The association between sociocultural variables and predictors of prostate cancer screening among black men in New York city: Implications for interventions

B17

There is growing emphasis on interventions to promote informed decisions about prostate cancer screening (i.e., prostate-specific antigen (PSA) test and digital rectal exam (DRE)) among Black men. However, most interventions to date pay little attention to sociocultural variables that may influence screening decisions and intentions. The current study examined four sociocultural variables previously shown to be relevant to healthcare participation in Black populations - medical mistrust, healthcare avoidance, collectivism, and Black identity - and their association with key predictors of health behavior as described by the Theory of Planned Behavior (TPB): attitudes about PSA/DRE tests, subjective norms relevant to prostate cancer screening, perceived behavioral control (PBC) over PSA/DRE tests, and intention to have PSA/DRE tests. Participants were 210 Black men between 40-75 years recruited in New York City. TPB measures included PSA test attitudes (8 items; α=.78), DRE attitudes (8 items; α =.79), and single items assessing norms, PBC, and screening intention. Participants also completed the Group-Based Medical Mistrust Scale (12 items;α =.87), the Avoidance of Healthcare Scale (4 items; α =.73), a measure of collectivism, or the extent to which one prioritizes the family or group over the individual (6 items;α =.87), and the Centrality subscale of the Multidimensional Inventory of Black Identity (8 items, α =.73). Potential covariates assessed included demographics, past prostate cancer screening, physician recommendation to screen, and physician explanation of the pros and cons of PSA/DRE tests. Separate multivariate regression analyses were conducted controlling for significant covariates. Results showed that attitudes about PSA test were significantly associated with healthcare avoidance (β= -.12, p<.004) and Black identity (β=.17, p<.002). PBC over PSA test was not related to any sociocultural variables. Attitudes about DRE were associated with mistrust (β= -.18, p<.004) and avoidance (β= -.20, p<.0001). PBC over DRE was also associated with mistrust (β= -.18, p<.04) and avoidance (β= -.28, p<.0001). Perceived social norms regarding prostate cancer screening in general were related to collectivism (β=.40, p<.003). Interestingly, none of the sociocultural variables were associated with intent to have either a PSA test or DRE. These results indicate that sociocultural variables are associated with theoretically proposed predictors of PSA/DRE tests among Black men and provide insight into the social context in which prostate cancer screening decisions are made. Interventions that promote informed decisions about prostate cancer screening in this population may be enhanced by addressing sociocultural factors.