Knowledge, attitude and perception of Italian dental students toward HPV-related oropharyngeal cancer and vaccination: a cross-sectional study

Knowledge, attitude and perception of Italian dental students toward HPV-related oropharyngeal cancer and vaccination: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, attitude and perception of Italian dental students toward HPV-related oropharyngeal cancer and vaccination: a cross-sectional study Gennaro Musella, Simone Liguori, Tiziana Cantile, Daniela Adamo, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4632572/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background : Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide and is a leading cause of oropharyngeal cancer. This study aimed to carry out a KAP survey on HPV infection, HPV-related oropharyngeal cancer and HPV vaccination among dental students. Methods : Through an online self-administered questionnaire, data on dental students' sociodemographic characteristics, knowledge, attitudes and perceptions concerning HPV-related oropharyngeal cancer, infection and vaccination were acquired for a total of 82 questions. Results : A total of 412 dental students completed the questionnaire. The general knowledge rate was 69.5%. In terms of perception, the students provided good insight into their future role in combating HPV disease. Regarding attitudes, most participants felt comfortable talking about HPV topics with patients; however, only approximately 50% of them were inclined to recommend the vaccine regardless of sex. Compared with male and first-year students, female and last-year degree students demonstrated more positive attitudes and perceptions, respectively. Conclusions : This study revealed that dental students have a solid understanding of and positive attitudes toward and perceptions of HPV+ oropharyngeal cancer and its prevention, highlighting their readiness to incorporate HPV prevention into their practice. This emphasizes the key role of the dental profession in addressing oropharyngeal cancer and HPV-related diseases and promoting awareness of the HPV vaccine among the population. Clinical Relevance : By increasing dental students' awareness of HPV, they may be better equipped to educate patients about HPV, promote vaccination, and implement preventative measures. Additionally, the study highlights the need for targeted educational interventions to improve knowledge and attitudes, to enhance the overall public health impact. Human Papillomavirus Viruses Oropharyngeal Neoplasms knowledge attitude KAP Dental Students Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide, affecting approximately 75–80% of sexually active people in their lifetime [1–4]. While most infections are asymptomatic and resolve on their own within 1–2 years, long-lasting or multiple reinfections, especially with high-risk strains, are associated with cervical, antenatal and oropharyngeal cancers (OP cancers) [5, 6]. Although the most common cause of HPV infection is cervical cancer, HPV is currently a major and increasingly common cause of head and neck cancers in both sexes[7–10], with a rapid increase among males [11]. It is estimated that 70% of OP-cancers are HPV+.[12] The incidence and mortality of OP-cancer are 757,000 new cases per year (M/F ratio of 2.5) and 367,000 deaths per year, respectively [13]. Currently, one of the main approaches for preventing HPV infection and related cancers is vaccination [14, 15]. Since clinical trials on the vaccine suggest that its efficacy is greater in HPV-naïve individuals, the ideal time for vaccination is before any sexual activity begins[16]. Indeed, all three vaccinations are approved for use in boys and girls from 9 years of age and are administered in 2–3 doses [17]. According to data from the Behavioral Risk Factor Surveillance System, a considerable majority of individuals who have not received HPV vaccination have visited oral health care providers within the previous year, underscoring their potential importance in facilitating discussions about HPV, raising awareness, and promoting agreement on vaccination [18]. Among health care providers, dentists could play a leading role in the primary prevention of HPV + OP-cancer by instructing patients and their parents about the risks of infection and spreading information on vaccination availability [19–22], as recommended by the American Dental Association and the American Academy of Pediatric Dentistry [23]. This requires dental providers to be prepared to answer patients’ questions about HPV infection and vaccines and to educate them about the connection between HPV and OP-cancer [24, 25]. However, discussions related to these issues were infrequent in the oral health care setting, which may be due to a lack of knowledge and communication skills among oral health care professionals [18, 26]. To address these gaps, dental students, as future health care providers, must be trained to increase public understanding of HPV + diseases, and establishing their level of awareness is the first step in evaluating whether it is necessary to strengthen educational training programs. KAP (knowledge, attitude, and perception) surveys are well suited for this purpose because of their simplicity in design, ability to generate quantifiable data, ease of interpretation and concise way in which the results can be presented. Furthermore, KAP surveys facilitate cross-cultural comparisons [27]. Since, to the best of our knowledge, no similar studies exist in the literature, the aim of this paper is to assess HPV knowledge, attitudes, and perceptions among Italian dental students. MATERIALS AND METHODS Study description The present study has been conducted by the Oral Medicine Unit, Department of Neuroscience, Reproductive and Oral Sciences of the “Federico II” University, Naples (Italy), in collaboration with the “Scuola Medica Salernitana”, Department of Medicine, Surgery and Dentistry, Salerno (Italy), from February 2023 to May 2023. The study is compliant with the ethical principles of the World Medical Association Declaration of Helsinki and the methods carried out in this study were approved by the Ethics Committee of the “Federico II” University of Naples, Italy (No. 437/20).. The students received a link via e-mail to participate in the self-administered online questionnaire via Google Forms, which included mandatory responses. Participation was voluntary, and consent was obtained online from all the participants. Since a validated instrument specifically designed to assess KAP related to HPV-related OP-cancer, HPV infection and vaccination among pediatric dentists has already been published [28], the present survey was conducted using the same validated questionnaire, adapting items only when necessary (“Attitude” section), to be appropriate for dental students. The time required to complete the questionnaire was 15 minutes. Description of the questionnaire The questionnaire included four sections. The first part included 4 questions related to students’ demographic data: gender, age range, graduation year attendance, and university geographical macroarea. The second part consisted of 48 statements and aimed to investigate the students’ knowledge of HPV + cancer (statements 1–18), infection (statements 19–33), and vaccines (statements 34–48). For this part, “true”/”false” dichotomous responses were used (Figs. 1 – 3 ), and knowledge statements were scored as correct (+ 1) or incorrect (0), with the percentage of respondents answering correctly reported in the final analysis. The third and fourth parts consisted of 20 and 10 statements related, respectively, to the perceptions and attitudes of students about HPV + OP-cancer, infection and vaccination (Figs. 4 and 5 ). A five-point Likert scale for each statement was used with five answer options: 5. Strongly agree; 4. Agree; 3. Neither agree nor disagree; 2. Disagree; 1. Strongly disagree. The sample size for the study was calculated before the questionnaires were administered. With a 5% margin of error and a 95% confidence level, it was calculated that when the number of dental students in Italy was approximately 4000, the required sample size was 351. Statistical analysis Sociodemographic factors were analyzed to determine the frequency distribution and relative frequencies of both dichotomous (gender) and nondichotomous categorical variables (age range, graduation year attendance and university geographical macroarea). To assess the participants’ level of knowledge, the number and average number of correct answers were calculated; subsequently, a comparison was conducted using Pearson's chi-square test to evaluate the variations in correct answer ratios across different demographic