The purpose of this study was to determine the factors related to young black men’s intention to screen for prostate cancer as well as their engagement in prostate cancer risk-reduction behaviors. The study tested the significance of the constructs – age, attitude (direct and indirect), social influence, comfortability, cues to action, health screening experiences and knowledge – in predicting young black men’s intention to screen for prostate cancer; as well as the significance of the constructs – age, cues to action, exercise and knowledge – in predicting engagement in prostate cancer risk-reduction behaviors. Demographic/personal factors were also explored in related to the model predictors. Web-based and paper-pencil surveys were administered to 279 black men aged between 18 – 40 years from the Austin area. Three focus groups were conducted to collect information regarding young black men’s behavioral beliefs toward prostate cancer screening as well as their comfortability with prostate examinations. The number of usable surveys was 267. Using direct and indirect measures, the combination of attitude, social influence, comfortability (indirect model), and knowledge explained 41.0 and 43.0 percent of the variance in intention to screen for prostate cancer, respectively; with social influence being the strongest predictor ([Beta]=0.41; p <0.01 for the direct model and [Beta]=0.47 for the indirect model). For the model with prostate cancer risk-reduction as the outcome variable, the model accounted for 10.0 percent of the variance in behavior with only knowledge ([Beta]=0.19; p=0.03) as significant predictor. Interventions that address young black men’s attitude, social influence, comfortability, and knowledge may be necessary to increase young men’s intention to screen for prostate cancer when it is recommended by a physician. Additionally, factors surrounding exercise and knowledge may be important in increasing young men’s engagement in prostate cancer risk-reduction behaviors. Future studies using intention as a predictor of young men’s behavior are needed to assess the influence of intention on prostate cancer screening. / text

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among men in the United States. In African American men, the disease is typically detected at a more advanced stage and mortality is twice the rate of Caucasian men. However, African American men are less likely to participate in prostate cancer screening. The purpose of this descriptive study was to assess the relationship between health beliefs, knowledge, and selected demographic variables (age, income and education) and a man’s decision to participate in prostate cancer screening among African American men dwelling in rural communities. The conceptual framework for the study was the Health Belief Model. Participants for the study were recruited through contacts within rural communities within west central Alabama. A convenience sample of 90 African American men between the ages of 40-82 years of age was recruited. Analysis of the research data indicated that there was a statistically significant difference in motivation (health belief), knowledge, and age of men who participated in prostate cancer screening compared to those who did not participate in prostate cancer screening. Forward logistic regression was used to determine which independent variables [health beliefs (benefits, barriers, motivation); knowledge; age; income; and education] were predictors of prostate cancer screening. Results indicated the overall model of one predictor, motivation, was statistically reliable in predicting prostate cancer screening participation among the rural dwelling men surveyed. The model accounted for 15 to 20% of the variance. The sensitivity of the model in predicting those who would participate in prostate cancer screening was 85%. The odds of those who would participate in prostate cancer screening were 1.3 times greater for each one unit increase in motivation. Results indicate a need for more educational and motivational interventions to promote informed decision making by African American men in regards to prostate screening activities. These interventions need to be culturally sensitive and geared toward African American men, specifically those living in rural areas.

African Americans bear a disproportionately high burden of cancer incidence and mortality in this country. The purpose of this dissertation was to investigate factors associated with African-American men, who are incarcerated, making informed health decisions about participation in prostate cancer screening, as well as exploring factors that reduce modifiable risk factors for cancer. The United States incarcerates more people per capita than any country in the world and African American men are overrepresented in the U.S. prison system This dissertation is composed of three manuscripts. The first paper reviews the current literature about the factors that influence African-American males in making informed decisions about whether to participate in prostate cancer screening. The second paper uses existing data from a sample of 129 incarcerated African American men to examine the value of an intervention aimed at reducing modifiable risks for cardiovascular disease – and by extension, cancer – in inmates. The third paper explores predictors of intent to screen (or not) for prostate cancer in incarcerated African-American males, as well as those factors that influence informed decision-making in this population. These papers provide an overview of factors that influence incarcerated African-American men’s health decisions (health literacy, having a relative with previous diagnosis). These findings can be used to guide future research that addresses African-American male decision-making about personal health outcomes.

