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Prostate Cancer Prevention and Early Detection Decisions Among Black Males Less Than 40 Years Old

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Prostate Cancer Prevention and Early Detection Decisions Among Black Males Less Than 40 Years Old Copyright by Motolani Eniola Ogunsanya 2014 The Thesis Committee for Motolani Eniola Ogunsanya Certifies that this is the approved version of the following thesis: PROSTATE CANCER PREVENTION AND EARLY DETECTION DECISIONS AMONG BLACK MALES LESS THAN 40 YEARS OLD APPROVED BY SUPERVISING COMMITTEE: Committee: Carolyn M. Brown, Supervisor Jamie C. Barner Folakemi T. Odedina PROSTATE CANCER PREVENTION AND EARLY DETECTION DECISIONS AMONG BLACK MALES LESS THAN 40 YEARS OLD by Motolani Eniola Ogunsanya, B.Pharm Thesis Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Master of Science in Pharmaceutical Sciences The University of Texas at Austin May 2014 Dedication I dedicate this book to my loving and supportive husband, Dr. Taiwo Babatunde Adedipe and to my parents, Mr. and Mrs. Olufemi Ogunsanya who love me unconditionally, who always believe in my dreams and never hold back any resources in my pursuit of those dreams. This is also dedicated to my closest friends and colleagues; you have been sources of support in more ways than you know. I also dedicate this book in honor of Engr. Olu Balogun [July 28, 1938 – March 2, 2009] whose vibrant life was cut short by prostate cancer and whose encouraging and vibrant spirit taught me to dream, to set goals and to persevere…Keep resting in peace. Acknowledgements I would like to first and foremost thank God, for only through his grace, mercy and strength, did I survive this journey. “I can do all things through Christ who strengthens me” (Philippians 4:13). I would like to begin by first acknowledging the members of my thesis committee. I specially would like to acknowledge my mentor and supervisor, Dr. Carolyn M. Brown. I am truly grateful for her guidance, encouragement, and her belief in my ability as a researcher. The thought-provoking, helpful and inspiring advice and comments she gave me were extremely valuable to this research. I would also like to thank my dissertation committee, Dr. Jamie C. Barner for her insight on data analysis and Dr. Folakemi T. Odedina for her insight on theoretical models and suggestions on important predictors used in this study. I am fortunate to have such esteemed faculty to work with. I would also like to thank Dr. Ford, Dr. Karen L. Rascati and Dr. Kenneth A. Lawson for their help academically and for supporting my attendance at national pharmacy meetings. I would also like to thank Stephanie Crouch for all always being there to help especially with my transition to grad school and all of her sagely advice. I would also like to acknowledge my fellow colleagues in the Health Outcomes and Pharmacy Practice Division, Busuyi Olotu, Andrew Thach, Xiaojing Ma, Poojee Sudhapalli, Youli Ling, Tatiana Makhinova and Benita Bamgbade. Thanks for all your help and support along the way. Additionally, I want to thank my “research assistant,” Brittany Corbell for being my wingman and helping immensely with organizing the v focus groups, data transcription, and recruiting participants for the survey. I would also like to thank Arpita Kabaria and Somtochukwu Okafor for helping with data collection and recruitment. I would also like to thank former graduate students who have continued to provide encouragement and advice throughout this process. Special thanks to The Oladapos (Abiola and Ayoade). Most of all, I want to thank my mom for her love and support. I would be remiss if I did not thank these contact persons for allowing me to recruit participants in their respective churches: Mr. Richard Barner, Greater Mount Zion Church in Austin and Loretta Ejakpomewhe, Redeemed Christian Church. I would also like to thank all the men who graciously agreed to participate in this study. You know who you are: without you my lofty goals would not have been reached. May 2014 vi PROSTATE CANCER PREVENTION AND EARLY DETECTION DECISIONS AMONG BLACK MALES LESS THAN 40 YEARS OLD Motolani Eniola Ogunsanya, M.S. Phr. The University of Texas at Austin, 2014 Supervisor: Carolyn M. Brown The purpose of this study was to determine the factors related to young black men’s intention to screen for prostate cancer as well as their engagement in prostate cancer risk-reduction behaviors. The study tested the significance of the constructs – age, attitude (direct and indirect), social influence, comfortability, cues to action, health screening experiences and knowledge – in predicting young black men’s intention to screen for prostate cancer; as well as the significance of the constructs – age, cues to action, exercise and knowledge – in predicting engagement in prostate cancer risk- reduction behaviors. Demographic/personal