Preventive Health Services Use, Medical Mistrust, Cancer and African American Men: A Secondary Data Analysis and Systematic Review
Creators: name: White, Nzingha
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2012

description: Background: African American men are at increased risk for cancer incidence and mortality. Cancer related risk factors such as tobacco use and obesity are associated with several cancers, including colorectal cancer. Moreover, high rates of tobacco use and obesity among African American men, along with receipt of fewer preventive services likely intensifies the disparity of cancer morbidity and mortality. African American men with higher levels of medical mistrust have been found to both schedule and receive fewer preventive services, including the routine health examination. Evidence that explores the relationship between the routine health examination, cancer related risk factors and medical mistrust is scant. Accordingly, compared to all other US adults, incidence and mortality rates of colorectal cancer are highest among African American men while adherence to screening remains low. There is growing data that adherence among African American men may be higher than previous estimates. No consensus on guideline consistent colorectal cancer screening adherence among African American males is currently available. Therefore, this paper both explores factors associated with preventive health service use, and reviews the relevant literature on adherence to colorectal cancer screening among African American men. Methods: This paper includes both a secondary data analysis which explores the association between the routine health examination, cancer related risk factors and medical mistrust among African American men and a systematic review of colorectal cancer screening adherence among African American men. The Theory of Reasoned Action served as the conceptual framework for the data analysis. Bivariate and multivariate analyses assessed unadjusted and adjusted associations. PubMed (Medline), EMBASE and CINAHL databases were searched for all relevant articles on colorectal cancer screening adherence among African American men. Results: African American men who received a routine health examination within the last year had higher body mass indices than men who did not receive an examination (B=1.38, p=0.024, 95% CI 0.16-2.59). There was no association between smoking status and receipt of a routine health examination (OR= 1.24, p=0.452, 95% CI 0.71-2.18) and medical mistrust did not moderate the relationship between the routine health examination and either smoking status (p=0.535) or body mass index (p=0.60). A review of 125 titles and seven eligible articles, revealed that there was significant heterogeneity in the study populations, methods, results, and quality of studies, as well as a lack of objective data, examining adherence to colorectal cancer screening among African American men. Conclusions: Receipt of a routine health examination is associated with having a higher body mass index, but not with smoking status. In addition, these relationships were not moderated by medical mistrust. Consistent, objective, high quality, nationally representative data, examining true adherence to colorectal cancer screening among African American men is currently unavailable.