characteristics. For nondichotomous categorical variables, an added post hoc analysis was performed when the chi-square test was used. An additional comparison was performed by grouping questions based on the same main topics (1–18 for HPV + OP-cancer, 19–33 for infection, and 34–48 for vaccination). Regarding attitude and practice, the frequency distribution was evaluated, and a related comparison of the scores assigned to each question was performed with the Kruskal‒Wallis and Mann‒Whitney tests for nondichotomous variables and Pearson's chi-square test for dichotomous variables. The negative statements used in the attitude and perception questions were reverse coded to allow the statistical analysis of all the responses. Statistical significance was determined by considering a p value of less than 0.05 for all conducted tests. For multiple comparisons, Bonferroni correction was used to adjust the p values accordingly. RESULTS Sociodemographic data A total sample of 412 dental students completed the questionnaire. The sample analyzed was almost equally divided into males and females, and the majority of participants were aged between 22–23 years and were attending their 2nd or 4th year of university. Table 1 summarizes the sociodemographic characteristics by gender, age group, year of graduation and university geographical macro area. Table 2 shows the percentage of correct answers stratified by sociodemographic data. Table 1 Sociodemographic analysis of respondents who participated in the survey N = 412. Characteristics Number of students (%) Gender Male 202 (49) Female 210 (51) Age range (Years) ≤ 19 40 (9.7) 20–21 108 (26.2) 22–23 137 (33.3) ≥ 24 127 (30.8) Attendance (Years) 1° 64 (15.5) 2° 84 (20.4) 3° 62 (15) 4° 84 (20.4) 5° 70 (17) 6° 48 (11.7) Geographical macro area North 140 (34.0) Centre 135 (32.8) South 137 (33.2) Table 2 Percentage of correct responses on knowledge on HPV-related OP-cancer, infection, and vaccine, according to gender, age range, graduation year attendance and university geographical macro-area. KNOWLEDGE (CORRECT RESPONSE) Characteristics HPV + OP-Cancer HPV Infection HPV vaccine Total Gender Male 67.3% 66.2% 72.4% 68,6% Female 66.8% 67.8% 76.1% 70.2% Age range (Years) ≤ 19 56.8% 58.8% 65.8% 60.5% 20–21 62.4% 61.3% 71.6% 65.1% 22–23 68.8% 69.0% 75.8% 71.2% ≥ 24 72.3% 72.0% 77.8% 74.0% Attendance (Years) 1° 59.2% 60.3% 68.5% 62.7% 2° 61.8% 60.0% 69.5% 63.8% 3° 63.6% 64.7% 73.6% 67.3% 4° 71.4% 70.6% 77.2% 73.1% 5° 70.5% 72.8% 77.6% 73.6% 6° 78.6% 76.0% 81.9% 78.8% Geographical macro-area North 66.1% 66.2% 73.4% 68.6% Centre 68.3% 66.7% 74.3% 69.8% South 66.7% 68.0% 75.4% 70.0% Knowledge HPV-Related OP-Cancer (Statements 1–18) The total percentage of correct answers for knowledge about HPV + OP-cancer was 67.0% (Table 2 ). Over 50% of participants replied incorrectly to only 2 out of the 18 questions concerning knowledge of HPV + OP-cancer. These participants lacked awareness that papilloma and verruca vulgaris were not HPV + premalignant lesions (67.5% answered incorrectly) and that HPV + OP-cancer was not commonly preceded by recognizable premalignant lesions (62.1% answered incorrectly). More than 90% of the students surveyed knew that HPV can lead to cervical cancer and can produce the abnormal cervical cells found in the Pap test. The results of the chi-square test indicated that there was no statistically significant difference in gender distribution (p = 0.733) or university geographical macroarea (p = 0.349). However, significant differences were observed in terms of age range (p < 0.001) and graduation year attendance (p < 0.001). Post hoc analysis and p values are reported in Table 3 . Table 3 Association between the responses on Knowledge (HPV + OP-Cancer, Infection and Vaccine), Attitudes and Perceptions, and Socio-demographic characteristics. Multiple comparisons Knowledge - HPV + OP-Cancer Knowledge - Infection Knowledge - Vaccine Attitude Perception Gender Male Female 0.733 0.217 0.006* 0.000* 0.001* Age Range (Years) ≤ 19 20–21 0.085 1.000 0.074 0.036* 0.137 22–23 0.000* 0.000* 0.000* 0.000* 0.000* ≥ 24 0.000* 0.000* 0.000* 0.004* 0.207 20–21 22–23 0.000* 0.000* 0.052 0.001* 0.006* ≥ 24 0.000* 0.000* 0.001* 0.279 0.781 22–23 ≥ 24 0.128 0.255 1.000 0.004* 0.011* Attendance (Years) 1° 2° 1.000 1.000 1.000 0.036* 0.137 3° 0.590 0.365 0.284 0.000* 0.000* 4° 0.000* 0.000* 0.000* 0.207 0.004* 5° 0.000* 0.000* 0.000* 0.010* 0.000* 6° 0.000* 0.000* 0.000* 0.023* 0.002* 2° 3° 1.000 0.155 0.652 0.006* 0.001* 4° 0.000* 0.000* 0.001* 0.781 0.279 5° 0.000* 0.000* 0.001* 0.161 0.106 6° 0.000* 0.000* 0.000* 0.290 0.109 3° 4° 0.001* 0.024* 1.000 0.004* 0.011* 5° 0.010* 0.000* 0.943 0.188 0.712 6° 0.000* 0.000* 0.010* 0.112 0.064 4° 5° 1.000 1.000 1.000 0.126 0.020* 6° 0.110 0.099 0.667 0.204 0.542 5° 6° 0.004* 1.000 1.000 0.863 0.135 Geographical macro-area North Centre 0.482 1.000 1.000 1.000 1.000 South 1.000 0.694 0.629 1.000 1.000 Centre South 0.916 1.000 1.000 1.000 1.000 HPV infection (Statements 19–33) The total percentage of correct answers for knowledge was 66.9% (Table 2 ). Out of 15 questions, only 4 were incorrectly answered by more than 60% of the participants. These participants were unaware that infection transmission can be possible by any skin-to-skin contact (82.3% answered incorrectly); human papilloma virus may be transmitted among family members by kissing and digital contact (75.2% answered incorrectly); the majority of contagions can be cleared on their own within 1 to 2 years (58.7% answered incorrectly); and the percentage of sexually active individuals who acquire infection over the course of their lifetime was not 30% (62.9% answered incorrectly). On the other hand, more than 90% of the students knew that this infection occurred in both sexes. There were no statistically significant differences found in relation to gender (p = 0.217) or university geographical macroarea (p = 0.465) when using the chi-square test; instead, significant differences were observed for age range (p < 0.001) and graduation year attendance (p < 0.001). Table 3 shows the post hoc analysis and p values. HPV vaccine (Statements 34–48) The total percentage of correct answers for knowledge about the HPV vaccine was 74.3% (Table 2 ). Out of 15 questions, only 3 were incorrectly answered by more than 50% of the participants. These participants wrongly held that vaccination was recommended for sexually active individuals (83.7% answered incorrectly); individuals were screened for infection before vaccination (61.7% answered incorrectly); and the vaccine efficacy remained the same regardless of age (54.1% answered incorrectly). Approximately 90% of participants answered correctly concerning the recommendation of the vaccine before the start of sexual activity and the importance of continuing screening for infection despite vaccination. Using the chi-square test, statistically significant differences were observed in relation to all the demographic variables, except for university geographical macroarea (p = 0.453): gender (p = 0.006), age range (p < 0.001) and year of education (p < 0.001). The results of the post hoc analysis and the p values are reported in Table 3 . Perception More than 90% of dental students thought that dentists should educate their patients about the link between HPV and OP-cancer; more than 80% of participants considered the role of the dentist important in the prevention of infection and in the promotion of vaccination. Among the parental barriers to vaccine acceptability, 67.2% of the responders agreed or strongly agreed that patients’ parents would decline vaccination due to a lack of adequate knowledge of sexually transmitted infection; however, only 45.1% and 34.2% agreed or strongly agreed that vaccine refusal can be due to fear of adverse effects and fear of encouraging sexual activity in their children, respectively. Using the Kruskal‒Wallis test, no statistically significant differences were recorded regarding age range (p = 0.384) or university geographical macroarea (p = 0.639), but statistically significant differences were observed in relation to graduation year attendance (p = 0.003) and gender (p = 0.001) (Table 3 ). Attitude More than 85% of the participants agreed or strongly agreed with the periodically updated knowledge on HPV-related diseases by attending lectures/seminars/conferences and reading scientific papers; approximately 80% would feel comfortable talking about HPV + cancer, infection and vaccines with patients and their parents. Just over 50% of the respondents were not inclined to recommend the vaccine to either sex. Statistically significant differences were detected in terms of age range (p = 0.003), gender (p < 0.001) and graduation year attendance (p < 0.001) but not in terms of university geographical macroarea (p = 0.952). The results of the Mann‒Whitney test are shown in Table 3 . All the frequencies and frequency distributions of the answers are reported in Appendix A (Tables A1-A5). DISCUSSION Since the incidence of HPV + OP-cancer is increasing, dentists, in collaboration with other healthcare professionals, could play a key role in HPV prevention by recommending HPV vaccination to patients and discussing HPV infection and links to OP-cancer [20, 29]. Dental students, as future healthcare professionals, must have an adequate level of knowledge, along with a positive attitude toward vaccination and effective communication skills, to address this need. Knowledge Among the 3 subitems analyzed, the highest percentage of correct answers concerned knowledge of the vaccine (74.3%), followed by the HPV + OP-cancer and infection items, with values of 67.0% and 66.9%, respectively. This finding indicates increased interest among students in vaccination and highlights the intertwined relationship between awareness of HPV infection and understanding of HPV + OP-cancer. Furthermore, enhancing this knowledge is essential for improving dental care providers’ role in HPV prevention and helping them discuss these topics with patients [24]. Almost all interviewed students were aware of the possibility that HPV caused OP and cervical cancer, but only approximately 50–60% knew that HPV caused anogenital cancer. This was certainly due to the higher prevalence of HPV + cervical and OP-cancer [8] and to the greater attention given to these cancers during the course of the studies. Therefore, awareness about the possibility of infection determining cancer in other anatomical sites should be implemented [30], strengthening knowledge in dental curricula. Statistically significant differences for all three subitems analyzed among students with different degrees were found, with higher percentages of correct responses from students enrolled in the last years of university agreeing with the published literature [31–34]. Additionally, statistically significant differences were found between the knowledge of the 1st and 2nd years and that of the 5th and 6th years. This is probably due to the information acquired by students during their 3rd and 4th years while attending various courses. Specifically, the infectious disease course equipped students with knowledge about HPV biology, the replication cycle, routes of infection, and HPV-associated diseases. In the dermatology course, both cutaneous and mucosal HPV-related benign lesions were identified. Furthermore, the oral pathology and head and neck pathology courses covered information on HPV + oropharyngeal cancer and vaccination. Perception Overall, the students showed good perceptions of their future role in combating HPV infection. In fact, 82.5% and 91.1% of participants agreed and strongly agreed, respectively, about the role of dentists in preventing infection and in educating patients on the link between HPV and OP-cancer. Additionally, 87.9% of respondents generally promoted vaccination in line with the published literature [31], which indicated that students were ready to debate it with their patients. Although our sample demonstrated satisfactory knowledge of the 3 subitems, most of the students acquired more information on HPV + diseases during the attendance of the degree course, in agreement with Spanish, Dutch, Jordan and American students [31, 35–37]. These data demonstrated the students' perception of wanting to learn as much as possible on this topic to correctly implement primary prevention against this infection in their future profession [38]. Moreover, 2 out of the 3 students surveyed thought that patients’ parents were interested in prevention and would accept vaccination to prevent STIs and to avoid potentially carcinogenic infections, and when vaccination declined, they thought this was due to a lack of adequate knowledge of STIs. Parents’ knowledge and opinions about vaccines are among the main factors that influence the decision to vaccinate [39]. Consequently, health professionals must develop and reinforce communication strategies for addressing parental concerns about vaccines to help them in their decision-making [40–42]. In support of this, a study showed that 1 out of 5 parents agreed to vaccinate their sons against HPV after receiving a vaccine information sheet[43]. Furthermore, approximately 80% and 88% of the students agreed that the dentist has an important role in preventing HPV infection and should promote vaccination. Our results, coupled with those reported by Naavaal et al. in the American population [24], suggest that both future dentists and the general population are inclined to accept and integrate HPV prevention discussion into dental clinical practice. Attitude According to Wright’s results, more than 2 out of the 3 sampled students felt comfortable talking about HPV + cancers, infection and vaccination with patients and parents [36]. Only approximately 50% of participants were inclined to recommend the vaccine regardless of sex, with a statistically significant difference in favor of women. This showed that students still need to raise awareness of the role of the vaccine in men, which is important for increasing immunization coverage and reducing HPV + diseases [44]. For HPV + cancer, most students agreed that they would routinely carry out oral cancer screening on their patients, in accordance with a Spanish survey [35]. This result was promising if we considered that a positive attitude in discussions about patient and early diagnosis strategies by dental professionals, who have a good knowledge background, could have a direct helpful impact on OP-cancer patient survival [45]. Almost 90% of the students interviewed were inclined to periodically update their knowledge on HPV + diseases by attending education programs and reading scientific papers, according to Lingam et al. [46]. Therefore, educational training programs are necessary to achieve a better understanding of infection and its association with OP-cancer [37]. Statistically significant differences were found for perception and attitude in relation to both gender and graduation year attendance. Specifically, female students and students in their last years in a degree course demonstrated more positive attitudes and perceptions. For graduation year attendance, these results were expected considering that older students participated in internships and were more aware of the effects of HPV + diseases on patients' lives and that their perceptions and attitudes were supplemented by these internships. Limitations This study had limitations that should be considered. First, there is a potential risk of bias in the survey responses, as participants may have been inclined to respond according to the researcher's expectations, particularly in the Attitude section. Second, the nonmandatory nature of participation might have led to self-selection bias, with only the most knowledgeable students about HPV opting to participate. However, online surveys offer advantages over paper-based surveys, such as ensuring complete responses from participants, thus minimizing the risk of incomplete or inaccurate data that may arise from skipped questions. CONCLUSIONS The findings from the current study are encouraging, but students expressed the need to acquire more information about HPV infection and its link to oropharyngeal cancer and vaccines. Nevertheless, dental students are aware and well focused on integrating HPV prevention correctly and with appropriate knowledge into their daily practice. This confirms the crucial role of the dental profession in addressing HPV-related diseases and in raising awareness about the role of the HPV vaccine in preventing oropharyngeal cancers among the general population. Declarations Ethics Approval Statement: Ethics Committee of the “Federico II” University of Naples, Italy (No. 437/20). Author Contribution: Conceptualization, G.M., N.C. and S.L.; data curation, A.B, M.A. and F.C.; formal analysis, D.A., A.B. and M.M; funding acquisition: Si.L, M.M., F.C.; investigation, G.M., Si.L. and D.A.; methodology, V.C.A.C and T.C.; project administration, T.C. and F.C.; resources, M.M., M.A. and D.A.; software, V.C.A.C, Si.L. and A.B.; supervision, S.L and M.D.M; validation, M.D.M, S.L.; visualization, S.L. and M.D.M.; writing—original draft, G.M., T.C. and N.C.; writing—review & editing, S.L. and M.D.M. . All authors have read and agreed to the published version of the manuscript. Availability of data and materials: The data that support the findings of this study are available from the corresponding author upon request. Funding: No funding was obtained for this study. Conflicts Of Interest Disclosure: The authors declare no conflict of interest. Acknowledgements: Not applicable Consent for publication: Ethics Committee of the “Federico II” University of Naples, Italy (No. 437/20). References Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, Vignat J, Ferlay J, Bray F, Plummer M, Franceschi S (2012) Global burden of human papillomavirus and related diseases. Vaccine 30 Suppl 5F12–23. 