Louie E. Ross

Use of the Prostate-Specific Antigen Test among U.S. Men: Findings from the 2005 National Health Interview Survey

Background: Although evidence that prostate cancer deaths are reduced by screening for elevated prostate-specific antigen (PSA) concentration coupled with early diagnosis and treatment is insufficient to advocate routine screening for prostate cancer, PSA testing has become more common in the past decade. We examined characteristics that might influence testing and compared test use between men ages 40 to 49 and 50 to 79 years. Methods: We used data from 7,669 participants with no history of prostate cancer in the 2005 National Health Interview Survey. Results: Among men reporting about PSA testing, an estimated 16% of 40- to 49-year-old men and 49% of 50- to 79-year-old men had a PSA test in the past 2 years. In multivariate analyses, among men ages 40 to 49 years, non-Hispanic Black men were more likely (P < 0.05) to have had a PSA test than non-Hispanic White men. We found no significant difference by race/ethnicity in men ages 50 to 79 years. Higher education, higher poverty threshold, usual source of medical care, family history of prostate cancer, and comorbid conditions were associated with increased PSA test use in both age groups. Additionally, men ages 50 to 79 years born in the United States, who were married, had private or military health insurance, and had been diagnosed with another cancer type were more likely to be tested. Conclusions: Findings from the multivariate analyses indicated significantly higher PSA test use among younger non-Hispanic Black men than among non-Hispanic White men. These findings may indicate that healthcare providers are getting and conveying the message of increased risk of prostate cancer among African American men. (Cancer Epidemiol Biomarkers Prev 2008;17(3):636–44)

Comparing Knowledge of Colorectal and Prostate Cancer Among African American and Hispanic Men

African American and Hispanic men are less likely to participate in prostate and colorectal cancer screening and have poorer outcomes from these diseases. Guided by the Patient/Provider/System Theoretical Model for Cancer Screening, this study compares the relationships among knowledge of prostate and colorectal cancer, perceptions of cancer fatalism, common sources of cancer information, and awareness of cancer resources screening between African American (n = 72) and Hispanic (n = 47) men who attend federally qualified health centers and a hospital-based primary care clinic in a southern state. African American men were older, had higher levels of education, and were more knowledgeable about cancer than Hispanic men were. However, Hispanic men were more fatalistic about cancer. Most men in both groups were more likely to get cancer information from the television and/or radio, with few accessing the Internet for this information. The men were not aware of many of the leading cancer-related organizations and programs. Nurses continue to play a critical role in patient education and enhancing screening rates. These findings suggest that culturally and educationally appropriate intervention strategies are needed to enhance knowledge and that the television/radio may be an effective medium for delivering these strategies.

Afrocentricity and Racial Socialization among African American College Students

This article reviews and examines conceptual issues and definitions related to Afrocentricity and racial socialization. Data for the study were obtained from a survey of 453 African American college students. Afrocentricity has been conceptualized as being multidimensional. Several variables thought to represent both the constructs of Afrocentricity and racial socialization were constructed, analyzed for their reliabilities, and combined into attitudinal scales. This exploratory analysis sought to ascertain if two attitudinal scales were related. Findings from this study suggest that the overall scales or composite variables are positively related and that a strong interitem correlation among the individual statements exists. This study (a) provides insight on future development of an Afrocentric scale, (b) helps to clarify the importance of racial socialization as it relates to Afrocentricity, and (c) gives direction and encouragement for future research on African Americans

Discussions about prostate cancer screening between U.S. primary care physicians and their patients.

ObjectiveThis study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior.MethodsWe analyzed data from the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression.ResultsEighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31–40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice.ConclusionsBoth individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S.

Testicular Cancer Among African American College Men: Knowledge, Perceived Risk, and Perceptions of Cancer Fatalism

African American men present at later stages of testicular cancer and have higher mortality rates than Caucasian men. Lack of awareness, beliefs, and access to care may influence this disparity. Guided by the Powe fatalism model, this comparative study assessed knowledge of testicular cancer, perceived risk, and cancer fatalism among African American and Caucasian men who attended selected colleges and universities. Data were collected using the Powe Fatalism Inventory, the Testicular Cancer Knowledge Survey, and the Perceived Cancer Risk Survey. The majority (n = 190) of men were African American (70%), and the remainder were Caucasian. African American men were significantly younger than Caucasian men. African American men also had lower testicular cancer knowledge scores, higher perceptions of cancer fatalism, and lower perceived risk for the disease. Rates of testicular cancer screening were low for all the men. Research should focus on further understanding the relationship between cancer fatalism and health-promoting behaviors among African American men.

Primary Care Physician Reports of Amount of Time Spent with Male Patients in Prostate Cancer Screening Discussions

Background: Major health organizations recommend that physicians discuss the risks and benefits of prostate cancer screening with men before ordering tests. The length of time that health care providers spend discussing prostate cancer screening-related issues with patients has been given little attention. The purpose of this study was to determine the amount of time that primary care physicians (PCP) in the United States reported spending in discussions about prostate cancer screening with patients by selected PCP individual, practice-related, and screening-related factors. Methods: Data were obtained from the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. We determined whether PCP characteristics were associated with amount of time spent with patients. Results: Results showed that female, African American or other race, and older PCP spend more time (above the median) with patients compared to their referents. Also, more time spent with male patients was more often associated with PCP having practices in urban inner city areas as well as when the screening decision was shared between the PCP and the patient/family. Conclusion: Results from this study offer some insight into the amount of time that PCP report spending with patients in discussing prostate cancer screening-related issues specifically, and confirms the involvement of individual as well as practice-level factors.

