Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men
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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.
KEY WORDSmasculinity medical mistrust preventive health services delays African-American men
This research was supported by a Student Award Program award to the first author from the Blue Cross and Blue Shield of Michigan Foundation (Grant # 657.SAP), The Robert Wood Johnson Foundation Health & Society Scholars Program, and The University of North Carolina Cancer Research Fund. Additional research and salary support during the preparation of this manuscript was provided to the first author from the National Center for Minority Health and Health Disparities (Award # 1L60MD002605-01), and National Cancer Institute (Grant # 3U01CA114629-04 S2).
The first author wishes to thank faculty, student, and community members of the UNC Men’s Health Research Lab: Yasmin Cole-Lewis, Travis Melvin, Justin Smith, Allison Mathews, Dr. Keon Gilbert, Melvin R. Muhammad, and Donald Parker for their assistance with data collection for the African-American Men’s Health & Social Life Study. The first author also thanks Dr. Amani Nuru-Jeter, Keith Hermanstyne, Adebiyi Adesina, and Michael Hammond for their assistance with data collection. The authors thank Dr. Nestor Lopez-Duran for his feedback about the statistical analyses.
Conflict of Interest
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