10.1016/j.vaccine.2012.07.055 Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S (2016) Global burden of cancers attributable to infections in 2012: a synthetic analysis. 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Int J Environ Res Public Health 19. 10.3390/ijerph19020790 Vazquez-Otero C, Vamos CA, Thompson EL, Merrell LK, Griner SB, Kline NS, Catalanotto FA, Giuliano AR, Daley EM (2018) Assessing dentists' human papillomavirus-related health literacy for oropharyngeal cancer prevention. J Am Dent Assoc 149:9–17. 10.1016/j.adaj.2017.08.021 Dahlstrom KR, Day AT, Sturgis EM (2021) Prevention and Screening of HPV Malignancies. Semin Radiat Oncol 31:297–308. 10.1016/j.semradonc.2021.02.011 Poelman MR, Brand HS, Forouzanfar T, Daley EM, Jager DHJ (2018) Prevention of HPV-Related Oral Cancer by Dentists: Assessing the Opinion of Dutch Dental Students. J Cancer Educ 33:1347–1354. 10.1007/s13187-017-1257-9 Keser GYG, Pekiner FN (2021) Aug) Assessment of Knowledge Level and Awareness About Human Papillomavirus Among Dental Students. J Cancer Educ 36:664–669. 10.1007/s13187-019-01683-3 Farsi NJASS, Al Qathmi M, Merdad M, Marzouki H, Merdad L (2020 Dec) Knowledge of Human Papillomavirus (HPV) and Oropharyngeal Cancer and Acceptability of the HPV Vaccine among Dental Students. Asian Pac J Cancer Prev 21 1:3595–3603. 10.31557/APJCP.2020.21.12.3595 Doshi D, Reddy BS, Karunakar P, Deshpande K (2015) HPV, Cervical Cancer and Pap Test Related Knowledge Among a Sample of Female Dental Students in India. Asian Pac J Cancer Prev 16:5415–5420. 10.7314/apjcp.2015.16.13.5415 Lorenzo-Pouso AIG-VP, Banga C, Gallas M, Pérez-Sayáns M, García A, Daley EM, Gasamáns I (2019) Human Papillomavirus-Related Oral Cancer: Knowledge and Awareness Among Spanish Dental Students. J Cancer Educ 34:782–788. 10.1007/s13187-018-1373-1 Daley EM, Thompson EL, Vamos CA, Griner SB, Vazquez-Otero C, Best AL, Kline NS, Merrell LK (2018) HPV-Related Knowledge Among Dentists and Dental Hygienists. J Cancer Educ 33:901–906. 10.1007/s13187-016-1156-5 Sallam M, Al-Fraihat E, Dababseh D, Yaseen A, Taim D, Zabadi S, Hamdan AA, Hassona Y, Mahafzah A, Sahin GO (2019) Dental students' awareness and attitudes toward HPV-related oral cancer: a cross sectional study at the University of Jordan. BMC Oral Health 19:171. 10.1186/s12903-019-0864-8 Gilkey MB, McRee AL (2016) Provider communication about HPV vaccination: A systematic review. Hum Vaccin Immunother 12:1454–1468. 10.1080/21645515.2015.1129090 Gust DA, Darling N, Kennedy A, Schwartz B (2008) Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics 122:718–725. 10.1542/peds.2007-0538 Syrjanen S, Termine N, Capra G, Paderni C, Panzarella V, Campisi G (2012) Oral HPV infection: current strategies for prevention and therapy. Curr Pharm Des 18:5452–5469. 10.2174/138161212803307581 Staras SAVS, Patel RP, Shenkman EA (2014) Oct 21 Parent perceptions important for HPV vaccine initiation among low income adolescent girls. Vaccine 32:6163-9. 10.1016/j.vaccine.2014.08.054 Navarro-Illana P, Diez-Domingo J, Navarro-Illana E, Tuells J, Aleman S, Puig-Barbera J (2014) Knowledge and attitudes of Spanish adolescent girls towards human papillomavirus infection: where to intervene to improve vaccination coverage. BMC Public Health 14:490. 10.1186/1471-2458-14-490 Basu P, Mittal S (2011) Acceptability of human papillomavirus vaccine among the urban, affluent and educated parents of young girls residing in Kolkata, Eastern India. J Obstet Gynaecol Res 37:393–401. 10.1111/j.1447-0756.2010.01371.x Schwarz TM, Honsberg T, Stephan N, Dannecker C, Gallwas J, Crispin A, Weissenbacher ER, Kolben T (2016) HPV vaccination: acceptance and influencing factors among young men in Germany. Future Microbiol 11:227–234. 10.2217/fmb.15.132 Dodd RH, Marlow LA, Waller J (2016) Discussing a diagnosis of human papillomavirus oropharyngeal cancer with patients: An exploratory qualitative study of health professionals. Head Neck 38:394–401. 10.1002/hed.23916 Lingam AS, Koppolu P, Alhussein SA, Abdelrahim RK, Abusalim GS, ElHaddad S, Asrar S, Nassani MZ, Gaafar SS, Bukhary FMT, AlGhamdi AS, Barakat A, Noushad M, Almoallim H (2022) Dental Students' Perception, Awareness and Knowledge About HPV Infection, Vaccine, and Its Association with Oral Cancer: A Multinational Study. Infect Drug Resist 15:3711–3724. 10.2147/IDR.S365715 Additional Declarations No competing interests reported. Supplementary Files APPENDIXA.docx Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 26 Jun, 2024 Submission checks completed at journal 26 Jun, 2024 First submitted to journal 24 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4632572","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319161105,"identity":"d167acf0-47a3-4ff8-b721-d90f04013d01","order_by":0,"name":"Gennaro Musella","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Gennaro","middleName":"","lastName":"Musella","suffix":""},{"id":319161106,"identity":"4140d04a-5ecd-4641-baa8-f3c559a0b886","order_by":1,"name":"Simone Liguori","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDACZgglwwamDGygIgaEtfBAtaTBtODTA9UCpQ/DBHBrkW/nTnxcUMHAw8e/xvBxRcH5xO3svAc/MBT8wanF4DDvZuMZZ4AOk3hjbHjG4Hbizma+ZAl8DjNg5t0mzdsG0nLGTLIBqGXDYR4DvFrkm0Fa/sG1nANpMf6B1/uHQVoagFr4e0BaDoC0mOF3GMgvPMckgLawFRs2GCQbg7RYJBgY43ZY/9mNj3lqbOTk+w9vfNjwx052w/kzxjc+/JHD7TAIkACiBCR+Ag51qID/AFHKRsEoGAWjYAQCAIZjRRrEP9XAAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, 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Coppola","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Noemi","middleName":"","lastName":"Coppola","suffix":""},{"id":319161110,"identity":"a8d610b7-b673-4e33-8dce-5460149226e2","order_by":5,"name":"Federica Canfora","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Federica","middleName":"","lastName":"Canfora","suffix":""},{"id":319161111,"identity":"2870a799-b537-4029-b1f3-2c0dbb587e12","order_by":6,"name":"Andrea Blasi","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Periodontology Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Blasi","suffix":""},{"id":319161112,"identity":"cf63af62-3deb-48cc-820f-f9c7f3bddb07","order_by":7,"name":"Martina Mignogna","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Martina","middleName":"","lastName":"Mignogna","suffix":""},{"id":319161113,"identity":"4d45fdfd-cd55-4933-8dd0-b1dcd0612aae","order_by":8,"name":"Massimo Amato","email":"","orcid":"","institution":"Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, Baronissi","correspondingAuthor":false,"prefix":"","firstName":"Massimo","middleName":"","lastName":"Amato","suffix":""},{"id":319161114,"identity":"49d61604-2864-4b66-bb30-5f580b3e06e5","order_by":9,"name":"Vito Carlo Alberto Caponio","email":"","orcid":"","institution":"Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia","correspondingAuthor":false,"prefix":"","firstName":"Vito","middleName":"Carlo Alberto","lastName":"Caponio","suffix":""},{"id":319161115,"identity":"54eca944-4596-4bad-b1a5-7323c7c442fc","order_by":10,"name":"Michele Davide Mignogna","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Michele","middleName":"Davide","lastName":"Mignogna","suffix":""},{"id":319161116,"identity":"797638e2-b90b-4c7b-a763-a1768374cd99","order_by":11,"name":"Stefania Leuci","email":"","orcid":"","institution":"Department of Neuroscience, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, University of Naples Federico II, Naples","correspondingAuthor":false,"prefix":"","firstName":"Stefania","middleName":"","lastName":"Leuci","suffix":""}],"badges":[],"createdAt":"2024-06-25 00:05:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4632572/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4632572/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60706001,"identity":"c234e3e9-be76-4007-95a3-f744b9d81181","added_by":"auto","created_at":"2024-07-19 19:25:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":245818,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire assessing dental students’ knowledge on HPV-related OP-cancer. Statements used required one of the following responses: “true”/ “false”.