Compared to other-race peers, Black women are disproportionately impacted by human papillomavirus [HPV] infection, related health outcomes, and cervical cancer mortality as a result of suboptimal HPV vaccine uptake during adolescence. Few studies in the United States have examined psychosocial determinants of HPV vaccine acceptability and hesitancy among Black parents. The current study integrated the health belief model and the theory of planned behavior to evaluate the extent to which psychosocial factors are associated with pediatric HPV vaccination intentions among this population.N = 402; age range = 25 to 69 years, M = 37.45, SD = 7.88) of daughters ages 9 to 15 years completed an online survey assessing HPV infection and vaccine beliefs and attitudes across four domains: Mother’s HPV Perceptions, Mother’s Vaccine Attitudes, Cues to Action, and Perceived Barriers to HPV Vaccination. Participants indicated their willingness to vaccinate their daughter on a 5-level ordinal scale (“I will definitely not have my daughter get the vaccine” to “I will definitely have my daughter get the vaccine”) which was dichotomously recoded for binomial logistic regressions.Black mothers  intended to vaccinate their daughter. Number of daughters, mother’s HPV vaccine status, perceived HPV vaccine benefits, HPV vaccine safety concerns, pediatric HPV vaccine peer norms, and doctor recommendations emerged as independent factors of Black mothers’ intentions to vaccinate their daughters against HPV when controlling for all other factors.In addition to medical training to increase doctor recommendation of the HPV vaccine for Black girls, population-tailored public health messaging aimed at promoting HPV vaccine acceptance among Black mothers is urgently needed. This messaging should engage community support and emphasize the benefits of vaccination for adolescent Black girls while also addressing parental concerns regarding the safety of pediatric HPV vaccination. AdolescNot all women face the same risk for HPV infection. In the United States, Black women are disproportionately impacted by the transmission of HPV, face greater risk of HPV-related outcomes ranging from genital warts to various cancers, and have the highest mortality rate of cervical cancer –12. DataVaccine hesitancy is the refusal or delay in the acceptance of a vaccination despite availability of the vaccine or vaccination services . StudiesBlack parents in the United States, however, have been severely underrepresented in research examining attitudes and beliefs regarding pediatric HPV vaccination. Most research in the United States has drawn on samples consisting of largely non-Hispanic white populations and has not examined potential racial/ethnic similarities or differences given small minority sample sizes. Consequently, little is known about the psychosocial factors underlying HPV vaccination intentions and related attitudes among Black parents. What is known about Black parents’ attitudes toward pediatric HPV vaccination primarily draws on a few qualitative studies. The themes reported in these studies suggest that Black parents are influenced by not only the constructs identified in the health belief and theory of planned behavior models, but also systemic barriers and sociocultural factors. For example, some Black parents report that although HPV-specific knowledge would be central to their decision-making process , they fe1.1.A key goal of the 2020 Global Strategy to Accelerate the Elimination of Cervical Cancer is the complete vaccination of 90% of girls between ages 9 and 15 by the year 2030 . As of J2.2.1.The current study surveyed Black female or woman-identifying primary guardians (referred to as “mothers” in this article) of adolescent young girls who have not received the HPV vaccine. We focus on mothers because research suggests they are typically the primary parent responsible for health care decisions regarding their children and make nearly 80% of these health care decisions , 47. Inc2.2.Data were collected between December 2021 and February 2022. Purposive recruitment of Black mothers across the United States was conducted by Qualtrics XM which sent emails to potential participants from survey panels of individuals interested in taking paid surveys. A 17-item screener determined eligibility based on age, gender, ethnicity/race, education level, parental role, age and gender of children, daughter’s HPV vaccine status (if applicable), and English competency. A total of 3,440 individuals responded to the Qualtrics XM email invitation and 516 (23.7%) individuals who began the screener were eligible based on inclusion criteria. The final sample included 402 participants who completed the full survey  based on items previously validated to examine perceived severity of HPV infection (α = 0.91).nfection . A highePerceived severity of HPV infection among daughters was assessed with three items  (α = 0.91).future”) . A highe2.3.3.General vaccination attitudes assessed parental attitudes about pediatric vaccines with four items measuring positive  and negative attitudes  (α = 0.79).ations”) . NegativPerceived benefits of the HPV vaccine were assessed with three items to measure parents’ perceptions of how effective the HPV vaccine is for preventing infection, genital warts, and HPV-related cancer  (α = 0.91). older”) . A higheHPV vaccine safety concerns were assessed using six items  (α = 0.94).on her”)  and an aon her”) . A higheMother’s self-efficacy regarding HPV vaccination was assessed with two items  (α = 0.84).accine”) . A highe2.3.4.Subjective norms in the community were assessed with a single composite score comprised of 7 items measuring whether parents believed community members  support HPV vaccination for young girls (α = 0.79).ng girls . A higheSubjective norms among mother’s peers were assessed with seven of eight items measuring parents’ perceptions of HPV vaccine acceptability among peers  (α = 0.88).accine”) . The addDoctor recommendation of HPV vaccine was measured with two items. The first item was created for the current study  and provided three response options . The second item assessed the perceived influence of doctor recommendations  (t HPV?”) . In the 2.3.5.Inaccessibility of the HPV vaccine was assessed with three items  (α = 0.76).inated”)  and a foinated”) . A higheCultural medical mistrust was assessed with the 12-item Group Based Medical Mistrust Scale (α = 0.90).st Scale  which inSexual risk taking and sexual stigma concerns were measured with two items  (α = 0.86).active”)  and an aactive”) . A highe2.3.6.Mother-specific demographics and characteristics included self-reported age, highest level of obtained education, employment status, annual household income and subjective financial security, number of daughters ages 9–15 years, HPV infection and HPV vaccine awareness, vaccine history including HPV vaccination status, and marital status and co-parent support, if applicable. Understanding of HPV infection and awareness of the HPV vaccine were measured with two dichotomous (yes or no) items . Partici2.4.A priori G*Power analyses were conducted to determine the size of the sample needed to detect a significant effect with an alpha level of p = 0.05 and a power level of 1 − β = 0.80 for a two-sided binomial logistic regression where the suggested sample size was 324. The current sample of 402 mothers is sufficient. There was no missing data in the current study. All analyses were conducted in SPSS 27. Variables were described with frequencies and percentages or means and standard deviations as appropriate. Likewise, all continuous variables were screened for outliers and normal distribution. Exploratory independent t-tests and Chi-square tests of independence with adjusted standardized residuals were conducted to preliminarily examine (a) demographics and participant  characteristics  eristics . A serieeristics . Lastly,eristics . Mother-3.3.1.SD = 7.88; 25 to 69 years old) and most attended college. A majority were employed at time of participation. However, there was considerable variability in annual household income across the sample although half of the sample subjectively rated their financial situation as “I have just enough.” Nearly 60% of participants lived in the Southern United States. At time of data collection, nearly all of the participants had previously heard of the HPV infection and were aware that there was an HPV vaccine. However, less than a third of mothers were themselves vaccinated against HPV. Further, out of a total of 11 recommended vaccines, mothers received about 6 vaccines on average (SD = 3.10). Vaccination uptake ranged from 