Patients and general practitioner knowledge and perception of testicular self-examination for cancer.

PURPOSE: Testicular cancer (TC) predominantly affects young men and early detection enhances survival. However, uncertainty surrounds the impact of population-wide screening. Testicular self-examination (TSE) is a simple detection method but there is a gap in current practices that needs to be assessed. Our goal was to assess the perceptions and knowledge of male subjects in the general population (MP) and general practitioners (GPs) regarding TSE for TC. METHODS: Two distinct surveys evaluating knowledge and perceptions of TSE for TC were administered to GPs and MP, aged 15‒45-years. Factors that could favour the realisation of TSE or improve the knowledge of TC were evaluated by multivariable logistic regression. RESULTS: Overall, 1048 GPs (mean (SD) age: 35.1 ± 10.3 years) and 1032 MP (mean (SD) age: 27 ± 8.2 years) answered the survey. Among the GPs, only 93 (8.9%) performed scrotal examination for TC screening. Although the majority (n = 993, 94.8%) were aware of the age of onset of TC, most (n = 768, 73.3%) did not know the overall survival rate from TC. GPs familiar with the guidelines were more likely to explain TSE to their patients (OR = 2.5 [95% CI 1.5‒4.1]; p < 0.01). Among the MP, 800 (77.5%) admitted that they did not know how to perform TSE and 486 (47.1%) did not know the main symptoms associated with TC. MP who had already undergone TC screening were more likely to be familiar with the main symptoms (OR = 2.1 [95% CI 1.6‒2.7]; p < 0.001) and MP who knew someone with TC or who had already undergone TC screening were more likely to be aware of the correct prevalence of TC (OR = 1.9 [95% CI 1.3‒2.7], p < 0.01; and OR = 1.6 [95% CI 1.2‒2.1], p < 0.01; respectively). CONCLUSION: The knowledge of both GPs and MP regarding TC could be improved. TSE screening and knowing someone close with TC improved the awareness of our subjects.

Cardiovascular Risks in Testicular Cancer: Assessment, Prevention, and Treatment.

PURPOSE OF REVIEW: Testicular cancer (TC) is the leading cancer in men between 18 and 39 years of age. Current treatment involves tumor resection followed by surveillance and/or one or more lines of cisplatin-based chemotherapy (CBCT) and/or bone marrow transplant (BMT). Ten years after treatment, CBCT has been associated with significant atherosclerotic cardiovascular disease (CVD) including myocardial infarction (MI), stroke, and heightened rates of hypertension, dyslipidemia, diabetes mellitus, and metabolic syndrome (MetS). Additionally, low testosterone levels and hypogonadism contribute to MetS and may further drive CVD. RECENT FINDINGS: CVD in TCS has been associated with worse physical functioning accompanied by role limitations, decreased energy, and decreased overall health. Exercise may play a role in ameliorating these effects. Systematic CVD screening practices are needed at TC diagnosis and in survivorship. We encourage a multidisciplinary partnership between primary care physicians, cardiologists, cardio-oncologists, medical oncologists, and survivorship providers to address these needs.

Effects of Information Provided to University Students Through an Educational Brochure on Health Beliefs and Testicular Self-Examination.

This study aimed to examine the effect of an educational brochure about testicular cancer and its early diagnosis on the health beliefs and self-examination of participants. The pretests/posttests were conducted in a quasi-experimental design with non-randomized groups and a control group of university students. The study recruited students enrolled in the psychological counseling and guidance department of a Turkish public university. The research sample comprised 92 students, 48 in the experimental and 44 in the control group. An educational brochure about testicular cancer and self-examination was provided to the experimental group. The data includes a personal information form, testicular cancer and health beliefs scale about testicular self-examination, and the form for self-examination. Mann Whitney U, Wilcoxon, and chi-square analyses were performed for data analysis. A significant difference was found between the scores of the experimental and control groups regarding seriousness/caring, benefit and health motivation, obstacles, and self-efficacy (p < 0.05). Moreover, the testicular self-examination ratio was determined as 83.3% in the experimental group and 4.5% in the control group. It can be asserted that the training brochure is effective in promoting the self-examination of testicles. It may be recommended to conduct experimental studies with larger study groups to increase testicular self-examination.

Awareness and Performance of Testicular Self-Examinations: An Analysis of Social and Cultural Barriers to Cancer Screenings in a US Orthodox Jewish Community.

