Hidden barriers between knowledge and behavior

Abstract

BACKGROUND Prostate cancer (PC) mortality is much greater for African American than for Caucasian men. To identify patient factors that might account for some of this disparity, men within 6 months of diagnosis were surveyed about health attitudes and behavior. METHODS Using Rapid Identification in the North Carolina Cancer Registry, 207 African American and 348 Caucasian recently diagnosed PC patients were identified and surveyed. RESULTS African American men were younger and less often currently married, and had lesser education, job status, and income than Caucasian men (all P < .001). African American men were at no greater distance to medical care, but had less access: poorer medical insurance coverage, more use of public clinics and emergency wards, less continuity with a primary physician, and more often omitted physician visits they felt they needed. They also expressed less trust in physicians. African American men acknowledged their greater risk of PC, accepted greater responsibility for their health, and reported more personal failures that delayed diagnosis. African American men more often requested the tests that diagnosed their cancers, which resulted more often from routinely ordered screening tests for Caucasian men. African American men expressed less interest in nontraditional treatments. CONCLUSIONS Despite lesser education, African American men in North Carolina are aware of their increased risk of cancer, the importance of treatment, and their responsibility for their health. Obstacles to timely diagnosis and appropriate care, including greater physician distrust, appear more likely to arise from reduced access and continuity of medical care arising from their worse socioeconomic position. Cancer 2007 © 2007 American Cancer Society.

Racial and Geographic Disparities in Late-Stage Prostate Cancer Diagnosis in Florida

“…However, NHB were still more likely than NHW and Hispanic men to be diagnosed with late-stage cancer, which is consistent with the literature. 23,38 In this study, age was statistically significant, indicating younger men were more likely to be diagnosed at late-stage cancer. However the difference is minimal.…”

“…22,23 This finding may have health policy implications. Moreover, our findings on smoking confirm the detrimental effect of tobacco use on prostate health.…”

“…13,14,16-19 Disparities in late-stage diagnosis by geographical location have been associated with poor access to primary health care, lack of health insurance and difference in coverage. 20-23 …”

Geographically-weighted regression analysis of percentage of late-stage prostate cancer diagnosis in Florida

“…A growing body of evidence supports the association of PCa risk with farming, due to exposure to toxic chemicals, especially pesticides (Alavanja et al, 2003; Meyer, Coker, Sanderson, & Symanski, 2007; Settimi, Masina, Andrion, & Axelson, 2003). Geographical disparities in percent of late-stage PCa have been associated with poor access to primary health care, lack of health insurance and difference in coverage (Mandelblatt, Yabroff, & Kerner, 1999; Mullins, Blatt, Gbarayor, Yang, & Baquet, 2005; Roetzheim et al, 1999; Talcott et al, 2007). …”

Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida

“…A growing body of evidence supports the association of prostate cancer risk to farming due to exposure to toxic chemicals, especially pesticides (Alavanja et al, 2003; Meyer, Coker, Sanderson, & Symanski, 2007; Settimi, Masina, Andrion, & Axelson, 2003). Geographical disparities in late-stage diagnosis have been associated with poor access to primary health care, lack of health insurance, and difference in coverage (Mandelblatt, Yabroff, & Kerner, 1999; Mullins, Blatt, Gbarayor, Yang, & Baquet, 2005; Roetzheim et al, 1999; Talcott et al, 2007). …”