36% to approximately 78% with the MMR  vaccine being most reported . Half of the mothers also reported receiving the most recent flu vaccine  and the COVID-19 vaccine . Half of the sample also indicated experience or familiarity with abnormal pap smear results and about 60% had experience or familiarity with STIs; however, most reported no experience or familiarity with genital warts or HPV-related cancer diagnoses.SD = 2.05). Approximately 60% of the daughters were between 9 and 12 years old and 40% were between 13 and 15 years old. The age of oldest daughters  was significantly older than only daughters , t (400) = −6.18, p < 0.001. Most daughters received public health insurance and about 40% had at least one preexisting health condition; most common was asthma . Out of a total of 10 recommended pediatric vaccines, daughters received about 6 vaccines on average (SD = 3.10). Routine vaccination uptake ranged from 40% to approximately 79% depending on the vaccine with the varicella  and MMR  vaccines being most reported. Just over two-thirds of participants (61.9%) reported sharing parenting responsibilities with a co-parent.More than 80% of participants had only one daughter between the ages of 9 and 15 years old. Participants with more than one daughter in this age range reported on their oldest daughter between the ages of 9 and 15 years. On average, daughters were 11.86 years old (3.2.N = 402) was approximately equal with 48% (n = 193) of mothers intending to and 52% (n = 209) of mothers not intending to vaccinate their daughters. Differences in demographics and participants characteristics across HPV vaccination intentions are reported in The sample (3.3.3.4.As shown in 4.In the current study, 48% of mothers intended to vaccinate their daughter while 52% did not. HPV vaccine acceptability varies in this population where endorsement ranges from 44–70% . IntentiAmong the various mother-specific and daughter-specific covariates considered in our multivariable model, mother’s HPV vaccine status and number of daughters reported by participants retained significant associations with vaccination intentions when controlling for all other factors. Mother’s HPV vaccine status, specifically, had the largest effect on HPV vaccination intentions than any other factor with a 300% increase in odds. As such, family health practitioners and women’s health care providers should actively involve mothers and other female guardians in efforts to promote HPV vaccination among this population. These efforts might include taking opportunities to provide catch-up vaccinations for eligible younger mothers and utilizing cervical cancer screenings as opportunities to promote and recommend the vaccine for adolescent daughters. On the other hand, intentions to vaccinate were lower among mothers with more than one daughter ages 9–15. This finding likely indicates difficulty navigating the HPV vaccination process for multiple eligible daughters. As such, providers should utilize evidence-based strategies to support mothers navigating this process including screening patient charts and flagging daughters eligible for the vaccine prior to health visits, administering vaccines to all eligible daughters at a single visit, and utilizing reminder/recall messages to keep the family engaged in completing the HPV vaccine series .4.1.HPV knowledge did not have as strong an association as anticipated, with over 80% of mothers indicating higher levels of knowledge about HPV and the HPV vaccine than expected based on prior research (research . Rather,research , 38, 39,research , 61, ourresearch , especiaresearch  and provresearch . Consistresearch , however4.2.Mother’s Vaccine Attitudes explained the largest percentage of variance in HPV vaccination intentions among this sample. The significant effects of HPV vaccine benefits and HPV vaccine safety are consistent with qualitative work conducted among Black parents that demonstrate the value of the HPV vaccine as a tool to protect Black young girls from severe outcomes like genital warts and cancer, despite parents’ skepticism, concern, and mistrust in response to the relative newness of the vaccine and perceived potential harm to fertility and other long-term or future health consequences (equences –38, 40. equences . These mequences . Safety equences , 31, 33.equences . Public equences . Parentsequences . Such meequences , 70. Pub4.3.Cues to Action, including community and peer norms and physician recommendations, also had significant bivariate associations. Although community norms did not retain an independent effect in multivariate analysis, mother’s peer norms and doctor’s recommendation of the HPV vaccine did. When controlling for all other factors, the effect of peer support and doctor’s recommendation increased the odds of intending to vaccinate by 67 and 15%, respectively. These findings reflect previous qualitative work describing how Black mothers valued support of the HPV vaccine from other parents and church leaders in the community (Factors associated with ommunity  and welcommunity –41, 70. ommunity . For thiommunity  and alsoommunity , 74. Conommunity –78.4.4.Perceived Barriers were associated with vaccination intentions in unadjusted analyses but did not significantly add to the multivariable integrated model. Consistent with previous research, perceived inaccessibility of the HPV vaccine was negatively associated with HPV vaccination intentions in bivariate analyses (analyses , 27, 29.analyses , 70. In analyses . Messageanalyses , 38, 39.analyses , 27, 33.analyses , 81. Paranalyses . This tyanalyses .5.This study is unique in that it surveys a relatively large sample of Black mothers with unvaccinated daughters, and therefore, contributes a much-needed quantitative evaluation of Black mother’s attitudes and beliefs regarding vaccinating their young daughters against HPV infection. However, the results presented here must be interpreted within the limitations of the study. Findings are based on cross-sectional data which cannot examine longitudinal causal effects of the hypothesized predictors on intentions to vaccinate against HPV nor can the study confirm a positive relationship between plans to vaccinate and actualized vaccine uptake among this population. Further, participant recruitment and participation were conducted entirely online, and consequently, participation was limited to individuals with access to the internet on web-enabled devices and who frequently participate in online surveys for compensation. As a result, the current study may not have reached those who do not have access to the internet or are not engaged in online survey-taking. Further, demographic data suggest that while there is considerable representation across household income, a majority of the sample complete one or more years of college. Therefore, the HPV attitudes, beliefs, and vaccination intentions of those who have obtained less education may not be adequately captured in the current study. Additionally, 58.7% of the sample resided in the Southern U. S. states. However, there was no significant effect of region on HPV vaccination intentions, and further, this percentage is nationally-representative and mirrors estimates that 58.7% of the United States Black population lives in the South .6.Early HPV vaccination is associated with greater vaccine efficacy and improved population-level coverage . HoweverThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Fordham University IRB. The patients/participants provided their written informed consent to participate in this study.AG and CF: conceptualization, methodology, and funding acquisition. AG: writing-original draft, data visualization, and formal analysis. CF: supervision & mentorship and writing-review & editing. All authors contributed to the article and approved the submitted version.This study was supported by funding from the Center for Ethics Education at Fordham University, the American Psychological Association Division 38 Graduate Student Research in General Health Psychology Award, and the PSI CHI Mamie Phipps Clark Diversity Research Grant.The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The present study can be useful in preliminary design stage before performing rigorous and expensive numerical or experimental study.Failure of pipelines below road pavement results to the disruption of both the traffic movement and the consumers of the pipelines. Intermediate safeguard layer can be used to protect the pipeline from heavy traffic loads. The present study proposed analytical solutions to obtain the dynamic response of buried pipe below road pavement with and without