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/ee0dc77b11912d38008b1aae.jpg"},{"id":60705369,"identity":"64ec9edd-62b6-4b0f-a278-2dbea44d8bf4","added_by":"auto","created_at":"2024-07-19 19:17:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":223737,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire assessing dental students’ knowledge on HPV infection. Statements used required one of the following responses: “true”/ “false”.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/e63c155fab46910c718a0a50.jpg"},{"id":60705365,"identity":"63f69225-9e86-41ed-bfa3-797e95c6307d","added_by":"auto","created_at":"2024-07-19 19:17:09","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":741476,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire assessing dental students’ knowledge on HPV vaccine. Statements used required one of the following responses: “true”/ “false”.\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/bd5e3dede6f869221b1a5daa.jpg"},{"id":60705367,"identity":"a58a077c-be5b-4421-90a6-ddcf25f04416","added_by":"auto","created_at":"2024-07-19 19:17:09","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":325718,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire assessing dental students’ perceptions on HPV-related OP-cancer, infection, and vaccine. Level of agreement to each statement was assessed by a five-point Likert scale: 1. strongly disagree; 2. disagree; 3. neither agree nor disagree; 4. agree; 5. strongly agree.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/d9484aef4b8b03191987908f.jpg"},{"id":60705368,"identity":"0c13965e-bf62-4d3b-ac37-2add7ac48976","added_by":"auto","created_at":"2024-07-19 19:17:09","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":207196,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire assessing dental students’ attitude on HPV-related OP-cancer, infection, and vaccine. Level of agreement to each statement was assessed by a five-point Likert scale: 1. strongly disagree; 2. disagree; 3. neither agree nor disagree; 4. agree; 5. strongly agree.\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/a7e8307c8f95b48daef4b6bf.jpg"},{"id":60707465,"identity":"3fe23fa1-ab98-4466-a198-e3db3db26609","added_by":"auto","created_at":"2024-07-19 19:33:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2638179,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/f2d1417e-e915-4dac-9b35-08bd4a4ffee1.pdf"},{"id":60705371,"identity":"b3119d47-3512-49c1-9b35-f874f4eab7ef","added_by":"auto","created_at":"2024-07-19 19:17:09","extension":"docx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":36264,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIXA.docx","url":"https://assets-eu.researchsquare.com/files/rs-4632572/v1/56e4137a7bbef1aa5c786aea.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, attitude and perception of Italian dental students toward HPV-related oropharyngeal cancer and vaccination: a cross-sectional study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHuman papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide, affecting approximately 75\u0026ndash;80% of sexually active people in their lifetime [1\u0026ndash;4]. While most infections are asymptomatic and resolve on their own within 1\u0026ndash;2 years, long-lasting or multiple reinfections, especially with high-risk strains, are associated with cervical, antenatal and oropharyngeal cancers (OP cancers) [5, 6]. Although the most common cause of HPV infection is cervical cancer, HPV is currently a major and increasingly common cause of head and neck cancers in both sexes[7\u0026ndash;10], with a rapid increase among males [11].\u003c/p\u003e \u003cp\u003eIt is estimated that 70% of OP-cancers are HPV+.[12] The incidence and mortality of OP-cancer are 757,000 new cases per year (M/F ratio of 2.5) and 367,000 deaths per year, respectively [13]. Currently, one of the main approaches for preventing HPV infection and related cancers is vaccination [14, 15]. Since clinical trials on the vaccine suggest that its efficacy is greater in HPV-na\u0026iuml;ve individuals, the ideal time for vaccination is before any sexual activity begins[16]. Indeed, all three vaccinations are approved for use in boys and girls from 9 years of age and are administered in 2\u0026ndash;3 doses [17].\u003c/p\u003e \u003cp\u003eAccording to data from the Behavioral Risk Factor Surveillance System, a considerable majority of individuals who have not received HPV vaccination have visited oral health care providers within the previous year, underscoring their potential importance in facilitating discussions about HPV, raising awareness, and promoting agreement on vaccination [18].\u003c/p\u003e \u003cp\u003eAmong health care providers, dentists could play a leading role in the primary prevention of HPV\u0026thinsp;+\u0026thinsp;OP-cancer by instructing patients and their parents about the risks of infection and spreading information on vaccination availability [19\u0026ndash;22], as recommended by the American Dental Association and the American Academy of Pediatric Dentistry [23]. This requires dental providers to be prepared to answer patients\u0026rsquo; questions about HPV infection and vaccines and to educate them about the connection between HPV and OP-cancer [24, 25]. However, discussions related to these issues were infrequent in the oral health care setting, which may be due to a lack of knowledge and communication skills among oral health care professionals [18, 26]. To address these gaps, dental students, as future health care providers, must be trained to increase public understanding of HPV\u0026thinsp;+\u0026thinsp;diseases, and establishing their level of awareness is the first step in evaluating whether it is necessary to strengthen educational training programs. KAP (knowledge, attitude, and perception) surveys are well suited for this purpose because of their simplicity in design, ability to generate quantifiable data, ease of interpretation and concise way in which the results can be presented. Furthermore, KAP surveys facilitate cross-cultural comparisons [27].\u003c/p\u003e \u003cp\u003eSince, to the best of our knowledge, no similar studies exist in the literature, the aim of this paper is to assess HPV knowledge, attitudes, and perceptions among Italian dental students.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy description\u003c/h2\u003e \u003cp\u003e The present study has been conducted by the Oral Medicine Unit, Department of Neuroscience, Reproductive and Oral Sciences of the \u0026ldquo;Federico II\u0026rdquo; University, Naples (Italy), in collaboration with the \u0026ldquo;Scuola Medica Salernitana\u0026rdquo;, Department of Medicine, Surgery and Dentistry, Salerno (Italy), from February 2023 to May 2023. The study is compliant with the ethical principles of the World Medical Association Declaration of Helsinki and the methods carried out in this study were approved by the Ethics Committee of the \u0026ldquo;Federico II\u0026rdquo; University of Naples, Italy (No. 437/20).. The students received a link via e-mail to participate in the self-administered online questionnaire via Google Forms, which included mandatory responses. Participation was voluntary, and consent was obtained online from all the participants. Since a validated instrument specifically designed to assess KAP related to HPV-related OP-cancer, HPV infection and vaccination among pediatric dentists has already been published [28], the present survey was conducted using the same validated questionnaire, adapting items only when necessary (\u0026ldquo;Attitude\u0026rdquo; section), to be appropriate for dental students. The time required to complete the questionnaire was 15 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDescription of the questionnaire\u003c/h2\u003e \u003cp\u003eThe questionnaire included four sections. The first part included 4 questions related to students\u0026rsquo; demographic data: gender, age range, graduation year attendance, and university geographical macroarea. The second part consisted of 48 statements and aimed to investigate the students\u0026rsquo; knowledge of HPV\u0026thinsp;+\u0026thinsp;cancer (statements 1\u0026ndash;18), infection (statements 19\u0026ndash;33), and vaccines (statements 34\u0026ndash;48). For this part, \u0026ldquo;true\u0026rdquo;/\u0026rdquo;false\u0026rdquo; dichotomous responses were used (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and knowledge statements were scored as correct (+\u0026thinsp;1) or incorrect (0), with the percentage of respondents answering correctly reported in the final analysis. The third and fourth parts consisted of 20 and 10 statements related, respectively, to the perceptions and attitudes of students about HPV\u0026thinsp;+\u0026thinsp;OP-cancer, infection and vaccination (Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). A five-point Likert scale for each statement was used with five answer options: 5. Strongly agree; 4. Agree; 3. Neither agree nor disagree; 2. Disagree; 1. Strongly disagree.