title: Cancer symptom awareness and barriers to medical help seeking in Scottish adolescents: a cross-sectional study.
abstract: BACKGROUND
  Initiatives to promote early diagnosis include raising public awareness of signs and symptoms of cancer and addressing barriers to seeking medical help about cancer. Awareness of signs and symptoms of cancer and emotional barriers, such as fear, worry, and embarrassment, strongly influence help seeking behaviour. Whether anxiety influences seeking medical help about cancer is not known. The purpose of this study about adolescents was to examine: 1) the relationship between contextual factors and awareness of signs and symptoms of cancer and barriers (including emotional barriers) to seeking medical help, and 2) associations between anxiety and endorsed barriers to seeking medical help. Interpretation of data is informed by the common sense model of the self-regulation of health and illness.
  
  
  METHODS
  A cross-sectional study of 2,173 Scottish adolescents (age 12/13 years) using the Cancer Awareness Measure. Socio-demographic questions were also included. Descriptive statistics were calculated and two Poisson regression models were built to determine independent predictors of: 1) the number of cancer warning signs recognized, and; 2) number of barriers to help seeking endorsed.
  
  
  RESULTS
  Analysis identified that knowing someone with cancer was a significant independent predictor of recognising more cancer warning signs whereas Black and Minority Ethnic status was a significant independent predictor of recognising fewer cancer warning signs. Emotional barriers were the most commonly endorsed, followed by family, service and practical barriers. Over two thirds of adolescents were 'worried about what the doctor would find' and over half were 'scared'. Higher anxiety scores, knowing more cancer warning signs and female gender were significant independent predictors of barriers to help seeking.
  
  
  CONCLUSIONS
  Improving cancer awareness and help seeking behaviour during adolescence may contribute to early presentation. Contextual factors (for example, ethnicity, gender, knowing someone with cancer), and emotional dimensions (for example, anxiety, fear, worry) are critical components in help seeking behaviours. The role of emotional factors indicates that public health campaigns focused on awareness and help seeking may benefit from having a more emotional focus, for example, including references to feelings, such as, fears and worries.
authors.affiliation: Cancer Care Research Centre, School of Health Sciences, University of Stirling, FK9 4LA, Stirling, UK. gill.hubbard@stir.ac.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Hubbard
authors.forename: Iona
authors.initials: I
authors.lastname: Macmillan
authors.forename: Anne
authors.initials: A
authors.lastname: Canny
authors.forename: Liz
authors.initials: L
authors.lastname: Forbat
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.forename: Ronan E
authors.initials: RE
authors.lastname: O'Carroll
authors.forename: Sally
authors.initials: S
authors.lastname: Haw
authors.forename: Richard G
authors.initials: RG
authors.lastname: Kyle
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001007:Anxiety; D002648:Child; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012606:Scotland; D012959:Socioeconomic Factors