The impact of Chatbot-Assisted Self Assessment (CASA) on intentions for sexual health screening in people from minoritised ethnic groups at risk of sexually transmitted infections.

Background Sexually transmitted infections (STIs) present a significant global public health issue, with disparities in STI rates often observed across ethnic groups. The study investigates the impact of Chatbot-Assisted Self Assessment (CASA) on the intentions for sexual health screening within minoritised ethnic groups (MEGs) at risk of STIs as well as the subsequent use of a chatbot for booking STI screening. Methods A simulation within-subject design was utilised to evaluate the effect of CASA on intentions for STI/HIV screening, concern about STIs, and attitudes towards STI screening. Screening intentions served as the dependent variable, while demographic and behavioural factors related to STI/HIV risk were the independent variables. ANCOVA tests were conducted to measure the impact of CASA on these perceptions. Results Involving 548 participants (54% women, 66% black, average age=30years), the study found that CASA positively influenced screening intentions t (547)=-10.3, P t (544)=-4.96, P t (543)=-4.36, P Conclusion CASA increased motivations for STI screening intentions among ethnically diverse communities. The intervention's non-judgemental nature and the chatbot's ability to emulate sexual history-taking were critical in fostering an environment conducive to behavioural intention change. The study's high acceptability indicates the potential for broader application in digital health interventions. However, the limitation of not tracking actual post-intervention behaviour warrants further investigation into CASA's real-world efficacy.

Factors associated with sexually transmitted shigella in men who have sex with men: a systematic review.

BACKGROUND: Outbreaks of sexually transmitted shigella have been reported in men who have sex with men (MSM) since the 1970s and present a major public health issue. Understanding the factors associated with the sexual transmission of shigella may inform future control strategies. METHODS: We systematically searched four bibliographical databases (January 2000-February 2022) for manuscripts in English. We used a two-stage process to assess eligibility: the primary author conducted an initial screen and then three authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts that included MSM diagnosed with sexually transmitted shigella where specific factors associated with transmission were identified. RESULTS: Thirteen manuscripts met the inclusion criteria that included 547 individuals. Sexually transmitted shigella in MSM was associated with: residing in a capital city/urban region, living with HIV (including engaging in seroadaptive sexual behaviour, having a low CD4 count, having a HIV viral load >100 000 and not engaging with HIV care), using HIV pre-exposure prophylaxis, use of geospatial mobile phone applications to meet sexual partners, visiting sex on premises venues, chemsex and recreational drug use, sexual behaviour (including multiple non-regular sexual partners and oral-anal sexual contact) and concomitant STIs. CONCLUSION: We have highlighted some important risk behaviours and factors that are associated with sexually transmitted shigella in MSM that can be used to target future shigella control interventions.

Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a "feminisms" systematic review.

BACKGROUND: Recent years have seen record levels of migration to Europe. Female migrants are at heightened risk of developing mental health disorders, yet they face barriers to accessing mental health services in their host countries. This systematic review aims to summarise the barriers and facilitators to accessing mental health support for female migrants in Europe. METHODS: The review follows PRISMA guidelines, and the protocol was pre-published on PROSPERO. Six electronic databases were searched: CINAHL, Global Health Database, Medline, PsycARTICLES, PsycINFO and Web of Science. Thematic analysis was undertaken on the identified studies. A feminist quality appraisal tool was applied. RESULTS: Eight qualitative, six quantitative and five mixed methods studies were identified. Barriers included a lack of information, stigma, religious and cultural practices and beliefs, and a lack of consideration of gender-specific needs within the health system. Gender-sensitive services, supportive general practitioners and religious leaders facilitated access. CONCLUSIONS: The design of mental health research, services, policies, and commissioning of support for migrants must consider female migrant needs. Mental health support services must be culturally aware and gender sensitive. REGISTRATION: The review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021235571.

Medical students' awareness of health issues, attitudes, and confidence about caring for lesbian, gay, bisexual and transgender patients: a cross-sectional survey.

