Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The contribution of masculinity to men’s healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men.
To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays.
DESIGN AND PARTICIPANTS
A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009).
Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status.
After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60–0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45–0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34–5.20), blood pressure (OR: 3.03; 95% CI: 1.45–6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03–4.23).
Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men’s blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men’s potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.
- Cherry, DK, Woodwell, DA, Rechtsteiner, EA (2007) National Ambulatory Medical Care Survey: 2005 summary. Advance Data 2007: pp. 1-39
- Sandman D, Simantov E, An C, Fund C, Harris L. Out of touch: American men and the health care system. Commonwealth Fund New York, 2000.
- Viera, A, Thorpe, J, Garrett, J (2006) Effects of sex, age, and visits on receipt of preventive healthcare services: a secondary analysis of national data. BMC Health Serv Res 6: pp. 15 CrossRef
- Neighbors, HW, Howard, CS (1987) Sex differences in professional help seeking among adult Black Americans. Am J Community Psychol 15: pp. 403-17 CrossRef
- Green, CA, Pope, CR (1999) Gender, psychosocial factors and the use of medical services: a longitudinal analysis. Soc Sci Med 48: pp. 1363-72 CrossRef
- National healthcare disparities report. Agency for Healthcare Research and Quality, 2006. U.S. Dept. of Health and Human Service, Rockville
- Arias, E (2007) United states life tables, 2004. Natl Vital Stat Rep 56: pp. 1-39
- Thom, T, Haase, N, Rosamond, W (2006) Heart disease and stroke statistics–2006 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 113: pp. e85-151 CrossRef
- Wong, MD, Chung, AK, Boscardin, JW (2006) The contribution of specific causes of death to sex differences in mortality. Public Health Rep 121: pp. 746-54
- Hertz, RP, Unger, AN, Cornell, JA, Saunders, E (2005) Racial disparities in hypertension prevalence, awareness, and management.. Arch Intern Med 165: pp. 2098-104 CrossRef
- Nelson, K, Norris, K, Mangione, CM (2002) Disparities in the diagnosis and pharmacologic treatment of high serum cholesterol by race and ethnicity: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med 162: pp. 929-35 CrossRef
- Barnett, E, Casper, MC, Halveron, TA (2000) Men and heart disease an atlas of racial and ethnic disparities in mortality. Office for Social Environment and Health Research, West Virginia University, Morgantown
- American Cancer Society. Colorectal Cancer Facts & Figures 2008-2010. In: Society AC, ed. Atlanta, 2008.
- American Cancer Society. Cancer Facts & Figures for African Americans 2009-2010. In: Society AC, ed. Atlanta, 2009.
- Agrawal, S, Bhupinderjit, A, Bhutani, MS (2005) Colorectal cancer in African Americans. Am J Gastroenterol 100: pp. 515-23 CrossRef
- Ndubuisi, SC, Kofie, VY, Andoh, JY, Schwartz, EM (1995) Black-White differences in the stage at presentation of prostate cancer in the District of Columbia. Urology 46: pp. 71-7 CrossRef
- Harper, S, Lynch, J, Burris, S, Davey Smith, G (2007) Trends in the black-white life expectancy gap in the United States, 1983-2003. J Am Med Assoc 297: pp. 1224-32 CrossRef
- Kung, HC, Hoyert, DL, Xu, J, Murphy, SL (2008) Deaths: final data for 2005. Natl Vital Stat Rep 56: pp. 1-120
- Ravenell, JE, Whitaker, EE, Johnson, WE (2008) According to him: barriers to healthcare among African-American men. J Natl Med Assoc 100: pp. 1153-60
- Whitley, EM, Samuels, BA, Wright, RA, Everhart, RM (2005) Identification of barriers to healthcare access for underserved men in Denver. J Mens Health Gend 2: pp. 421-8 CrossRef
- Cheatham, CT, Barksdale, DJ, Rodgers, SG (2008) Barriers to health care and health-seeking behaviors faced by Black men. J Am Acad Nurse Pract 20: pp. 555-62 CrossRef
- Hammond, WP, Matthews, D, Corbie-Smith, G (2010) Psychosocial factors associated with routine health examination scheduling and receipt among African-American men. J Natl Med Assoc 102: pp. 276-289
- Wade, JC (2008) Masculinity ideology, male reference group identity dependence, and African American men's health-related attitudes and behaviors. Psychol Men Masc 9: pp. 5-16 CrossRef