This study assessed barriers to testicular self-examination (TSE) performance in a population of US Modern Orthodox Jewish undergraduate students. Participants answered questionnaires that measured their TSE performance and their attitudes toward TSEs. Out of 541 participants, 301 (55.6%) had heard of TSEs, 177 (32.7%) had ever performed a TSE, and 21 (3.9%) performed TSEs once per month in the past year. Significant positive associations of TSE awareness and practice included self-efficacy and engagement with medical professionals vis-à-vis testicular health. Shame and adherence to certain religious beliefs negatively correlated with awareness and performance of TSEs. The results demonstrate medical professionals' integral role in educating young individuals about TSEs.

Adequate asparaginase is important to prevent central nervous system and testicular relapse of pediatric Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia.

Asparaginase (Asp) is one of the most important drugs for treating acute lymphoblastic leukemia (ALL). However, off-protocol Asp administration (OPAA) or hypersensitivity may disturb its pharmacokinetic profile. In this retrospective study, we sought to determine whether OPAA and hypersensitivity to Escherichia coli asparaginase (E coli Asp) impaired extramedullary relapse prevention in a pediatric ALL cohort treated according to SCMC-ALL-2005 protocol from 2005 to 2014 at the Shanghai Children's Medical Center (SCMC). In total, 676 patients were enrolled in this study, including 369 with OPAA and 60 exhibiting hypersensitivity to E coli Asp. At the end of the most recent follow-up, 58 patients had extramedullary relapse. The 5-year cumulative extramedullary relapse incidence in patients with OPAA was 11.01%, whereas that in patients without OPAA was 5.28% (P = .0036). Moreover, the 5-year cumulative extramedullary relapse incidence in patients that exhibited hypersensitivity to E coli Asp was 16.48%, whereas that in patients without hypersensitivity was 7.59% (P = .0195). Concerning the relapse site, OPAA not only increased central nervous system (CNS) relapse but testicular relapse as well. Based on Fine and Gray multivariate analysis, OPAA and hypersensitivity to Asp were independent risk factors for extramedullary relapse. In conclusion, to prevent extramedullary relapse of ALL, adequate duration to administrate Asp was more important than the total dosage, and more attention should be paid to Asp inadequate due to hypersensitivity.

The impact of age at orchiopexy on testicular cancer outcomes.

PURPOSE: To estimate how many boys with UDT must undergo orchiopexy to prevent one case of TC, one death from TC and one exposure to TC treatment beyond radical orchiectomy as compared to being treated at an older age. METHODS: This retrospective study utilized data from a 2007 Swedish study of males who underwent orchiopexy for UDT (Pettersson et al.). TC incidence for boys undergoing orchiopexy for UDT was assessed based on the age at orchiopexy (0-6 years, 7-9 years, 10-12 years, 13-15 years). The incidence of TC in each age cohort was calculated and used to determine the number needed to treat (NNT) for each age group using assumptions based on published TC outcomes. RESULTS: For an index patient ≤ 6 years, 372 boys need to undergo orchiopexy to prevent a single case of TC, 1488 boys to prevent exposure to TC therapy beyond radical orchiectomy, and 5315 boys to prevent a single TC-related death compared to treatment at an older age. CONCLUSION: While there is evidence supporting benefits of early orchiopexy, the NNT to affect TC outcomes is very high. Even those with delayed orchiopexies have low risk for TC poor outcomes. This information can be used when counseling patients and families faced with UDT about the risks related to TC, especially with comorbidities.

cd44 deletion suppresses atypia in the precancerous mouse testis.

Loss-of-function of RHAMM causes hypofertility and testicular atrophy in young mice, followed by germ cell neoplasia in situ (GCNIS) of the testis, cellular atypia, and development of the testicular germ cell tumor (TGCT) seminoma. These pathologies reflect the risk factors and phenotypes that precede seminoma development in humans and-given the high prevalence of RHAMM downregulation in human seminoma-link RHAMM dysfunction with the aetiology of male hypofertility and GCNIS-related TGCTs. The initiating event underlying these pathologies, in RHAMM mutant testis, is premature displacement of undifferentiated progenitors from the basal compartment. We hypothesized that cd44 (both cancer initiating cell- and oncogenic progression marker) will drive GCNIS development, induced by RHAMM-loss-of-function in the mouse. We report that cd44 is expressed in a specific subset of GCNIS testes. Its genetic deletion has no effect on GCNIS onset, but it ameliorates oncogenic progression. We conclude that cd44 expression, combined with RHAMM dysfunction, promotes oncogenic progression in the testis.