factors were also explored in related to the model predictors. Web-based and paper-pencil surveys were administered to 279 black men aged between 18 – 40 years from the Austin area. Three focus groups were conducted to collect information regarding young black men’s behavioral beliefs toward prostate cancer screening as well as their comfortability with prostate examinations. The number of usable surveys was 267. Using direct and indirect measures, the combination of attitude, social influence, comfortability (indirect model), and knowledge explained vii 41.0 and 43.0 percent of the variance in intention to screen for prostate cancer, respectively; with social influence being the strongest predictor (β=0.41; p <0.01 for the direct model and β=0.47; p <0.01 for the indirect model). For the model with prostate cancer risk-reduction as the outcome variable, the model accounted for 10.0 percent of the variance in behavior with only knowledge (β=0.19; p=0.03) as significant predictor. Interventions that address young black men’s attitude, social influence, comfortability, and knowledge may be necessary to increase young men’s intention to screen for prostate cancer when it is recommended by a physician. Additionally, factors surrounding exercise and knowledge may be important in increasing young men’s engagement in prostate cancer risk-reduction behaviors. Future studies using intention as a predictor of young men’s behavior are needed to assess the influence of intention on prostate cancer screening. viii THE GRAD STUDENT Student, student, burning bright In the middle of the night What immortal hand or eye Could frame thy thesis? In what distant web based sites Are etched the articles to bring the light On what hope I dare divine What computer dare incline To answer all the images? At what shoulder, and what art, Could twist the synapse of my brain? When my brain began to think, What dread thought, my brain did speak? What the question? What the frame? In what furnace is my brain? What the theory? What dread grasp Dared its mysteries thoughts collapse. When the student put down her fears And watered heaven with her tears, Did she smile her work to see? Did those who wrote before make thee? Student, student, burning bright In the middle of the night What immortal hand or eye Could frame thy thesis? Culled from Jennifer Reneé Smith (April 22, 2002) Based on The Tyger by William Blake (1794) ix Table of Contents TABLE OF CONTENTS ...................................................................................... x LIST OF TABLES ............................................................................................. xvi LIST OF FIGURES ............................................................................................ xxi CHAPTER ONE: INTRODUCTION .................................................................. 1 1.1 THE RESEARCH PROBLEM ......................................................................... 1 1.2 STUDY SIGNIFICANCE AND IMPLICATIONS ......................................... 5 1.3 CONCEPTUAL FRAMEWORK .................................................................... 7 1.4 DEFINITION OF TERMS ............................................................................... 7 1.5 THE ASSUMPTIONS ...................................................................................... 8 1.6 DELIMITATIONS ......................................................................................... 10 1.7 SUMMARY .................................................................................................... 11 CHAPTER TWO: LITERATURE REVIEW AND THEORETICAL FRAMEWORK .................................................................................................... 12 2.1 PROSTATE CANCER ................................................................................... 12 2.1.1 Signs and Symptom ........................................................................ 14 2.1.2 Commonly Known Risk Factors .................................................... 14 2.1.3 Treatment ........................................................................................ 15 2.1.4 Survival ........................................................................................... 16 2.1.5 Economic Burden of Prostate Cancer In the USA .......................... 16 2.2 PREVENTION ............................................................................................... 17 2.2.1 Lifestyle Modification .................................................................... 17 2.2.2 Prostate Cancer Screening ............................................................... 19 2.2.1.1 Prostate Cancer Screening in Black Men ........................ 20 2.2.3 Potential Benefits of Screening ...................................................... 21 2.2.4 Potential Harms of
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