The association between prior ano-digital health behavior and self or partner anal exams among MSM

Jie Deng, The University of Texas School of Public Health


Background: Anal cancer is common among men having sex with men (MSM). If any malignant abnormality is detected in the anus at early stages using appropriate screening tests, further malignant development may be prevented. An annual digital anorectal exam (DARE) is recommended as one of the screening tests because most anal cancers at early stages are palpable. DARE can be conducted in the anal canal by a clinician by inserting a gloved and lubricated finger into the anus. However, many people are reluctant to seek DARE at clinic due to various reasons. Alternatively, people might conduct self-anal exams (SAE) and partner-assisted anal exams (PAE) at home. SAE and PAE are clinician-taught but self or partner-assisted DARE on themselves to detect any abnormality in the anus. The feasibility of SAE and PAE is currently under study (SAE Study). Findings from the SAE Study so far indicate the majority reported agreeing or strongly agreeing that they would conduct an SAE/PAE in the future. If the procedures are found efficacious, they can compensate for limited clinician use of DARE. However, nothing is known about the characteristics of people who might prefer an SAE or PAE (i.e. SAE/PAE) compared to those who would prefer a clinician-provided DARE among MSM. We surmised that persons who had previously palpated their anal canal for health reasons might prefer the SAE/PAE; therefore, the objective of this study is to determine the association between prior ano-digital health behavior (whether an individual has ever checked his anus before due to suspicion of a problem) and a preference for SAE/PAE or DARE among MSM. Methods: The study is part of the SAE/PAE feasibility study which included one clinic visit in central Houston (NIH; PI, Nyitray; Grant Number, 5R21CA181901-02). The study recruited 201 MSM, aged 27 – 80 years old, living in Harris County, TX (or persons who live in the Houston metro area with insurance or other health care benefits) who were able to understand and speak English and currently not diagnosed with any abnormalities in the anus. During the clinic visit, the participants received an SAE/PAE training and an evaluation of their subsequent performance by a clinician. Information such as prior ano-digital health behavior and preferences for SAE/PAE or DARE were collected during the visit. A Directed Acyclic Graph (DAG) was used to make explicit assumptions about the relationships among the covariates and to reduce potential bias. In addition, log-binomial regression was conducted with univariate and multivariate regression models to determine the associations between a preference for SAE/PAE and prior ano-digital health behavior as well as other covariates. Age was retained in modeling as a potential confounder as it was a variable identifying persons who voiced a preference for doing the SAE/PAE in the future. Results: A total of 189 individuals participated in the study. Over half (n = 99, 52.4%) reported preferring SAE/PAE in the future. The majority (n = 115, 60.8%) reported not assessing their anus for disease before the study. The association between prior ano-digital health behavior and a preference for SAE/PAE was not significant among MSM before or after controlling for race, educational level and attitude regarding SAE/PAE (adjusted Prevalence Ratio [aPR] 0.86; 95% CI, 0.67 – 1.10). Race and educational level were found significantly associated with the preference for SAE/PAE or DARE in the analyses. Conclusion: A preference for SAE/PAE was similar whether people did or did not check the health of their anus before SAE/PAE training. However, Black/African American and other races preferred SAE/PAE less compared to White/Caucasian. Also, people with 13 – 16 years of education prefer SAE/PAE most compared to those with lower or higher education level.

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Recommended Citation

Deng, Jie, "The association between prior ano-digital health behavior and self or partner anal exams among MSM" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10249216.