Testicular cancer knowledge amongst Lebanese university students and the effect of a social media awareness campaign

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Testicular self-examination (TSE) leads to early diagnosis. We aimed, in this study, to evaluate the knowledge among young Lebanese male university students concerning TC and their practice of TSE. We also evaluated the use of social media (SM) for an awareness campaign. Methods Using an online survey, we evaluated male students' knowledge at our university and the factors associated with increased knowledge and practice of TSE. Then we conducted an entirely virtual awareness campaign using social media and an awareness video and evaluated its effect. Results Only 14% (N=115) had previously received awareness about TC, and 31% (N=254) previously had a testicular examination by a healthcare professional (HCP). Risk factors were identified correctly by 13% (N=160). Factors that were associated with the increased practice of TSE were medical studies (OR = 8.55, CI [3.93-19.50]), previous awareness about TC (OR=3.35, CI [1.90-5.92]), and high TC knowledge score (OR=1.38, CI [1.07-1.77]). Higher knowledge scores were associated with studying for seven years (OR=1.93, CI [1.23-3.05]) or more (OR=1.55, CI [1.09-2.19]). After the awareness campaign, 70% of the student practiced TSE, 15% talked with their HCP about TC, and 43% transmitted knowledge to others. About 4.6% of students discovered that they have risk factors for TC. The median amount of knowledge learned by the students was 8 over 10 (IQR 7-9). Most students (90%) had a good experience using social media for awareness. Conclusions Young university students in Lebanon have poor knowledge about TC and its risk factors. TSE is poorly practiced in non-medical students, especially in the most concerned men with risk factors. Education about TC increases the practice of TSE. The use of social media is an effective method for awareness campaigns and can improve health-related practices. self-examination testicular neoplasm social media Lebanon awareness Figures Figure 1 Figure 2 Introduction Testicular cancer (TC) is the most common malignancy in men between 15–40 years (1). Its incidence has nearly doubled over the last four decades for unknown reasons, and it is the highest among Caucasian men (2). Although there is no primary method to prevent it (3), TC is one of the most treatable cancers. Most patients have a low-stage disease and high survival rates with standard therapy. When caught early, the cure rate is close to 100 percent (2). Despite previous statements against TC screening due to its low incidence and lack of data to support a benefit (4), recent guidelines are recommending testicular self-examination (TSE) for early detection in patients with risk factors (2,5), and after a shared decision with other patients after the discussion about the potential risk and benefits of this practice. A recent extensive survey in the United States showed that men do not feel knowledgeable about testicular cancer, have a favorable attitude towards testicular self-examination, and want their doctor to discuss these topics (4). In Lebanon, the 5-year prevalence rate of TC is 10.22 per 100 000, with 100 new cases diagnosed per year (6). Although awareness campaigns for prostate cancer are regularly organized in Lebanon, little attention is given to TC (7). We aimed, in this study, to evaluate the knowledge among young Lebanese male university students concerning TC and their practice of TSE. We also evaluated the usage of social media (SM) to conduct an awareness campaign since it is a flourishing area of study in the field of public health. Methods Study design We conducted our study at the Holy Spirit University of Kaslik – Lebanon, between October 1, 2021, and November 30, 2021. We contacted all male students on three campuses during the coronavirus 2 pandemic. An entirely virtual awareness campaign was conducted using social media, online surveys, and a YouTube teaching video to reach the students, and it is summarized in Figure 1. All male students' e-mail addresses and phone numbers were collected from the university database. One week before the launching of the study, we diffused an attractive post about TC on the university's social media pages (Facebook, Instagram). Students were notified by mail and invited to participate in the study. We created and diffused questionnaires using a web-based application. The first questionnaire included an initial introduction stating the study's intention and that the survey was anonymous and short, with 12 questions and an estimated time for completion of fewer than 10 minutes. Questions were displayed only after consenting to participate. It covered demographic data (age, major, year of study), previous exposure to the TC (family or personal history, previous awareness, previous testicular examination by a healthcare professional (HCP)), knowledge assessment concerning TC (frequency of the disease, benefits of early detection, most concerned age group, risk factors), and the practice of TSE. A personalized message was sent to each student's phone, with a small explicative text and a link to the survey. A second reminder was sent by phone message one week later. Data collection ended two weeks later. The department of Urology at our university hospital prepared a short (2 minutes) awareness video published on YouTube (8), which was sent via phone message to all students, regardless of their participation in the survey (allowing everyone to benefit from the campaign). It stated the facts about TC and explained TSE based on the latest recommendations of the American Urology Association (AUA), the European Associations of Urology (EAU), and the American Cancer Society (ACS). A second questionnaire was sent one month later to evaluate the campaign, the amount of knowledge gained, and the practice of TSE. Statistical analysis For descriptive analysis, we used means, medians, and interquartile ranges (IQR) for continuous variables and percentages for discrete variables. We used the student's t-test and the chi-square test for continuous and discrete variables for comparative analysis. For multivariate analysis, we used a general linear model to study the effect of age, major, year of study, hometown, family history of TC, previous awareness about TC, previous testicular examination by HCP on the knowledge score, and the practice of testicular self-examination. Confidence intervals were fixed to 95% with significative p values <0.05. We did not have missing values because answers were mandatory for all the questions in the online surveys. The analysis was conducted using RStudio 2021.09.0 "Ghost Orchid" Release for Windows (9). Results Study population and demographics We identified and contacted 2787 male students on the university's three campuses. Overall, 807 (28.95%) consented to participate. The median age was 21 years (IQR 19–23). Students from all the faculties responded. The highest response rate was 26% (N = 206) from the engineering faculty and the lowest from the nursing school, corresponding to 0.4% (N = 3). Medical students' responses counted for 16% (N = 132) (Fig. 2 ). Most students were in their first year of study (25%, N = 200). Students that studied for more than seven years, mainly doctorate or medical students, counted for 5.7% (N = 46) of responses. Demographic data are detailed in Table 1 . Table 1 Demographic characteristics of students Characteristic Median (IQR) or N (%) Age 21.0 (19.0–23.0) 40 11 (1.4%) Major Architecture 105 (13%) Business 150 (19%) Engineering 206 (26%) Law 42 (5.2%) Medicine 132(16%) Music 38 (4.7%) Nursing 3 (0.4%) Sciences 121 (15%) Theology 10 (1.2%) Year of study 1 200 (25%) 2 111 (4%) 3 143 (18%) 4 121 (15%) 5 121 (15%) 6 47 (5.8%) 7 18 (2.2%) 7+ 46 (5.7%) Knowledge about testicular cancer Concerning students' knowledge about testicular cancer (Table 2 ), 64% (N = 513) considered the disease not frequent, 28% (N = 223) thought that it could happen at any age, and 31% believed that the most affected age group is beyond 50 years old (N = 249). The majority of students (91%, N = 734) considered that early detection is beneficial, 8.6% (N = 69) were not sure of its benefit, and 0.5% (N = 4) did not see any benefit from early detection. Students were given four risk factors (cryptorchidism, personal or family history of TC, alcohol, and smoking) and had to pick, as per their knowledge, one or many correct risk factors for TC or choose the option "no specific risk factors". Only 13% (N = 160) answered correctly (cryptorchidism or personal or family history of TC), 70% (N = 562) answered correctly partially (only one correct RF, or two correct and at least one wrong), and 17% (N = 139) had wrong answers (wrong RF or considered there is none). Table 2 Knowledge and previous awareness about testicular cancer Question Answers Median (IQR) or N (%) Practice of TSE No 628 (78%) Yes 179 (22%) Family history of TC No 769 (95%) Yes 38 (4.7%) Previous awareness about TC No 692 (86%) Yes 115 (14%) Examination before by a HCP No 553 (69%) Yes 254 (31%) Knowledge questions • Is testicular cancer frequent? No 513 (64%) Yes 38 (36%) • Which age range is most concerned? 