Psychosocial determinants of colorectal Cancer screening uptake among African-American men: understanding the role of masculine role norms, medical mistrust, and normative support

Associations between Anti-Gay Prejudice, Traditional Masculine Self-Concept, and Colorectal Cancer Screening-Related Outcomes among Black and White Men in the United States

BACKGROUND

Colorectal cancer screening can reduce colorectal cancer risk, yet many men are not up to date with screening guidelines. Although previous qualitative studies have suggested links among anti-gay prejudice, traditional masculine self-concept, racial identity, and colorectal cancer screening among men, scholars have yet to fully explore these associations using quantitative data. This study used a nationally representative sample of Black and White men in the United States to test these associations and examine the sociodemographic correlates.

METHODS

Using the National Opinion Research Center (NORC)/AmeriSpeak probability-based panel, we recruited a sample of Black and White men in the United States ages 45 to 74 years who had never been diagnosed with colorectal cancer (N = 909). Participants completed an online questionnaire measuring anti-gay prejudice, traditional masculine self-concept, sociodemographic variables, and screening-related outcomes (awareness of screening test options, screening intention, and adherence to screening recommendations).

RESULTS

Black participants reported higher levels of anti-gay prejudice and traditional masculine self-concept than White participants. Anti-gay prejudice was associated with lower awareness and lower screening intention. Black participants reported higher intention to follow screening recommendations but not higher odds of actual adherence than White participants.

CONCLUSIONS

Men with anti-gay prejudice are less likely to be aware of colorectal cancer screening test options and less likely to intend to engage in colorectal cancer screening. The results have implications for the design and development of future interventions aimed at increasing colorectal cancer screening rates.

IMPACT

Future studies could develop targeted interventions and observe subsequent changes or conduct longitudinal studies to further explore the role of anti-gay prejudice in colorectal cancer screening.

Adherence to mt-sDNA testing for colorectal cancer screening among new users in a US Black population

OBJECTIVE

Colorectal cancer (CRC) poses significant mortality risks, particularly among Black individuals, who experience the highest CRC incidence and mortality rates in the United States. This study examined adherence to multi-target stool DNA (mt-sDNA) testing in this population.

METHODS

This retrospective cohort analysis used Exact Sciences Laboratories (ESL)-linked claims data from January 2017 to December 2023 on Black patients in the United States aged 45 and older. High-risk individuals, those with payers other than commercial plans, managed care organizations, Medicare Advantage, Medicaid, or Medicare, and individuals with mt-sDNA prescriptions outside the study period were excluded. Adherence was defined as the percentage of patients returning the test kit with valid results within 365 days of shipment. Logistic regression analysis was used to identify factors associated with adherence.

RESULTS

Among 434,951 patients included in the study, the overall adherence to mt-sDNA testing was 62.0% (N = 266,981), with a mean time to adherence of 27.6 days (SD = 44.17). Females, older adults (76+ years), and non-metropolitan residents had higher adherence than males, younger adults, and metropolitan patients (all p < 0.001), respectively. Patients with orders from GI specialists had higher adherence than other prescribing clinicians (NP/PA: OR = 0.39, OB/GYN: OR = 0.54, Other: OR = 0.38, PCP: OR = 0.50; all p < 0.001). Digital outreach, especially SMS and email combination, was also associated with higher adherence (OR = 1.25, p < 0.001).

CONCLUSIONS

This large, national study found a 62.0% adherence rate to mt-sDNA testing among Black individuals. Higher adherence was associated with being female, older age, non-metropolitan residence, and digital outreach. While the findings highlight the promise of mt-sDNA, further research is needed to explore its full potential in improving CRC screening adherence across different demographic groups.

Application of an implementation premortem: A novel qualitative approach leveraging prospective hindsight to enhance barbershop health interventions for Black men

Barbershop-based efforts to promote health among Black men have been uniquely successful. Despite the success of these efforts, the emphasis on outcomes as opposed to how these outcomes can be achieved has created a gap in the literature. The present study addresses this gap by describing implementation-related program priorities that Black men identify for barbershop-based interventions. Twenty-three Black men participated in implementation premortem activities. Participants were: (i) given details about a barbershop-based health promotion effort, (ii) told that the effort had failed, and (iii) were asked to identify potential sources of program failure and strategies to overcome those challenges. The frequency of program priorities was calculated based on the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, and focus group data were analyzed using an inductive thematic qualitative data analytic approach. Data analyses occurred in three phases: (i) excerpts were grouped by Phase, Domain, and Construct of the EPIS Framework; (ii) themes within each excerpt were then identified using an inductive approach; and (iii) themes were organized into conceptually similar and parsimonious categories. Participants suggested that the biggest source of program failure was that more attention needed to be paid to Program Fit during the Implementation Phase. Participants reported concerns with the accessibility and convenience of the effort. Additional participant concerns included economic issues, community ownership, climate, staffing processes, cultural sensitivity, engagement, and trust. The implementation of health promotion programs for Black men should pay particular attention to how the intervention fits the needs, lives, and contexts of potential participants.

