United States; workgroup consensus statement development; health career pathways program presentations; strategic forecasting regarding challenges and opportunities in developing a coalition of health professions organizations to support men of color in the health professions; and frameworks for exploring coalition building.

Background. Public dental insurance programs for children aim to provide access to care, but barriers remain that preclude care delivery. Understanding these barriers is an important health policy concern.Methods. A telephone audit sought to ascertain availability of oral health care for children in dental offices eligible to bill Medicaid. Female callers posing as mothers called eligible offices requesting appointments. In this cross-over design, offices were randomized to public or private insurance for initial calls and then to the other condition after a washout period.Results. Using mixed models, privately insured patients had 5.9 times (95% CI, 4.55 to 7.69) greater odds of obtaining an appointment than Medicaid patients. Compared with patients in Cook County, suburban patients had slightly better odds, whereas nonurban patients in larger and smaller rural counties had lower odds of success.Conclusions. Medicaid compares poorly with private insurance for providing access to pediatric oral health care. Regardless of insurance conditions, access is poor in less urban environments compared with metropolitan communities.Practical Implications. Even Medicaid-enrolled dental practices limit the care they extend to insured children. Providing Medicaid by itself cannot overcome large oral health care access disparities, which are greatest in rural communities.

This study assessed if higher levels of self-reported stress were associated with self-reported oral health-related quality of life (OHRQoL) among a sample of college-educated Black men. Using a community-based participatory approach, a questionnaire was developed and distributed using two validated instruments, the Holmes-Rahe Stress Inventory and the Oral Health Impact Profile-14. Eighty men completed the questionnaire, with 58.8% reporting Holmes-Rahe scores above 150 (mean=209, SD=175.2). The highest OHIP-14 mean ratings on a scale of 0 to 3 were for feeling self-conscious (mean=.67), painful aching (mean=.55), feeling embarrassed (mean=.49), and eating discomfort (mean=0.48). Among participants with Holmes-Rahe Stress Inventory scores above 150, mean OHRQoL levels were significantly higher for domains of painful aching (p=.007), eating discomfort (p=.038), feeling self-conscious (.006), and experiencing tense feelings (.049). Higher stress levels may be associated with college-educated Black men's experiences of oral health-related physical pain and psychological discomfort.

Purpose: Adolescent girls (10-19 years) in Eastern and Southern Africa face a high risk of pregnancy and HIV infection. However, few studies have examined whether the profound developmental, social, and economic changes that accompany adolescent motherhood contribute to HIV risk. This study examines the intersection between adolescent motherhood and HIV infection across 10 Eastern and Southern African countries, where over half of all HIV infections occur among adolescent girls. Methods: To evaluate whether adolescent motherhood is associated with HIV infection, we used Demographic and Health Survey data on girls (15-19 years) with HIV test results (N 1/4 19,932) from Eswatini, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. We examined unweighted bivariate and multivariable associations between adolescent motherhood and HIV using mixed effects logistic regression models that included a country-level random intercept. We examined heterogeneity in the association by testing country-level random slopes using a likelihood ratio test and used intraclass correlation to measure the proportion of total variance explained at the country level. Results: Nearly one fifth of adolescent girls were mothers (range: 9.80%-38.90%), and the HIV prevalence among all adolescent girls was 3.3% (range: 1.03%-10.07%). Relative to nonmothers, adolescent mothers were, on average, older, poorer, and more likely to be married, rural dwellers, and household heads. Adolescent motherhood was positively associated with HIV infection in bivariate and multivariable analyses (odds ratio: 1.87; 95% confidence interval: 1.57-2.23; adjusted odds ratio: 1.53; 95% CI: 1.24-1.89). Discussion: Among adolescents with HIV test results, we observed a robust association between adolescent motherhood and HIV infection across 10 high-burden countries. (C) 2021 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

PURPOSE:The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education.METHODS:The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts.RESULTS:Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service.CONCLUSIONS:The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

Abstract Background Racism negatively affects the life experiences and subsequent health of Black men, including oral disease prevalence and outcomes. Few examples in the literature discuss how racism may affect successful, unsuccessful, and non‐attempts to address Black men's oral health. Aims This commentary describes anti‐racism approaches to address Black men's oral health through community‐based participatory research, oral health promotion, and workforce recruitment. Materials and Methods Stakeholders from two organizations and one dental school share their experiences and key insights on how to strengthen efforts while minimizing the influence of racism on Black men's participation. Results Common insights identified were a need to engage a diverse range of Black men within varying social and economic contexts, race and gender concordance among program leaders and participants, and the value of partnership to reach Black men in places where they feel comfortable and supported. Discussion and Conclusion These examples stress the imperative of addressing racism among Black men in the development and improvement of targeted oral health interventions. They also emphasize the value of commitment from institutional leadership, relationship building with Black men, and the empowerment of Black men to lead program development and implementation efforts.