20–30 157 (19%) 30–40 163 (20%) 40–50 15 (1.9%) >50 249 (31%) No specific age 223 (28%) • Is early detection beneficial? No 4 (0.5%) Yes 734 (91%) Not sure 69 (8.6%) • What are the risk factors for TC? Correct 106 (13%) Partially correct 562 (70%) Wrong 139 (17%) Composite knowledge score 4 (3–4) 0* 0 1 3 (0.4%) 2 56 (6.9%) 3 267 (33%) 4 357 (44%) 5 107 (13%) 6^ 17 (2.1%) * Lowest level of knowledge ^ Highest level of knowledge TSE: Testicular self-examination; TC: Testicular cancer; HCP: Healthcare professional For subsequent statistical analysis, students' age was divided into six classes. We also created a composite knowledge score detailed in Table 3 . We assigned a grade to each possible answer to the questions related to the knowledge about TC, with the highest grades for the correct answers. The score was graded over 6, with the lowest knowledge level 0 and the highest 6. Our population's median composite knowledge score was 4 (IQR 3–4). Table 3 Composite knowledge score about testicular cancer Question Possible answers Status Grade Is testicular cancer frequent? No Correct 1 Yes Incorrect 0 Which age group (in years) is mostly concerned? 20–30 Correct 1 30–40 Incorrect 0 40–50 Incorrect 0 > 50 Incorrect 0 No specific age group Incorrect 0 Is early detection beneficial? No Incorrect 0 Maybe Not incorrect 1 Yes Correct 2 Which of the following are risk factors for TC? 1- cryptorchidism 2- personal or family history of TC 3- smoking 4- alcohol consumption 3 and/or 4 Incorrect 0 (1 and/or 2) and (3 and/or4) Partially correct 1 1 and 2 Correct 2 TC: testicular cancer Previous testicular cancer awareness and practice of self-examination Overall, 4.7% (N = 38) had a family history of TC. Only 14% (N = 115) received previous awareness, and 31% (N = 254) previously had a testicular examination by a HCP. Overall, 22% (N = 179) have already practiced TSE (Table 2 ). Factors associated with the practice of testicular self-examination On bivariate analysis, students aged between 20 and 30 were 1.5 to 2 times more likely to practice TSE (RR = 1.50 [1.12–2.01], RR = 1.98 [1.29–3.04], respectively). Medical students practiced TSE 4 times more than other students (RR = 4.54 [2.96–6.99]). Students who studied for 6, 7, or more years were more likely to practice TSE (RR = 2.20 [1.29–3.76], RR = 2.68 [1.37–5.24], RR = 4.05 [2.67–6.13], respectively). Students who had TC knowledge scores of 5/6 and 6/6 (reflecting high levels of knowledge) were 2 to 3 times more likely to perform TSE (RR = 2.36 [1.17–4.72], RR = 2.88 [1.22–6.79], respectively). Students who received previous awareness about TC and those who had a previous testicular examination by a HCP were three times more likely to practice TSE (RR = 3.69 [2.93–4.63], RR = 3.39 [2.61–4.40], respectively). A family history of TC was not associated with increased TSE. On multivariate analysis, only medical students (OR = 8.55, CI [3.93–19.50]), previous awareness about TC (OR = 3.35, CI [1.90–5.92]), and high TC knowledge score (OR = 1.38, CI [1.07–1.77]) were significantly associated with the practice of self-examination (Table 4 ). Table 4 Multivariate analysis showing associations between the practice of testicular self-examination and other variables Characteristic OR [CI 95%] Age 1.00 [0.94–1.05] Major Architecture Reference Business 1.14 [0.50–2.63] Engineering 1.02 [0.48–2.23] Law 0.74 [0.20–2.38] Medicine 8.55 [3.93–19.50] Music 1.33 [0.40–4.02] Nursing 2.56 [0.07–48.74] Sciences 1.36 [0.60–3.14] Theology 3.17 [0.49–17.08] Year of study 1 Reference 2 1.03 [0.49–2.12] 3 1.07 [0.53–2.12] 4 1.88 [0.90–3.91] 5 1.66 [0.76–3.62] 6 2.76 [0.98–7.67] 7 2.21 [0.50–9.68] 7+ 3.09 [1.00-9.86] Family history of TC No Reference Yes 1.07 [0.39–2.74] Previous awareness No Reference Yes 3.35 [1.90–5.92] Previous examination by a HCP No Reference Yes 6.91 [4.46–10.92] TC Knowledge score 1 1.37 [1.07–1.77] TSE: Testicular self-examination; TC: Testicular cancer; HCP: Healthcare professional Factors associated with increased knowledge score Multivariate analysis showed that the only factor that increased knowledge score was studying for seven years (OR = 1.93, CI [1.23–3.05]) or more (OR = 1.55, CI [1.09–2.19]). Surprisingly, having a family history of TC (OR = 0.63, CI [0.48–0.84]) was significantly associated with a lower knowledge score. Previous awareness, major, age, and previous testicular examination by a HCP, were not associated with increased knowledge (Table 5 ). Table 5 Multivariate analysis showing associations between composite knowledge score and other variables Characteristic OR [CI 95%] Age 0.98 [0.97-1.00] Major Architecture Reference Business 0.89 [0.71–1.11] Engineering 1.12 [0.91–1.38] Law 0.88 [0.64–1.21] Medicine 1.08 [0.85–1.38] Music 1.00 [0.72–1.38] Nursing 1.34 [0.50–3.61] Sciences 1.16 [0.92–1.46] Theology 0.70 [0.39–1.24] Year of study 1 Reference 2 0.92 [0.75–1.13] 3 1.00 [0.83–1.21] 4 0.88 [0.71–1.08] 5 0.99 [0.80–1.24] 6 0.85 [0.63–1.15] 7 1.93 [1.23–3.05] 7+ 1.55 [1.09–2.19] Family history of TC No Reference Yes 0.63 [0.48–0.84] Previous awareness No Reference Yes 1.09 [0.90–1.32] Previous examination by a HCP No Reference Yes 1.04 [0.91–1.18] TSE: Testicular self-examination; TC: Testicular cancer; HCP: Healthcare professional Evaluation of the awareness campaign The second survey showed that 70% of the student practiced TSE, 15% talked with their HCP about TC, and 13% had abnormal findings. About 4.6% of students discovered that they have risk factors for TC, and 43% transmitted knowledge to others. The mean amount of knowledge learned by the students was 7.39 over 10, with a median of 8 ( 7 – 9 ). Students with higher knowledge levels (7–9/10) were more likely to perform TSE (RR = 1.61, CI [1.05–2.46]). For this study, most of them (90%) had a good experience using social media platforms (questionnaire on the phone and the teaching YouTube video). Only 10% rated the experience as normal, and no one rated it as bad. Discussion Although there is no expert consensus on screening for TC, early detection is associated with smaller tumor size at presentation, higher curability, and reduced treatment costs ( 10 ). There is no high-level evidence to support screening programs ( 11 , 12 ). However, the AUA, EAU, and ACS advise monthly self-examination in men with risk factors (personal or familial history of TC, cryptorchidism) since stage and prognosis are related to early diagnosis ( 2 , 5 ), and the ACS details how TSE should be performed ( 13 ). Therefore, the primary purpose of strategies to prevent TC should be the implementation of educational programs designed to increase awareness and knowledge about the risk factors of TC and the practice of TSE in higher-risk men ( 14 ). We launched this online awareness campaign using social media during the COVID-19 pandemic to prevent the spreading of the virus. We used the online survey method for data collection because it offers easy access to respondents, rapid data collection with low cost, particularly with large samples, and enables the construction of random samples avoiding selection bias ( 15 ). To optimize the patients' responses, we used an e-mail pre-notification to invite them to participate in the study, a reminder to complete the survey, a semi-automatic log-in, a simple design, and a short survey that takes less than 10 minutes ( 16 ). We also sent a