Speaking Out: Factors Influencing Black Americans' Engagement in COVID-19 Testing and Research

Black communities in the United States (U.S.) have faced stark inequalities in COVID-19 outcomes. The underrepresentation of Black participants in COVID-19 testing research is detrimental to the understanding of the burden of the disease as well as the impact of risk factors for disease acquisition among Black Americans. Prior scholarship notes that the reluctance to engage in medical research among Black people is, in part, due to the exploitation and abuse this community has seen from the medical field and other social institutions. To better understand the barriers and motivations for COVID-19 testing among Black Americans, this study utilized intersectionality as methodological and theoretical frameworks to examine and investigate the barriers and motivations influencing participation in COVID-19 serosurveys (blood test and interview) among the metro-Atlanta Black communities. From May to October 2021, we took a community-based participatory research approach and conducted 52 semi-structured interviews to uncover different Black communities' feelings and opinions towards COVID-19 testing. Key reasons participants agreed to the blood test include (1) curiosity; (2) health upkeep; (3) family/community/social responsibility; and (4) importance of research. Participants' reasons for rejecting the blood test were (1) unnecessary/no benefit; (2) fear (of the known and unknown); (3) fear of needles and/or blood; and (4) discomfort with test setting/procedure. Our findings show that perspectives on willingness to engagement in testing or to not participate varied across gender and age for Black individuals.

A socioecological taxonomy of determinants to colorectal cancer screening in black men: Insights from a mixed-methods systematic review

Background

In the United States, African/Black American (henceforth Black) men face significantly higher mortality rates from colorectal cancer (CRC) compared to other gender, racial, and ethnic groups. Although CRC is preventable and treatable with early detection, screening rates among Black men remain low. This study aimed to synthesize existing literature on the barriers and facilitators (determinants) of CRC screening to offer guidance to primary care teams in their efforts to improve screening uptake.

Methods

We performed a comprehensive systematic review of full-text, peer-reviewed studies published in English to explore the various determinants influencing CRC screening among Black men. Using key terms like "Black or African American," "male," and "colorectal cancer screening," we searched databases including PubMed, PsychInfo, CINAHL, and Embase, published between 2009 and 2022.

Findings

The search identified 1235 articles, with 54 meeting the inclusion criteria. Most studies were cross-sectional, examining determinants across the socioecological system. Key barriers included a lack of CRC screening knowledge, poor patient-provider communication, lack of access to screening, and medical mistrust stemming from systemic racism. Significant facilitators included aging, receiving a provider recommendation, having social support, and effective culturally appropriate outreach strategies.

Conclusions

Key themes and significant findings from the review provide actionable strategies for primary care teams. These include enhancing knowledge about CRC screening within the patient population, improving patient-provider interactions, and reducing barriers to accessing screening. Future research should aim to develop culturally appropriate and collaborative preventive care strategies to improve screening adherence and CRC-related outcomes.

Medical mistrust and receptivity to lung cancer screening among African American and white American smokers

Although medical mistrust is associated with lower cancer screening uptake among racial minorities, such as African Americans, potential impacts on cancer screening among White Americans are generally understudied. In this study, we examined links from medical mistrust to lung cancer screening among African American (N = 203) and White American (N = 201) smokers. Participants completed the Group-Based Medical Mistrust Scale and viewed a brief online educational module about lung cancer risks, etiology, and screening. Thereafter, participants reported their receptivity to lung cancer screening using a Theory of Planned Behavior (TPB) measurement framework (attitudes, normative beliefs, perceived control, and intentions). Medical mistrust predicted lower screening receptivity across all TPB measures for both racial groups. Although medical mistrust was higher among African Americans, there were no race differences in screening receptivity. However, there was some evidence that race moderates the relationship between medical mistrust and screening attitudes. While greater mistrust predicted more negative attitudes among both races, this effect was stronger among White Americans than African Americans. Findings suggest that group-based medical mistrust is a barrier to lung cancer screening for both African Americans and White Americans and illustrates the need to address medical mistrust as a barrier to screening for both racial minority and nonminority populations.

Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines

BACKGROUND/AIMS

Clinical guidelines should ideally be formulated from data representative of the population they are applicable to; however, historically, studies have disproportionally enrolled non-Hispanic White (NHW) patients, leading to potential inequities in care for minority groups. Our study aims to evaluate the extent to which racial minorities were represented in the United States Colorectal Cancer Surveillance Guidelines.

METHODS

We reviewed US guidelines between 1997 and 2020 and all identified studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps, and hyperplastic polyps. We analyzed the proportion of studies reporting race, and among these studies, we calculated the racial distribution of patients and compared the proportion of Non-NHW patients between each subtype.

RESULTS

For all guidelines, we reviewed 75 studies encompassing 9,309,955 patients. Race was reported in 24% of studies and 14% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for adenomas, 22% for sessile serrated polyps, and 15% for hyperplastic polyps. For the 2020 guidelines, we reviewed 33 studies encompassing 5,930,722 patients. Race was reported in 15% of studies and 21% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for tubular adenomas. Race was not cited for any other 2020 guideline.

CONCLUSION

Racial minorities are significantly underrepresented in US Colorectal Cancer Surveillance Guidelines, which may contribute to disparities in care. Future studies should prioritize enrolling a diverse patient population to provide data that accurately reflects their population.

Sociocultural and masculinity influences on colorectal cancer screening participation among Hispanic/Latino men in Florida, New York, and Texas

BACKGROUND

This cross-sectional study explored how masculinity beliefs may influence colorectal cancer (CRC) screening participation among ethnic subgroups of screening-age-eligible (45-75 years) Hispanic/Latino men.

METHODS

Using a consumer panel, we recruited self-identified Hispanic/Latino men fluent in English or Spanish, and residing in Florida, New York, or Texas. The Masculinity Barriers to Medical Care (MBMC) scale and its six subscales were used to assess masculinity beliefs. Multivariable logistic regression was used to estimate the association between MBMC and CRC screening participation, adjusting for Hispanic/Latino subgroup, marital status, survey language, age group, and health insurance status. Results were then stratified by Hispanic/Latino subgroup.

RESULTS

Of the participants (n=611), approximately 31% identified as Puerto Rican, 30% as other Hispanic/Latino, 26% as Mexican, and 14% as Cuban; 63% had ever been screened for CRC. We found no differences in the prevalence of screening participation by Hispanic/Latino subgroup. The majority of participants had completed both a stool-based test and an exam-based screening test (29.3%). After adjusting for confounding, MBMC reduced the odds of screening participation. Slight MBMC-subscale differences were observed by Hispanic/Latino subgroup. For example, higher scores on the Restrictive Emotionality subscale were associated with a lower likelihood of screening participation among Puerto Rican men, but higher odds of screening for Cuban men.

CONCLUSIONS

Masculinity barriers to CRC screening may exist. Tailored interventions to address masculinity barriers among specific Latino subgroups may improve CRC screening uptake in this population.

Colorectal Cancer Screening Rates at Federally Qualified Health Centers From 2014 to 2022: Incomplete Recovery From COVID-19 and Worsening Disparities

INTRODUCTION

Federally Qualified Health Centers (FQHC) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. Overall CRC screening participation in the United States declined during the COVID-19 pandemic and recovered by 2021; however, trends in underresourced settings are unknown.

METHODS

Using Uniform Data System data from 2014 to 2022, we assessed trends in FQHC CRC screening rates nationally, in California, and in Los Angeles County and determined clinic-level factors associated with recent screening rate changes. For each FQHC, we calculated the screening rate change from 2019 to 2020, 2020 to 2021, and 2020 to 2022. We used mixed-effects linear regression to determine clinic-level characteristics associated with each screening rate change.

RESULTS

Across all FQHC (n = 1,281), 7,016,181 patients were eligible for CRC screening in 2022. Across the United States and in California, median screening rates increased from 2014 to 2019, severely declined in 2020, and failed to return to prepandemic levels by 2022. Both nationally and in California, CRC screening declined most dramatically from 2019 to 2020 in FQHC serving majority Hispanic/Latino patients or a high proportion of patients experiencing homelessness. From 2020 to 2022, screening rates did not recover completely in US FQHC, with disproportionate recovery among FQHC serving majority non-Hispanic Black patients.