Many people suffer poor oral health due to dentists not providing care to them. The number of foreign-trained dentists in the US is increasing, yet little is known about their involvement in providing care to underserved populations. Dental education programs use community-based dental education (CBDE) to expose dental students to access to care issues, and encourage them to provide care to underserved populations upon graduation. The aim of this study was to assess foreign-trained dentists' attitudes about access to care issues after completing a CBDE course at a dental school in the Midwest. Fifty-two dentists participated in the CBDE program from 2018 to 2019, as part of an advanced standing curriculum, and completed guided, reflective essays. Forty-seven dentists agreed to have their essays anonymously coded for research. Four researchers reviewed the essays independently, developed a coding scheme, and recoded to agreement. The main themes dentists mentioned were the affect of the CBDE program on enhancing their clinical skills, fostering an awareness of healthcare system inadequacies, as well as an awareness of how specific social determinants limit access to care, and helping to encourage a sense of personal and professional responsibility to address access to care issues. This study highlights the value of CBDE on helping future dental providers learn about and reflect on access to care issues. It also provides insight into foreign-trained dentists' attitudes about access to care issues, and supports their participation in CBDE programs to foster their contributions in addressing access to care issues in the US.

The purpose of this article is to discuss the challenges surrounding the underrepresentation of Black/African American (BAA) men in dentistry and dental education and present a rationale for anti-racism strategies to address them. Data and insights from the literature are presented to discuss how racism may derail BAA's opportunities to achieve a dental education through stereotyping, social, and academic isolation. Additionally, the authors present commentary and testimonials on the importance of mentorship to guide BAA men into and through dental careers. Additionally, the article describes two examples of successful career pathway programs, and highlights the significance of historically Black colleges and universities to promoting diversity within the dental profession. Anti-racism recommendations for change include more direct attention to how dental school humanistic environments support BAA men, committing human and financial resources for program development, and using data-driven metrics to assess those programs longitudinally. The commitment of dental education to promote oral health equity demands more than appreciation of BAA men's contributions, but a commitment to creating and advancing opportunities that assure their success.

Over 2 million renters in the United States are legally evicted annually, and even more renters experience other landlord-related forced moves each year. While past research has documented an association between legal eviction and HIV risk, no studies have examined the relationship between forced moves and sexual partnership dynamics longitudinally, or the pathways through which forced moves impact such risk. Addressing this gap is imperative, particularly given inequities that place Black renters and women at disproportionate risk of eviction. This study leverages data from a longitudinal cohort study of 282 adults in New Haven to examine whether landlord-related forced moves reported at baseline (including, but not limited to, legal eviction) is associated with HIV sexual risk reported six months later. We use bootstrapped path analyses to examine intimate partner violence (IPV) victimization and perpetration as potential mediators. One-fifth of participants (21.2%) had experienced a landlord-related forced move at baseline. At follow up, nearly two-thirds (63.8%) reported at least one HIV sexual risk factor, one in seven (14.2%) reported IPV victimization, and one in ten (10.3%) reported IPV perpetration. Individuals who reported landlord-related forced moves were more likely to report IPV victimization (standardized beta = 0.19, SE = 0.08, p = .02) and IPV perpetration (beta = 0.25, SE = 0.09, p = .003). Both IPV victimization and perpetration mediated the association between landlord-related forced moves and HIV sexual risk (indirect victimization effect, beta = 0.09, SE = 0.05, p = .06; indirect perpetration effect, beta = 0.16, SE = 0.07, p = .02), though IPV victimization was only marginally significant. In conclusion, IPV is itself a negative consequence of forced moves that also contributes to other negative health effects, like HIV risk. Therefore, providers should offer violence screening and referral for clients who have recently faced a forced move. Simultaneously, policy-level solutions to prevent eviction and increase housing affordability are urgently needed to address the rising burden - and inequitable distribution - of evictions among low-income renters.

We sought to examine whether and how landlord-related forced moves (inclusive of, but not limited to, legal eviction) were associated with emergency department (ED) use over time. We used survey data collected between 2017 and 2019 among 283 low-income participants in New Haven, CT to examine whether experiencing a legal eviction or other landlord-related forced move (T0) was associated with increased odds of ED use 6 months (T1) and 12 months (T2) later. We conducted bootstrapped mediation analyses to examine indirect effects of post-traumatic stress symptoms. One-fifth of participants (n = 61) reported a recent forced move at baseline (T0); half of these were legally evicted. Landlord-related forced moves were associated with ED use at T1 (AOR = 2.06, 95 % CI: 1.04–4.06) and T2 (AOR = 3.05, 95 % CI: 1.59–5.88). After adjustment for sociodemographic factors and other health-related confounders, legal eviction was not significantly associated with ED use at T1 (AOR = 1.61, 95 % CI: 0.68–3.81), but was significantly associated with ED use at T2 (AOR = 3.58, 95 % CI: 1.58–8.10). Post-traumatic stress symptoms accounted for 15.1% of forced moves’ association with ED use (p

Structural racism negatively affects the health of Black populations in the U.S. Black populations experience a higher burden of oral diseases, such as tooth decay, periodontal disease, and oral and pharyngeal cancers than other racial groups experience. Oral health literature refers to racial inequities in the context of social disadvantage. However, structural racism perpetuates those contributory social disadvantages, such as inadequate access to affordable housing, education, and employment. In addition, in states where nearly 50% of U.S. Black populations reside, there is an inequitable distribution of adult Medicaid dental benefits as well as an inequitable availability of both Black and non-Black oral health care providers. Addressing structural racism in oral health should involve commitment among stakeholders to establish awareness and equity through community-building, policy, oral health workforce development, and research.