personalized phone message for all male students, with a small explicative text and a link to the survey, because a personalized approach was shown to produce significantly higher response rates ( 17 ). We got a response rate of 28.95%, which is relatively low but common in web-based surveys in specific populations (students in our study), and comparable to the literature ( 15 ). We had good participation from all faculties, reflecting that the subject interested all young men, regardless of their specialties. The low rate of nursing students' responses (0.4% of total responses) can be explained by the low ratio of men to women in this school (a total of 8 male students in the nursing faculty, with 3 respondents). The lack of education about testicular cancer in schools, universities, and mass media was apparent, with low rates of correct identification of the risk factors (13%), exposure to previous awareness (14%), and previous testicular examination by a HCP (31%). This poor knowledge about TC and TSE was also found in the systematic review of Saab et al., which included 25 articles and had the same research question ( 18 ). Family history was not associated with an increased practice of TSE, in contrast to the results of June et al., who found a significant association between familial TC and family members' awareness ( 19 ). This finding underlines the importance of focusing education on the risk factors. Higher knowledge scores were associated with increased TSE, and previous awareness and education on TC were positively and significantly associated with the practice of TSE on bivariate and multivariate analysis. Ryszawy et al ( 20 ) reported the same finding, which raises the importance of implementing awareness campaigns to increase the knowledge of men concerning TC. Medical students were the only students with significant practice of TSE. This finding is in line with the previous work of Yazici et al. ( 21 ) and highlights the importance of targeting non-medical students. Our method, using SM exclusively for awareness, increased the level of engagement of men and doubled the rate of self-examination, which is a crucial element in early detection. Almost all the participants found this virtual awareness campaign good. It stimulated 43% to transmit knowledge to others, which means an exponential spreading of awareness. Our results are comparable with previous studies about the effect of SM on cancer awareness ( 22 ). It allows the dissemination of health messages rapidly and at a low cost to large numbers of people across large geographical areas ( 23 ). Although SM improves attitudes and practices related to health ( 24 , 25 ), there is little evidence about whether it improves cancer screening and early diagnosis ( 26 , 27 ). Older adults are usually largely obscured in SM representation of cancer and cancer experience ( 25 ). However, this is not an issue for consideration, particularly for TC, since the targeted population is young men, the biggest users of social media ( 24 ). Our study had several limitations. First, it is a single institution study which limits its generalizability. Second, we could not analyze the non-response bias since the survey was anonymous. However, if data collection were not anonymous, the response rate would probably have been lower since there are questions about personal and family history of TC and TSE, which are still taboo in our middle eastern society (relating to fertility and masculinity themes). Third, the beneficial effect of this campaign on the practice of TSE was only evaluated in the short term. Long-term observation is needed to evaluate its effect in the long term. Conclusion Young men in Lebanon have poor knowledge of testicular cancer and its risk factors, with a lack of awareness campaigns and little attention from HCP. TSE is poorly practiced in non-medical students, even in most concerned groups with risk factors for TC, and its practice is affected by previous education about TC. Our study highlights the need to implement national awareness campaigns to increase the knowledge of Lebanese men about TC. SM is an effective method for awareness campaigns and can play a major role in health promotion. It allows the dissemination of health messages rapidly, at a low cost, to a large number of people and improves health-related attitudes and practices. Abbreviations TC testicular cancer TSE testicular self-examination SM social media HCP healthcare professional AUA American Urology Association EAU European Associations of Urology ACS American Cancer Society IQR interquartile ranges Declarations Ethics approval and consent to participate Informed consent was obtained from all the participants to the survey which was approved by our institution ethical board. Study protocols were approved by a the "Notre Dame des Secours University Hospital" ethics committee. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no conflict of interest. Funding No funding was required for this work. Authors' contributions AK: Participated in writing of the paper and data analysis. MA: Reviewed the paper. JEK: Participated in data analysis and prepared the figures. RH: Participated in data analysis. SA: Participated in data analysis. AM: Participated in research design. SB: Participated in research design. TA: Participated in data collection. REK: Participated in research design and performance of the research and supervised the work. The author(s) read and approved the final manuscript. Acknowledgments N/A. References Pierorazio PM, Albers P, Black PC, Tandstad T, Heidenreich A, Nicolai N, et al. Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary. Eur Urol. 2018 Jun;73(6):899–907. Stephenson A, Eggener SE, Bass EB, Chelnick DM, Daneshmand S, Feldman D, et al. Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. J Urol. 2019 Aug;202(2):272–81. Kalan Farmanfarma K, Mahdavifar N, Mohammadian-Hafshejani A, Salehiniya H. Testicular cancer in the world: an epidemiological review. 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Simulated parents: developing paediatric trainees' skills in giving bad news. J Paediatr Child Health. 2009 Mar;45(3):133–8. Farsi D. Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers. J Med Internet Res. 2021 Apr 5;23(4):e23205. Macdonald S, Cunningham Y, Patterson C, Robb K, Macleod U, Anker T, et al. Mass media and risk factors for cancer: the under-representation of age. BMC Public Health. 2018 Apr 26;18(1):490. Di Bello F, Collà Ruvolo C, Cilio S, La Rocca R, Capece M, Creta M, et al. Testicular cancer and YouTube: What do you expect from a social media platform? Int J Urol. 2022 Jul;29(7):685–91. Pagoto S, Waring ME, Xu R. A Call for a Public Health Agenda for Social Media Research. J Med Internet Res. 2019 Dec 19;21(12):e16661. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2219234","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":150334379,"identity":"293ca631-cc42-432f-a2ec-1470aaa03c0c","order_by":0,"name":"Anthony Kanbar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYHACNhBhwMDAA6QqgJidgYGxAa8OZmQtZ4AUM0laGNuI0MI/u//Yg487Dhvzz+49+Llynk3ifmbmgw9nMNjJ6eLQJ3HnMLvhzDOHzSTunEuWPLstLbGHmS3ZcANDsrHZARzW3Ehmk+ZtO2zDcCPHQLJx22GgFh4zyQcMBxK34dAiD9MifyPH+GfjHCK0GEC1mBncyDGTbGyAatmAR4vhjWQzyZlt6caGN/LSLBuOpRn3HAb6ZYYBbr/I3Uh8JvGxzdpw3o3cwzcbamxk29ubDz7sqbCTw+l9CGjGcDBe5SBQR1DFKBgFo2AUjGAAAPBXXLF2CihfAAAAAElFTkSuQmCC","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Kanbar","suffix":""},{"id":150334380,"identity":"c1eb0f8a-1c06-432a-8693-37d8e1cbea2d","order_by":1,"name":"Maher Abdessater","email":"","orcid":"","institution":"Centre Hospitalier Universitaire Notre Dame des Secours","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maher","middleName":"","lastName":"Abdessater","suffix":""},{"id":150334381,"identity":"0785b739-a93a-4504-8520-dde6828ededf","order_by":2,"name":"Joey El Khoury","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Joey","middleName":"El","lastName":"Khoury","suffix":""},{"id":150334382,"identity":"4c937e84-633e-445c-90aa-cfbc9e5a3950","order_by":3,"name":"Rami Halabi","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rami","middleName":"","lastName":"Halabi","suffix":""},{"id":150334383,"identity":"1787a8a6-0527-466d-8971-cfd5229903fc","order_by":4,"name":"Serge