Zimbabwean men at risk of developing prostate cancer (PC) are diagnosed late or not at all. A cross sectional, quantitative study was done in Zimbabwe to establish physicians' attitudes and beliefs towards PC screening and diagnosis. Descriptive statistics were obtained to determine physicians' beliefs and attitudes using the Physician Attitudes and Beliefs Questionnaire Survey. The instrument incorporated validated instruments, the Burns' Cancer Belief Scale and Physician Survey on Prostate Cancer Screening, and demographic questions to measure specific independent variables, potentially influencing attitudes and beliefs. Means and standard deviations were conducted for continuous variables for beliefs and attitudes, and frequencies and percentages for categorical variables were calculated. Data from 206 respondents were analyzed utilizing multiple regression and MANOVA analysis to determine significance. The average Belief score was 3.96 (SD = 1.04), which reflected an overall belief score falling in the neutral range of response options. Linear regression results were significant, F(19, 178) = 2.09, p = 0.007, R2 = 0.18, suggesting that screening, stage of cancer, gender, training location, culture, total years in practice, and specialty accounted for 18% of the variance in Belief score. Attitude score predicted by screening (p = .000), stage of cancer (p = .005), race (p = .000), and culture (p = .020), was also significant. Screening and training location were significant predictors. Results will benefit physicians improve their attitudes using suggested continued education, resulting in improved screening practices and PC diagnosis. The public health system will potentially see PC death rates decline over time increasing life expectancy.

Prostate cancer is the second most often diagnosed cancer and internationally the sixth foremost cause of cancer death in males, as of 2011. Within the United States it is the most common form of cancer in men with 186,000 new cases and with an overall 28,600 deaths in 2008, and it is the second leading kind of cancer-related death in men. The widespread threat that prostate cancer poses against men across the globe cannot be understated, and its initiation and progression must be understood in order to truly comprehend its implicated risks and possible forms of treatment. As its name implies, prostate cancer is a form of cancer that develops in the prostate gland located in the male reproductive system. Its progress starts when standard semen-secreting prostate gland cells mutate into cancer cells. Although its developments may start at the prostate gland, cancer cells may metastasize to other parts of the body through circulation systems such as the lymph nodes. The main sites of metastasis for prostate cancer include the adrenal gland, the bones, the liver and the lungs. Although there are treatments available for prostate cancer, there is no definitive cure. The primary goal of this project was to find an alternative form of treatment, which is what will be necessary to combat this cancer.

Abstract Title: The Relationship between Perceived Personal Risk of getting Prostate cancer and Prostate-Specific Antigen (PSA) Screening Yeatoe G. McIntosh, MPH Candidate Advisor: Emmanuel Anum, MBChB, MPH, PHD Preceptor: Emmanuel Anum, MBChB, MPH, PHD Background: Prostate cancer is one of the most common cancer diagnoses in the United States. The American Cancer Society estimates that in 2008 28,660 deaths would be attributed to prostate cancer, projecting it to be the leading cause of cancer deaths in U.S. men. Despite the potential threat this cancer presents to men and the potential for improved disease outcomes from early detection, guidelines for screening for prostate cancer are varied, and disparities in screening prevalence exist. In addition, disparities in knowledge about prostate cancer screening and misconceptions about the disease seem widespread. The main purpose of this study was to determine the relationship between perceived personal risk of getting prostate cancer and prostate cancer screening with the Prostate-specific antigen (PSA) test. Methods: Data were collected from the 2003 Health Information National Trends Survey (HINTS). Overall, 1,815 men ages 35 and above were included in the sample after exclusion of men ages 18-34. Logistic regression analyses were conducted to assess the association between perceived personal risk and prostate cancer screening with PSA test, while testing for interaction and further adjusting for possible confounders. A reduced model, in which variables with non-significant Wald chi-squared statistic had been excluded, was compared to the full model to access the change in parameter estimates. Using the model-based approach, we compared models with interaction terms to the one without interaction terms using the likelihood ratio test. Parameter estimates from the best fitting model were reported using the design-based method. SAS version 9.1 statistical software was used for analyses. Results: Among men ages 35-49, those who perceived their risk as high, were significantly less likely to screen than those who perceived their risk as low (OR: 0.20 95% CI: 0.05-0.78). Within ages 50-64 and 65 and above, there were no significant differences between perceived risk levels and PSA testing. Men, who did receive healthcare provider recommendation for screening, were more likely to obtain prostate cancer (PSA) screening than men who did not receive such recommendation (OR: 92.56 95% CI 36.56, 234.36). Conclusions: The relationship between perceived personal risk of getting prostate cancer and PSA screening is modified by age. As men aged, their odds of screening increased. The most significant predictor of PSA screening was health provider recommendation. PSA screening showed no association with either race or household income.

