Prostate Cancer: “Real Men” are Checking it Out in South Carolina


By Houkje Ross


Closing the Gap, Supporting State Offices of Minority Health • September/October 2000


Gardenia Ruff is on a mission to im-prove the health status of 

minorities in South Carolina. As the director of South 

Carolina’s Office of Minority Health, she is excited about 

the attention minority health issues are receiving across the state. Ruff 

continues to work on many issues, and decided to tackle prostate 

cancer because of a lack of emphasis in general on male health issues 

and the limited number of initiatives that are culturally competent. 

In 1998, funding from the federal Office of Minority Health 

enabled Ruff to develop the Prostate Cancer Health Communication 

and Education Initiative for African American males in South Carolina. Within the last decade, prostate cancer has become a major health 

problem in South Carolina. Statistics from the Centers of Disease 

Control and Prevention and the American Cancer Society, hospital 

discharge data, and death certificates show that the state has one of the 

highest rates of prostate cancer mortality in the nation. 

Several organizations in South Carolina have set out to educate 

and screen African American men for prostate cancer but, “they have 

not taken into consideration the need to seek community involvement in the development and implementation of acceptable educational programs for the target population,” according to a summary of 

the initiative. 

Ruff ’s project, which did seek community involvement, developed a health education guide poster and other educational materials 

that work for African American communities in her state. The message, “Real Men Get It Checked,” confronts masculinity issues while 

encouraging men to get prostate screenings. 

Success Comes from Listening to the Community 

The initiative has been highly successful, in part because Ruff 

and her staff made a point of gaining an understanding of African 

American attitudes, beliefs, and knowledge about health and prostate 

cancer. Outreach materials, tools, and methods were all developed 

based on what the African American community told the South Carolina team. 

With one urban and one rural county represented, the initiative 

used focus groups to gather information on definitions of health, early 

exposure to health messages, sources of health information, and knowledge of prostate cancer and screening methods. 

Focus group participants, who included both men and women, 

were asked to develop messages that would encourage men to participate in early screening. Initially, the community resisted participation 

in the focus groups. Many African Americans are tentative when it 

comes to discussing cancer and sexuality. But once a well-respected 

community member facilitated the process of recruiting members and 

word spread, participation was no longer a problem. 

The focus groups determined that clear, to-the-point messages 

should be used when conducting outreach to African 

American males. A trusted messenger and a comfortable 

and familiar setting also play a large part in how well 

African American males respond to outreach. Threats to masculinity, 

denial, fear of impotence, death, and rectal exams all were cited as 

barriers to screening. The focus group results revealed: 

•	 African American males had no clear definition of health. Being 

pain free, however, was associated with good health. 

•	 Media sensationalism, hysteria, and mixed messages about health 

contribute to a lack of trust in the African American community. 

•	 Unnatural food production (i.e. steroid injections, food additives) and preparation was associated with cancer. 

•	 Rural respondents were more likely to perceive a correlation between soil, ground water, air pollution and cancer. Lack of consumption of home-grown vegetables was also associated with the 

increase in cancer. 

•	 Cancer is not discussed because cancer always means death. 

•	 Doctor and hospital visits were not a part of early family rituals. 

•	 Women expressed frustration in men’s lack of cooperation in 

scheduling and following through with doctor’s visits, and over 

men’s unwillingness to learn about diseases that can have a devastating effect on the individual as well as the entire family. 

•	 A lack of knowledge of the location and function of the prostate 

was evident, particularly in the rural male group ages 21-39. 

“We have had an overwhelmingly positive response from those 

who participated in the prostate education. Both the men and women 

found it to be very useful. Ten years ago this would not have happened,” said Ruff. “We accomplished what we set out to do; we 

reached our target population,” she said. Palmetto Baptist Hospital, 

one of the largest teaching hospitals in the state, has adopted the 

model Ruff and her staff developed. 

The hospital gave grants to 30 churches throughout the state, 

which will use the “Real Men Get it Checked” prostate cancer information materials. Many organizations have expressed an interest in 

using the posters and materials Ruff ’s office developed; other organizations want to adapt the materials for colorectal screening. “I would 

estimate that as many as 12,000 people could be reached through the 

church grants,” said Ruff. 

Other states can use South Carolina’s model, but Ruff says they 

should still conduct focus groups to fine-tune the model to their 

target population. 

For more information, contact: Gardenia Ruff, South 

Carolina Office of Minority of Health, (803) 898-3344.

Office of Minority Health Resource Center	 U.S. Department of Health and Human Services