Assaf","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Serge","middleName":"","lastName":"Assaf","suffix":""},{"id":150334384,"identity":"03a21116-2857-4de8-9452-b93bebb55ae8","order_by":5,"name":"Anthony Mina","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Mina","suffix":""},{"id":150334385,"identity":"93799068-0589-4087-af70-b9952e969a27","order_by":6,"name":"Sabine Breidy","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sabine","middleName":"","lastName":"Breidy","suffix":""},{"id":150334386,"identity":"e0a634ec-6b30-4173-9415-4a8ada30be7d","order_by":7,"name":"Toufic Awad","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Toufic","middleName":"","lastName":"Awad","suffix":""},{"id":150334387,"identity":"bdc2db75-89c6-42b9-95fe-821dd2d3f458","order_by":8,"name":"Raghid El Khoury","email":"","orcid":"","institution":"Holy Spirit University of Kaslik (USEK)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Raghid","middleName":"El","lastName":"Khoury","suffix":""}],"badges":[],"createdAt":"2022-10-30 17:44:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2219234/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2219234/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":28924486,"identity":"b2b42fe0-4b20-4553-abc7-a16adbd626a1","added_by":"auto","created_at":"2022-11-10 22:16:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77474,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTitle\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe timeline shows the strategy followed in our social media awareness campaign about testicular cancer.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eLegend\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo optimize the students’ responses, we used an e-mail pre-notification and social media posts, one week prior to the first survey. For the survey we used a personalized approach, with a semi-automatic log-in, a simple design, a short survey that takes less than 10 minutes, and a personalized phone message with a small explicative text and a link to the survey. A reminder to complete the survey was sent one week after the survey and was followed by a YouTube teaching video (week 2) that reached all students. The survey 2, six weeks later, evaluated the campaign and its effect. TSE: testicular self-examination\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2219234/v1/aa2110d964e66c097a05d212.png"},{"id":28924485,"identity":"f51d985e-ce8c-44df-b95f-4c2f3ddb7ec9","added_by":"auto","created_at":"2022-11-10 22:16:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTitle\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTree map chart showing the distribution by faculty of the students who responded.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eLegend\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eT: Theology; N: Nursing\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2219234/v1/9a54cc8a74efb181b1a6ac2a.png"},{"id":33334024,"identity":"b1c03742-34ec-4dd1-9def-292afc48d218","added_by":"auto","created_at":"2023-02-23 09:29:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":509938,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2219234/v1/10069e00-2ba6-4758-aabc-b8d7b8bd360a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Testicular cancer knowledge amongst Lebanese university students and the effect of a social media awareness campaign","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTesticular cancer (TC) is the most common malignancy in men between 15\u0026ndash;40 years\u0026nbsp;(1). Its incidence has nearly doubled over the last four decades for unknown reasons, and it is the highest among Caucasian men\u0026nbsp;(2). Although there is no primary method to prevent it\u0026nbsp;(3), TC is one of the most treatable cancers. Most patients have a low-stage disease and high survival rates with standard therapy. When caught early, the cure rate is close to 100 percent \u0026nbsp;\u0026nbsp;(2).\u003c/p\u003e\n\u003cp\u003eDespite previous statements against TC screening due to its low incidence and lack of data to support a benefit\u0026nbsp;(4), recent guidelines are recommending testicular self-examination (TSE) for early detection in patients with risk factors\u0026nbsp;(2,5), and after a shared decision with other patients after the discussion about the potential risk and benefits of this practice. A recent extensive survey in the United States showed that men do not feel knowledgeable about testicular cancer, have a favorable attitude towards testicular self-examination, and want their doctor to discuss these topics\u0026nbsp;(4).\u003c/p\u003e\n\u003cp\u003eIn Lebanon, the 5-year prevalence rate of TC is 10.22 per 100 000, with 100 new cases diagnosed per year\u0026nbsp;(6). Although awareness campaigns for prostate cancer are regularly organized in Lebanon, little attention is given to TC\u0026nbsp;(7).\u003c/p\u003e\n\u003cp\u003eWe aimed, in this study, to evaluate the knowledge among young Lebanese male university students concerning TC and their practice of TSE. We also evaluated the usage of social media (SM) to conduct an awareness campaign since it is a flourishing area of study in the field of public health.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eWe conducted our study at the Holy Spirit University of Kaslik \u0026ndash; Lebanon, between October 1, 2021, and November 30, 2021. We contacted all male students on three campuses during the coronavirus 2 pandemic. An entirely virtual awareness campaign was conducted using social media, online surveys, and a YouTube teaching video to reach the students, and it is summarized in Figure 1. All male students\u0026apos; e-mail addresses and phone numbers were collected from the university database.\u003c/p\u003e\n\u003cp\u003eOne week before the launching of the study, we diffused an attractive post about TC on the university\u0026apos;s social media pages (Facebook, Instagram). Students were notified by mail and invited to participate in the study.\u003c/p\u003e\n\u003cp\u003eWe created and diffused questionnaires using a web-based application. The first questionnaire included an initial introduction stating the study\u0026apos;s intention and that the survey was anonymous and short, with 12 questions and an estimated time for completion of fewer than 10 minutes. Questions were displayed only after consenting to participate. It covered demographic data (age, major, year of study), previous exposure to the TC (family or personal history, previous awareness, previous testicular examination by a healthcare professional (HCP)), knowledge assessment concerning TC (frequency of the disease, benefits of early detection, most concerned age group, risk factors), and the practice of TSE. A personalized message was sent to each student\u0026apos;s phone, with a small explicative text and a link to the survey. A second reminder was sent by phone message one week later. Data collection ended two weeks later.\u003c/p\u003e\n\u003cp\u003eThe department of Urology at our university hospital prepared a short (2 minutes) awareness video published on YouTube\u0026nbsp;(8), which was sent via phone message to all students, regardless of their participation in the survey (allowing everyone to benefit from the campaign). It stated the facts about TC and explained TSE based on the latest recommendations of the American Urology Association (AUA), the European Associations of Urology (EAU), and the American Cancer Society (ACS).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA second questionnaire was sent one month later to evaluate the campaign, the amount of knowledge gained, and the practice of TSE.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eFor descriptive analysis, we used means, medians, and interquartile ranges (IQR) for continuous variables and percentages for discrete variables. We used the student\u0026apos;s t-test and the chi-square test for continuous and discrete variables for comparative analysis. For multivariate analysis, we used a general linear model to study the effect of age, major, year of study, hometown, family history of TC, previous awareness about TC, previous testicular examination by HCP on the knowledge score, and the practice of testicular self-examination. Confidence intervals were fixed to 95% with significative p values \u0026lt;0.05. We did not have missing values because answers were mandatory for all the questions in the online surveys. The analysis was conducted using RStudio 2021.09.0 \u0026quot;Ghost Orchid\u0026quot; Release for Windows (9).