The national recommendations for use of the prostate specific antigen (PSA) test for prostate cancer screening have been modified over the years as scientific evidence emerged. Current screening recommendations discourage widespread PSA screening for men at low to average risk, but provide specific guidelines for shared-decision making between men and their health providers about the benefits and risks of PSA testing. This study was an examination of relationships between men’s assessment of the quality of their care and communication with their health providers, the extent to which providers engage men in recommended discussions about PSA testing, and factors associated with shared-decision making and PSA testing. Secondary data from the U.S. Health Information National Trends Survey 4, Cycle 2 that included men with no history of prostate cancer and in the recommended age ranges for prostate cancer screening were analyzed (N=777). Non-Hispanic white men rated their quality of care higher than men of other races (c2 (49, n=635) = 7.23, p = 0.0098), whereas Hispanic men gave the lowest ratings compared to other men (c2 (49, n=635) = 5.42, p = 0.024). Previous PSA testing was reported by 64% of the men, 56% of whom stated that they discussed screening with their provider and 80% reported that they were asked if they wanted to have the test done. However, only 21% - 39% reported having ever discussed the pros and cons of PSA testing. Discussing PSA testing with a provider was the strongest predictor of obtaining the test (OR=69.5, CI = 23.6 – 204.6) but the effect was significantly modified when providers and patients engaged in the shared-decision making process (OR = 47.42, CI = 14.91 – 150.74). Age, education level and perceived quality of care were consistent, positive predictors of PSA testing. These results indicate there is a gap in provider-patient discussions about PSA screening and suggest that health providers may not be following the recommended guidelines for the content of the discussions needed to facilitate shared-decision making. Effective provider-based interventions to increase shared-decision-making about PSA testing are needed if the national objectives for prostate cancer screening are to be met.

Despite the growing concerns about routine prostate-specific antigen (PSA) screening in men, little is known about the societal and economic impact of screening among the African American population. The purpose of this qualitative case study was to explore beliefs among African American men about PSA screening, funding for screening, and the role of the United States Preventive Service Task Force in addressing the problem. Guided by rational choice theory, data collection consisted of completion of a health beliefs survey, face-to-face interviews, field notes taken during interview, and interview audio recording. The population for the study included African American men residing in a large metropolitan Midwestern city, who are between the ages of 45 and 65, and who have not been diagnosed with prostate cancer disease. Data were analyzed using NVivo10-© to identify themes and patterns. Results from the study show that the decision to participate in prostate screening for African American men is hindered due to concerns about access, cost, and affordability. These three factors should be further evaluated in a larger setting for a greater understanding of their roles in more effective screening programs and policies. Insights gained from this study may positively impact future policy by providing a deeper understanding of the beliefs held by African American men on the issue of prostate cancer screening that may eventually lead to developing and successfully implementing policies that can be cost effective.

Timely detection of prostate cancer (PCA) with prostate-specific antigens (PSA) and digital rectal examinations (DRE) are essential in optimizing incidence, minimizing prevalence, and reducing mortality rates. Given the low levels of participation in cancer screening, this study was conducted to examine the factors men consider when deciding whether to screen for PCA in Nigeria. A cross-sectional, online-based survey of 180 consenting Nigerian men 50 years old and older was carried out. Logistic regression analysis and descriptive statistics were used to analyze the data. Based on the data, there was a moderate positive association between the health belief model constructs and DRE/PSA screening intentions, which were statistically significant (p < 0.05). The results also demonstrated that there were no statistically significant associations between previous screening and age, previous screening and ethnicity, and previous screening and education among men in the sample (all p > 0.05). Of the 180 men surveyed, 29% (n = 53) had been screened for PCA before, while 76% (n = 137) reported no health insurance. Factors significantly associated with screening included income, insurance, and family history of PCA (all p < 0.05). Cancer fatalism, pain, and embarrassment were the most common barriers to screening reported. Focused interventions that help healthcare providers identify barriers quickly could improve screening outcomes. The implications for positive social change from this study include an increase in PCA screening, positive screening intentions, and a decrease in PCA mortality rate among men in Nigeria.

The most common and enduring explanation for the way research is used (or abused or not used) in policy is the ‘two communities’ theory. According to this theory, the problematic relationship between research and policy is caused by the different ‘cultures’ inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these ‘two communities’. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australia—breast cancer screening, prostate cancer screening, needle and syringe programs in the community, and needle and syringe programs in prisons—are used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. These theories bring different determinants and dynamics of the relationship to light and each is at least partially successful in increasing our understanding of the relationship between research and policy. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, ‘regimes of truth’ and ‘regimes of practices’ found in public health policy and research. This study has found that in three of the four case studies, public health policy was strongly influenced by research, the exception being NSP in prisons. In all cases, however, it is not possible to construct a robust and coherent account of the policy process or the policy outcome without considering the multifaceted role of research. When these theories are explored at a more fundamental level they support the argument that when research influences policy it is transformed into knowledge-for-policy by being invested with meaning and power. This process of transformation occurs through social and political action that mobilises ideal structures (such as harm minimisation and the World Health Organisation’s principles for evaluating screening programs) and material structures (such as medical journals and government advisory bodies) to resolve meta-policy problems (such as how to define complex public health problems in a way that makes them amenable to empirical research and practical action). This study provides good evidence that the notion of ‘research transfer’ between ‘two communities’ is a flawed way of understanding the research–policy relationship. Rethinking the relationship between research and policy involves building an enhanced theoretical repertoire for understanding this complex social interaction. This step is essential to the success of future efforts to make public health policy that is effective, just and emancipatory. This study makes a contribution to this task.