BACKGROUND: Lesbian, gay, bisexual and transgender (LGBT) patients have an increased incidence of a range of health problems, and face many barriers to accessing healthcare. Our research aimed to explore the awareness of health issues and attitudes of medical students towards LGBT patients' health including barriers to health services, their attitudes towards inclusion of LGBT content in the curriculum and their confidence with providing care for their LGBT patients in the future. METHODS: Medical students were recruited to take part in a cross-sectional survey. We used a 28-item survey to explore views about the undergraduate medical curriculum. RESULTS: 252 surveys were analysed from 776 eligible participants. Attitudes towards LGBT patients were positive but awareness and confidence with respect to LGBT patients were variable. Confidence discussing sexual orientation with a patient significantly increased with year of study but confidence discussing patient gender identity did not. The majority of participants (n = 160; 69%) had not received specific training on LGBT health needs, and 85% (n = 197) wanted to receive more training. CONCLUSIONS: Increasing the amount of LGBT teaching in undergraduate medical curricula could help to increase the quality of doctor-patient interactions, to facilitate patients' disclosure of sexual orientation and gender identity in healthcare and increase the quality of healthcare.

A decline in patient disclosure of heterosexuality in the English General Practice Patient Survey: a longitudinal analysis of cross-sectional data.

BACKGROUND: Persistent health inequalities in relation to both health care experiences and health outcomes continue to exist among patients identifying with a marginalized sexual orientation (MSO). OBJECTIVE: To compare the patterns of sexual orientation disclosure within primary care in England over a 5-year period. METHODS: Descriptive analysis of cross-sectional, repeat measure, fully anonymized survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808 332 (2017) and 1 037 946 (2011/2012). RESULTS: The analysis samples comprised between 396 963 and 770 091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or 'other' sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or 'other' increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56-0.99%). CONCLUSION: We found a year-on-year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, 'other sexual orientation' or preferring not to say. Heteronormative environments extend to health care settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients.

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment.

BACKGROUND: In the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. METHODS AND FINDINGS: Between 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather than observed in the real world. CONCLUSIONS: Our results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.

Sexual healthcare professionals' views on HPV vaccination for men in the UK.

BACKGROUND: Human Papillomavirus (HPV) vaccination for men could prevent anal cancers amongst men who have sex with men (MSM). METHODS: An e-survey of attitudes towards vaccination for men in the UK was conducted in July-August 2014. RESULTS: Among 325 sexual health professionals, 14% were already vaccinating men against HPV, 83% recommended gender-neutral HPV vaccination and 65% recommended targeting MSM. Over 50% reported having poor knowledge about the use of HPV vaccine for MSM and the skills to identify MSM likely to benefit from HPV vaccination. CONCLUSIONS: Clear advice and guidelines on HPV vaccine use for men at sexual health clinics are required to ensure equitable opportunities for vaccination.

Factors associated with good adherence to self-care behaviours amongst adolescents with food allergy.

BACKGROUND: Our understanding of factors which affect adherence to health sustaining self-care behaviours in adolescents with food allergy is limited. This study used the Health Belief Model to explore the relationship between food allergic adolescents' health beliefs, demographic, structural and social psychological factors with adherence to self-care behaviours, including allergen avoidance and carrying emergency medication. METHODS: A cross-sectional study of 188 13- to 19- olds identified from hospital prescribed auto-injectable epinephrine for food allergy. Data were collected on demographics, structural factors, social psychological factors, health beliefs and current adherence behaviour using a postal questionnaire. RESULTS: Full adherence was reported by 16% of participants. Multivariate analysis indicated that adherence was more likely to be reported if the adolescents belonged to a support group (OR = 2.54, (1.04, 6.20) 95% CI), had an anaphylaxis management plan (OR = 3.22, (1.18, 8.81) 95% CI), perceived their food allergy to be more severe (OR = 1.24, (1.01, 1.52) 95% CI) and perceived fewer barriers to disease management (OR = 0.87, (0.79, 0.96) 95% CI). CONCLUSIONS: Membership of a patient support group and having an anaphylaxis management plan were associated with good adherence to self-care behaviours in adolescents with food allergy. Our results suggest that interventions to improve provision and utilisation of management plans, address adolescents' perceptions of the severity of anaphylaxis and reduce barriers to disease management may facilitate good adherence behaviours than focussing on knowledge-based interventions.

