CORTISOL RESPONSE TO PROSTATE CANCER SCREENING INFORMATION AMONG AFRICAN AMERICAN MEN

Abstract

According to national statistics, African American men have a 60% higher incidence rate, are diagnosed at later stages, and have twice the mortality rate of Caucasian men. The prostate cancer disparity is especially salient in North Carolina where African American men have a mortality rate that is almost 3 times that of Caucasian men. Although the American Cancer Society does not endorse routine prostate cancer screening, it remains a priority to focus on prostate cancer screening education in African American men in the effort to evaluate psychological harms in providing prostate cancer educational information and to increase appropriate screening for early detection of prostate cancer in this high risk group. An underlying theme of research on barriers to screening is stress, however stress related to receiving information about prostate cancer screening information and has never been studied from a psycho-physiological standpoint. The current study assessed relationships between cortisol response, masculinity beliefs, prostate cancer screening knowledge and intent, health care utilization, subjective distress and demographic characteristics among African American men in the pre-screening age range (aged 25-40 years). The primary research questions were 1) Do African American men exposed to information about prostate cancer screening evidence a measurable cortisol response following this exposure?, and 2) Are masculinity beliefs and/or prostate cancer screening knowledge related to cortisol response following exposure to prostate cancer screening information? The participant's mean cortisol levels after exposure to prostate cancer screening information (M = .157. SD = 08) were significantly less than baseline cortisol levels (M =.207, SD = .16), t(53) = -3.65, p = .001. Primary analyses revealed no significant associations between cortisol response and masculinity beliefs. Results of secondary analyses revealed that participant's self-reported level of prostate cancer screening knowledge after exposure to educational information (M = 64.83, SD = 25.5) was significantly greater than (M = 22.08, SD = 24.00), t(35) = 9.36, p = < .001. Interestingly, participants who reported not having a primary care physician had significantly greater prostate cancer screening knowledge change scores (M = 52.65, SD = 25.25) than those individual who reported having a primary care physician (M = 30.41, SD = 24.54), t(34) = 2.61, p = .013. However, self- report of prostate cancer screening knowledge was not significantly different between the two groups after exposure to prostate cancer educational information. In addition, a higher level of power dominance was positively associated with self-reported distress related to the DRE r(n = 36) = .38, p = .03, 95% CI [.06, .63]. In conclusion, providing prostate cancer screening information to African American men of prescreening age does not appear to be a stressor as measured by salivary cortisol. However, identifying psycho-physiological barriers to behavior may lead to more innovative ways to improve positive behavioral outcomes in relationship to prostate cancer screening. Specifically, increasing exposure to prostate cancer screening information in these men may increase confidence to have discussions with their doctors, which is especially important in the light of the current stance of the USPSTF and conflicting recommendations from other organizations.