considering safeguard based on the concept of triple and double beam system respectively. Pavement layer, safeguard and the pipeline are considered as Euler Bernoulli’s beam. Advanced soil model is used (viscoelastic foundation with shear interaction between springs) to model the surrounding soil. Self-weight of soil is also considered in the present study. The obtained governing coupled differential equations are solved adopting finite sine Fourier transform, Laplace transform and their inverse transformation. The proposed formulation is initially verified with the past numerical and analytical studies and then validated with the three-dimensional finite element based numerical analysis. From parametric study it is perceived that the stability of the pipe can be significantly increased by providing intermediate barrier. Further, pipe deformation is increases with increasing traffic loads. At very high-speed range (> 60 m s Hence, it is essential to ensure the safety of the underground pipelines below the road pavement. The pipeline should resist both the overburden soil pressure and live traffic loads. Alzabeebee et al.4 carried out 3D numerical analysis to investigate the response of polyvinyl chloride (PVC) and concrete pipe under UK standard traffic loads. The combined effect of traffic load and ground water fluctuations on underground concrete pipes has been investigated by Li et al.5 through 3D finite element based numerical analysis. It was observed that the pipe stress and vertical deflection are directly proportional to the permeability co-efficient and void ratio. Alzabeebee et al.6 performed a comparative numerical analysis to study the impact of static and moving traffic loads on buried pipes. From numerical analysis, it was observed that the effect of soil plasticity on pipe response is negligible for the particular adopted condition and static traffic loads provides higher pipe deformation compared to moving traffic loads. Further, Xu et al.7 examined the longitudinal response of a 1.4 m diameter jointed  reinforced concrete pipeline under traffic loads. The study was carried out numerically using finite difference based program FLAC-3D. It was noticed that the pipe response significantly changes with soil stiffness. However, the impact of gasket stiffness on longitudinal pipe response was minor. The influence of moving traffic load on the response of buried pipe in cohesionless soil was studied through both 3D numerical and centrifuge modeling by Saboya et al.8. Rakitin and Xu9 performed centrifuge tests on large diameter (1.4 m) buried pipelines under heavy traffic loads (up to 850 kN). Maximum unfavorable condition was achieved when the heaviest axle was just above the pipe crown. With increasing soil cover depth initial bending moment of the pipe was increased due to soil weight but moment due to traffic load was significantly reduced. The behaviour of buried culvert subjected to different loading condition including traffic loading is also assessed by performing field test and full-scale laboratory test11. However, underground utilities  can be protected from external live loads such as traffic loads or loads generated from permanent ground deformation by providing suitable barrier system. For instance, EPS geofoam can be used as a barrier to protect underground pipes or culverts from additional stresses induced from external dead or live loads12. Concrete cap or protective reinforced slab can also be used to protect the pipeline below highway from surface loads or dig-ups13. Moreover, experimental and numerical studies are conducted on geocell reinforced soil to protect the underground pipelines from traffic loads17. Another important aspect of underground projects is the rockburst incident. Researchers are proposed various prediction model to predict the rockburst hazard20. Robert et al.21 conducted both field and numerical study to obtain the response of underground water pipes subjected to traffic loads.Pipelines act as veins across the country and are the main means of transportation for a variety of things including water, oil, natural gas, telecommunication and electricity lines. Pipelines are generally buried below the ground surface due to the scarcity of unused land, to maintain smooth operation of modern urbanization and to protect from damage due to vandalism. In urban areas pipelines are often placed below the road pavement. Deformation of pipelines below the road pavement due to moving traffic load cause the inconvenience of the traffic movement. Further, if pipeline fails it may lead to the disruption of whole pipe network, discomfort of the consumers, source of firing and leads to a disaster depending on the substance carrying by the pipelines. For viz. failure of water pipeline below the pavement may results small leaks without effecting the pavement, water leakage through the pavement, uplifts the pavement, or cavity generation below the pavement22 investigated the critical speed of high-speed rail considering the theory of beam on elastic foundation. The limitation of the study is that it did not incorporate the system damping and any shear interaction between elastic springs. Yin23 performed an analytical study for reinforced beam on single parameter elastic foundation subjected to a point load. Chaudhuri and Choudhury26 proposed different simplified theoretical solutions for buried pipe subjected to ground deformation resulting from seismic landslide, horizontal transverse ground deformation, and static pipe bursting underneath respectively. The prior studies were conducted considering pipe as Euler Bernoulli’s or Timoshenko beam and soil as single parameter Winkler or 2-parameter Pasternak foundation. Adopting the similar concept of beam-spring model Wu et al.27 and Chaudhuri and Choudhury28 examined the dynamic behaviour of buried pipe subjected to surface and subsurface blast loads respectively. Further, Zhang et al.30 investigated the response of pavement structure on geocell reinforced embankment under vehicle loads (concentrated loads and moving load respectively) using double beam model. As per the author’s knowledge closed-form analytical study on pipe below road pavement with and without intermediate safeguard is not available in the literature. In this regard, the present study proposed closed form solutions for buried pipe with and without protective layer below the pavement structure subjected to moving traffic load by idealizing the problem as triple and double beam system respectively. Soil is idealized as advanced soil model, i.e., viscoelastic foundation with shear interaction between distinct springs. The self-weight of the soil above the pipe and the safeguard layer is also considered. After conducting verification studies with the past numerical and analytical works and a validation study with three-dimensional finite element based numerical analysis, a parametric study is carried out to understand the advantage of protective layer and the impact of traffic load and traffic velocity on pipe response for both barrier and without barrier system.Apart from full scale experimental and three-dimensional numerical analyses, another alternative way of solving complex soil-structure interaction related problem in a simplified way is the analytical approach which is based on beam spring concept. For instance, Kausel et al.The main contribution of the present study is the proposed closed-form solutions to obtain the response of pipe under traffic load with and without considering intermediate safeguard layer. In literature, no such analytical solutions are available. In industrial applications or in the preliminary design stage of buried pipe below road pavement, proposed solutions can be used to get quick and approximate results with moderate accuracy. Simply putting the input values and following the flowchart as depicted in Fig. L) is taken as sufficiently long to avoid the influence of boundary conditions on peak pipe responses. The present study proposed a generalized formulation considering different layers of soil in between the beams. In Fig. K1, K2, K3, C1, C2, C3, and G1, G2, G3 respectively. m1, m2, m3 and D1, D2, D3 are the mass per unit length and flexural rigidity of the top, mid and bottom beam respectively. γ1, γ2 and h1, h2 are the unit weight and thickness of the top and mid soil layer respectively. Similarly, in Fig. K1, K2, C1, C2 and G1, G2 respectively. m1, m2 and D1, D2 are the mass per unit length and flexural rigidity of the top, and bottom beam respectively. γ and h are the unit weight and thickness of the top soil layer respectively. For simplicity, the outputs of the present