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Social Ecological Factors Influencing Cancer-Related Preventive Health Behaviors in African American Men

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Social Ecological Factors Influencing Cancer-Related Preventive Health Behaviors in African American Men Social Ecological Factors Influencing Cancer-Related Preventive Health Behaviors in African American Men DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Jaymia Ann Mitchell, M.S.S.W Graduate Program in Social Work The Ohio State University 2010 Dissertation Committee: Holly Dabelko-Schoeny, Advisor Tom Gregoire Randi Love Copyright by Jaymia Ann Mitchell 2010 Abstract Problem Statement: African American men are disproportionately burdened by cancer and mortality rates among African American men for prostate and colorectal cancer are particularly high compared to other racial/ethnic groups. Poor health behaviors are known contributors to cancer risk yet little is known about the cancer-related preventive health behaviors undertaken by African American men. Health behaviors occur in the context of social and ecological conditions which are hypothesized to influence health- related decision-making. Little research has been done to evaluate the contribution of social and ecological conditions to cancer-related preventive health behaviors among black men. Methods: The purpose of this study was to identify social and ecological predictors of cancer-related preventive health behaviors in African American men. African American men over the age of 18 (N=229) were recruited from a community health fair in East Cleveland, Ohio and anonymously surveyed about their demographic characteristics, health practices, health histories, and several conditions of their social environment. Analysis included correlations and logistic regression. Findings: Most participants were over the age of 40 (88.6%), unmarried (59.8%), and had at least a high school diploma (91%); while 48.5% reported being unemployed. With regard to the cancer-preventive health behavior outcomes under study; 35.4% (N=81) of black male participants had received any type of colorectal cancer screening (e.g. colonoscopy or sigmoidoscopy) while half of respondents (N=116) reported having received a form of ii prostate cancer screening (i.e. prostate specific antigen testing or digital rectal examination). When asked about the frequency and intensity of physical activity, 43% (N=99) of participants reported engaging in moderate intensity physical activity for 120 minutes or more per week. Lastly, 63% of men reported consuming any fruit in the previous 24 hours and 81% reported consuming any vegetable in the previous 24 hours (N=224). Older age, having a usual healthcare provider, and higher levels of education were the best predictors of prostate cancer screening. Older age and having a usual healthcare provider were the best predictors of colorectal cancer screening receipt. Having a family history of cancer and fruit and vegetable consumption positively predicted physical activity while increased delays in medical care were a negative predictor. Engaging in physical activity was the only predictor of fruit and vegetable consumption. Conclusions: This research underscores the influence of social determinants on health behaviors. Further research into the relationships between social contextual factors and preventive health behaviors are needed to identify additional pathways by which social conditions constrain or promote personal health decision- making. Public policy and practice interventions should be directed at reducing barriers to engaging in cancer-related preventive health behaviors for underserved populations such as African American men. iii This document is dedicated to my husband Jeremy Mitchell, whose good humor and unconditional support has been my most valuable resource during this undertaking. iv Acknowledgments I would first like to acknowledge my creator, thank you for having a plan for my life, for your mercy and compassion and the refreshing that comes from time spent in your presence. To three of the most important people in my life, Lessie Shorter, Jovanna Tyree, and Brooke Burns Jackson, the sisterhood I have experienced during my friendship with each of you individually and collectively has changed my life. Your honesty, encouragement, and prayers have fortified me in adversity. To my mother, Valerie, thank you for instilling in me the importance of education and follow-through to achieve my goals. I would like to acknowledge my father James Price, who taught me by example to be persistent an undeterred by rejection. To my brother James Zachary, your work ethic and vision at such a young age has been an inspiration for me, and I hope I have made you proud also. To my mother-in-law, Dr. Angela Webster-Smith, thank you for always encouraging me, praying for