Social Ecological Predictors ofProstate- Specific Antigen BloodTest andDigital Rectal Examination inBlackAmericanMen

'1~~~~~~~~~~~O Financial support: This project wasfunded inpart bytheCenters for Disease Control andPrevention (CDC), Association of Schools ofPublic Health (ASPH) andtheAgency for Toxic Substances andDisease Registry (ATSDR) under Cooperative Agreement #S1 391-20/20. Disclaimer: Theterms African Americans andblacks areused interchangeably because manypeople continue torefer to themselves inthis manner. Theterms represent Americans of African descent. Background: Black American mencontinue tosuffer disproportionately from epidemically higher rates ofprostate cancer. Wehypothesize that complex reasons forpersistently higher deathrates ofprostate cancer inthis groupare steeped insocial factors associated with health access. Methods: Weutilized datafrom theIt's All About Uprostate cancer prevention study amongblack mentoinvestigate: 1) whatsocial ecological factors werepredictive ofprostatespecific antigen (PSA) testing anddigital rectal examinations (DRE); 2)ifblack menwereaware ofprostate cancer screeningand, ifscreening wasavailable, would they take thePSA andDRE?Quantitative cross-sectional datafrom acohort of 276black menwith nodiagnosis ofprostate cancer were analyzed toidentify characteristics, beliefs, practices andattitudes ofthis group toward prostate cancer screening. Wecreatedasocial ecological model toexamine which social factors(i.e., environmental, personal, person/environment interplay, black culture andinstitutional policy) werepredictive ofPSAandDRE, PSAonly andDREonly. Toreduce data andidentify datapatterns, factor analyses (tested for reliabilitybycalculating Cronbach alpha scores) wereperformed. Variables werestandardized with Zscores andanalyzed with predictive analytic software technology (SPSS, version 12). A multivariate binary logistic regression wasconducted toidentify predictors ofPSAandDRE. Results: Asignificant predictor ofbothPSAandDREwasthe physician's direct prostate cancer communication message (P<0.010). Significant correlations exist inPSAandDREoutcomeswith aphysician's engaging communication style (P<0.01 2), encouragement toscreen (P<0.001) andsharing prostate cancer information (P<0.001); aswasmenunderstanding theserious risk ofprostate cancer (P<0.001), culture (P<0.004), positive interaction with healthcare staff, significant other(s) andproviders (P<0.001), andenvironmental dimensions (P<0.006). Aprofile offour major self-reported barriers to screening wereidentified (i.e., fear, internal locus ofhealth, comfort level andexternal locus ofhealth). Lastly, menwho utilized health systems with aprostate cancer screening policyhadhigh percentages ofPSAandDRE(63.3%), PSAonly (70.9%) andDREonly (81.7%o). Conclusion: Aphysician's aggressive, positive engagement in shared decision-making, tailored social influences promoting prostate cancer prevention amongblack men,aswell as institutional screening policy, hasthepotential toincrease early detection andreduce morbidity amongthis group.