DISCUSSION

CRC screening rates at FQHC did not return to prepandemic levels by 2022, and recovery varied by FQHC patient characteristics. Tailored interventions addressing low and decreasing CRC screening rates in FQHC are urgently needed to mitigate worsening CRC disparities.

Identifying Populations at Risk for Lung Cancer Mortality from the National Health and Nutrition Examination Survey (2001-2018) Using the 2021 USPSTF Screening Guidelines

Lung cancer (LC) is the leading cause of cancer mortality in the United States. To combat this predicament, early screening and critically assessing its risk factors remain crucial. The aim of this study was to identify the value of specific factors from the National Health and Nutrition Examination Survey (NHANES) from 2001-2018, as they relate to lung cancer mortality in the US Preventive Services Task Force (USPSTF)-eligible population. A total of 3545 adults who met USPSTF criteria were extracted from 81,595 NHANES participants. The LC Death Risk Assessment Tool was used to calculate the number of deaths per 1000 individuals. The Mann-Whitney U test and one-way ANOVA determined the statistical significance of the factors involved in LC mortality. Male sex, African and Hispanic ethnicity, lower education attainment, and secondhand exposure to cigarette smoke correlated with an increased risk of LC mortality. Additionally, the factor of emotional support from NHANES data was analyzed and did not show any benefit to reducing risk. By identifying individuals at high-risk, preventative measures can be maximized to produce the best possible outcome.

Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care

BACKGROUND

Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale.

METHODS

We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions.

DISCUSSION

Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities.

TRIAL REGISTRATION

NCT06401174.

From Organizing Medicine to Cooking With More Leafy Greens: A Dyadic, Qualitative Analysis of How Older African American Couples Take Care of Each Other's Health

Guided by the Dyadic Theory of Illness Management, we explored spousal health management behaviors and their congruence within seventeen older African American married couples participating in a dyadic exercise intervention. Both prior to and after the intervention, spouses reported how they took care of their partner's health as well as what their partner did for them. Data were analyzed using theoretical thematic analysis, and five health management behaviors domains were identified (diet, exercise, self-care, medical compliance, relationship maintenance). Both partners were most likely to encourage healthier diets and exercise. Wives tended to report more behaviors compared to husbands. Couples had little congruence in their appraisals of each other's health management behaviors, and patterns were stable over time. Findings suggest incongruence in couples' health management behaviors represented complementary, collaborative efforts to support each other and that husbands may underestimate how much care they both provide to and receive from their wives.

Influence of Health Insurance Types on Clinical Cancer Care Accessibility and Quality Using All of Us Database

Background and Objectives: Cancer, as the second leading cause of death in the United States, poses a huge healthcare burden. Barriers to access to advanced therapies influence the outcome of cancer treatment. In this study, we examined whether insurance types affect the quality of cancer clinical care. Materials and Methods: Data for 13,340 cancer patients with Purchased or Medicaid insurance from the All of Us database were collected for this study. The chi-squared test of proportions was employed to determine the significance of patient cohort characteristics and the accessibility of healthcare services between the Purchased and Medicaid insurance groups. Results: Cancer patients who are African American, with lower socioeconomic status, or with lower educational attainment are more likely to be insured by Medicaid. An analysis of the survey questions demonstrated the relationship between income and education level and insurance type, as Medicaid cancer patients were less likely to receive primary care and specialist physician access and more likely to request lower-cost medications. Conclusions: The inequities of the US healthcare system are observed for cancer patient care; access to physicians and medications is highly varied and dependent on insurance types. Socioeconomic factors further influence insurance types, generating a significant impact on the overall clinical care quality for cancer patients that eventually determines treatment outcomes and the quality of life.

