Leveraging the Family Influence of Women in Prostate Cancer Efforts Targeting African American Men

Enhancing health attitudes and information engagement among African American men using an online health education intervention

BACKGROUND AND OBJECTIVES

In this article, we describe the results of a 6-month follow-up assessment among African American (AA) men who participated in the Black Men's Health Forum, a 6-week online health education intervention.

METHODS

A pre-post survey design was used to capture attitudes and behaviors before and 6-months after the intervention. The 6-month follow-up used the health conscious scale, Health Information Orientation Scale (HIOS), and the Short Multidimensional Inventory Lifestyle Evaluation (SMILE) to assess changes in attitudes toward health, health information seeking, and health behaviors. In addition, the influence of accountability partners among AA male participants of the forum was examined.

RESULTS

A sample of 24 AA men [61.7 years of age (range: 34.1 to 75.9 years of age)] completed the follow-up. Participants became more self-aware of their health (5.6 to 6.2, p = 0.0093), more motivated to improve health (5.8 to 6.5, p = 0.0181), and took more personal responsibility for their health (5.6 to 6.4, p = 0.0099). Results from the HIOS revealed that health information engagement increased among participants (2.7 to 3.1, p = 0.0168).

CONCLUSIONS

AA men's attitudes towards health and information engagement were successfully improved through an online health education intervention. In addition, we leveraged family and friends in the lives of men to serve as a support system for men in the study to help improve health behaviors.

Perceptions, Knowledge, and Attitudes of General Population About Prostate Cancer-Associated Risk Factors: A Systematic Review of Qualitative Studies Focusing on Lifestyle

PURPOSE OF REVIEW

Prostate cancer (PCa) is the most prevalent cancer and the third deadliest in Europe among men. PCa has several well-established risk factors; however, the influence of lifestyle factors remains under investigation, which may hinder efforts to encourage healthier behavior adoption. Thus, this systematic review explored the general population's perceptions, knowledge, and attitudes regarding PCa-related risk factors.

RECENT FINDINGS

Eighteen qualitative studies were included after searching PubMed, Scopus, Web of Science, and EMBASE scientific databases between January 2013 and February 2023. Five major themes emerged from the 18 included studies: PCa knowledge, risk factors, lifestyle pattern changes, motivation/barriers to changing habits, and lifestyle advice support. Participants identified age, family history, genetics, and race/ethnicity as risk factors for PCa, but no consensus has been reached regarding lifestyle. However, most of the participants were willing to adopt healthier habits. Support from healthcare professionals (HPs), family, and friends, the desire for more time with loved ones, and fear of PCa consequences were cited as motivators for habit changes. However, poor economic conditions, work schedules, age, and PCa limitations hamper lifestyle changes. Effective interventions require personalized support and credible information from healthcare providers. Collaboration between family, friends, and HPs is crucial for promoting healthier behaviors and enhancing PCa management. This systematic review highlights the need for further research and innovative approaches to empower individuals towards healthier lifestyles, which could help prevent PCa or, at the very least, promote better treatment outcomes.

Prostate Cancer Foundation Screening Guidelines for Black Men in the United States

BACKGROUND

In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States.

METHODS

A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.

CONCLUSIONS

These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).

The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer

PURPOSE

To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort.

METHODS

The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer.

RESULTS

Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men.

CONCLUSION

Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

The Black Men's Health Forum: Improving Health Knowledge and Willingness to Participate in Research

The Black Men's Health Forum, a 6-week online health education intervention for African American men and accountability partners of African American men, was conducted to increase awareness of health issues that disproportionately affect African American men. In this article, we describe the intervention and report on the immediate benefits of the intervention, including changes in health knowledge and perception of research participation. Participants completed a pre-evaluation prior to participating in the forum and a post-evaluation after each session to capture data on sociodemographic information, medical history, health knowledge, and health behaviors. A total of 60 participants (30 African American men and 30 accountability partners) completed the forum. African American men had a mean age of 61.1 years while accountability partners had a mean age of 57.6 years. Overall health knowledge increased by 6.9 points for African American men and 2.8 points for accountability partners. Before the forum began, nine African American men reported ever participating in a research study. The proportion of African American men who reported that they would definitely participate in research in the next 12 months after participating in the forum increased by 40%. Through culturally tailored programming, the Black Men's Health Forum increased access to health information as well as African American male medical professionals and health researchers for African American men in the community. Exposure to health information resulted in significant increases in health knowledge and willingness to participate in health research among African American men.

Enhancing public awareness and practice of prostate cancer screening among African men: A scoping review

BACKGROUND

Prostate cancer (PCa)-related incidence is on the increase, with black South African men presenting disproportionately with aggressive disease. Recent studies show a greater net benefit of prostate-specific antigen (PSA) screening of black men compared with the general population. This scoping review provides an overview of available research on strategies that have enhanced PCa screening awareness and practice in the African setting.

