Abstract
Introduction: The impetus for this study was the epidemiological finding that even though cancer prevalence is similar, the outcome for African Americans compared to whites, on average, is worse. It was hypothesized that certain attitudes within the African American community are influential in reducing participation in screening and treatment, therefore producing more adverse outcomes. In 2009, we conducted a population-based study of the knowledge, attitudes and behaviors of African Americans relevant to cancer in general. The findings were intended to inform the design and implementation of community interventions to increase the knowledge and awareness about cancer, prevention and treatment among the African American population in Michigan.
Methods: The focus for the Five Cities Survey was African American adult men and women 18 years of age or older within five Michigan cities (Detroit, Flint, Lansing, Pontiac, and Saginaw) which are residence to almost 80% of the state African American population. Trained interviewers from the Michigan State University's Institute for Public Policy and Social Research conducted the random digit telephone survey of eligible respondents in each of the cities. A disproportionate stratified, list-assisted random digit dial (RDD) sampling design was used. A total of 2,001 interviews eligible adults were completed at a response rate ranging from 49% to 61%.
Results: Income levels in most cities were lower than $35,000 a year. There were high levels of misconceptions surrounding cancer topics; such as misbeliefs about “surgery causing cancer to spread through the body”; “the causative role of environmental toxins”; “role of divine power in cancer cure”. On the other hand, there was lower awareness of 1)the role of sexual behaviors or HPV in cervical cancer etiology; 2) the fact that African Americans have a lower survival rate from some cancers; 3) the causative role of tobacco use in cancer; and 4) the preventive effect of a healthy lifestyle. The factor leading to getting cancer which was rated the highest by respondents was heredity. For women who had not had a Pap test for the past three years, the most frequent reasons they gave were lack of doctor's recommendation; not having a regular doctor; or personally not desiring a test. There were varying degrees of agreement with administering the HPV vaccine to age eligible girls. Of women who didn't receive regular mammograms 54% of Detroit women reported the reason being “fear of knowing they had cancer”. For others the most common reasons given were cost and personal choice of not having the test. Awareness of higher prostate cancer incidence among African American men varied from 46% to 75% and knowledge of typical warning signs for prostate cancer was at lower levels than desired (16% to 30%). At least one third of respondents had no knowledge of risk factors for colorectal cancer. The percent of cigarette smokers in African American adults within each of the 5 cities ranged from 26% to 36% compared to 18% in the general population.
Conclusion: There is clear need to continue tailoring cancer control messages to the unique needs of the African American public for reducing gaps in knowledge and cancer related behaviors. System changes are needed for better access to care and increased cultural competence of the health care system. Continuous surveillance is needed to guide interventions.
Citation Format: May Darwish Yassine. Cancer-related knowledge and attitudes among African American adults in Michigan: Five Cities Survey. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B41.
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