study are obtained considering identical soil stiffness. Following equations are used for calculating soil stiffness, shear parameter and damping coefficients32.Es and B are the Young’s modulus of soil and width of the beam respectively, γ is the rate at which the vertical displacement in the ground diminishes with depth, νs and ξ are the Poisson’s ratio of soil and damping ratio respectively.Figure The current study proposed analytical solutions for the buried pipe with and without safeguard below the road pavement. The coupled differential equations and corresponding solutions for both the prior mentioned cases are stated in the subsequent sections.Fmax is the maximum traffic load and V is the traffic velocity.The governing coupled differential equations of top (pavement), mid (safeguard) and bottom (pipe) beam as shown in Fig. xn = 1, 2, 3, ….First, finite sine Fourier transform is applied to solve the coupled differential equations. The finite sine Fourier transform for spatial co-ordinate For simply supported beams as shown in Fig. The following equations can be obtained after performing finite Sine-Fourier transform on both sides of Eqs. –6)11\do11\do6)11t can be expressed ass is the transformed variable of time (t). At initial condition  both displacement and velocity will be zero. Taking Laplace transformation with respect to t on both sides of Eqs. , th, tht canEquations –18) can can18) cNow, performing finite Sine-Fourier inverse transformation following expression is obtainedFinally, beam’s deflection response in space and time domain can be obtained by conducting Laplace inverse transformation of Eq. 22\documeFor the case of pipe without safeguard as shown in Fig. Similar to preceding section, for simply supported beams Fig. b, the avApplying finite Sine-Fourier transform on both sides of Eqs.  and 24)24), follt on both sides of Eqs. (Taking Laplace transformation with respect to  of Eqs.  and 28)t on bothEquations –30) can can30) cPerforming finite Sine-Fourier inverse transformationNow performing Laplace inverse transformation of Eq. , followiThe flowchart of the present methodology for both pipe with and without safeguard below pavement subjected to traffic load is depicted in Fig. 33 and Jiang et al.34. Jiang et al.34 investigated the dynamic response of multi-layer beams interconnected by Winkler springs subjected to moving load to simulate the railway track system. Jiang et al.34 verified the proposed analysis with the results of a triple beam-spring system under moving load performed by Yulin et al.33. Yulin et al.33 conducted both analytical solution and numerical analysis using ANSYS software. The detail parameters used for the analysis are listed in Table −1 and compared with the past analytical and numerical studies as depicted in Fig. −1 is compared with the results obtained by Yulin et al.33 and is shown in Table The present analysis is verified with past numerical and analytical studies performed by Yulin et al.−1 is considered. Both the cases namely, the pipe with and without intermediate barrier system as depicted in Fig. Moreover, in the present study a three-dimensional finite element based numerical analysis is performed using PLAXIS 3D to validate the proposed analytical formulation. The soil, pavement layer and the barrier layer have been modeled using 10-noded tetrahedral elements. Plate elements are used to model the buried pipeline. A typical soil domain with model dimensions and mesh discretization is shown in Fig. The benefit of providing intermediate safeguard and the influence of traffic load and traffic velocity on buried pipe response considering both barrier and without barrier system has been investigated in the subsequent sections. The soil, pipe, barrier, pavement and traffic parameters are listed in Table −1 are shown in Fig. Mid-span deflection time history for both triple beam (with barrier) and double beam (without barrier) system subjected to moving traffic load with velocity 30 m sTo study the impact of traffic loads on pipe response, traffic load is increased from 100 to 500 kN with an increment of 50 kN keeping all other parameters are fixed as shown in Table −1 keeping all other parameters are constant. From Fig. −1, peak pipe displacement for with and without barrier system are 2.13 mm and 11.49 mm respectively. However, considering the feasible range of highway traffic speed, it can be concluded that the influence of traffic velocity on peak pipe response is negligible.To understand the influence of traffic velocity on pipe response, velocity is increased up to 80 m s33 and Jiang et al.34. The analytical study is also validated with 3D finite element based program PLAXIS 3D. Further, a parametric study is conducted to investigate the benefit of using intermediate safeguard layer and the impact of traffic load and traffic velocity on buried pipe’s response. Following are the salient inferences from the present study:The proposed simplified formulation can be used to inspect the response of buried pipe subjected to traffic loads.Suitable intermediate barrier system can be provided to protect the pipelines from traffic loads.Pipe deformation is increases with increasing traffic loads.The influence of traffic speed on pipe response is negligible considering the possible range of highway traffic speed.−1), pipe deformation is significantly rises with increasing the traffic speed.At very high range of traffic velocity (> 60 m sThe current study proposed closed-form analytical solutions for buried pipe with and without intermediate defensive layer below road pavement. The pavement structure, intermediate safeguard layer and pipe are modelled using Euler Bernoulli’s beam. Traffic load is considered as moving point load. The soil is idealized as viscoelastic foundation with shear interaction between individual springs. The self-weight of the soil is also considered in the study. The finite sine Fourier transform, Laplace transform and their inverse are used to solve the obtained coupled governing differential equations. The proposed formulation is verified with the past numerical and analytical studies performed by Yulin et al.The study can be further refined considering the plasticity and non-linearity of pipe and soil materials. The effect of ground water table can also incorporate as future scope of work. Further, pipe can be better replicated using shell elements instead of beam as beam is not able to simulate the pipe ovalization phenomenon.


Does human papillomavirus (HPV) awareness differ by educational attainment and race and ethnicity?In this cross-sectional study of the Health Information National Trends Survey (2017-2020) data among US adults, HPV awareness varied by educational level and by race and ethnicity. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational level and by race and ethnicity; less than one-third of the population knew HPV could cause noncervical cancers, which differed by educational level but not by race and ethnicity.These findings suggest that educational attainment and race and ethnicity should be considered when designing HPV campaigns to expand knowledge opportunities for HPV-related cancers prevention. This cross-sectional study assesses the weighted prevalence of human papillomavirus awareness by educational attainment and race and ethnicity among US noninstitutionalized adults. Understanding disparities in human papillomavirus (HPV) awareness is crucial, given its association with vaccine uptake.To investigate differences in HPV awareness by educational attainment, race, ethnicity, and their intersectionality.This cross-sectional study used the Health Information National Trends Survey (HINTS) 5 cycles 1 to 4 data . The data were analyzed from December 12, 2022, to June 20, 2023. A sample of the noninstitutionalized civilian US population 18 years or older was included in the analysis.Weighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cancer, stratified by educational attainment and by race and ethnicity. Interaction between educational attainment and race and ethnicity was assessed using a Wald test.A total of 15 637 participants had educational attainment data available; of these, 51.2% were women, and the median age was 58  years. A total of 14 444 participants had race and ethnicity information available; of these, 4.6% were Asian, 13.9% were Black, 15.3% were Hispanic, 62.6% were White, and 3.6% were of other race or ethnicity . Awareness of HPV by educational attainment ranged from 40.4% for less than high school to 78.2% for college or higher; awareness by race and ethnicity ranged from 46.9% among Asian individuals to 70.2% among White