Exploring Preventive Health Care Utilization Among Black/African American Men

Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being "somewhat" familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

Medical mistrust, culturally targeted message framing, and colorectal cancer screening among African Americans

Mistrust in the information and treatment provided by medical professionals and organizations hinders cancer screening among African Americans. However, its impact on responses to health messaging aimed at bolstering screening uptake is unknown. The present study examined the effects of medical mistrust on message framing and culturally targeted health messaging about colorectal cancer (CRC) screening. Screening eligible African Americans (N = 457) completed the Group-Based Medical Mistrust scale and then viewed an informational video about CRC risks, prevention, and screening, during which all participants received either a gain or loss-framed message about screening. Half of participants received an additional culturally targeted screening message. After messaging, all participants completed Theory of Planned Behavior measures of CRC screening receptivity, as well as items assessing expectations about experiencing racism when obtaining CRC screening (i.e., anticipatory racism). Hierarchical multiple regressions showed that medical mistrust predicted lower screening receptivity and greater anticipatory racism. Additionally, effects of health messaging were moderated by medical mistrust. Among participants high in mistrust, targeted messaging-regardless of message frame-bolstered normative beliefs about CRC. Additionally, only targeted loss-framed messaging bolstered attitudes toward CRC screening. Although targeted messaging reduced anticipatory racism among participants with high mistrust, anticipatory racism did not mediate messaging effects. Findings indicate medical mistrust may be an important culturally-relevant individual difference to attend to in addressing CRC screening disparities, including its potential to impact responses to cancer screening messaging.

Perceived economic pressure and colorectal cancer-related perceptions among U.S. males (aged 45-75)

PURPOSE

To examine whether a greater perception of economic pressure would be associated with more-negative attitudes, greater perceived barriers, and lower subjective norms regarding colorectal cancer (CRC) and CRC screening among males aged 45-75 years.

METHODS

We recruited 492 self-identified males aged 45-75 years living in the United States. We operationalized perceived economic pressure as a latent factor with three subscales: can't make ends meet, unmet material needs, and financial cutbacks. Our dependent variables were attitudes toward CRC and CRC screening, perceived barriers to completing a CRC screening exam, and subjective norms regarding CRC screening (e.g., how others value CRC screening). We tested a hypothesized model using structural equation modeling with maximum-likelihood estimation, adjusting for covariates, and made post-hoc modifications to improve model fit.

RESULTS

Greater perceived economic pressure was associated with more-negative attitudes toward CRC and CRC screening (β = 0.47, 95% CI: 0.37,0.57) and with greater perceived barriers to CRC screening (β = 0.22, 95% CI: 0.11, 0.34), but was not significantly associated with subjective norms (β = 0.07, 95% CI: - 0.05, 0.19). Perceived economic pressure was an indirect pathway by which lower-income and younger age were associated with more-negative attitudes and greater perceived barriers.

CONCLUSIONS

Our study is one of the first to show that, among males, perceived economic pressure is associated with two social-cognitive mechanisms (i.e., negative attitudes, greater perceived barriers) that are known to influence CRC screening intent and, ultimately, CRC screening completion. Future research on this topic should employ longitudinal study designs.

Medical Mistrust Among a Racially and Ethnically Diverse Sample of Sexual Minority Men

Purpose: Medical mistrust is a barrier to health care utilization and is associated with suboptimal health outcomes. Research on mistrust among sexual minority men (SMM) is limited and largely focuses on Black SMM and HIV, with few studies assessing mistrust among SMM of other race/ethnicities. The purpose of this study was to examine differences in medical mistrust among SMM by race. Methods: From February 2018 to February 2019, a mixed-methods study examined the health-related beliefs and experiences of young SMM in New York City. The Group-Based Medical Mistrust Scale (GBMMS) was used to measure medical mistrust related to race, and a modified version of the scale assessed mistrust related to one's "sexual/gender minority" status (Group-Based Medical Mistrust Scale-Sexual/Gender Minority [GBMMS-SGM]). With an analytic sample of 183 cisgender SMM, a one-way multivariate analysis of variance was used to examine differences in GBMMS and GBMMS-SGM scores by race/ethnicity [Black, Latinx, White, "Another Racial Group(s)"]. Results: There were significantly different GBMMS scores by race, with participants of color reporting higher levels of race-based medical mistrust than White participants. This finding is supported by effect sizes ranging from moderate to large. Differences in GBMMS-SGM scores by race were borderline; however, the effect size for Black and White participants' GBMMS-SGM scores was moderate, indicating that higher GBMMS-SGM scores among Black participants is meaningful. Conclusion: Multilevel strategies should be used to earn the trust of minoritized populations, such as addressing both historical and ongoing discrimination, moving beyond implicit bias trainings, and strengthening the recruitment and retention of minoritized health care professionals.