\u003c/p\u003e \u003cp\u003eThe sample size for the study was calculated before the questionnaires were administered. With a 5% margin of error and a 95% confidence level, it was calculated that when the number of dental students in Italy was approximately 4000, the required sample size was 351.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSociodemographic factors were analyzed to determine the frequency distribution and relative frequencies of both dichotomous (gender) and nondichotomous categorical variables (age range, graduation year attendance and university geographical macroarea). To assess the participants\u0026rsquo; level of knowledge, the number and average number of correct answers were calculated; subsequently, a comparison was conducted using Pearson's chi-square test to evaluate the variations in correct answer ratios across different demographic characteristics. For nondichotomous categorical variables, an added post hoc analysis was performed when the chi-square test was used. An additional comparison was performed by grouping questions based on the same main topics (1\u0026ndash;18 for HPV\u0026thinsp;+\u0026thinsp;OP-cancer, 19\u0026ndash;33 for infection, and 34\u0026ndash;48 for vaccination). Regarding attitude and practice, the frequency distribution was evaluated, and a related comparison of the scores assigned to each question was performed with the Kruskal‒Wallis and Mann‒Whitney tests for nondichotomous variables and Pearson's chi-square test for dichotomous variables. The negative statements used in the attitude and perception questions were reverse coded to allow the statistical analysis of all the responses.\u003c/p\u003e \u003cp\u003eStatistical significance was determined by considering a p value of less than 0.05 for all conducted tests. For multiple comparisons, Bonferroni correction was used to adjust the p values accordingly.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSociodemographic data\u003c/p\u003e \u003cp\u003eA total sample of 412 dental students completed the questionnaire. The sample analyzed was almost equally divided into males and females, and the majority of participants were aged between 22\u0026ndash;23 years and were attending their 2nd or 4th year of university. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the sociodemographic characteristics by gender, age group, year of graduation and university geographical macro area. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the percentage of correct answers stratified by sociodemographic data.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic analysis of respondents who participated in the survey N\u0026thinsp;=\u0026thinsp;412.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNumber of students (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge range\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(26.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(30.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eAttendance\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(20.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(20.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eGeographical macro area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(34.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(32.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(33.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of correct responses on knowledge on HPV-related OP-cancer, infection, and vaccine, according to gender, age range, graduation year attendance and university geographical macro-area.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eKNOWLEDGE (CORRECT RESPONSE)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHPV\u0026thinsp;+\u0026thinsp;OP-Cancer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHPV Infection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHPV vaccine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge range (Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e71.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eAttendance (Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eGeographical macro-area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eHPV-Related OP-Cancer (Statements 1\u0026ndash;18)\u003c/h2\u003e \u003cp\u003eThe total percentage of correct answers for knowledge about HPV\u0026thinsp;+\u0026thinsp;OP-cancer was 67.0% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Over 50% of participants replied incorrectly to only 2 out of the 18 questions concerning knowledge of HPV\u0026thinsp;+\u0026thinsp;OP-cancer. These participants lacked awareness that papilloma and verruca vulgaris were not HPV\u0026thinsp;+\u0026thinsp;premalignant lesions (67.5% answered incorrectly) and that HPV\u0026thinsp;+\u0026thinsp;OP-cancer was not commonly preceded by recognizable premalignant lesions (62.1% answered incorrectly). More than 90% of the students surveyed knew that HPV can lead to cervical cancer and can produce the abnormal cervical cells found in the Pap test.\u003c/p\u003e \u003cp\u003eThe results of the chi-square test indicated that there was no statistically significant difference in gender distribution (p\u0026thinsp;=\u0026thinsp;0.733) or university geographical macroarea (p\u0026thinsp;=\u0026thinsp;0.349). However, significant differences were observed in terms of age range (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and graduation year attendance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post hoc analysis and p values are reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between the responses on Knowledge (HPV\u0026thinsp;+\u0026thinsp;OP-Cancer, Infection and Vaccine), Attitudes and Perceptions, and Socio-demographic characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMultiple comparisons\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKnowledge - HPV\u0026thinsp;+\u0026thinsp;OP-Cancer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKnowledge - Infection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eKnowledge -\u003c/p\u003e \u003cp\u003eVaccine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePerception\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.006*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Range (Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026le;\u0026thinsp;19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20\u0026ndash;21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.036*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e22\u0026ndash;23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e20\u0026ndash;21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e22\u0026ndash;23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.006*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e22\u0026ndash;23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge;\u0026thinsp;24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttendance (Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e1\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.036*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.023*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e2\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.006*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e3\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e4\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.020*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6\u0026deg;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographical macro-area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNorth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCentre\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSouth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCentre\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSouth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eHPV infection (Statements 19\u0026ndash;33)\u003c/h2\u003e \u003cp\u003eThe total percentage of correct answers for knowledge was 66.9% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Out of 15 questions, only 4 were incorrectly answered by more than 60% of the participants. These participants were unaware that infection transmission can be possible by any skin-to-skin contact (82.3% answered incorrectly); human papilloma virus may be transmitted among family members by kissing and digital contact (75.2% answered incorrectly); the majority of contagions can be cleared on their own within 1 to 2 years (58.7% answered incorrectly); and the percentage of sexually active individuals who acquire infection over the course of their lifetime was not 30% (62.9% answered incorrectly).