individuals. Awareness of HPV vaccines across educational attainment ranged from 34.7% among those with less than high school to 74.7% among those with a college degree or higher and by race and ethnicity from 48.4% among Asian individuals to 68.2% among White individuals. Among adults who were aware of HPV, knowledge that HPV causes cervical cancer differed by educational attainment, ranging from 51.7% among those with less than high school to 84.7% among those with a college degree or higher, and by race and ethnicity, ranging from 66.0% among Black individuals to 77.9% among Asian individuals. The interaction between educational attainment and race and ethnicity on HPV awareness and HPV vaccine awareness was not significant; however, within each educational attainment level, awareness differed by race and ethnicity, with the lowest awareness consistently among Asian individuals regardless of educational attainment. Within each racial and ethnic group, HPV awareness and HPV vaccine awareness significantly decreased with decreasing educational attainment.Disparities in HPV awareness were evident across social factors, with the lowest awareness among Asian individuals and individuals with lower educational attainment. These results emphasize the importance of considering social factors in HPV awareness campaigns to increase HPV vaccination. Intersectionality refers to the compounding effect of several social attributes that may result in widening disparities and inequalities.24 It is essential to recognize that race and ethnicity, although crucial factors, serve as proxies for many unmeasured social and structural variables. These variables may encompass factors such as access to health care, socioeconomic status, cultural influences, and systemic bias, which play a pivotal role in shaping individual awareness and knowledge related to HPV.Although many US-based studies report prevalence of HPV awareness and knowledge either by educational level aloneWe estimated the weighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV can cause cancer, by educational attainment, race and ethnicity, and the intersection of educational attainment and race and ethnicity during 2017 to 2020. As a secondary analysis, we assessed temporal trends across survey cycles to examine whether HPV awareness and knowledge by educational attainment and race and ethnicity have improved in recent years.25 Participants were chosen through a complex stratified, random sampling procedure among households from a nationwide list of addresses. The survey includes adults 18 years or older in the civilian, noninstitutionalized US population. HINTS collects information on the knowledge of, attitudes toward, and use of health-related information. Regarding HPV, the survey includes questions about HPV awareness, HPV vaccine awareness, and knowledge of HPV-related cancers. We restricted the analysis to cycles 1 to 4 because these surveys included overlapping questions on HPV awareness and knowledge.We used self-reported data from the Health Information National Trends Survey (HINTS), obtained by merging HINTS-5 cycles 1 to 4 . HINTS is a nationally representative survey that is administered by the National Cancer Institute through mailed questionnaires.STROBE) reporting guideline. Additional information on the HINTS survey design and methodology are found elsewhere.25HINTS was reviewed by the Westat Institutional Review Board and was deemed exempt from review and informed consent by the US National Institutes of Health Office of Human Subjects Research Protections. Our study used publicly available data with deindividualized information and followed the Strengthening the Reporting of Observational Studies in Epidemiology (Our primary outcomes were (1) awareness of HPV and HPV vaccines and (2) knowledge that HPV causes cancers of the cervix, penis, anus, and oropharynx, as measured by questions in eTable 1 in Our main independent variables were (1) highest level of educational attainment  and (2) self-reported race and ethnicity   were excluded from the education-stratified analysis, and those with missing race and ethnicity data (10.2%) were excluded from the race and ethnicity–stratified analysis  and 95% CIs were estimated using logistic regression, adjusting for confounders determined a priori, including age group, sex, marital status, and race and ethnicity. For the race and ethnicity–stratified analysis, AORs were calculated, adjusting for age group, sex, marital status, and educational attainment. To determine whether there was a linear association between educational attainment and HPV awareness and knowledge, To examine the intersection of educational attainment and race and ethnicity, we estimated weighted prevalence of HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cervical cancer for each racial and ethnic group across each educational attainment level. Questions regarding penile, anal, and oral cancer were not included in the intersection analysis due to lack of power; the overall prevalence of knowledge that HPV causes noncervical cancers was low. The interaction between educational attainment and race and ethnicity on HPV awareness and knowledge outcomes was assessed using a Wald test, adjusting for age group, sex, and marital status.P < .05 was considered statistically significant. All analyses were conducted using Stata, version 17, software (StataCorp LLC).Last, we estimated temporal trends in HPV awareness and knowledge for all outcomes across the survey cycle for each educational level and race and ethnicity using logistic regression, treating survey cycle (year) as a continuous variable. Due to small sample sizes of participants obtaining an educational level of less than high school after stratifying by race and ethnicity, we grouped the last educational category as high school graduate or less for both the intersection analysis and the time trends analysis. Two-sided A total of 15 637 HINTS participants had data on educational attainment; of these, 51.2%  were women and 48.8%  were men . Most ofP < .001 for trend), from 78.2%  for individuals with a college degree or higher to 40.4%  for individuals with less than high school (P = .03 for trend); HPV vaccine awareness remained stable across survey cycles for all educational attainment levels. (P = .002 for trend). Across survey cycles, knowledge that HPV causes cervical cancer significantly declined over time for all educational levels, most notably for individuals with a high school education or less . . . Knowled trend). .P < .001 for heterogeneity), ranging from 46.9%  for Asian individuals to 70.2%  for White individuals (P = .005 for trend) (P = .02 for heterogeneity), ranging from 66.0%  for Black adults to 77.9%  for Asian adults (P = .15 for heterogeneity)  . Among an adults . Among ageneity)  and remageneity) .P < .001 for heterogeneity). Among each racial and ethnic group, lower levels of educational attainment were associated with less HPV awareness and HPV vaccine awareness; for example, among Hispanic individuals, 80.5%  with a college degree or higher were aware of HPV compared with 45.0%  with a high school education or less (P < .001 for trend). Among adults who were aware of HPV, knowledge that HPV can cause cervical cancer differed by race and ethnicity among those with a college degree or higher  and those with some college education  but did not differ by race and ethnicity among participants with a high school education or less . Among each racial and ethnic group, lower levels of educational attainment were associated with less knowledge that HPV can cause cervical cancer (P < .05 for trend), except for Asian participants and participants of other race or ethnicity.The interactions between educational attainment and race and ethnicity on HPV awareness, HPV vaccine awareness, and knowledge that HPV causes cervical cancer were not significant; however, disparities in HPV awareness and knowledge still existed across each intersection . SpecifiIn this large, nationally representative cross-sectional study of US adults, we observed significant differences in HPV awareness and knowledge by levels of educational attainment and race and ethnicity during 2017 to 2020. Individuals with lower educational attainment and those from a minority racial and ethnic group were less aware of HPV and the HPV vaccine compared with those with higher educational attainment and White individuals. While a large proportion of adults who were aware of HPV knew HPV could cause cervical cancer (74.5%), less than one-third of individuals knew HPV could cause noncervical cancers. Additionally, knowledge of HPV’s causal