The Effect of Testicular Self-Examination Education on Knowledge, Performance, and Health Beliefs of Turkish Men.

Testicular cancer is the most common cancer among young adult men and easily detected at an early stage by periodic testicular self-examination (TSE); however, health care providers seldom teach TSE, thus opportunities for early detection are missed. We aimed to evaluate the efficacy of TSE education on the knowledge, performance, and health beliefs of Turkish young men. This quasi-experimental follow-up research was conducted on 174 male Health Science university students in Turkey. The data was collected by a modified socio-demographic form and questionnaire, and the Turkish version of Champion Health Belief Model Scale which was performed at two stages: before and 3 months after education. Before education, 66.2% of the students did not know anything about TSE, and the main reason for not to perform TSE was the lack of knowledge prior to education. The results showed a significant increase in the perceived benefits in terms of TSE after education (p < 0.05). Furthermore, a positive improvement in the behavior of the students toward TSE was observed after education. These results indicate that TSE training is effective in young men, but TSE training should be repeated periodically for better efficacy. These results support that health professionals should have a more active role in the training of adult young men in colleges in terms of TSE.

The role of social-cognitive and emotional factors on testicular self-examination.

OBJECTIVE: This study determined the role of social-cognitive and affective factors in promoting testicular self-examination. METHODS: Male participants (N = 115) rated their perceptions of testicular cancer, social-cognitive variables (attitude, subjective norm, and perceived control), and their emotions towards testicular cancer (anxiety and shame) and testicular self-examination (anticipated regret and relief). Participants also stated whether or not they had performed a testicular self-examination within the last month. RESULTS: Perceived control and anticipated relief positively predicted testicular self-examination within the last month. Both these factors also positively predicted the intention to self-examine in the future. Intention was also positively predicted by attitude and negatively predicted by shame. CONCLUSIONS: These results highlight the importance of social-cognitive and emotional factors in promoting health screening. Targeting these factors might improve the effectiveness of testicular self-examination interventions. Copyright © 2016 John Wiley & Sons, Ltd.

Testicular Cancer Awareness and Knowledge: Is It the Same? Exploratory Study in a Mixed-Gender Population.

Testicular cancer (TC) is among the most common malignancies in the young male. Awareness plays an important role, because delay in diagnosis affects outcome. Testicular self-examination (TSE) is controversial, but recent evidence shows some cost benefits in performing this exam versus a late-stage diagnosis. The aims of this study are to determine and compare awareness for TC and TSE in males and females with the actual knowledge to this disease in an academic population. An exploratory study using an online questionnaire about TC and TSE was performed in a public university. Answers were collected and submitted to statistical analysis. A total of 815 participants-507 males (62.2 %) and 308 females (37.7 %)-answered the survey. The participants that responded that they were aware of TC were 399/507 (78.7 %) males and 275/308 (89.3 %) females. About half (48.9 %) of male and 42.2 % of female respondents did not answered correctly to most common symptom, and only 15 % of males and 25 % of females answered to the question on age at diagnosis. Both gender subjects rated TSE as very important, and the majority of females were motivated to advise male partners or friends to perform TSE. This study reported a good awareness on TC and TSE, but comparing to the correct knowledge about this disease, results are disappointing. The actual knowledge about TC is low and comparable in men and women. Women revealed a better understanding of this disease and importance of TSE, suggesting that they can assume an important role in promoting health behaviors in men.

Tweeting About Prostate and Testicular Cancers: Do Twitter Conversations and the 2013 Movember Canada Campaign Objectives Align?