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and demographics\u003c/h2\u003e \u003cp\u003eWe identified and contacted 2787 male students on the university's three campuses. Overall, 807 (28.95%) consented to participate. The median age was 21 years (IQR 19\u0026ndash;23). Students from all the faculties responded. The highest response rate was 26% (N\u0026thinsp;=\u0026thinsp;206) from the engineering faculty and the lowest from the nursing school, corresponding to 0.4% (N\u0026thinsp;=\u0026thinsp;3). Medical students' responses counted for 16% (N\u0026thinsp;=\u0026thinsp;132) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Most students were in their first year of study (25%, N\u0026thinsp;=\u0026thinsp;200). Students that studied for more than seven years, mainly doctorate or medical students, counted for 5.7% (N\u0026thinsp;=\u0026thinsp;46) of responses. Demographic data are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (IQR) or N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.0 (19.0\u0026ndash;23.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e374 (46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340 (42%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eMajor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArchitecture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngineering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206 (26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132(16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMusic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eYear of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge about testicular cancer\u003c/h2\u003e \u003cp\u003eConcerning students' knowledge about testicular cancer (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), 64% (N\u0026thinsp;=\u0026thinsp;513) considered the disease not frequent, 28% (N\u0026thinsp;=\u0026thinsp;223) thought that it could happen at any age, and 31% believed that the most affected age group is beyond 50 years old (N\u0026thinsp;=\u0026thinsp;249). The majority of students (91%, N\u0026thinsp;=\u0026thinsp;734) considered that early detection is beneficial, 8.6% (N\u0026thinsp;=\u0026thinsp;69) were not sure of its benefit, and 0.5% (N\u0026thinsp;=\u0026thinsp;4) did not see any benefit from early detection. Students were given four risk factors (cryptorchidism, personal or family history of TC, alcohol, and smoking) and had to pick, as per their knowledge, one or many correct risk factors for TC or choose the option \"no specific risk factors\". Only 13% (N\u0026thinsp;=\u0026thinsp;160) answered correctly (cryptorchidism or personal or family history of TC), 70% (N\u0026thinsp;=\u0026thinsp;562) answered correctly partially (only one correct RF, or two correct and at least one wrong), and 17% (N\u0026thinsp;=\u0026thinsp;139) had wrong answers (wrong RF or considered there is none).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge and previous awareness about testicular cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnswers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (IQR) or N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePractice of TSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e628 (78%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of TC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e769 (95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious awareness about TC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e692 (86%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExamination before by a HCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e553 (69%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254 (31%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge questions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026bull; Is testicular cancer frequent?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e513 (64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026bull; Which age range is most concerned?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e249 (31%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo specific age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026bull; Is early detection beneficial?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e734 (91%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026bull; What are the risk factors for TC?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePartially correct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e562 (70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWrong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eComposite knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e357 (44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6^\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e* Lowest level of knowledge\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e^ Highest level of knowledge\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eTSE: Testicular self-examination; TC: Testicular cancer; HCP: Healthcare professional\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor subsequent statistical analysis, students' age was divided into six classes. We also created a composite knowledge score detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. We assigned a grade to each possible answer to the questions related to the knowledge about TC, with the highest grades for the correct answers. The score was graded over 6, with the lowest knowledge level 0 and the highest 6. Our population's median composite knowledge score was 4 (IQR 3\u0026ndash;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComposite knowledge score about testicular cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePossible answers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStatus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIs testicular cancer frequent?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eWhich age group (in years) is mostly concerned?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo specific age group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIs early detection beneficial?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaybe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot incorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWhich of the following are risk factors for TC?\u003c/p\u003e \u003cp\u003e1- cryptorchidism\u003c/p\u003e \u003cp\u003e2- personal or family history of TC\u003c/p\u003e \u003cp\u003e3- smoking\u003c/p\u003e \u003cp\u003e4- alcohol consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 and/or 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1 and/or 2) and (3 and/or4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePartially correct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 and 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eTC: testicular cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePrevious testicular cancer awareness and practice of self-examination\u003c/h2\u003e \u003cp\u003eOverall, 4.7% (N\u0026thinsp;=\u0026thinsp;38) had a family history of TC. Only 14% (N\u0026thinsp;=\u0026thinsp;115) received previous awareness, and 31% (N\u0026thinsp;=\u0026thinsp;254) previously had a testicular examination by a HCP. Overall, 22% (N\u0026thinsp;=\u0026thinsp;179) have already practiced TSE (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with the practice of testicular self-examination\u003c/h2\u003e \u003cp\u003eOn bivariate analysis, students aged between 20 and 30 were 1.5 to 2 times more likely to practice TSE (RR\u0026thinsp;=\u0026thinsp;1.50 [1.12\u0026ndash;2.01], RR\u0026thinsp;=\u0026thinsp;1.98 [1.29\u0026ndash;3.04], respectively). Medical students practiced TSE 4 times more than other students (RR\u0026thinsp;=\u0026thinsp;4.54 [2.96\u0026ndash;6.99]). Students who studied for 6, 7, or more years were more likely to practice TSE (RR\u0026thinsp;=\u0026thinsp;2.20 [1.29\u0026ndash;3.76], RR\u0026thinsp;=\u0026thinsp;2.68 [1.37\u0026ndash;5.24], RR\u0026thinsp;=\u0026thinsp;4.05 [2.67\u0026ndash;6.13], respectively). Students who had TC knowledge scores of 5/6 and 6/6 (reflecting high levels of knowledge) were 2 to 3 times more likely to perform TSE (RR\u0026thinsp;=\u0026thinsp;2.36 [1.17\u0026ndash;4.72], RR\u0026thinsp;=\u0026thinsp;2.88 [1.22\u0026ndash;6.79], respectively). Students who received previous awareness about TC and those who had a previous testicular examination by a HCP were three times more likely to practice TSE (RR\u0026thinsp;=\u0026thinsp;3.69 [2.93\u0026ndash;4.63], RR\u0026thinsp;=\u0026thinsp;3.39 [2.61\u0026ndash;4.40], respectively). A family history of TC was not associated with increased TSE.