role in noncervical cancers has not improved over time during recent survey cycles for any level of educational attainment or race and ethnicity.27 Studies have also demonstrated very low prevalence of knowledge that HPV causes penile, anal, and oropharyngeal cancer (approximately 30%).27 To expand on the foundation set by these prior studies among adults overall, our study more granularly investigates knowledge differences across sociodemographic groups to elucidate knowledge gaps and disparities. Specifically, HPV vaccine awareness was as low as 34.7% among individuals with less than high school education compared with 74.7% among individuals with a college degree or higher; these differences were masked by overall estimates of HPV vaccine awareness. By race and ethnicity, HPV vaccine awareness was as low as 48.4% among Asian individuals compared with 68.2% among White individuals. Most notably, when looking within cross-strata of educational attainment and race and ethnicity, only 27.4% of Asian individuals attaining a high school education were aware of the HPV vaccine, which emphasizes the importance of considering multiple identities to adequately address population-level knowledge gaps and heath disparities.Our results corroborate studies that have demonstrated approximately 65% of US adults are aware of HPV and the HPV vaccine, and among those who are aware of HPV, approximately 70% know that HPV can cause cervical cancer.29 Our results suggest that this systemic issue may have contributed to observed disparities in HPV awareness and knowledge among individuals with lower educational attainment and individuals from racial and ethnic minority backgrounds. Educational attainment and racial and ethnic identification are highly correlated through mechanisms rooted in structural racism.31 Historical and commemoratory injustices in education, including disparities in school funding, biased disciplinary practices, and unequal resource allocation, have created substantial barriers to educational attainment for some racial and ethnic groups.31 Studies show the importance of access to community health and resource centers that provide access to education, financial resources, and pathways for HPV vaccination and risk prevention.33 By acknowledging the compounding impact of educational disparities and structural racism, we can better understand how to disseminate resources equitably among groups with less HPV awareness and knowledge.Our results highlight the compounding effects of educational attainment and race and ethnicity. However, social constructs such as race and ethnicity also serve as proxies for outcomes such as lower educational attainment due to the influence of historical and pervasive oppression, including institutional and systemic racism. These forms of discrimination are deeply embedded into US society and have perpetrated unequal allocation of resources such as quality health care, education, and economic opportunities for racial and ethnic minority groups.34 only 1 in 4 US adults attaining a high school education or less who were aware of HPV knew that HPV could cause anal cancer. Currently, national screening recommendations are not available for noncervical HPV-driven cancers, such as anal and oropharyngeal cancer, which may contribute to the lack of knowledge and awareness about these cancers in general.We found no improvement in knowledge of HPV’s causal role in cancer, which presents a pressing need to improve education surrounding HPV-associated cancers. Specifically, knowledge that HPV can cause noncervical cancers did not significantly change from 2017 to 2020 for all educational attainment levels and racial and ethnic groups. Although it has been well-established that 90% of anal cancers are attributed to HPV,A major strength of our study was the survey’s large, nationally representative sample. Several cycles were merged to increase power and provide more stable estimates, especially given that many studies of HPV awareness and knowledge by educational attainment or race and ethnicity only examined a single survey cycle and were limited in sample size. Additionally, substantial efforts were made to reduce potential selection bias in the HINTS methodology through complex sampling and weighting. To our knowledge, our study is the first to disentangle the association of highly correlated variables  with HPV awareness and knowledge and to describe more recent trends in HPV awareness and knowledge over time by educational attainment and race and ethnicity.25 Additionally, we were unable to separately examine some historically underrepresented races  and more granular groups of ethnicity  due to low sample sizes. Furthermore, the language in the questionnaires was not entirely consistent across surveys. For example, to capture gender, the HINTS-5 cycles 1 to 3 asked, “Are you male or female?” while HINTS-5 cycle 4 asked, “On your original birth certificate, were you listed as male or female?” This language shift may have resulted in the overlap of sex and gender, resulting in inaccurate representation of distributions by identity.This study has some limitations. Survey response rates for HINTS-5 were low, with rates of 32.4% , 32.9% , 30.3% , and 36.7% , and these low response rates may have resulted in the poorer capture of racial and ethnic minority groups, such as individuals identifying as Hispanic or African American, as noted in the HINTS methodology.In this cross-sectional study, we highlight important differences in HPV awareness and knowledge among US adults with lower educational attainment and among racial and ethnic minority groups, suggesting 2 potential issues: (1) inequitable dissemination of information and (2) a need to tailor messages regarding HPV-related information. Educational attainment and race and ethnicity should be considered when disseminating HPV awareness campaigns to expand equitable opportunities to reduce HPV knowledge disparities. Because vaccination is a highly researched strategy to prevent HPV-driven cancers, increasing HPV awareness and knowledge allows individuals to better understand their health and factors regarding health-related decision-making. If HPV awareness and knowledge can be expanded and improved among adults, they may be more likely to obtain vaccination for their children during age-appropriate periods.


Penile squamous cell carcinoma (PSCC) is a rare and aggressive cancer. About half of all PSCC cases are thought to be related to human papillomavirus (HPV) or have increased expression of p16 by immunohistochemistry (IHC), a surrogate marker for HPV infection. HPV/p16 positivity is generally a marker of better outcomes in more common squamous cell carcinomas, but the studies evaluating its prognostic value in PSCC are conflicting. In this systematic review, we aim to summarize the existing literature on the impact of these biomarkers on PSCC prognosis and determine their potential value in identifying patients with more favorable biology.PSCC is a rare cancer, with approximately half of all cases related to HPV. While HPV and p16 IHC testing have proven their prognostic value for oropharyngeal cancer, this is not yet established for PSCC. The current level of evidence exploring the relation between PSCC and HPV is moderate, so we conducted a systematic review following PRISMA guidelines to evaluate the prognostic role of HPV and p16 IHC in PSCC clinical outcomes. We searched the PubMed, Embase, and Cochrane databases and identified 34 relevant studies that met our inclusion criteria. Of these, 33 were retrospective cohort studies, and one was a cross-sectional study. Nine studies reported that HPV-positive and p16-positive PSCC had better overall survival (OS) and disease-free survival (DFS). This study highlights the need for a meta-analysis to determine the role of routine HPV status or p16 staining testing as part of the initial diagnosis and staging of PSCC patients worldwide. Penile squamous cell carcinoma (PSCC) is a rare genitourinary cancer with fewer than 2500 newly diagnosed cases and 500 deaths annually reported in the United States . IncidenThe development of PSCC is frequently linked to multiple risk factors, such as inadequate hygiene, absence of circumcision, tobacco smoking, specific genetic conditions, and the presence of HPV, which can be found in 30–50% of cases ,10,11,12Two markers, namely p16 overexpression and HPV status, are associated with HPV in PSCC and play a crucial role in determining prognostic significance. Generally, PSCC cases that are positive for HPV and p16 exhibit a more favorable prognosis compared to those that are HPV-negative. Consequently, determining