\u003c/p\u003e \u003cp\u003eOn the other hand, more than 90% of the students knew that this infection occurred in both sexes.\u003c/p\u003e \u003cp\u003eThere were no statistically significant differences found in relation to gender (p\u0026thinsp;=\u0026thinsp;0.217) or university geographical macroarea (p\u0026thinsp;=\u0026thinsp;0.465) when using the chi-square test; instead, significant differences were observed for age range (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and graduation year attendance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the post hoc analysis and p values.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eHPV vaccine (Statements 34\u0026ndash;48)\u003c/h2\u003e \u003cp\u003eThe total percentage of correct answers for knowledge about the HPV vaccine was 74.3% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Out of 15 questions, only 3 were incorrectly answered by more than 50% of the participants. These participants wrongly held that vaccination was recommended for sexually active individuals (83.7% answered incorrectly); individuals were screened for infection before vaccination (61.7% answered incorrectly); and the vaccine efficacy remained the same regardless of age (54.1% answered incorrectly).\u003c/p\u003e \u003cp\u003eApproximately 90% of participants answered correctly concerning the recommendation of the vaccine before the start of sexual activity and the importance of continuing screening for infection despite vaccination.\u003c/p\u003e \u003cp\u003eUsing the chi-square test, statistically significant differences were observed in relation to all the demographic variables, except for university geographical macroarea (p\u0026thinsp;=\u0026thinsp;0.453): gender (p\u0026thinsp;=\u0026thinsp;0.006), age range (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and year of education (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The results of the post hoc analysis and the p values are reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePerception\u003c/h2\u003e \u003cp\u003eMore than 90% of dental students thought that dentists should educate their patients about the link between HPV and OP-cancer; more than 80% of participants considered the role of the dentist important in the prevention of infection and in the promotion of vaccination. Among the parental barriers to vaccine acceptability, 67.2% of the responders agreed or strongly agreed that patients\u0026rsquo; parents would decline vaccination due to a lack of adequate knowledge of sexually transmitted infection; however, only 45.1% and 34.2% agreed or strongly agreed that vaccine refusal can be due to fear of adverse effects and fear of encouraging sexual activity in their children, respectively.\u003c/p\u003e \u003cp\u003eUsing the Kruskal‒Wallis test, no statistically significant differences were recorded regarding age range (p\u0026thinsp;=\u0026thinsp;0.384) or university geographical macroarea (p\u0026thinsp;=\u0026thinsp;0.639), but statistically significant differences were observed in relation to graduation year attendance (p\u0026thinsp;=\u0026thinsp;0.003) and gender (p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAttitude\u003c/h2\u003e \u003cp\u003eMore than 85% of the participants agreed or strongly agreed with the periodically updated knowledge on HPV-related diseases by attending lectures/seminars/conferences and reading scientific papers; approximately 80% would feel comfortable talking about HPV\u0026thinsp;+\u0026thinsp;cancer, infection and vaccines with patients and their parents. Just over 50% of the respondents were not inclined to recommend the vaccine to either sex.\u003c/p\u003e \u003cp\u003eStatistically significant differences were detected in terms of age range (p\u0026thinsp;=\u0026thinsp;0.003), gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and graduation year attendance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but not in terms of university geographical macroarea (p\u0026thinsp;=\u0026thinsp;0.952). The results of the Mann‒Whitney test are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAll the frequencies and frequency distributions of the answers are reported in Appendix A (Tables A1-A5).\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSince the incidence of HPV\u0026thinsp;+\u0026thinsp;OP-cancer is increasing, dentists, in collaboration with other healthcare professionals, could play a key role in HPV prevention by recommending HPV vaccination to patients and discussing HPV infection and links to OP-cancer [20, 29]. Dental students, as future healthcare professionals, must have an adequate level of knowledge, along with a positive attitude toward vaccination and effective communication skills, to address this need.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge\u003c/h2\u003e \u003cp\u003eAmong the 3 subitems analyzed, the highest percentage of correct answers concerned knowledge of the vaccine (74.3%), followed by the HPV\u0026thinsp;+\u0026thinsp;OP-cancer and infection items, with values of 67.0% and 66.9%, respectively. This finding indicates increased interest among students in vaccination and highlights the intertwined relationship between awareness of HPV infection and understanding of HPV\u0026thinsp;+\u0026thinsp;OP-cancer. Furthermore, enhancing this knowledge is essential for improving dental care providers\u0026rsquo; role in HPV prevention and helping them discuss these topics with patients [24].\u003c/p\u003e \u003cp\u003eAlmost all interviewed students were aware of the possibility that HPV caused OP and cervical cancer, but only approximately 50\u0026ndash;60% knew that HPV caused anogenital cancer. This was certainly due to the higher prevalence of HPV\u0026thinsp;+\u0026thinsp;cervical and OP-cancer [8] and to the greater attention given to these cancers during the course of the studies. Therefore, awareness about the possibility of infection determining cancer in other anatomical sites should be implemented [30], strengthening knowledge in dental curricula. Statistically significant differences for all three subitems analyzed among students with different degrees were found, with higher percentages of correct responses from students enrolled in the last years of university agreeing with the published literature [31\u0026ndash;34].\u003c/p\u003e \u003cp\u003eAdditionally, statistically significant differences were found between the knowledge of the 1st and 2nd years and that of the 5th and 6th years. This is probably due to the information acquired by students during their 3rd and 4th years while attending various courses. Specifically, the infectious disease course equipped students with knowledge about HPV biology, the replication cycle, routes of infection, and HPV-associated diseases. In the dermatology course, both cutaneous and mucosal HPV-related benign lesions were identified. Furthermore, the oral pathology and head and neck pathology courses covered information on HPV\u0026thinsp;+\u0026thinsp;oropharyngeal cancer and vaccination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePerception\u003c/h2\u003e \u003cp\u003eOverall, the students showed good perceptions of their future role in combating HPV infection. In fact, 82.5% and 91.1% of participants agreed and strongly agreed, respectively, about the role of dentists in preventing infection and in educating patients on the link between HPV and OP-cancer. Additionally, 87.9% of respondents generally promoted vaccination in line with the published literature [31], which indicated that students were ready to debate it with their patients.\u003c/p\u003e \u003cp\u003eAlthough our sample demonstrated satisfactory knowledge of the 3 subitems, most of the students acquired more information on HPV\u0026thinsp;+\u0026thinsp;diseases during the attendance of the degree course, in agreement with Spanish, Dutch, Jordan and American students [31, 35\u0026ndash;37]. These data demonstrated the students' perception of wanting to learn as much as possible on this topic to correctly implement primary prevention against this infection in their future profession [38]. Moreover, 2 out of the 3 students surveyed thought that patients\u0026rsquo; parents were interested in prevention and would accept vaccination to prevent STIs and to avoid potentially carcinogenic infections, and when vaccination declined, they thought this was due to a lack of adequate knowledge of STIs. Parents\u0026rsquo; knowledge and opinions about vaccines are among the main factors that influence the decision to vaccinate [39]. Consequently, health professionals must develop and reinforce communication strategies for addressing parental concerns about vaccines to help them in their decision-making [40\u0026ndash;42]. In support of this, a study showed that 1 out of 5 parents agreed to vaccinate their sons against HPV after receiving a vaccine information sheet[43].