{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:24:37Z","timestamp":1787163877362,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,6,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sexual behavior is associated with human papillomavirus (HPV)\u2013positive head and neck cancer, whereas tobacco and alcohol use are associated with HPV\u2013negative cancer. A case\u2010control study was designed to investigate additional demographic and behavioral factors independently associated with these distinct oral cancers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From 2011 to 2014, 249 newly diagnosed oral cavity and oropharyngeal squamous cell carcinoma (OSCC) cases were matched (1:2) on age, gender, and self\u2010identified race to 498 controls without a cancer history attending the outpatient otolaryngology clinic at The Ohio State University in Columbus. Cases were stratified by detection of high\u2010risk HPV DNA and RNA in tumors. Demographic and behavioral data were collected using an audio computer\u2010assisted self\u2010interview, and associations with HPV\u2013positive versus HPV\u2013negative OSCCs were investigated by use of univariable and multivariable conditional logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjustment for oral sexual behavior, the odds of HPV\u2013positive cancer decreased with the patient's years of education. Annual income, tobacco smoking, alcohol drinking, marijuana smoking, and poor oral hygiene were not associated with HPV\u2013positive OSCC. In contrast, the odds of HPV\u2013negative OSCC increased independently with decreased annual income, decreased with a high number of marijuana hit\u2010years, and increased with fewer than annual dental visits after adjustment for lifetime tobacco and alcohol use. Sexual behavior and education were not associated with HPV\u2013negative OSCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The distinct risk\u2010factor profiles for HPV\u2013positive and HPV\u2013negative OSCC are confirmed and extended in this case\u2010control study, thus supporting 2 principal etiological pathways for OSCC development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay Summary<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Sexually acquired human papillomavirus (HPV) infection is an established cause of tonsil and base of tongue cancers. This study compared and contrasted risk factors for HPV\u2013positive and HPV\u2013negative oral cancers.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Low number of years of education and sexual behavior are associated with HPV\u2013positive cancer. In contrast, low annual income, infrequent dental visits, and tobacco and alcohol use are associated with HPV\u2013negative cancers.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Long\u2010term marijuana use appears protective for HPV\u2013negative cancer.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Public health efforts to address these modifiable risk factors may prevent oral cancer.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.33440","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T09:12:50Z","timestamp":1614071570000},"page":"2099-2110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Independent association of marijuana use and poor oral hygiene with HPV\u2013negative but not HPV\u2013positive head and neck squamous cell carcinomas"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1925-9712","authenticated-orcid":false,"given":"Jitesh B.","family":"Shewale","sequence":"first","affiliation":[{"name":"Department of Thoracic\/Head and Neck Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K. 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