\u003c/p\u003e \u003cp\u003eOn multivariate analysis, only medical students (OR\u0026thinsp;=\u0026thinsp;8.55, CI [3.93\u0026ndash;19.50]), previous awareness about TC (OR\u0026thinsp;=\u0026thinsp;3.35, CI [1.90\u0026ndash;5.92]), and high TC knowledge score (OR\u0026thinsp;=\u0026thinsp;1.38, CI [1.07\u0026ndash;1.77]) were significantly associated with the practice of self-examination (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis showing associations between the practice of testicular self-examination and other variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR [CI 95%]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00 [0.94\u0026ndash;1.05]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eMajor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArchitecture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14 [0.50\u0026ndash;2.63]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngineering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02 [0.48\u0026ndash;2.23]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74 [0.20\u0026ndash;2.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.55 [3.93\u0026ndash;19.50]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMusic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33 [0.40\u0026ndash;4.02]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.56 [0.07\u0026ndash;48.74]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.36 [0.60\u0026ndash;3.14]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.17 [0.49\u0026ndash;17.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eYear of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03 [0.49\u0026ndash;2.12]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07 [0.53\u0026ndash;2.12]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.88 [0.90\u0026ndash;3.91]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.66 [0.76\u0026ndash;3.62]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.76 [0.98\u0026ndash;7.67]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.21 [0.50\u0026ndash;9.68]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.09 [1.00-9.86]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of TC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07 [0.39\u0026ndash;2.74]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.35 [1.90\u0026ndash;5.92]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious examination by a HCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.91 [4.46\u0026ndash;10.92]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC Knowledge score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.37 [1.07\u0026ndash;1.77]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eTSE: Testicular self-examination; TC: Testicular cancer; HCP: Healthcare professional\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with increased knowledge score\u003c/h2\u003e \u003cp\u003eMultivariate analysis showed that the only factor that increased knowledge score was studying for seven years (OR\u0026thinsp;=\u0026thinsp;1.93, CI [1.23\u0026ndash;3.05]) or more (OR\u0026thinsp;=\u0026thinsp;1.55, CI [1.09\u0026ndash;2.19]). Surprisingly, having a family history of TC (OR\u0026thinsp;=\u0026thinsp;0.63, CI [0.48\u0026ndash;0.84]) was significantly associated with a lower knowledge score. Previous awareness, major, age, and previous testicular examination by a HCP, were not associated with increased knowledge (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis showing associations between composite knowledge score and other variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR [CI 95%]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98 [0.97-1.00]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eMajor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArchitecture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89 [0.71\u0026ndash;1.11]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngineering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.12 [0.91\u0026ndash;1.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88 [0.64\u0026ndash;1.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08 [0.85\u0026ndash;1.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMusic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00 [0.72\u0026ndash;1.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.34 [0.50\u0026ndash;3.61]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16 [0.92\u0026ndash;1.46]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTheology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.70 [0.39\u0026ndash;1.24]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eYear of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92 [0.75\u0026ndash;1.13]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00 [0.83\u0026ndash;1.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88 [0.71\u0026ndash;1.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99 [0.80\u0026ndash;1.24]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85 [0.63\u0026ndash;1.15]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.93 [1.23\u0026ndash;3.05]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.55 [1.09\u0026ndash;2.19]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of TC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63 [0.48\u0026ndash;0.84]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09 [0.90\u0026ndash;1.32]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious examination by a HCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04 [0.91\u0026ndash;1.18]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eTSE: Testicular self-examination; TC: Testicular cancer; HCP: Healthcare professional\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of the awareness campaign\u003c/h2\u003e \u003cp\u003eThe second survey showed that 70% of the student practiced TSE, 15% talked with their HCP about TC, and 13% had abnormal findings. About 4.6% of students discovered that they have risk factors for TC, and 43% transmitted knowledge to others. The mean amount of knowledge learned by the students was 7.39 over 10, with a median of 8 (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Students with higher knowledge levels (7\u0026ndash;9/10) were more likely to perform TSE (RR\u0026thinsp;=\u0026thinsp;1.61, CI [1.05\u0026ndash;2.46]). For this study, most of them (90%) had a good experience using social media platforms (questionnaire on the phone and the teaching YouTube video). Only 10% rated the experience as normal, and no one rated it as bad.