Sexual behavior and perceived risk for oropharyngeal cancer among men who have sex with men: A psychometric scale validation

Abstract

ABSTRACT Background Men who have sex with men (MSM) are at increased risk for human papillomavirus-associated oropharyngeal cancer (HPV-OPC). The objective of this analysis was to create a psychometrically validated scale to measure perception of risk for HPV-OPC. Methods We conducted an exploratory and a confirmatory factor analysis to determine and confirm the latent factor structure. We used a path diagram to evaluate the relationship between the validated scale and perceived risk for HPV-OPC. The model was determined to be a good fit if it met all criteria: Root Mean Square Error of Approximation (RMSEA) ≤0.06; Standardized Root Mean Residual (SRMR) ≤0.08; Comparative Fit Index (CFI) ≥0.90 and Tucker-Lewis Index (TLI) ≥0.90. We report standardized estimates and 95% confidence intervals. Results This cross-sectional study recruited 1315 MSM. A majority (73.33%) of MSM had performed fellatio on ≥20 partners, 36.98% had rimmed ≥20 partners, and 5.31% had performed cunnilingus on ≥10 partners in their lifetime. Six sexual history survey items loaded onto two latent factors: Sexual risk behaviors: class 1 and sexual risk behaviors: class 2. The final model statistics indicated good fit: RMSEA = 0.064, SRMR = 0.059, CFI = 0.996, and TLI = 0.993. Sexual risk behaviors: class 1 was associated with greater perceived risk for HPV-OPC (0.217, 95% CI: 0.138-0.295). Age, HIV status, HPV vaccination status, and sexual risk behaviors: class 2 were not associated with perceived risk for HPV-OPC. Conclusion MSM assessed risk for HPV-OPC based upon their lifetime number of cisgender male sexual partners, rimming partners, and fellatio partners but not other sexual behaviors. MSM may be responsive to future HPV-OPC educational interventions and opportunities for screening.