the HPV and p16 status can aid in estimating prognosis and making informed treatment decisions .While p16-positive status through immunohistochemistry (IHC) is considered a robust marker of HPV infection in oropharyngeal squamous cell carcinoma, according to the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines, its value in PSCC is less clear ,14. StudA previous systematic review and meta-analysis of twenty studies concluded that men with HPV-positive or p16-positive PSCC had significantly better disease-specific survival (DSS) . HoweverWe performed a systematic literature search in the electronic databases PubMed, Embase, and the Cochrane Library, covering articles published between March 1992 and December 2022. The database search was filtered to include articles written in English. The search terms used were “Prognosis” OR “Prevalence” AND “HPV” OR “Human Papillomavirus” OR “Human Papillomaviruses” OR “Papillomaviridae” OR “human papillomavirus” OR “Cyclin-Dependent Kinase Inhibitor p16” OR “p16INK4” OR “Cyclin-Dependent Kinase Inhibitor-2A” OR “p16INK4A Protein” OR “CDKN2A Protein” OR “CDKN2 Protein” AND “Penile Neo-plasms” OR “Penile Neoplasms” OR “Penis Neoplasms” OR “Penis Neoplasm” OR “Penile Neoplasm” OR “Penis Cancer” OR “Penile Cancer” OR “Penile carcinoma” OR “penis carcinoma” OR “penis tumor” OR “penile cancers”.JC conducted the initial search, and subsequently, KP and AM independently verified the abstracts and selected manuscripts. Disagreements were resolved through collaborative discussions to achieve consensus. A fourth author, RS, addressed any unresolved conflicts. Supplementary information was reviewed using reference lists to ensure comprehensiveness. The study adhered to the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist  17]..17].Only peer-reviewed studies in English or with available translations were eligible for inclusion in the analysis. In cases where a study population was reported in multiple papers, only data from the most up-to-date paper and providing the most complete information were utilized. Case reports, abstracts, letters to the editor, and review articles were excluded from the analysis.Two reviewers independently evaluated the quality of the chosen papers using a modified Newcastle–Ottawa Scale (NOS). The scale comprised 8 items divided into three domains: subject selection criteria (0–4 points), comparability of subjects (0–2 points), and outcomes (0–3 points). The maximum achievable score was 9 points, with a score of more than 5 points indicating high quality. A total of 34 articles were identified and selected for data extraction. Data tables were created to systematically capture relevant information from the texts, tables, and figures of each included study. These tables included details such as the first author, publication year, country, year of sample collection, follow-up time, type of tissue testing method, p16 testing technique, the definition of p16 positivity (overexpression), number of evaluators for p16 staining, sample size, the number of HPV-positive and HPV-negative PSCC cases, the number of p16-positive PSCC cases, and various survival endpoints. The examined survival outcomes encompassed overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS).During our research, we encountered studies that presented the median age of patients, along with either the interquartile range (IQR) or range, rather than providing the mean and standard deviation. To approximate the mean age, we adopted the methodology introduced by Wan et al.  in 2014,In this systematic review, we conducted an analysis of the data derived from a total of 34 studies encompassing 3994 patients diagnosed with PSCC. These studies spanned the period from 1970 to 2022. The estimated mean age of the patients was determined to be 62.3 years. Among the studies included in our analysis, Brazil and the United States both had the highest number of studies, with each country contributing eight studies  method for HPV detection ,37,38,39Nineteen studies included in our analysis examined samples to evaluate the p16+ status using immunohistochemical (IHC) staining. Two different methodologies were employed for grading p16 on IHC. Six studies utilized a quantitative measurement approach, where the cut-off for considering a sample as p16-positive ranged from >10% to >75% of cells exhibiting positive staining ,26,29,48None of the included studies demonstrated a significant association between HPV positivity and improved overall survival (OS). However, p16 status was found to be associated with improved OS in three independent analyses ,29,46. NThe presence of HPV positivity was associated with improved disease-free survival (DFS) and was statistically significant in four of the studies ,26,28,39In three of the studies, HPV positivity was associated with improved disease-specific survival (DSS) ,32,37. CThis systematic review presents an analysis of 34 studies, aiming to provide an up-to-date overview of the prognostic significance of HPV status and p16 expression in PSCC. The inclusion of recent studies has significantly enhanced previous efforts on this topic, notably by substantially increasing the sample size and incorporating a more diverse patient population from various global sites.The risk factors for PSCC can vary across countries and regions. While some risk factors, like HPV, are consistent globally, others may be more prevalent in specific populations. For example, Brazil has been identified as having one of the highest incidence rates of PSCC worldwide, possibly due to a high prevalence of HPV infection, lower rates of circumcision, and socioeconomic factors such as limited access to healthcare and education about safe sex practices . On the Certain high-risk HPV genotypes, particularly HPV-16 and HPV-18, are strongly associated with p16 overexpression in infected cells. HPV-16—being the most oncogenic and prevalent high-risk genotype—is strongly linked to the development of various cancers, including cervical, anal, vulvar, vaginal, certain head and neck cancers, and penile cancers ,52. In cIt is crucial to note that combining multiple prevention strategies, including HPV vaccination, screening, and safe sexual practices, can have the greatest impact on reducing HPV-related diseases. However, challenges such as vaccine hesitancy, lack of awareness, and limited access to vaccination programs can hinder vaccine uptake. Sociocultural factors and stigma surrounding discussions about sexual health and genital cancers may also create barriers to open dialogue, education, and prevention efforts ,56,57.The 2022 World Health Organization (WHO) classification of penile cancer, as suggested by Menon et al., recommends the utilization of p16 screening whenever possible to differentiate between HPV-associated and HPV-independent PSCC . This upIn our review, we conducted a multivariate analysis and found that p16 positivity was associated with improved OS and DSS in a subset of published studies. Specifically, in 3 out of 11 (27%) studies, p16 positivity was associated with improved OS, and in 4 out of 7 (57%) studies, p16 positivity was associated with improved DSS. In comparison, HPV positivity was not significantly associated with improved OS in any of the 10 studies analyzed (0%), and it was associated with improved DSS in only 3 out of 10 30%) studies. Most of the included studies in our review demonstrated good methodological quality, with a majority achieving a Newcastle–Ottawa Scale (NOS) score higher than 7 and a median total score of 7 IQR 7–8.25). However, it is important to acknowledge the limitations of our systematic review. We did not include unpublished studies or studies published in languages other than English, which may introduce publication bias and limit the comprehensiveness of the evidence base. Furthermore, another limitation in our study arises from the observed variability in the definitions of p16 positivity among the twenty included studies that assessed p16 status. Out of these studies, six ,26,29,48. However% studiesThe inclusion of fourteen additional studies, since the publication of the meta-analysis by Sand et al. , provideThe current guidelines from EAU–ASCO recommend conducting p16 testing through IHC in all individuals diagnosed with PSCC [Our systematic review highlights the importance of conducting an updated comprehensive meta-analysis to define the potential role of these biomarkers in PSCC. We anticipate that this will address the discordance between p16 and HPV and uncover a potentially stronger prognostic value for p16 positivity on the outcomes of PSCC patients.