METHODS

Relevant databases were searched to identify 2010-2021 studies. Following scoping review guidelines, data were extracted, summarised and quantitatively analysed.

RESULTS

Of the 21 articles included, 19 were from the United States. Nine were published within the last five years and 14 were pre-test/post-test. Most articles evaluated the effect of health-promoting strategies on awareness and practice of PCa screening among black men. Community-oriented strategies enhanced awareness and practice of PCa screening. Healthcare providers and community members, including PCa survivors, participated in the strategies' planning, development and implementation. Topics that improve PCa knowledge and clear cultural misconceptions were addressed, targeting public spaces unique to these men. Prostate cancer health education methods were diverse, comprehensive, user friendly and culturally sensitive.

CONCLUSION

More research on strategies to enhance PCa screening awareness and practice among African men is needed, as this is scarce. Strategies enhancing PCa screening awareness and practice among African men are community oriented and entail health education methods, topics, presenters and venues. These strategies can be adopted in the South African setting.Contribution: This study recommends strategies to enhance the awareness and practice of PCa screening among African men.

Pentz R. Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exist among Black men in this country. The primary objective of this systematic review is to describe the reported disparities in screening, diagnostics, and treatments as well as efforts to alleviate these disparities through community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, subanalyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal-access care environments have shown similar outcomes regardless of race. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials, and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. IMPLICATIONS FOR PRACTICE: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher prostate-specific antigen, and other adverse factors, but outcomes can be attenuated in trials or in equal-access care environments. Recent data have shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts, and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities.

Knowledge of prostate cancer presentation, etiology, and screening practices among women: a mixed-methods systematic review

BACKGROUND

With the burden of prostate cancer, it has become imperative to exploit cost-effective ways to tackle this menace. Women have demonstrated their ability to recognize early cancer signs, and it is, therefore, relevant to include women in strategies to improve the early detection of prostate cancer. This systematic review seeks to gather evidence from studies that investigated women's knowledge about (1) the signs and symptoms, (2) causes and risk factors, and (3) the screening modalities of prostate cancer. Findings from the review will better position women in the fight against the late detection of prostate cancer.

METHODS

The convergent segregated approach to the conduct of mixed-methods systematic reviews was employed. Five databases, namely, MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Web of Science, and EMBASE (Ovid), were searched from January 1999 to December 2019 for studies conducted with a focus on the knowledge of women on the signs and symptoms, the causes and risk factors, and the screening modalities of prostate cancer.

RESULTS

Of 2201 titles and abstracts screened, 22 full-text papers were retrieved and reviewed, and 7 were included: 3 quantitative, 1 qualitative, and 3 mixed-methods studies. Both quantitative and qualitative findings indicate that women have moderate knowledge of the signs and symptoms and the causes and risk factors of prostate cancer. However, women recorded poor knowledge about prostate cancer screening modalities or tools.

CONCLUSIONS

Moderate knowledge of women on the signs and symptoms and the causes and risk factors of prostate cancer was associated with education. These findings provide vital information for the prevention and control of prostate cancer and encourage policy-makers to incorporate health promotion and awareness campaigns in health policies to improve knowledge and awareness of prostate cancer globally.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework (OSF) registration DOI: https://doi.org/10.17605/OSF.IO/BR456.

Culturally Responsive Health Promotion to Address Health Disparities in African American Men: A Program Impact Evaluation

African American (AA) men continue to experience worse health outcomes compared to men of other races/ethnicities. Community-based interventions are known to be effective in health promotion and disease prevention. The program objectives were to (a) increase knowledge and risk awareness of targeted conditions, (b) change health-care-seeking attitudes toward regular primary care among AA men, and (c) improve their lifestyle-related health behaviors by leveraging the influence of women in their lives. The community-engaged educational intervention targeted both men and women and included eight 90-min sessions per cohort. Topics included prostate cancer, cardiovascular disease, diabetes, mental health, health-care access, and healthy lifestyle. Sessions were both didactic and interactive. A pre-/post-intervention questionnaire assessed knowledge. Interviews were conducted with male participants and a focus group discussion (FGD) with women to assess program impact. Interview and FGD transcripts were analyzed for themes and recommendations. Major themes were-increased knowledge/awareness of risk associated with chronic conditions, change in health-care-seeking attitudes, increased self-efficacy to engage the health-care system, and lifestyle changes. Other impacts reported were building community/social support, a safe and enabling learning environment, and enhanced community health status overall. Recommendations included having extended, more in-depth sessions, targeting the younger generation, smaller cohort sizes, and more community-based health programming. Community-engaged health promotion using a cohort model as well as including women can be effective in increasing knowledge, enhancing self-efficacy, and providing the much-needed social support. These can influence health-related behaviors and thus contribute to improving health outcomes for AA men.