- Andersen, RM (1995) Revisiting the behavioral model and access to medical care: Does it matter?. J Health Soc Behav 36: pp. 1-10 CrossRef
- Bradley, EH, McGraw, SA, Curry, L (2002) Expanding the Andersen model: the role of psychosocial factors in long-term care use. Health Serv Res 37: pp. 1221-42 CrossRef
- Mahalik, JR, Burns, SM, Syzdek, M (2007) Masculinity and perceived normative health behaviors as predictors of men's health behaviors. Soc Sci Med 64: pp. 2201-9 CrossRef
- Courtenay, WH (2000) Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Soc Sci Med 50: pp. 1385-401 CrossRef
- Månsdotter, A, Lundin, A, Falkstedt, D, Hemmingsson, T (2009) The association between masculinity rank and mortality patterns: a prospective study based on the Swedish 1969 conscript cohort. J Epidemiol Community Health 63: pp. 408-13 CrossRef
- Marcell, AV, Ford, CA, Pleck, JH, Sonenstein, FL (2007) Masculine beliefs, parental communication, and male adolescents' health care use. Pediatrics 119: pp. e966-75 CrossRef
- Musa, D, Schulz, R, Harris, R, Silverman, M, Thomas, SB (2009) Trust in the health care system and the use of preventive health services by older Black and White adults. Am J Public Health 99: pp. 1293-9 CrossRef
- O'Malley, AS, Sheppard, VB, Schwartz, M, Mandelblatt, J (2004) The role of trust in use of preventive services among low-income African-American women. Prev Med 38: pp. 777-85 CrossRef
- Addis, ME, Mahalik, JR (2003) Men, masculinity, and the contexts of help seeking. Am Psychol 58: pp. 5-14 CrossRef
- Helgeson, VS (1994) Relation of agency and communion to well-being: Evidence and potential explanations. Psychol Bull 116: pp. 412-28 CrossRef
- Mahalik, JR, Lagan, HD, Morrison, JA (2006) Health behaviors and masculinity in Kenyan and U.S. male college students. Psychol Men Masc 7: pp. 191-202 CrossRef
- Helgeson, VS (1990) The role of masculinity in a prognostic predictor of heart attack severity. Sex Roles 22: pp. 755-74 CrossRef
- Helgeson, V, Fritz, H (1999) Unmitigated agency and unmitigated communion: Distinctions from agency and communion. J Res Pers 33: pp. 131-58 CrossRef
- Bound, J, Freeman, RB (1992) What Went Wrong? The erosion of relative earnings and employment among young Black men in the 1980s. Q J Econ 107: pp. 201-32 CrossRef
- Holzer, HJ, Offner, P (2002) Trends in employment outcomes of young black men, 1979-2000. Institute for Research on Poverty, University of Wisconsin--Madison, Madison
- Hammond, WP, Mattis, JS (2005) Being a man about It: Manhood meaning among African American men. Psychol Men Masc 6: pp. 114-26 CrossRef
- Wallace M. Black Macho and the Myth of the Superwoman. Verso, 1999.
- Staples R. Black masculinity: The Black male's role in American society. Feminism and Masculinities. 2004:121.
- Abreu, J, Goodyear, R, Campos, A, Newcomb, M (2000) Ethnic belonging and traditional masculinity ideology among African Americans, European Americans, and Latinos. Psychology of Men and Masculinity 1: pp. 75-86 CrossRef
- Gordon, E (1997) Cultural politics of black masculinity. Transforming Anthropology 6: pp. 36-53 CrossRef
- Aronson, RE, Whitehead, TL, Baber, WL (2003) Challenges to masculine transformation among urban low-income African American males. Am J Public Health 93: pp. 732-41 CrossRef
- Wade, JC, Brittan-Powell, C (2001) Men's attitudes toward race and gender equity: The importance of masculinity ideology, gender-related traits, and reference group identity dependence. Psychol Men Masc 2: pp. 42-50 CrossRef
- Sheldon, S, Serpe, RT (1994) Identity salience and psychological centrality: equivalent, overlapping, or complementary concepts?. Social Psychology Quarterly 57: pp. 16-35 CrossRef
- Hogg, MA, Terry, DJ, White, KM (1995) A tale of two theories: A critical comparison of identity theory with social identity theory. Soc Psychol Q 58: pp. 255-69 CrossRef
- LaVeist, T, Nickerson, K, Bowie, J (2000) Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev 57: pp. 146-61
- Gamble, VN (1997) Under the shadow of Tuskegee: African Americans and health care. Am J Public Health 87: pp. 1773-8 CrossRef
- Hammond, W (2010) Psychosocial correlates of medical mistrust among African American men. Am J Community Psychol 45: pp. 86-107 CrossRef
- Guide to Clinical Preventive Services. Agency for Healthcare Research and Quality, Rockville
- Vasan, RS, Kannel, WB (2009) Strategies for cardiovascular risk assessment and prevention over the life course: Progress amid imperfections. Circulation 120: pp. 360-3 CrossRef
- Lynch, J, Smith, GD (2005) A life course approach to chronic disease epidemiology. Annu Rev Pub Health 26: pp. 1-35 CrossRef