Purpose: The purpose of this study was to explore caregivers' comfort levels and preferences for answering sensitive questions about themselves and their children in a pediatric dental setting. Methods: An electronically delivered survey was completed by 206 caregivers in the waiting area of a dental school's pediatric clinic. The survey items assessed were demographic, general health, behavioral health, oral health, and living conditions. A factor analysis was conducted for each set of questions, and a mean comfort level was calculated for each factor. Comfort levels were assessed on a five-point Likert scale, with one being least comfortable and five being most comfortable. Results: The questions caregivers were less comfortable answering about themselves were concerning traumatic events, stress, coping (mean equals 3.39), and living conditions (mean equals 3.24) versus demographics (mean equals 3.84) and physical and oral health (mean equals 3.99; P<0.001). They were also less comfortable answering questions about their children's trauma, stress, coping (mean equals 3.65), and experiences with violence and sexual activity (mean equals 3.13) than about demographics/general health (mean equals 4.11) and oral health (mean equals 4.21; P<0.001). The main reasons for the discomfort were the questions' sensitive nature and their belief that they had any relationship to their children's oral health. Conclusion: This study provides knowledge of caregivers' lower comfort levels discussing sensitive topics in a dental setting and provides context for interventions focused on how dentists can better communicate with caregivers about their own adverse experiences as well as their children's.

PURPOSE Dentists can address childhood obesity by educating patients about mediating factors, such as nutrition and dietary habits, facilitating behavioral interventions, and participating in interprofessional collaborations. Dental schools are encouraged to prepare future dentists to address childhood obesity. The aim of this study was to assess dental students' attitudes, comfort, and perceived barriers discussing nutrition and obesity prevention with parents and caregivers of children aged 0-5, after a one-time service-learning experience in a pediatric primary care setting to promote oral health. METHODS Following conversations with parents and caregivers, students completed an 11-item survey via Qualtrics. RESULTS Of 144 second-year dental students that participated in the service-learning experience over 2 years, 101 participated in the survey for a response rate of 70.1%. Most students agreed that dentists' roles include discussing nutrition (98.0%) and obesity prevention (83.2%). During the service-learning experience, 78.2 percent of students discussed nutrition, and 5.0% discussed obesity prevention, with 3.0% and 22.8% of students reporting some level of discomfort with each topic, respectively. The most reported barriers for discussing both nutrition and obesity prevention were concern for "appearing judgmental" and "fear of offending clients." Mean comfort scores among students who reported barriers of "appearing judgmental" (p = < 0.0001) and "fear of offending clients" (p = 0.017) for nutrition discussions, and a "lack of parental acceptance of guidance" as a barrier for discussing obesity prevention (p = 0.016), suggest that those barriers were associated with less comfort. CONCLUSION Dental students' perceived barriers to discussing nutrition and obesity prevention with parents and caregivers may negatively influence dental students' comfort.

This paper comments on the Effects of Racism on Oral Health in the United States (US). It provides the background and sets the stage to raise questions about race: how was race defined originally, what exactly is race, and how have racial categories been enumerated? Following this path, the paper broadens the scope of view regarding data attributable to racial categories pointing to social and cultural factors that influence overall health outcomes, particularly those related to oral health. Oral health researchers, advocates, providers, administrators, program planners, and funders, among others rely on data, often compiled by racial categories. We should be aware of potential vagaries that can accompany race-based data, and its interpretation and application, regarding oral health. The paper suggests we should be mindful of other influences that affect documented differences among populations regarding their oral health status.

Dental schools use community-based dental education (CBDE) to ensure students gain experience in treating diverse and underserved patient populations. However, it is unclear to what extent schools utilize CBDE experiences to increase students' knowledge of structural factors impacting access to care. The aim of this study was to determine the level and types of non- clinical learning included in CBDE experiences and how that learning is being assessed across U.S. dental schools. This cross- sectional analysis used an 18-item questionnaire distributed to associate deans and CBDE directors at all 66 U.S. dental schools. The questions focused on rotation structure, CBDE objectives, and didactic content for CBDE programs. Representatives from 31 schools-public (71%) and private (29%)-responded, for a 44% response rate. The primary objectives for the community-based rotations were reported to be demonstrating cultural competence in diverse clinical settings (93.1%), addressing access to care (86.2%), and diagnosing and treating oral diseases (75.9%). Of the respondents, 73% reported that their schools supported clinical experiences with non-clinical didactic course work, which addressed access to care (95%), professional responsibility (91%), social determinants of health (86%), the U.S. health care system (77%), health policy (73%), practice management (73%), motivational interviewing (50%), and public presentation training (32%). The results suggest that U.S. dental schools are using CBDE rotations to provide didactic content and assessing students on their knowledge of access to care, social determinants of health, interprofessional practice, and oral health policy. These important aspects of students' education provide additional evidence of the value of CBDE in dental education.