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough there is no expert consensus on screening for TC, early detection is associated with smaller tumor size at presentation, higher curability, and reduced treatment costs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). There is no high-level evidence to support screening programs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, the AUA, EAU, and ACS advise monthly self-examination in men with risk factors (personal or familial history of TC, cryptorchidism) since stage and prognosis are related to early diagnosis (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and the ACS details how TSE should be performed (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Therefore, the primary purpose of strategies to prevent TC should be the implementation of educational programs designed to increase awareness and knowledge about the risk factors of TC and the practice of TSE in higher-risk men (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe launched this online awareness campaign using social media during the COVID-19 pandemic to prevent the spreading of the virus. We used the online survey method for data collection because it offers easy access to respondents, rapid data collection with low cost, particularly with large samples, and enables the construction of random samples avoiding selection bias (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). To optimize the patients' responses, we used an e-mail pre-notification to invite them to participate in the study, a reminder to complete the survey, a semi-automatic log-in, a simple design, and a short survey that takes less than 10 minutes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). We also sent a personalized phone message for all male students, with a small explicative text and a link to the survey, because a personalized approach was shown to produce significantly higher response rates (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe got a response rate of 28.95%, which is relatively low but common in web-based surveys in specific populations (students in our study), and comparable to the literature (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). We had good participation from all faculties, reflecting that the subject interested all young men, regardless of their specialties. The low rate of nursing students' responses (0.4% of total responses) can be explained by the low ratio of men to women in this school (a total of 8 male students in the nursing faculty, with 3 respondents).\u003c/p\u003e \u003cp\u003eThe lack of education about testicular cancer in schools, universities, and mass media was apparent, with low rates of correct identification of the risk factors (13%), exposure to previous awareness (14%), and previous testicular examination by a HCP (31%). This poor knowledge about TC and TSE was also found in the systematic review of Saab et al., which included 25 articles and had the same research question (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFamily history was not associated with an increased practice of TSE, in contrast to the results of June et al., who found a significant association between familial TC and family members' awareness (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This finding underlines the importance of focusing education on the risk factors.\u003c/p\u003e \u003cp\u003eHigher knowledge scores were associated with increased TSE, and previous awareness and education on TC were positively and significantly associated with the practice of TSE on bivariate and multivariate analysis. Ryszawy et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) reported the same finding, which raises the importance of implementing awareness campaigns to increase the knowledge of men concerning TC.\u003c/p\u003e \u003cp\u003eMedical students were the only students with significant practice of TSE. This finding is in line with the previous work of Yazici et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and highlights the importance of targeting non-medical students.\u003c/p\u003e \u003cp\u003eOur method, using SM exclusively for awareness, increased the level of engagement of men and doubled the rate of self-examination, which is a crucial element in early detection. Almost all the participants found this virtual awareness campaign good. It stimulated 43% to transmit knowledge to others, which means an exponential spreading of awareness. Our results are comparable with previous studies about the effect of SM on cancer awareness (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). It allows the dissemination of health messages rapidly and at a low cost to large numbers of people across large geographical areas (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Although SM improves attitudes and practices related to health (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), there is little evidence about whether it improves cancer screening and early diagnosis (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Older adults are usually largely obscured in SM representation of cancer and cancer experience (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, this is not an issue for consideration, particularly for TC, since the targeted population is young men, the biggest users of social media (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study had several limitations. First, it is a single institution study which limits its generalizability. Second, we could not analyze the non-response bias since the survey was anonymous. However, if data collection were not anonymous, the response rate would probably have been lower since there are questions about personal and family history of TC and TSE, which are still taboo in our middle eastern society (relating to fertility and masculinity themes). Third, the beneficial effect of this campaign on the practice of TSE was only evaluated in the short term. Long-term observation is needed to evaluate its effect in the long term.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eYoung men in Lebanon have poor knowledge of testicular cancer and its risk factors, with a lack of awareness campaigns and little attention from HCP. TSE is poorly practiced in non-medical students, even in most concerned groups with risk factors for TC, and its practice is affected by previous education about TC.\u003c/p\u003e \u003cp\u003eOur study highlights the need to implement national awareness campaigns to increase the knowledge of Lebanese men about TC.\u003c/p\u003e \u003cp\u003eSM is an effective method for awareness campaigns and can play a major role in health promotion. It allows the dissemination of health messages rapidly, at a low cost, to a large number of people and improves health-related attitudes and practices.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etesticular cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTSE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003etesticular self-examination\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esocial media\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehealthcare professional\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Urology Association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEAU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Associations of Urology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Cancer Society\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003einterquartile ranges\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all the participants to the survey which was approved by our institution ethical board. Study protocols were approved by a the \u0026quot;Notre Dame des Secours University Hospital\u0026quot; ethics committee. All methods were performed in accordance with the relevant guidelines and regulations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was required for this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eAK: Participated in writing of the paper and data analysis. MA: Reviewed the paper. JEK: Participated in data analysis and prepared the figures. RH: Participated in data analysis. SA: Participated in data analysis. AM: Participated in research design. SB: Participated in research design. TA: Participated in data collection. REK: Participated in research design and performance of the research and supervised the work. The author(s) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003ePierorazio PM, Albers P, Black PC, Tandstad T, Heidenreich A, Nicolai N, et al. Non-risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary. Eur Urol. 2018 Jun;73(6):899\u0026ndash;907.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eStephenson A, Eggener SE, Bass EB, Chelnick DM, Daneshmand S, Feldman D, et al. Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. J Urol. 2019 Aug;202(2):272\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKalan Farmanfarma K, Mahdavifar N, Mohammadian-Hafshejani A, Salehiniya H. Testicular cancer in the world: an epidemiological review. World Cancer Research Journal. 2018.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDason S, Beebe S, Scimeca A, Posid T. Do men want to perform testicular self-examination? JCO. 2020 Feb 20;38(6_suppl):395\u0026ndash;395.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLaguna M, Albers P, Algaba F, Bokemeyer C, Boormans J. EAU Guidelines on Testicular Cancer. 