The role of induction chemotherapy (IC) in oropharyngeal squamous cell carcinoma (OPSCC) remains controversial. Its interpretation can be confounded by heterogeneity in chemosensitivity and human papillomavirus (HPV) status. This study aimed to investigate the prognostic impact of IC response in HPV‐positive and ‐negative OPSCC.Patients with OPSCC who underwent IC and concurrent chemoradiotherapy (CCRT) were retrospectively analyzed. Radiologic response to IC by ≥50% was defined as IC‐sensitive (IC‐s), while lesser response was deemed as IC‐resistant (IC‐r). Progression‐free survival (PFS) and overall survival (OS) were compared between subgroups.P < 0.001; 3y‐OS 98.3% vs. 67.4%, P = 0.002), the HPV‐positive subgroup  or the HPV‐negative subgroup . Multivariate analysis demonstrated that response to IC represents an independent prognosticator for 3‐year PFS  and 3‐year OS .A total of 51 HPV‐positive and 57 HPV‐negative patients were included. IC‐s patients accounted for 55.6%, 62.7%, and 49.1% in the entire cohort, HPV‐positive, and HPV‐negative subgroup, respectively. Compared with IC‐r subgroup, IC‐s was associated with better clinical outcomes either in the entire cohort (3y‐PFS 91.7%vs.43.7%, Response to IC exerts a critical predictive effect on prognosis of both HPV‐positive and ‐negative OPSCC. Personalized treatment strategy based on IC response is worthy of further exploration in the future. Response to induction chemotherapy is an important predictor of prognosis in HPV‐positive and ‐negative oropharyngeal squamous cell carcinoma. For nonoropharyngeal HNSCC such as larynx and hypopharynx cancer, IC is well‐recognized with benefits in larynx preservation,The response to IC reflects the intrinsic chemosensitivity in vivo. Given the high concordance of chemosensitivity and radiosensitivity, the response to upfront chemotherapy has been widely used as a biomarker to select patients for subsequent adaptive radiotherapy in various malignancies including HNSCC.22.1Patients with newly diagnosed OPSCC at Fudan University Shanghai Cancer Center between 2010 and 2020 were retrospectively reviewed under the approval of the institutional review board. Inclusion criteria were as follows: (1) treatment‐naïve and histologically confirmed OPSCC; (2) staged as II‐IVb; (3) HPV status available; (4) Karnofsky Performance Status Scale ≥70%; (5) received IC followed by concurrent chemoradiotherapy and (6) accessible pre‐ and post‐IC radiologic images for tumor evaluation , TP (docetaxel 75 mg/m2 on day 1 and cisplatin 75–80 mg/m2 on day 1) or PF (cisplatin 75–80 mg/m2 on day 1 and 5‐fluorouracil on days 1–5) regimen. CCRT started within 4 weeks after IC, consisting of intensity‐modulated radiotherapy (IMRT) with a radical dose of 60–70Gy in 30–35 fractions to the gross tumor, and cisplatin of 75–80 mg/m2 concurrently given every 3 weeks.Two or three cycles of IC were intended with TPF , overall survival , local recurrence‐free survival , regional recurrence‐free survival , and distant metastasis‐free survival .P < 0.05 was considered to be statistically significant.Statistical analysis was performed using the SPSS software . Categorical variables were compared between groups with the chi‐squared test or Fisher's exact test. Kaplan–Meier method followed by the log‐rank test was used to estimate and compare the survival outcomes. Cox proportional hazards model was used for the multivariate survival analysis. A value of 33.1P = 0.022), heavier smokers  and more nontonsil primary origins . The IC‐s subgroup of the HPV‐negative patients had a higher percentage of low N stage  than the corresponding IC‐r subgroup.In total, 457 patients were assessed for eligibility, of which 144 received IC. After excluding 34 patients who underwent surgery and two patients whose tumor response status could not be determined, 108 OPSCC patients met the inclusion criteria including 51 with HPV‐positive and 57 with HPV‐negative status. The baseline characteristics of the patients are shown in Table 3.2For the primary tumor, 45 of 108 patients (41.7%) achieved a CR, 39 (36.1%) achieved a major PR, 14 (13.0%) achieved a minor PR, 9 (8.3%) had SD and 1 (0.9%) had PD. For regional nodes, a CR in 21 (19.4%) patients, major PR in 43 (39.8%), minor PR in 18 (16.7%), SD in 25 (23.1%) and PD in 1 (0.9%) was observed. In total, the response to IC included CR in 12 (11.1%), major PR in 48 (44.4%), minor PR in 20 (18.5%), SD in 27 (25.0%), and PD in 1 (0.9%) patients. According to our definition, high sensitivity to IC was identified in 77.8% of patients for primary sites and 59.3% for lymph nodes, leading to an overall sensitivity of 55.6%  and IC‐s  when compared with HPV‐negative patients, suggesting that the HPV‐positive OPSCC is more sensitive to upfront chemotherapy. No differences in IC sensitivity were found in terms of age, gender, smoking history, primary site, or IC regimen.3.3The median follow‐up was 29.6 months . Overall, 29 patients (26.9%) in the entire cohort developed tumor relapse, including 13.0% local, 11.1% regional recurrence, and 8.3% distant metastasis. The 3‐year OS and PFS were 90.0% and 71.4%, respectively.The 3‐year OS and PFS for HPV‐positive OPSCC were 92.4% and 77.8%, respectively, compared with 81.4% and 65.3% for the HPV‐negative subgroup, respectively. HPV‐positive OPSCC was found to have improved PFS but not OS than the HPV‐negative OPSCC Figure .P = 0.390). Patients with low T stage (T1‐T2) showed prolonged OS and PFS  compared with the high T stage (T3‐T4) cohort.For the entire population, there was no obvious survival difference between heavy smokers and nonheavy smokers , RFS , and DMFS   and a marginally improved OS . The major survival benefit lay in the loco‐regional tumor control . Similar effects with PFS and OS were observed in the HPV‐negative subgroup , whereas the improvement was seen mainly in regional and distant control   Figure . In HPV‐) Figure . Interes) Figure .P < 0.001) and OS . In subset analyses, the multivariable Cox regression showed that IC‐s was significantly associated with PFS  and OS  in HPV‐negative OPSCC, as well as PFS  in HPV‐positive OPSCC. However, the response to IC failed to predict OS in HPV‐positive OPSCC  of HPV‐negative OPSCC was unexpectedly higher (75.4%) than that in the previous series (55%),Due to the retrospective nature of the present study, selection bias was inevitable and the results should be carefully interpreted. As the data were obtained from a single institution and the number of patients was limited, external validations with larger cohorts will be needed in the future. In addition, the effect of different IC regimens on tumor response and prognosis could not be analyzed because most patients received TP duplets. TPF has been established as the standard IC regimen due to more effective locoregional control over PF.In the 8th edition of AJCC guidelines, p16 immunohistochemistry was recommended as a surrogate marker due to its high consistency with HPV status determined by E6/E7 mRNA expression (the “golden standard”) or HPV ISH.In conclusion, this study represents the first attempt to demonstrate the prognostic impact of IC response in both HPV‐positive and HPV‐negative OPSCC. The response to IC provides a tool for better risk stratification and identification of candidates for subsequent treatment de‐intensification or intensification.Qixian Zhang, Tingting Xu, and Chunying Shen were involved in data curation, formal analysis, investigation, methodology, validation and writing—original draft. Wei Qian, Hongmei Ying, Xiayun He, and Yu Wang were involved in methodology, validation and writing—original draft. Qinghai Ji was involved in conceptualization, methodology, validation and writing—original draft. Chaosu Hu, Xin Zhou, and Xueguan Lu were involved in conceptualization, resources, funding acquisition, project administration, supervision and writing—review and editing.This study was supported by grants from Fudan University Shanghai Cancer Center Foundation Project (YJRC1903).The authors declare that there is no conflict of interests regarding the publication of this paper.This study was exempt from institutional review board approval due to the nature of the study. Because all data were de‐ identified, patient consent was waived.Figure S1.Click here for additional data file.