Human papillomavirus and vaccine-related perceptions among men who have sex with men: a systematic review.

BACKGROUND: Targeted human papillomavirus (HPV) vaccine could prevent HPV-related cancers and genital warts among men who have sex with men (MSM). In order to develop effective vaccination programmes for MSM, it is crucial to understand their knowledge, beliefs about HPV and attitudes towards HPV vaccine. METHODS: A systematic search of 10 databases examined articles investigating HPV knowledge and HPV-related perceptions among MSM. Each paper was assessed to identify potential research directions in the context of targeted HPV vaccination for MSM. RESULTS: We identified 16 studies that included 5185 MSM and conducted mainly in North America. Generally, participants were over 26 years old, had poor-to-moderate knowledge about HPV and were not concerned about HPV-related diseases. Over a half of MSM were willing to accept HPV vaccine, if offered. However, there was large variability in HPV vaccine acceptability, partially due to inconsistencies in methods of ascertainment but also different levels of HPV vaccine awareness. CONCLUSIONS: Despite several misconceptions and poor knowledge of HPV infection, MSM might be receptive to HPV vaccination. However, further research is needed to identify which factors contribute to potential vaccine uptake in hypothetical MSM-targeted HPV vaccination. Future studies need to target those MSM with little sexual experience, who would benefit most from HPV vaccination.

Achieving health equity through conversational AI: A roadmap for design and implementation of inclusive chatbots in healthcare.

BACKGROUND: The rapid evolution of conversational and generative artificial intelligence (AI) has led to the increased deployment of AI tools in healthcare settings. While these conversational AI tools promise efficiency and expanded access to healthcare services, there are growing concerns ethically, practically and in terms of inclusivity. This study aimed to identify activities which reduce bias in conversational AI and make their designs and implementation more equitable. METHODS: A qualitative research approach was employed to develop an analytical framework based on the content analysis of 17 guidelines about AI use in clinical settings. A stakeholder consultation was subsequently conducted with a total of 33 ethnically diverse community members, AI designers, industry experts and relevant health professionals to further develop a roadmap for equitable design and implementation of conversational AI in healthcare. Framework analysis was conducted on the interview data. RESULTS: A 10-stage roadmap was developed to outline activities relevant to equitable conversational AI design and implementation phases: 1) Conception and planning, 2) Diversity and collaboration, 3) Preliminary research, 4) Co-production, 5) Safety measures, 6) Preliminary testing, 7) Healthcare integration, 8) Service evaluation and auditing, 9) Maintenance, and 10) Termination. DISCUSSION: We have made specific recommendations to increase conversational AI's equity as part of healthcare services. These emphasise the importance of a collaborative approach and the involvement of patient groups in navigating the rapid evolution of conversational AI technologies. Further research must assess the impact of recommended activities on chatbots' fairness and their ability to reduce health inequalities.

Assessing the psychological predictors of benefit finding in patients with head and neck cancer.

BACKGROUND: Some individuals are able to gain psychological benefits from illness and adversity, such as a greater sense of purpose and closer relationships, termed 'benefit finding' (BF). The main aim of this study was to explore the extent to which BF is reported in patients with head and neck cancer (HNC). Secondary aims were to establish the relationships between BF, other patient-reported outcomes and predictive factors such as coping strategy and level of optimism. METHODS: This repeat measures study was conducted with 103 newly diagnosed patients with HNC. Self-completion questionnaires were used to assess BF pre-treatment and 6 months after treatment and pre-treatment coping, optimism, quality of life, anxiety and depression. Sixty-eight patients (66%) completed follow-ups. RESULTS: Moderate to high levels of BF were reported. Anxiety, depression and quality of life were not related to BF. Regression models of BF total score and three new factor analysed BF scales indicated that use of emotional support and active coping strategies were predictive of finding more positive consequences. Optimism, living with a partner and higher educational attainment were also found to have a protective effect. The amount of variance in BF explained by these five pre-treatment factors ranged from 32 to 46%. CONCLUSIONS: These findings demonstrate that both dispositional and potentially modifiable factors, in particular optimism and coping strategies, were associated with patients identifying positive consequences of a diagnosis of HNC. To maximise patient's longer-term resilience and adaptation, components of BF, either directly or via coping strategies, could be targeted for intervention.