Message Framing for Men? Gender Moderated Effects of Culturally Targeted Message Framing on Colorectal Cancer Screening Receptivity among African Americans

Receptivity to recommended colorectal cancer (CRC) screening can be enhanced by use of loss-framed health messaging that emphasizes possible consequences of failing to act. However, a simultaneous use of culturally targeted messaging may be needed to achieve effectiveness when loss-framed messaging is used with African Americans, especially to reduce racism-related cognitions aroused by standard loss framing that impede CRC screening receptivity. This study considered whether effects of stand-alone and culturally targeted message framing on CRC screening receptivity differ between African American men and women. African Americans eligible for CRC screening (Men=117, Women=340) viewed an informational video about CRC risks, prevention, and screening, and were randomized to receive a gain or loss-framed message about screening. Half of participants received an additional culturally targeted message. Using the Theory of Planned Behavior, we measured receptivity to CRC screening. We also measured arousal of racism-related cognitions. A significant three-way interaction suggested effects of messaging on CRC screening receptivity were moderated by gender. Participants were no more receptive to CRC screening when standard loss-framing was used, but were more favorable if loss-framing was culturally targeted. However, these effects were more pronounced among African American men. Contrary to prior findings, gender moderated effects of culturally targeted loss-framed messaging were not attributable to reducing racism-related cognitions. Findings add to growing recognition of important nuance in effective use of message framing to also include gender, while suggesting a critical need to explore gender-relevant mechanistic pathways, potentially including how health messaging activates masculinity-related cognitions among African American men.

Understanding the psychological antecedents of COVID-19 vaccine acceptance among Black Americans: implications for vaccine communication

BACKGROUND

Guided by the 5C (confidence, complacency, constraints, calculation, and collective responsibility) model of vaccination behavior, we examine the psychological antecedents of COVID-19 vaccine acceptance (i.e. attitudes and intentions toward COVID-19 vaccination) among Black Americans, a group disproportionately affected by the coronavirus pandemic.

METHOD

We conducted a national survey of Black Americans (N = 1,497) in February/March 2021.

RESULTS

We found that, among the five psychological antecedents, three (confidence, calculation - or extensive information searching, and collective responsibility) significantly predicted attitudes toward COVID-19 vaccination and had indirect effects on vaccination intentions through vaccination attitudes. Two antecedents (confidence and collective responsibility) also directly predicted vaccination intentions. Our analysis suggests that a partially mediated model produced better fit than a fully mediated model.

CONCLUSIONS

Developing culturally tailored interventions for Black Americans that build confidence in COVID-19 vaccines, highlight collective responsibility, and attend to Black Americans' information sources is key to boosting Black Americans' COVID-19 vaccine acceptance. Future research is needed to understand how historical and ongoing racism affects the psychological antecedents of COVID-19 vaccine acceptance among Black Americans.

Economic Pressure and Intention to Complete Colorectal Cancer Screening: A Cross-Sectional Analysis Among U.S. Men

Although men's lives can be saved by colorectal cancer (CRC) screening, its utilization remains below national averages among men from low-income households. However, income has not been consistently linked to men's CRC screening intent. This study tested the hypothesis that men who perceive more economic pressure would have lower CRC screening intent. Cross-sectional data were collected via an online survey in February 2022. Men (aged 45-75 years) living in the U.S. (N = 499) reported their CRC screening intent (outcome) and their perception of their economic circumstances (predictors). Adjusted binary and ordinal logistic analyses were conducted. All analyses were conducted in March 2022. Men who perceived greater difficulty paying bills or affording the type of clothing or medical care they needed (i.e., economic strain) were less likely to have CRC screening intent (OR = 0.67, 95% CI: 0.49, 0.93). This association was no longer significant when prior screening behavior was accounted for (OR = 0.75, 95% CI: 0.52, 1.10). Contrary to our hypothesis, men who reported more financial cutbacks were more likely to report wanting to be screened for CRC within the next year (OR = 1.06, 95% CI: 1.01, 1.11). This is one of the first studies to demonstrate that men's perceptions of their economic circumstances play a role in their intent to complete early-detection screening for CRC. Future research should consider men's perceptions of their economic situation in addition to their annual income when aiming to close the gap between intent and CRC screening uptake.

BarberED then screened: Disrupting the colorectal cancer disparity in urban Black men

BACKGROUND

Colorectal cancer (CRC) is the third most common diagnosed cancer among non-Hispanic Black people in the United States. Alarmingly, this population is also 40% more likely to succumb to the disease. Black men get diagnosed younger, present with late-stage disease, and have poor 5-year survival rates. In total, 42% of the racial disparity is due to differences in screening.