\u003c/p\u003e \u003cp\u003eFurthermore, approximately 80% and 88% of the students agreed that the dentist has an important role in preventing HPV infection and should promote vaccination. Our results, coupled with those reported by Naavaal et al. in the American population [24], suggest that both future dentists and the general population are inclined to accept and integrate HPV prevention discussion into dental clinical practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAttitude\u003c/h2\u003e \u003cp\u003eAccording to Wright\u0026rsquo;s results, more than 2 out of the 3 sampled students felt comfortable talking about HPV\u0026thinsp;+\u0026thinsp;cancers, infection and vaccination with patients and parents [36]. Only approximately 50% of participants were inclined to recommend the vaccine regardless of sex, with a statistically significant difference in favor of women. This showed that students still need to raise awareness of the role of the vaccine in men, which is important for increasing immunization coverage and reducing HPV\u0026thinsp;+\u0026thinsp;diseases [44]. For HPV\u0026thinsp;+\u0026thinsp;cancer, most students agreed that they would routinely carry out oral cancer screening on their patients, in accordance with a Spanish survey [35]. This result was promising if we considered that a positive attitude in discussions about patient and early diagnosis strategies by dental professionals, who have a good knowledge background, could have a direct helpful impact on OP-cancer patient survival [45].\u003c/p\u003e \u003cp\u003eAlmost 90% of the students interviewed were inclined to periodically update their knowledge on HPV\u0026thinsp;+\u0026thinsp;diseases by attending education programs and reading scientific papers, according to Lingam et al. [46]. Therefore, educational training programs are necessary to achieve a better understanding of infection and its association with OP-cancer [37].\u003c/p\u003e \u003cp\u003eStatistically significant differences were found for perception and attitude in relation to both gender and graduation year attendance. Specifically, female students and students in their last years in a degree course demonstrated more positive attitudes and perceptions. For graduation year attendance, these results were expected considering that older students participated in internships and were more aware of the effects of HPV\u0026thinsp;+\u0026thinsp;diseases on patients' lives and that their perceptions and attitudes were supplemented by these internships.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study had limitations that should be considered. First, there is a potential risk of bias in the survey responses, as participants may have been inclined to respond according to the researcher's expectations, particularly in the \u003cspan refid=\"Sec12\" class=\"InternalRef\"\u003eAttitude\u003c/span\u003e section. Second, the nonmandatory nature of participation might have led to self-selection bias, with only the most knowledgeable students about HPV opting to participate. However, online surveys offer advantages over paper-based surveys, such as ensuring complete responses from participants, thus minimizing the risk of incomplete or inaccurate data that may arise from skipped questions.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe findings from the current study are encouraging, but students expressed the need to acquire more information about HPV infection and its link to oropharyngeal cancer and vaccines. Nevertheless, dental students are aware and well focused on integrating HPV prevention correctly and with appropriate knowledge into their daily practice. This confirms the crucial role of the dental profession in addressing HPV-related diseases and in raising awareness about the role of the HPV vaccine in preventing oropharyngeal cancers among the general population.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval Statement:\u0026nbsp;\u003c/strong\u003eEthics Committee of the \u0026ldquo;Federico II\u0026rdquo; University of Naples, Italy (No. 437/20).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u0026nbsp;\u003c/strong\u003eConceptualization, G.M., N.C. and S.L.; data curation, A.B, M.A. and F.C.; formal analysis, D.A., A.B. and M.M; funding acquisition: Si.L, M.M., F.C.; investigation, G.M., Si.L. and D.A.; methodology, V.C.A.C and T.C.; project administration, T.C. and F.C.; resources, M.M., M.A. and D.A.; software, V.C.A.C, Si.L. and A.B.; supervision, S.L and M.D.M; validation, M.D.M, S.L.; visualization, S.L. and M.D.M.; writing\u0026mdash;original draft, G.M., T.C. and N.C.; writing\u0026mdash;review \u0026amp; editing, S.L. and M.D.M. . All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts Of Interest Disclosure:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eEthics Committee of the \u0026ldquo;Federico II\u0026rdquo; University of Naples, Italy (No. 437/20).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eForman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, Vignat J, Ferlay J, Bray F, Plummer M, Franceschi S (2012) Global burden of human papillomavirus and related diseases. 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Infect Drug Resist 15:3711\u0026ndash;3724. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IDR.S365715\u003c/span\u003e\u003cspan address=\"10.2147/IDR.S365715\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Human Papillomavirus Viruses, Oropharyngeal Neoplasms, knowledge, attitude, KAP, Dental Students","lastPublishedDoi":"10.21203/rs.3.rs-4632572/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4632572/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide and is a leading cause of oropharyngeal cancer. This study aimed to carry out a KAP survey on HPV infection, HPV-related oropharyngeal cancer and HPV vaccination among dental students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Through an online self-administered questionnaire, data on dental students' sociodemographic characteristics, knowledge, attitudes and perceptions concerning HPV-related oropharyngeal cancer, infection and vaccination were acquired for a total of 82 questions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 412 dental students completed the questionnaire. The general knowledge rate was 69.5%. In terms of perception, the students provided good insight into their future role in combating HPV disease. Regarding attitudes, most participants felt comfortable talking about HPV topics with patients; however, only approximately 50% of them were inclined to recommend the vaccine regardless of sex. Compared with male and first-year students, female and last-year degree students demonstrated more positive attitudes and perceptions, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e:\u003cem\u003e \u003c/em\u003eThis study revealed that dental students have a solid understanding of and positive attitudes toward and perceptions of HPV+ oropharyngeal cancer and its prevention, highlighting their readiness to incorporate HPV prevention into their practice. This emphasizes the key role of the dental profession in addressing oropharyngeal cancer and HPV-related diseases and promoting awareness of the HPV vaccine among the population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Relevance\u003c/strong\u003e: By increasing dental students' awareness of HPV, they may be better equipped to educate patients about HPV, promote vaccination, and implement preventative measures. Additionally, the study highlights the need for targeted educational interventions to improve knowledge and attitudes, to enhance the overall public health impact.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitude and perception of Italian dental students toward HPV-related oropharyngeal cancer and vaccination: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 19:17:04","doi":"10.21203/rs.3.rs-4632572/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-06-26T07:08:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-26T07:08:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-06-25T00:04:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7aafd0b3-89f0-4575-8472-90d035b6a282","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-07-19T19:17:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-19 19:17:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4632572","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4632572","identity":"rs-4632572","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}