Talking about links between sexually transmitted infections and infertility with college and university students from SE England, UK: a qualitative study.

BACKGROUND: Sexually transmitted infections (STIs) such as chlamydia and gonorrhoea are largely symptomless diseases which, left untreated, can result in serious complications including infertility. Fertility problems currently affect approximately one in seven couples in the UK and there is increasing demand for couples seeking reproductive technologies. Young people are at greatest risk of contracting STIs, therefore this study aimed to identify young people's knowledge and beliefs about the link between untreated STIs and infertility. METHODS: Focus groups were conducted with participants aged 16-24 years old inclusive in college or university settings in the SE of England. Groups were quota sampled on the basis of age and gender. A topic guide was used. The data were analysed using a framework analysis approach. RESULTS: Ten single-sex focus groups were conducted with sixty participants: six groups of college students and four groups of university students. Participants were generally aware of the link between STIs and potential infertility and considered the discussion of this subject very relevant at their age. Knowledge about how and why STIs potentially lead to fertility complications was poor. The issues of blame relating to infertility following an STI emerged, although most participants did not think that access to free reproductive technologies after an untreated STI should be limited. CONCLUSIONS: Young people would benefit from more education in order to improve their understanding of the long-term consequences of untreated STIs, such as infertility. Participants in our sample felt these were extremely relevant and important issues for them to understand alongside current education about STIs.

Patient sexual orientation and gender identity disclosure.

BACKGROUND: In the UK, 2.3% of men and 1.6% of women identify as lesbian, gay or bisexual (LGB). Of the UK population, 1% are estimated to identify as transgender (T). Of the LGB population, 46% do not disclose their sexual orientation to health care professionals (HCPs) and 18% of transgender patients avoid health care altogether. Non-disclosure of sexual orientation and/or gender identity contributes to worse health outcomes for LGBT patients. OBJECTIVES: This study aimed to explore medical students' perceptions of the barriers to health care for LGBT patients and the importance of patient disclosure of sexual orientation or gender identity. METHODS: Focus groups included medical students across five year-groups from a medical school in the South East of England. Discussions followed a pre-approved topic guide with a primary and co-facilitator present. Focus groups were audio-recorded, transcribed verbatim and the data underwent framework analysis. RESULTS: Forty-five undergraduate medical students participated (40% of whom were non-heterosexual). Most participants believed that the incorrect use of pronouns and discrimination would be a cause for non-disclosure of gender identity and sexual orientation to HCPs. Several participants thought it was more important to know a patient's gender identity than sexual orientation. Many participants felt that collecting sexual orientation information on healthcare registration forms is acceptable. DISCUSSION: More education regarding LGBT health needs and ways to encourage patient disclosure of sexual orientation or gender identity should be included in the undergraduate medical school curricula to increase the competency of future doctors when interacting with LGBT patients.

Is the Satisfaction with Cancer Information Profile (SCIP) valid for tailoring information for patients with head and neck cancer?

BACKGROUND: The Satisfaction with Cancer Information Profile (SCIP) has previously been shown to be a valid and reliable measure responsive to changes in patient satisfaction over time. It has been suggested that the SCIP might be used to guide the tailored provision of treatment information to patients with head and neck cancer but for this purpose the discrimination of the SCIP, not its responsiveness, should be assessed. This paper assesses whether the SCIP is valid as a discriminative measure suitable to guide tailored information. METHODS: The SCIP comprises two parts (SCIP-A and SCIP-B). The discrimination of both parts was explored in a UK sample of 82 newly diagnosed patients with head and neck cancer. Principal components analysis (PCA) was first used to explore the factor structure of the SCIP-A and SCIP-B: discrimination analyses were then conducted at the level of full scale, subscale and item. RESULTS: Principal components analysis revealed a coherent three-factor solution for the SCIP-A and a single factor for SCIP-B. Both parts of the SCIP proved to be discriminating at the full scale level (SCIP-A Delta = 0.92; SCIP-B Delta = 0.90). The SCIP-A also proved to be discriminating at the subscale level (Delta = 0.85 to 0.89). For the SCIP-A there was wide variation in the discrimination of individual items, confirming its potential to tailor information at the item level. For the SCIP-B, responses to most items indicated uniform satisfaction, suggesting that it would not be useful for tailoring information at the item level. CONCLUSION: The SCIP-A has been shown to be a valid discriminative measure and should prove suitable for tailoring treatment information at the level of item, subscale and total scale score. The SCIP-B, while a discriminating measure of total satisfaction, comprises too uniform a set of indicators of patient satisfaction to make it useful for tailoring information at the item level. Overall, the SCIP is valid as a measure of overall satisfaction with information about treatment and as a guide to tailoring such information.