LOCAL PROBLEM

In Rochester, New York, there are eight zip codes where less than 47% of the population completed CRC screening and six zip codes where men have 15% to 49% above expected cases of CRC.

METHODS

This qualitative improvement project took place in a barbershop in a zip code with subpar screening rates and higher-than-expected cases of CRC. Black men, 45-75 years of age, not current with CRC screening guidelines were recruited to participate after they received barber services. CRC screening was considered complete once a colonoscopy was scheduled.

INTERVENTIONS

Colorectal cancer education was provided by a nurse practitioner to barbers, who then provided education to their eligible patrons. After the education, patrons who decided to undergo screening were connected to a local gastroenterology group where a colonoscopy was scheduled.

RESULTS

Thirteen participants agreed to participate in the project. Nine participants scheduled CRC screening, and seven completed the colonoscopy evaluation.

CONCLUSIONS

Barbers and nurse practitioners are an ideal partnership when seeking to disrupt the CRC health care disparity. Members of the Black community who may not routinely participate in preventive care can be innovatively educated to improve their health status.

Masculinity Barriers to Ever Completing Colorectal Cancer Screening among American Indian/Alaska Native, Black, and White Men (Ages 45-75)

Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers to medical care are associated with lower rates of ever completing CRC screening, a survey-based study was employed from December 2020-January 2021 among 435 White, Black, and AIAN men (aged 45-75) who resided in the US. Logistic regression models were fit to four Masculinity Barriers to Medical Care subscales predicting ever completing CRC screening. For all men, being strong was associated with 54% decreased odds of CRC screening completion (OR 0.46, 95% CI 0.23 to 0.94); each unit increase in negative attitudes toward medical professionals and exams decreased the odds of ever completing CRC screening by 57% (OR 0.43, 95% CI 0.21 to 0.86). Black men who scored higher on negativity toward medical professionals and exams had decreased odds of ever screening. Consideration of masculinity in future population-based and intervention research is critical for increasing men's participation in CRC screening, with more salience for Black men.

Validating the Group-Based Medical Mistrust Scale with English and Spanish Speaking Latino Parents of Adolescents

BACKGROUND

Medical mistrust can be a barrier to health care utilization. While the Group-Based Medical Mistrust Scale (GBMMS) has been validated among diverse populations, we know little about its psychometric performance among English-Speaking (ES) and Spanish-Speaking (SS) Latinos. We aim to examine the factor structure of GBMMS among Latino parents and explore whether scale latent factor structures would be different across preferred languages.

METHODS

Parents of adolescents participating in an urban academic enrichment program for low-income students completed an online survey as part of a cross-sectional study about Human Papillomavirus (HPV) prevention. We tested the validity of the GBMMS in ES and SS respondents and performed exploratory factor analysis to identify latent factors. We examined scale scores, item means, item endorsement, and residual variance across language groups.

RESULTS

2-factor latent structure was identified for both ES and SS groups; factors were labeled as 'Suspicion' and 'System-wide discrimination.' Scale validity was better among SS (α = 0.76). Medical mistrust scores did not vary across language groups, but variation emerged in item endorsement by language.

DISCUSSION

Our results suggest that the factor structures of the medical mistrust construct, measured by the GBMMS, are similar across ES and SS Latinos and that the GBMMS is valid for both populations. High factor pattern loading reflects a shared mistrust of how health care systems view and treat people of their racial/ethnic background, independent of their preferred languages. Measurement of medical mistrust and identifying its underlying causes are needed within diverse populations to fully address structural- and community-level influences on health inequities.

Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men

Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.

'We can bear it!' Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B: A qualitative study

AIMS AND OBJECTIVES

To explore barriers to hepatocellular carcinoma screening among patients with hepatitis B.

BACKGROUND

Hepatitis B-related hepatocellular carcinoma is a major cause of cancer-related mortality globally. A preventive strategy for screening is needed to improve early tumour detection and overall survival. However, utilisation remains suboptimal and barriers are understudied and largely focused on clinical factors.

DESIGN

A qualitative study based on the preventive health model using phenomenological hermeneutical approach.

METHODS

Face-to-face semi-structured interviews were conducted with 23 hepatitis B patients from November 2020 to February 2021. Interpretative phenomenological analysis was used. The COREQ checklist was followed.