African american primary care physicians' prostate cancer screening practices.

Introduction: Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States. African American (AA) men have greater prostate cancer burden than other men. Little is known about AA primary care physicians’ (PCPs) practices regarding prostate cancer screening. Methods: We analyzed data from the 2007-2008 National Survey of Primary Care Physicians’ Practices Regarding Prostate Cancer Screening. The current study included 604 AA PCPs. Outcomes assessed were (a) offering screening using the prostate-specific antigen (PSA) test, (b) use of screening discussions to involve patients in the decision to screen, and (c) having a discussion policy to try to talk the patient into getting the screening tests. Results: Most AA PCPs were male (52%), younger than 50 years (61%), and had 21% to 100% AA patients in their practices (74%). The majority (94%) of AA PCPs offered prostate cancer screening using PSA, discussed the tests with their male patients to involve them in the decision to screen (83%), and had a policy to try to talk the patient into getting the screening tests (77%). Multivariate analysis showed that offering screening, use of discussions, and a usual policy to encourage taking the screening tests varied mainly by practice-related factors, including practice type, practice location, and percentage of AA patients in the practice. Conclusion: Data from this study indicate that most AA PCPs reported high proscreening behaviors for all 3 outcomes. Additionally, practice- and screening-related factors may be important when examining AA PCP screening behaviors.

US Primary Care Physicians’ Prostate Cancer Screening Practices: A Vignette-Based Analysis of Screening Men at High Risk

Background: Limited information exists on primary care physicians’ (PCPs) use of the prostate-specific antigen (PSA) test by patient risk category. We describe PCP responses to hypothetical patient scenario (PS) involving PSA testing among high-risk asymptomatic men. Methods: Data were from the 2007 to 2008 National Survey of Primary Care Physicians’ Practices Regarding Prostate Cancer Screening. PS#1: healthy 55-year-old white male with no family history of prostate cancer; PS#2: healthy 45-year-old African American male with no family history of prostate cancer; and PS#3: healthy 50-year-old male with a family history of prostate cancer. Data were analyzed in SAS/SUDAAN. Results: Most PCPs indicated that they generally discuss the possible benefits/risks of PSA testing with the patient and then recommend the test (PS#1-PS#3 range, 53.4%-68.7%; P < .001); only about 1% reported discussing and then recommending against the test. For PS#3, compared to PS#1 and #2, PCPs were more likely to discuss and recommend the test or attempt to persuade the patient who initially declines the test. For PS#3, all clinicians generally would order/discuss the PSA test and not rely on the patient to ask. Conclusion: Clinicians treat family history as an important reason to recommend, persuade, and initiate PSA testing.

Caregiver Strain, Quality of Life, and Symptom Distress Among Dyads of African American Cancer Survivors and Caregivers

African Americans are more likely to present in the advanced stages of cancer, but we know very little about the cancer survivorship experiences for them and their caregivers. Guided by the Quality of Life and Symptom Distress Interactional Framework, this descriptive, correlational study examined relationships among caregiver strain, caregivers’ quality of life (QoL), survivors’ symptom distress, and survivors’ QoL among dyads of African American cancer survivors and their primary caregiver. Survivors were recruited in the outpatient department at a comprehensive cancer center and nominated their caregiver who was contacted by phone. Data were collected using the Caregiver Strain Index, the Medical Outcome Survey Short Form 36, the Symptom Distress Scale, and a Demographic Questionnaire. There were 68 survivor-caregiver dyads (N = 136). The average age of the survivors was 52 years compared with 49 years for the caregivers, and the majority was female. Survivors were about 3 years post diagnosis, and the majority was still receiving treatment. Over one-third of the caregivers indicated high levels of strain, and their QoL was lower than the population norm. There were strong relationships between caregiver strain and subscales of the QoL measure. Survivors reported high levels of symptom distress and low QoL. There was a strong relationship between the caregiver strain, symptom distress of the survivor, and survivor QoL. Interventions within palliative care must be culturally specific and address the unmet needs of the survivor and caregiver.

Prostate cancer screening practices of African-American and non-African-American US primary care physicians: a cross-sectional survey

Purpose: We explored whether African-American (AA) primary care physicians (PCPs) have different prostate cancer screening practices compared to non-AA PCPs, after adjustment for potential confounding factors such as the proportion of AA patients in PCP practices. Methods: We used SAS/SUDAAN to compare weighted responses from AA PCPs (n = 604) with those from non-AA PCPs (n = 647) in the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. We used multivariate logistic regression to calculate the weighted odds ratios (OR) and 95% confidence intervals (CI). Results: We found that AA PCPs had higher odds of working in practices with above-the-median (≥ 21%) proportions of AA male patients (OR, 9.02; 95% CI: 5.85–13.91). A higher proportion of AA PCPs (53.5%; 95% CI: 49.5–57.4) reported an above-the-median proportion (≥ 91%) of PSA testing during health maintenance exams as compared to non-AA PCPs (39.4%; 95% CI: 35.5–43.4; P < 0.0002). After adjusting for the proportion of AA patients and other factors, we found that AA PCPs had higher odds of using PSA tests to screen men (OR, 1.74; 95% CI: 1.11–2.73). Conclusion: This study quantifies the magnitude of the differences reported in previous focus group studies. Our results may be helpful in hypothesis generation and in planning future research studies.