Can we predict which head and neck cancer survivors develop fears of recurrence?

OBJECTIVES: The objectives of this study were to investigate longitudinal predictors of fear of recurrence in survivors of head and neck cancer (HNC) using Leventhal's Common Sense Model (CSM) as a framework. The research questions were as follows: (a) to what extent do HNC patients report fear of cancer recurrence? (b) To what extent are fears of recurrence manifestations of illness-related anxiety? (c) Are fears of recurrence closely related to current symptoms, disease, and treatment-related factors, or psychological/socio-demographic factors? (d) What factors are predictive of long-term fears of recurrence? METHODS: A prospective repeat measures design was employed whereby a sample of 82 newly diagnosed HNC patients (54 males, 28 females, mean age 60 years) completed measures of fears of recurrence, illness perceptions, coping, and anxiety and depression, prior to treatment and 6-8 months after treatment (fears of recurrence only). RESULTS: A third of HNC patients at diagnosis reported relatively high levels of fears of recurrence, with 12% still reporting similar levels of fear 6-8 months after treatment. Fears of recurrence were not related to any socio-demographic factor (age, gender, ethnicity, marital status, and educational attainment) or disease, treatment, or symptom-related factors. Path analyses demonstrated that fears of cancer recurrence after treatment were directly predicted by pre-treatment fears and optimism. CONCLUSION: Although components of the CSM (cognitive and emotional representations, coping strategies) were associated with fears of recurrence, optimism was found to be the strongest predictor of fear, independent of anxiety and level of fear reported prior to treatment.

Sexual orientation disclosure in health care: a systematic review.

BACKGROUND: Significant health disparities between sexual minority individuals (that is, lesbian, gay, bisexual, or transgender [LGBT]) and heterosexual individuals have been demonstrated. AIM: To understand the barriers and facilitators to sexual orientation (SO) disclosure experienced by LGBT adults in healthcare settings. DESIGN AND SETTING: Mixed methods systematic review, including qualitative, quantitative, and mixed methods papers following PRISMA guidelines. METHOD: Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a qualitative synthesis was performed. Studies were included if their participants were aged ≥18 years who either identified as LGBT, had a same-sex sexual relationship, or were attracted to a member of the same sex. RESULTS: The review included 31 studies representing 2442 participants. Four overarching themes were identified as barriers or facilitators to SO disclosure: the moment of disclosure, the expected outcome of disclosure, the healthcare professional, and the environment or setting of disclosure. The most prominent themes were the perceived relevance of SO to care, the communication skills and language used by healthcare professionals, and the fear of poor treatment or reaction to disclosure. CONCLUSION: The facilitators and barriers to SO disclosure by LGBT individuals are widespread but most were modifiable and could therefore be targeted to improve healthcare professionals' awareness of their patients' SO. Healthcare professionals should be aware of the broad range of factors that influence SO disclosure and the potential disadvantageous effects of non-disclosure on care. The environment in which patients are seen should be welcoming of different SOs as well as ensuring that healthcare professionals' communication skills, both verbal and non-verbal, are accepting and inclusive.

A systematic review of the effectiveness of interventions using the Common Sense Self-Regulatory Model to improve adherence behaviours.