RESULTS

Four themes were identified: (i) miscognition, (ii) cultural stigma and taboo, (iii) social norms of enduring hardship and (iv) social barriers at the community, health system and policy levels. Patients had misconceptions about inactive carriers, asymptomatic nature of chronic hepatitis B, hepatocellular carcinoma risks and screening recommendations. Influenced by the taboo of hepatocellular carcinoma, stigma against hepatitis B and enduring hardship norms, they perceived screening as divination, avoided utilisation to hide disease status and endured symptoms until they were intolerable. Insufficient community support, a lack of shared decision-making in health systems, and inadequate rural reimbursement policy and hepatocellular carcinoma detection capacity further precluded utilisation.

CONCLUSIONS

Cognitive and sociocultural barriers precluded individuals' intention, utilisation and persistence of hepatocellular carcinoma screening. The results highlight intervention targets for miscognition, stigma, taboo and social norms; propose family-focused, community-based education programs; suggest health systems to introduce decision aids; and inform policymaking and upskilling of physicians in rural areas.

RELEVANCE TO CLINICAL PRACTICE

Collaborative efforts are needed to improve real-world hepatocellular carcinoma screening, including education to address knowledge deficiencies, psychological counselling to reduce stigma and taboo beliefs, support for shared decision-making and reimbursement policies.

Psychometric Properties and Analysis of the Masculinity Barriers to Medical Care Scale Among Black, Indigenous, and White Men

Non-Hispanic (NH) Black, American Indian/Alaska Native (Indigenous), and NH-White men have the highest colorectal cancer (CRC) mortality rates among all other racial/ethnic groups. Contributing factors are multifaceted, yet no studies have examined the psychometric properties of a comprehensive survey examining potential masculinity barriers to CRC screening behaviors among these populations. This study assessed the psychometric properties of our Masculinity Barriers to Medical Care (MBMC) Scale among NH-Black, Indigenous, and NH-White men who completed our web-based MBMC, Psychosocial Factors, and CRC Screening Uptake & Intention Survey. We conducted exploratory factor analysis on a sample of 254 men and multivariate analysis of variance (MANOVA) on a separate sample of 637 men nationally representative by age and state of residence. After psychometric assessment, the MBMC scale was reduced from 24 to 18 items and from six to four subscales. NH-Black men's mean scores were lowest on three of four subscales (Being Strong, Negative and Positive Attitudes) and highest on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-White men, NH-Black men had significantly lower Negative Attitudes subscale scores and significantly higher scores on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-Black men, NH-White men had significantly higher Being Strong and Positive Attitudes subscales scores. This study expands on previous research indicating that, among racialized populations of men, endorsement of traditional masculine ideologies influences engagement in preventive health behaviors. Our scale can be tailored to assess attitudes to screening for other cancers and diseases that disproportionately burden medically underserved populations.

Barriers to and Facilitators of Recruitment of Adult African American Men for Colorectal Cancer Research: An Instrumental Exploratory Case Study

PURPOSE

Racial and ethnic minorities remain underrepresented in research and clinical trials. Better understanding of the components of effective minority recruitment into research studies is critical to understanding and reducing health disparities. Research on recruitment strategies for cancer-specific research-including colorectal cancer (CRC)-among African American men is particularly limited. We present an instrumental exploratory case study examining successful and unsuccessful strategies for recruiting African American men into focus groups centered on identifying barriers to and facilitators of CRC screening completion.

METHODS

The parent qualitative study was designed to explore the social determinants of CRC screening uptake among African American men 45-75 years of age. Recruitment procedures made use of community-based participatory research strategies combined with built community relationships, including the use of trusted community members, culturally tailored marketing materials, and incentives.

RESULTS

Community involvement and culturally tailored marketing materials facilitated recruitment. Barriers to recruitment included limited access to public spaces, transportation difficulties, and medical mistrust leading to reluctance to participate.

CONCLUSION

The use of strategies such as prioritizing community relationship building, partnering with community leaders and gatekeepers, and using culturally tailored marketing materials can successfully overcome barriers to the recruitment of African American men into medical research studies. To improve participation and recruitment rates among racial and ethnic minorities in cancer-focused research studies, future researchers and clinical trial investigators should aim to broaden recruitment, strengthen community ties, offer incentives, and use multifaceted approaches to address specific deterrents such as medical mistrust and economic barriers.

Bias Issues in Colorectal Cancer Management: A Review

Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.