- Fields, LE, Burt, VL, Cutler, JA, Hughes, J, Roccella, EJ, Sorlie, P (2004) The burden of adult hypertension in the United States 1999 to 2000: A rising tide. Hypertension 44: pp. 398-404 CrossRef
- Hess, PL, Reingold, JS, Jones, J (2007) Barbershops as hypertension detection, referral, and follow-up centers for Black men. Hypertension 49: pp. 1040-6 CrossRef
- Hart, A, Bowen, DJ (2004) The feasibility of partnering with African-American barbershops to provide prostate cancer education. Ethn Dis 14: pp. 269-73
- Corbie-Smith, G, Flagg, E, Doyle, J, O’Brien, M (2002) Influence of usual source of care on differences by race/ethnicity in receipt of preventive services. J Gen Intern Med 17: pp. 458-64 CrossRef
- Witt, W, Kahn, R, Fortuna, L (2009) Psychological Distress as a Barrier to Preventive Healthcare Among U.S. Women. J Prim Prev 30: pp. 531-47 CrossRef
- Tessler, R, Mechanic, D, Dimond, M (1976) The effect of psychological distress on physician utilization: A prospective study. J Health Soc Behav 17: pp. 353-64 CrossRef
- Bellon, JA, Delgado, A, Luna, JD, Lardelli, P (1999) Psychosocial and health belief variables associated with frequent attendance in primary care. Psychol Med 29: pp. 1347-57 CrossRef
- Manning, WG, Wells, KB (1992) The effects of psychological distress and psychological well-being on use of medical services. Med Care 30: pp. 541-53 CrossRef
- Shuval, JT (1970) Social functions of medical practice. Jossey-Bass, San Francisco
- Radloff, LS (1977) The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1: pp. 385-401 CrossRef
- Levant, RF, Hirsch, LS, Celentano, E, Cozza, TM (1992) The male role: An investigation of contemporary norms. Journal of Mental Health Counseling 14: pp. 325-37
- Sheldon, S, Serpe, RT (1994) Identity salience and psychological centrality: equivalent, overlapping, or complementary concepts?. Soc Psychol Q 57: pp. 16-35 CrossRef
- Hair JF. Multivariate Data Analysis. Upper Saddle River, N.J.; Harlow: Pearson Education, 2009.
- Allison, PD (2000) Multiple imputation for missing data: A cautionary tale. Sociol Methods Res 28: pp. 301-9 CrossRef
- SPSS 17 for Windows. Chicago, Ill.: SPSS Inc., 2008.
- Boulware, LE, Marinopoulos, S, Phillips, KA (2007) Systematic review: The value of the periodic health evaluation. Ann Intern Med 146: pp. 289-300
- Fiscella, K, Franks, P, Clancy, CM (1998) Skepticism toward medical care and health care utilization. Med Care 36: pp. 180-9 CrossRef
- Elster, AB, Levenberg, P (1997) Integrating comprehensive adolescent preventive services into routine medicine care. Rationale and approaches. Pediatr Clin North Am 44: pp. 1365-77 CrossRef
- Marcell, AV The adolescent male. In: Heidelbaugh, JJ, Jauniaux, E, Landon, MB eds. (2007) Clinical men's health: evidence in practice. Saunders/Elsevier, Philadelphia, pp. 75-94
- Rich, JA (2001) Primary care for young African American men. J Am Coll Health 49: pp. 183 CrossRef
- Park, MJ, Paul Mulye, T, Adams, SH, Brindis, CD, Irwin, JCE (2006) The health status of young adults in the United States. J Adolesc Health 39: pp. 305-17 CrossRef
- Stamler, J, Daviglus, ML, Garside, DB, Dyer, AR, Greenland, P, Neaton, JD (2000) Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. J Am Med Assoc 284: pp. 311-8 CrossRef
- Wallston, K, Wallston, B Who is responsible for your health? The construct of health locus of control. In: Sanders, GS, Suls, JM eds. (1982) Social psychology of health and illness. L. Erlbaum Associates, Hillsdale, pp. 65-95
- United States Census Bureau. United States - Data Sets - American Fact Finder. 2009.
- The employment situation: December 2004-2007. U.S. Dept. of Labor, Bureau of Labor Statistics, Washington
- Reynolds, WM (1982) Development of reliable and valid short forms of the Marlowe-Crowne social desirability scale. J Clin Psychol 38: pp. 119-25 CrossRef
- Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men
Journal of General Internal Medicine
Volume 25, Issue 12 , pp 1300-1308
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical mistrust
- preventive health services delays
- African-American men
- Industry Sectors
- Author Affiliations
- 1. Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 334B Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
- 2. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- 3. UNC School of Medicine, Chapel Hill, NC, USA
- 4. Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
- 5. Department of Social Medicine, UNC School of Medicine, Chapel Hill, NC, USA