Prostate cancer is the most frequently diagnosed cancer of the reproductive system in men. Mass media campaigns have long been a tool for raising awareness of important health issues and changing health behavior. The Movember campaign was launched in Canada in 2007 with the goal of creating conversations about men's health in order to raise awareness and understanding about prostate cancer. In 2012, testicular cancer was added to the Movember Canada campaign agenda. Social networking sites such as Twitter are popular platforms for conversations in the digital age. Our objective was to determine if the Movember Canada 2013 campaign accomplished the goal of creating conversations about prostate and testicular cancers on the social media platform of Twitter. We conducted a content analysis of 4222 Canadian tweets posted during the November 2013 Movember Canada campaign to investigate whether tweets were health-related or non-health-related and to determine what topics of discussion were present in the tweets. There were significantly fewer health-related (n = 673) than non-health-related (n = 3549) tweets (p < 0.05). Few tweets (0.6 % of all tweets) referenced prostate or testicular cancers. Community engagement activities as well as moustache and grooming references were the most frequent topics in the health-related (10.49 and 1.97 %) and non-health-related (32.83 and 32.76 %) categories, which were significantly different by topic (p < 0.05). Findings from Twitter suggest that the Movember Canada 2013 did not meet the stated campaign objective of creating conversations about men's health and, specifically, about prostate and testicular cancers.

Tweeting About Prostate and Testicular Cancers: What Are Individuals Saying in Their Discussions About the 2013 Movember Canada Campaign?

Effective and persuasive health campaigns are an important tool for promoting cancer prevention education. The 2013 Movember Canada campaign presented an opportunity to raise awareness and funds about men's health with a particular focus on prostate and testicular cancers. The Movember campaign encouraged participants to talk about men's health (including prostate and testicular cancers) and had a strong presence on social media sites such as Twitter in November 2013. The objective of this study was to analyze tweets about the 2013 Movember Canada for underlying themes in order understand what those discussions were about. A directed content analysis methodology was used to analyze 2400 tweets. Tweets were read and coded for overt and latent themes in an iterative fashion until saturation of themes occurred. The major themes identified in the tweets were fundraising as a priority (34 %), making a change to men's health (18 %), the campaign as a moustache contest rather than a charity (26 %), the use of masculine metaphors/imagery (9 %), and the role of women as moustache supporters (4 %). Findings from Twitter suggest that users rarely associate their campaign efforts with prostate and/or testicular cancer in public online conversations about the 2013 Movember Canada campaign.

A conjugate of octamer-binding transcription factor 4 and toll-like receptor 7 agonist prevents the growth and metastasis of testis embryonic carcinoma.

BACKGROUND: The immune non-recognition is often the underlying cause of failure in tumor immunotherapeutic. This is because most tumor-related antigens are poorly immunogenic, and fail to arouse an efficient immune response against cancers. Here we synthesized a novel TLR7 agonist, and developed a safe and effective immunotherapeutic vaccine by conjugating this TLR7 agonist with the pluripotency antigen OCT4. METHODS: Purified recombinant OCT4 protein was covalently linked with a novel TLR7 agonist to form a TLR7-OCT4 conjugate (T7-OCT4). After conjugation, the in vitro release of IL-12 and IFN-γ was observed in spleen lymphocytes. Mice were immunized with TLR7-OCT4, and the release of IFN-γ, the percentages of CD3+/CD8+ T cells and the OCT4-specific cytotoxicity rates were measured. The immunized mice were challenged with mouse embryonic carcinoma (EC), and the tumor volume and tumor weight were determined. Blood routine examination was performed to evaluate the biosafety of TLR7 agonist and TLR7-OCT4 conjugate in mice. RESULTS: T7-OCT4 conjugate significantly increased the in vitro release of IL-12 and IFN-γ by mouse spleen lymphocytes. In addition, the release of IFN-γ, the percentages of CD3+/CD8+ T cells and the tumor-specific cytotoxicity rates in immunized mice were significantly higher. Importantly, in EC xenografted mice, immunization with T7-OCT4 conjugate decreased the growth of the tumor dramatically up to 90 %, as compared to mice immunized with OCT4 protein or TLR7 agonist alone. Furthermore, blood routine examination demonstrated that no abnormalities of the blood cells and components in the blood fluids were detected by T7-OCT4 and TLR7 agonist injections. CONCLUSIONS: Our results showed that conjugating OCT4 protein to the novel TLR7 agonist produced a vaccine which is effective and safe in preventing tumor growth in mice. Our results suggest that this type of vaccine formulation has great potentiality in preventive vaccines against OCT4 expressing tumors.

Bilateral testicular germ cell tumors in patients treated for clinical stage I non-seminoma within two risk-adapted SWENOTECA protocols.