2022;16\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eInternational Agency for Research on Cancer. The Global Cancer Observatory [Internet] [Internet]. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gco.iarc.fr/today/data/factsheets/populations/422-lebanon-fact-sheets.pdf\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBoustany J, Abdessater M, Akl H, Kanbar A, Khoury JE, Assaf S, et al. Prostate Cancer awareness in the Lebanese population: a cross sectional national survey. BMC Public Health. 2021 Sep 25;21(1):1744.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTesticular Cancer Awareness and self-exam|. Urology department | CHU-NDS | USEK [Internet] [Internet]. YouTube; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://youtu.be/egpXCGWdbCw\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eR Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2021.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSiegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012 Aug;62(4):220\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eScreening for testicular cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement - PubMed [Internet]. [cited 2022 October 30]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/21464350/\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLink K. Screening for testicualr cancer [Internet] [Internet]. UpToDate, Post TW, editor, UpToDate, Waltham, MA. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.uptodate.com/contents/screening-for-testicular-cancer\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eThe American Cancer Society. Testicular cancer early detection, diagnosis, and staging [Internet] [Internet]. 2018. Available from: Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cancer.org/cancer/testicular-cancer/detection-diagnosis-staging/detection.html\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePietrzyk Ł, Denisow-Pietrzyk M, Czeczelewski M, Ślizień-Kuczapski K, Torres K. Cancer education matters: a report on testicular cancer knowledge, awareness, and self-examination practice among young Polish men. Sci Rep. 2020 Nov;26(1):20684. 10(.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAerny-Perreten N, Dom\u0026iacute;nguez-Berj\u0026oacute;n MF, Esteban-Vasallo MD, Garc\u0026iacute;a-Riolobos C. Participation and factors associated with late or non-response to an online survey in primary care. J Eval Clin Pract. 2015 Aug;21(4):688\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSammut R, Griscti O, Norman IJ. Strategies to improve response rates to web surveys: A literature review. Int J Nurs Stud. 2021 Nov;123:104058.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSinclair M, O\u0026apos;Toole J, Malawaraarachchi M, Leder K. Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches. BMC Med Res Methodol. 2012 August 31;12:132.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSaab MM, Landers M, Hegarty J. Testicular Cancer Awareness and Screening Practices: A Systematic Review. Oncol Nurs Forum. 2016 Jan;43(1):E8\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePeters JA, Beckjord EB, Banda Ryan DR, Carr AG, Vadaparampil ST, Loud JT, et al. Testicular Cancer and Genetics Knowledge Among Familial Testicular Cancer Family Members. Journal of Genetic Counseling. 2008 Aug;17(4):351\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRyszawy J, Kowalik M, Wojnarowicz J, Rempega G, Kępiński M, Burzyński B, et al. Awareness of testicular cancer among adult Polish men and their tendency for prophylactic self-examination: conclusions from Movember 2020 event. BMC Urol. 2022 Sep 12;22(1):149.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYazici CM, Akgul M, Altin E, Eksi SE, Akdemir T, Dagdeviren N. Does education variability change testicular cancer awareness and testicular self-examination? J Pak Med Assoc. 2021 Jun;71(6):1592\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePlackett R, Kaushal A, Kassianos AP, Cross A, Lewins D, Sheringham J, et al. Use of Social Media to Promote Cancer Screening and Early Diagnosis: Scoping Review. J Med Internet Res. 2020 Nov;9(11):e21582. 22(.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGough JK, Frydenberg AR, Donath SK, Marks MM. Simulated parents: developing paediatric trainees\u0026apos; skills in giving bad news. J Paediatr Child Health. 2009 Mar;45(3):133\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFarsi D. Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers. J Med Internet Res. 2021 Apr 5;23(4):e23205.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMacdonald S, Cunningham Y, Patterson C, Robb K, Macleod U, Anker T, et al. Mass media and risk factors for cancer: the under-representation of age. BMC Public Health. 2018 Apr 26;18(1):490.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDi Bello F, Coll\u0026agrave; Ruvolo C, Cilio S, La Rocca R, Capece M, Creta M, et al. Testicular cancer and YouTube: What do you expect from a social media platform? Int J Urol. 2022 Jul;29(7):685\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePagoto S, Waring ME, Xu R. A Call for a Public Health Agenda for Social Media Research. J Med Internet Res. 2019 Dec 19;21(12):e16661.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"self-examination, testicular neoplasm, social media, Lebanon, awareness","lastPublishedDoi":"10.21203/rs.3.rs-2219234/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2219234/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTesticular cancer (TC) is the most common malignancy in men between 15–40 years. Testicular self-examination (TSE) leads to early diagnosis. We aimed, in this study, to evaluate the knowledge among young Lebanese male university students concerning TC and their practice of TSE. We also evaluated the use of social media (SM) for an awareness campaign.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing an online survey, we evaluated male students' knowledge at our university and the factors associated with increased knowledge and practice of TSE. Then we conducted an entirely virtual awareness campaign using social media and an awareness video and evaluated its effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly 14% (N=115) had previously received awareness about TC, and 31% (N=254) previously had a testicular examination by a healthcare professional (HCP). Risk factors were identified correctly by 13% (N=160). Factors that were associated with the increased practice of TSE were medical studies (OR = 8.55, CI [3.93-19.50]), previous awareness about TC (OR=3.35, CI [1.90-5.92]), and high TC knowledge score (OR=1.38, CI [1.07-1.77]). Higher knowledge scores were associated with studying for seven years (OR=1.93, CI [1.23-3.05]) or more (OR=1.55, CI [1.09-2.19]). After the awareness campaign, 70% of the student practiced TSE, 15% talked with their HCP about TC, and 43% transmitted knowledge to others. About 4.6% of students discovered that they have risk factors for TC. The median amount of knowledge learned by the students was 8 over 10 (IQR 7-9). Most students (90%) had a good experience using social media for awareness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYoung university students in Lebanon have poor knowledge about TC and its risk factors. TSE is poorly practiced in non-medical students, especially in the most concerned men with risk factors. Education about TC increases the practice of TSE. The use of social media is an effective method for awareness campaigns and can improve health-related practices.\u003c/p\u003e","manuscriptTitle":"Testicular cancer knowledge amongst Lebanese university students and the effect of a social media awareness campaign","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-10 22:16:50","doi":"10.21203/rs.3.rs-2219234/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef5cdd27-8b9f-4794-a98d-db102d06659c","owner":[],"postedDate":"November 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-02-23T09:29:36+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-10 22:16:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2219234","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2219234","identity":"rs-2219234","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}