me, and setting an example of excellence for African American women in academia. I would like to acknowledge my dear friends Esther and Guylando Moreno, who have generously opened up their home to me on countless occasions as a refuge when I needed to focus and write, and Dr. Sheria Spain, for studying along with me on several occasions. To my fellow colleagues Millie Harris, Dana Harley, and Victoria Venable, thank you sharing v your stories and sharing this journey with me, I believe you are among the few who truly understand my experiences. To Dr. Jacquelyn Meshelemiah, the wise advice you gave me before I began this doctoral program has remained with me, and I thank you for validating my ambition early on. To my committee members Dr. Tom Gregoire and Dr. Randi Love, I genuinely appreciate your timely feedback, your willingness to teach me and to challenge me to develop in areas where I was weak. And lastly, I would like to thank my advisor Dr. Holly Dabelko-Schoeny, for taking an unfeigned interest in my work on African American men’s health; for advising me on how to advance and develop as a writer, a scholar, a professional, and a teacher. Thank you for your thoughtful feedback and guidance at every juncture along my journey; for helping me to define and shape my professional identity; and for being a shining example of collaboration and prolific scholarship. I hope that this advising experience has been both fruitful and positive for you. vi Vita 2001...............................................................Charles F. Brush High School 2005…………………………………............B.A. Social Behavioral Science, The Ohio State University 2007…………………………………………M.S. Social Work, University of Tennessee 2007 to present ..............................................Graduate student, College of Social Work, The Ohio State University Fields of Study Major Field: Social Work vii Table of Contents Abstract………………………………………………………………………………….. ii Dedication .......................................................................................................................... iv Acknowledgements ..............................................................................................................v Vita....................................................................................................................................vii Table of Content……………………………………………………………………..…viii List of Tables……………………………………………………………………………..xi List of Figures……………………………………………………………….…………..xii Chapter 1: Introduction and Statement of the Problem………………………………...…1 African American Men: An Epidemiological Picture…………………………….1 The Purpose, Scope, and Significance of this Study……………………………...9 Social Ecological Theoretical Framework……………………………………….11 Research Questions………………………………………………………………12 Definition of Terms………………………………………………………………12 Chapter 2: Literature and Theory Review……………………………………………….14 The Science and Practice of Cancer Prevention…………………………………14 viii Diet as a Primary Cancer Prevention Strategy…………………………..15 Physical Activity as a Primary Cancer Prevention Strategy…………..…21 Prostate and Colorectal Cancer Screening as Secondary Cancer Prevention Strategies………………………………………………………………....25 Social, Cultural, and Environmental Correlates of Health and Cancer Prevention for African American Men…………………………………………………….…36 Racial Discrimination and Residential Segregation……………….….....36 Community Context and Social Environmental Resources……………...40 Stress……………………………………………………………………..45 Cultural Context…………………………………………………………46 Social Ecological Theoretical Framework……………………………………….48 Applications of Social Ecological Framework and Concepts…………...54 Social Ecological Framework Applied to Various Health Related Behavioral Studies…….………………………………………………....59 A Conceptual Model of Factors Influencing Cancer Related Preventive Health Behaviors in African American Men…………………...………..60 Chapter 3: Methods……………………………………………………...……………….65 Conceptual Model Summary………………………………………..…………...65 Study Research Questions and Hypotheses……………………………………...66 Data Source, Study Design, and Data Collection Procedures……………….…..68 ix Specific Measures………………………………………………………………70 Analysis Plan…………………………………………………………………...75 Chapter 4: Results………………………………………………………………………77 Descriptive Analysis……………………………………………………………77 Correlational Analysis……………………………………………………...….,.83 Logistic Regression Analysis……..……………………………………..………………88 Final Model………………...……………………………………………………93 Chapter 5: Discussion of Findings and Implications……………………………….......105 Summary of Findings…………………………………..……………………....106 Implications for Practice……………………………………..………………....113 Patient Navigation and Case Management……………………..……....113 Promoting Awareness of Hereditary Cancer Risk………………….......116 Increased Access, Acceptability, and Continuity of Primary Care.....….118 Implications for Public
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