BACKGROUND: A contralateral tumor occurs in 3.5-5% of men diagnosed with testicular germ cell cancer (TGCC). Biopsy of the contralateral testis may detect intratubular germ cell neoplasia ITGCNU, a precursor of TGCC. Biopsy of the contralateral testis to detect ITGCNU is controversial. If adjuvant chemotherapy (ACT) protects against bilateral cancer is debated. MATERIAL AND METHODS: A total of 1003 patients with clinical stage I (CS I) non-seminomatous testicular germ cell cancer (NSGCT) were included in two prospective, population-based protocols. Fifteen patients were excluded. Treatment was either adjuvant chemotherapy (n = 494), or surveillance (n = 494). Contralateral testicular biopsy was recommended for all patients, but was performed only in 282 patients. In case of ITGCNU radiotherapy (RT) to 16 Gy was recommended. RESULTS: During a follow-up of 8.3 years, 31 (3.6%) patients developed contralateral TGCC. ITGCNU was detected in 3.2% (9/282) of biopsied patients. The incidence of bilateral TGCC was similar following ACT, 2.5% (11/494), and surveillance, 3.4% (13/494), p = 0.41. Young age was a risk factor for metachronous TGCC (HR 0.93; 95% CI 0.88-0.99, p = 0.02). In total 2.2% (6/273) of patients without ITGCNU in the biopsy developed contralateral TGCC. One irradiated patient developed contralateral cancer, and one developed contralateral tumor before RT was given. CONCLUSION: ACT did not reduce the incidence of contralateral TGCC. Young patients had the highest risk of developing contralateral TGCC. The proportion of false negatives biopsies was higher than reported in earlier trials, but this may in part be related to patient selection, single biopsies and lack of mandatory immunohistochemistry.

The antibody-based targeted delivery of interleukin-4 and 12 to the tumor neovasculature eradicates tumors in three mouse models of cancer.

Preclinical studies with recombinant murine interleukin 4 (IL4) in models of cancer have shown potent tumor growth inhibition. However, systemic administration of human IL4 to cancer patients exhibited modest antitumor activity and considerable toxicities. To improve the therapeutic index and reduce side effects of this cytokine, we developed of a novel "immunocytokine" based on sequential fusion of murine IL4 with the antibody fragment F8 (specific to the alternatively spliced extra-domain A of fibronectin, a marker for tumor-angiogenesis) in diabody format. The resulting fusion protein, termed F8-IL4, retained full antigen-binding activity and cytokine bioactivity and was able to selectively localize on solid tumors in vivo. When used as single agent, F8-IL4 inhibited tumor growth in three different immunocompetent murine cancer models (F9 teratocarcinoma, CT26 colon carcinoma and A20 lymphoma). Furthermore, F8-IL4 showed synergistic effects when coadministered with immunocytokines based on IL2 and IL12. Indeed, combination therapy with an IL12-based immunocytokine yielded complete tumor eradication, in spite of the fact that IL4 and IL12 display opposite immunological mechanisms of action in terms of their polarization of T-cell based responses. No weight loss or any signs of toxicity were observed in treated mice, both in monotherapy and in combination, indicating a good tolerability of the immunocytokine treatment. Interestingly, mice cured from CT26 tumors acquired a durable protective antitumor immunity. Depletion experiments indicated that the antitumor activity was mediated by CD8+ T cells and by NK cells.

Educating young men about testicular cancer: support for a comprehensive testicular cancer campaign.

Despite the prevalence of testicular cancer among men 15-39 years of age, little has been done to increase awareness of this disease or educate males about its prevention. To fill this gap, the Standard Model of Health Communication was incorporated to design and implement a comprehensive testicular cancer campaign among male college students. To test the effectiveness of these messages, college students (N = 220) completed measures before and after the campaign. In addition, the authors obtained a control group of male college students (N = 52) who were not exposed to the messages. Survey items assessed awareness of testicular cancer and behaviors related to testicular cancer. Participants' knowledge of testicular cancer and likelihood of conducting a testicular self-exam increased significantly after being exposed to the campaign information. Men who were exposed to testicular cancer messages were more knowledgeable about testicular cancer and were more likely to conduct testicular self-examinations than were men in the control group.

Ideal timing of orchiopexy: a systematic review.