This systematic review assessed the effectiveness of the Common Sense Self-Regulatory Model in the design of interventions to improve adherence behaviours. Of nine eligible studies, six reported improvements in adherence behaviours and three showed moderate to large effects on return to work and lifestyle recommendations. Four studies stated how Common Sense Self-Regulatory Model constructs were addressed in the intervention and five measured illness perceptions as outcomes. Evidence was found for targeting cure/control perceptions in studies aimed at improving adherence behaviours. Future studies need to measure illness perceptions pre- and post-intervention to enable mediational analyses to assess the effect of Common Sense Self-Regulatory Model interventions on improving health outcomes.

An analysis of risk factors for oral cancer in young people: a case-control study.

The incidence of oral cancer amongst young adults is increasing in many European and high incidence countries. The aim of this study was to evaluate the major risk factors for oral cancer in young adults using a case-control design. A sample of 116 patients aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the south east of England were included. Two-hundred and seven controls who had never had cancer, matched for age, sex and area of residence, were recruited. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco products, cannabis, alcohol and diet. Conditional logistic analyses were conducted adjusting for social class, ethnicity, tobacco and alcohol habits. All tests for statistical significance were two-sided. The majority of oral cancer patients reported exposure to the major risk factors of tobacco and alcohol even at this younger age. The estimated risks associated with tobacco or alcohol were low (OR range: 0.6-2.5) among both males and females. Only smoking for 21 years or more produced significantly elevated odds ratios (OR=2.1; 95% CI: 1.1-4.0). Exposure associated with other major risk factors did not produce significant risks in this sample. Long term consumption of fresh fruits and vegetables in the diet appeared to be protective for both males and females. The results suggest that although this younger sample exhibit similar behavioural risk factors to older oral cancer patients, the low odds produced in addition to the relatively short duration of exposure, suggest that factors other than tobacco and alcohol may be implicated in the development of oral cancer in these younger patients.

Factors associated with delay in presentation among younger patients with oral cancer.

Despite the reported increase in the incidence of oral squamous cell carcinoma (OSCC) in under 45-year-olds, little is known regarding the pattern and reasons for delay in presentation in this younger age group. The aim of this study was to investigate factors predictive of patient (primary) delay in a sample of 53 newly diagnosed patients under the age of 45 years. Multiple logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for primary delay (> or = 21 days between patient first noticing signs or symptoms and seeking professional advice). Self-reported delay ranged from less than 1 week to 104 weeks, with a median of 5 weeks. A total of 33 patients (62%) reported a delay of at least 21 days. Three variables: lack of further education, perceptions of being under stress in the period prior to diagnosis, and lower amounts of tobacco smoked per day were included in the final model and together explained 43% of the variance in patient delay (R2 = 0.432). Although OSCC is relatively rare in this age group, the rise in incidence and the change in profile of risk factors may increase the odds of patient delay. This has important implications for increasing sign and symptom awareness among the public and primary health care professionals such as general medical practitioners and general dentists.

A systematic review of patient acceptance of screening for oral cancer outside of dental care settings.

This systematic review summarised the literature on patient acceptability of screening for oral cancer outside dental care settings. A comprehensive search of relevant literature was performed in EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, CINAHAL, psycINFO, CANCERLIT and BNI to identify relevant articles published between 1975 and Dec 2013. Studies reporting acceptability of oral cancer screening to undiagnosed individuals attending non-dental settings were eligible for inclusion. A total of 2935 references were initially identified from the computerised search but 2217 were excluded after screening the titles. From the abstracts of the remaining 178 articles, 47 full text articles were retrieved for further scrutiny, and 12 studies were found to be eligible for inclusion. In these studies, knowledge about oral cancer, anxiety related to the screening process, preference for care provision, and financial cost were influencing factors for the acceptance of screening. Written information provided to patients in primary care was reported to boost immediate knowledge levels of oral cancer, lessen anxiety, and increase intentions for screening. The majority of screening methods were entirely acceptable to patients; lack of acceptability from the patients' viewpoint was not a significant barrier to carrying out opportunistic screening of high-risk populations. In conclusion, the available evidence suggests that acceptance of, and satisfaction with oral cancer screening is high, particularly where patients have previously been educated about oral cancer. Further research focusing on patient's preferences would enable streamlining of the approach to oral cancer screening taken by any national programme.