The ideal management of cryptorchidism is a highly debated topic within the field of pediatric surgery. The optimal timing of orchiopexy is particularly unclear, as existing literature reports mixed recommendations. The aim of this study was to determine, based on a systematic review, the most favorable age at which orchiopexy should be performed. We conducted a systematic search of MEDLINE, Embase, CINAHL, and the Cochrane Library to find relevant articles. Two researchers quality assessed each study using the following tools: AMSTAR (systematic reviews), Jadad (RCTs), and MINORS (non-RCTs). We developed a conclusion based on the highest quality studies. We found one relevant systematic review, one RCT, and 30 non-RCTs. Fertility potential was greatest when orchiopexy was performed before 1 year of age. Additionally, orchiopexy before 10­11 years may protect against the increased risk of testicular cancer associated with cryptorchidism. Orchiopexy should not be performed before 6 months of age, as testes may descend spontaneously during the first few months of life. The highest quality evidence recommends orchiopexy between 6 and 12 months of age. Surgery during this timeframe may optimize fertility potential and protect against testicular malignancy in children with cryptorchidism.

Enhancing Testicular Cancer Prevention Among University Students: A Health Belief Model and Social Support Intervention.

BACKGROUND AND OBJECTIVE: Testicular cancer poses a significant health concern for young adults, particularly university students, who often lack tailored interventions. Drawing on the Health Belief Model and a social support strategy, this study implemented an innovative educational program to empower male university students with knowledge and promote proactive engagement in testicular cancer self-examination practices. MATERIAL AND METHOD: A quasi-experimental research design was utilized in this study. The study participants consisted of 350 male individuals aged 18-25, corresponding to the final academic year (fourth year). The educational intervention for the post-test phase group consisted of seven 50 to 60-minute training and education sessions designed to enhance knowledge and promote preventive behaviors related to testicular cancer. Various statistical tests, such as Chi-square tests, independent t-tests, Mann-Whitney tests, and Repeated Measurement ANOVA, were systematically employed to unravel meaningful insights and determine the statistical significance of observed trends. RESULTS: The findings showed significant improvements post-intervention in knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, social support, and testicular self-examination performance. CONCLUSION: The study underscores the effectiveness of the intervention in promoting preventive behaviours against testicular cancer among university students, laying the groundwork for future educational initiatives. 
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Testicular cancer knowledge among deaf and hearing men.

Testicular cancer typically affects young and middle-aged men. An educational video about prostate and testicular cancer was created in American Sign Language, with English open captioning and voice overlay, so that it could be viewed by audiences of diverse ages and hearing characteristics. This study recruited young Deaf (n = 85) and hearing (n = 90) adult males to help evaluate the educational value of the testicular cancer portion of this video. Participants completed surveys about their general, testicular, and total cancer knowledge before and after viewing the video. Although hearing men had higher pre-test scores than Deaf men, both Deaf and hearing men demonstrated significant increases in General, Testicular, and Total Cancer Knowledge scores after viewing the intervention video. Overall, results demonstrate the value of the video to Deaf and hearing men.

Humor-Based Messaging in Testicular Cancer Awareness Campaigns: A Comparative Critical Review.

Extensive research showcases the extent and efficacy of humor-based messaging in general health promotion. However, the work describing humor's use within testicular cancer (TC) awareness is less developed. The aim of this comparative critical review was to determine the impact of using humor-based messaging in TC awareness campaigns to achieve a baseline assessment from which future research can be modeled. A literature search was conducted using seven databases to locate relevant literature. Three research questions guided this investigation: (1) To what extent has humor been used in TC awareness campaigns? (2) What does the literature reveal about the use of humor-based messaging on relevant health outcomes? (3) What are the limitations within current TC awareness strategies? Six studies were included in the review, of which three directly assessed the use of humor in TC awareness vis-à-vis intervention designs. Humor-based strategies were implemented to enhance knowledge of TC and testicular self-examination (TSE) procedures, reduce anxiety surrounding detection threat, and promote TSE. The rhetoric provided to men via various health interventions relied on humor and slang to promote TSE among males. Despite the small sample size of the included studies, this review determined that humor may be useful in reducing uncomfortable feelings surrounding TSE, increasing awareness of TC, and promoting TSE. When using humor-based messaging, however, the audience and type of humor implemented must be considered. Limited research exists assessing the long-term impact humor in TC promotion on health behavioral changes, easing anxieties related to detection, and increased self-efficacy surrounding TSE.