1 Knowledge, and prostate cancer screening experience among African American men in Southside Chicago: An intervention strategy for risk reduction activities. P. Bassey Williams, Ph.D., CHES Chicago State University, Chicago, IL Chicago State University, Chicago, IL Anthony M. Sallar, PhD, MPH., MBA Anthony M. Sallar, PhD, MPH., MBA Ohio University, Athens OH. Emmanuel Osunkoya, MD Emmanuel Osunkoya, MD Chicago State University, Chicago, IL Chicago State University, Chicago, IL

2 PURPOSE OF THE STUDY  Assess the knowledge of prostate cancer, and prostate cancer screening experience among African-American inner-city men in South-side neighborhood of Chicago, Illinois.

3 NEED FOR THE STUDY  Higher prevalence and mortality rates due to prostate cancer have been reported, in excess, among men of color in the United States, in recent years, than the rest in the US population;  African-American men with national incidence rate of per 100,000 population, presently account for almost more than double the rates for Whites, 150.4; Hispanics, 125.8; American Indian/Alaska Natives, 77.7; Asian and Pacific Islander, 90.0), respectively;  Nationally, compared to whites and other major ethnic groups, African American males now have over two fold increased-risks of developing and dying from prostate cancer.  Currently, prostate cancer prevalence rate among African American men in Illinois, and Chicago metropolis far surpass those of other ethnic groups; the rate for the Roseland Southside community of Chicago for AA men now stands at 406.0/100,000 men.

4 METHODOLOGY Study Design :  Cross-sectional convenience sampling survey of African-American males aged years African-American males aged years - Inner-city Roseland Community, Chicago, IL - Inner-city Roseland Community, Chicago, IL  Roseland, (Pop. 52,723; AA Pop. = 97.8% ) The Sample The Sample Subjects recruited by direct solicitation from following settings: Subjects recruited by direct solicitation from following settings:  Fraternity groups & other men organizations  Churches and mosques  Club houses, drinking bars and barber shops  Neighborhood health centers and men’s clinics

5 Study Sample contd.  All participants signed informed consent forms as required by IRB for the protection of human subjects.  Participants were informed of the minimal risk associated with the study, assured of confidentiality, and informed that they could withdraw from the study at any time.  The study was approved by the Institutional Review Board of Chicago State University, Chicago, Illinois.

6 Sample Eligibility:  Non-White or non-Hispanic Black males;  Age 40 – 75 years;  Resident in a predominantly core inner-city African- American Roseland community of Southside Chicago, Illinois;  Not working in any health institutions or be a member of public health or allied health professions.

7 Instrumentation  Utilized a 38-item Prostate cancer knowledge, and screening behavior survey instrument originally developed by Chan et al. ( 2003).  The questionnaire elicited demographic information on,  Family history of prostate cancer,  Knowledge of symptoms and risk factors of prostate cancer,  Experience with PSA/digital testing, and  Willingness to screen for prostate cancer.  Percent participants who have had prostate cancer test

8 Instrument administration  Person-to-person interview by AA graduate students duly trained in oral survey instrument administration.  Objective of training the graduate students was to prevent bias and allowing for consistency in the conduct of the interview.  Instrument administration took 30 minutes approx.

9 Data Analysis:  Analyzed with SPSS 17.0 Software  Descriptive statistics  One-way analysis of variance and t-test at 0.05 level of significance t-test at 0.05 level of significance  Multiple regression analysis

RESULTS Table 1: Demographic distribution of participants by Age group. 10 Age group N =305 (%) < 40 1 (0.3) (12.8) (40.3) (36.7) 70 and above 30 (9.8)

11 Table 2: Demographic distribution of participants by Marital Status, N = 305 (%) Single/never married 75 (24.6) Married 124 (40.7) Separated 50 (16.4) Divorced 42 (13.8) Widowed 14 (4.6)

12 Table 3: Demographic distribution of participants by Educational Level, N = 305 (%) Educational Level Less than high school 14 (4.6) High school graduate 51 (16.7) College but < than Bachelor 124 (40.7) Bachelor’s degree 96 (31.5) Master’s or above Bachelor 20 (6.6)

13 Table 4: Demographic distribution participants by Income dimension, N = 305 (%) < $20,000 9 (3.0) $20,000-$34, (22.3) $35,000 - $49, (35.5) $50,000 - $74, (30.8) $75,000 and above 27 (8.9)

14 Table 5: Sources of Information on Prostate Cancer Screening, N = 305 (%) TV 66 (21.6) Radio 57 (18.7) Clinic/Doctor’s offices 42 (13.8) Relatives/friends 37 (12.1) Newspapers 30 (9.8) Magazines 29 (9.5) Work 25 (8.2) Somewhere else 16 (5.2)

15 Table 6: Sources of knowledge on Prostate Cancer Relatives/friends 69 (22.6) TV 64 (21.0) Radio 47 (15.4) Clinic/Doctor’s offices 44 (14.4) Work 36 (11.8) Newspapers 20 (6.6) Magazines 13 (4.3) Somewhere else 10 (3.3)

Table 7: Analysis of respondents’ knowledge of symptoms, testing, and risk factors for prostate cancer 16 Questions & Responses Symptoms Blood in urine can be a symptom of prostate cancer Trouble urinating can be a symptom of prostate cancer Difficulty having intercourse can be a symptom of prostate cancer A man who has prostate cancer may not have any symptoms Testing The prostate specific antigen test (PSA) is a blood test for prostate cancer PSA test can detect prostate cancer earlier than the digital rectal exam alone Doctors are sure that the PSA test is a useful test for prostate cancer The digital rectal exam is a blood test for prostate cancer Done together, the digital rectal exam and the PSA test can best screen for prostate cancer Risk factors The risk of getting prostate cancer is higher in a man who is older? The risk of getting prostate cancer is higher in man who has a family history of it. The risk of getting prostate cancer is higher in a man who is black /African American, than white/Caucasians N (%) Correct 126 (41.3) 154 (50.5) 153 (50.2) 66 (21.6) 252 (82.6) 109 (35.7) 144 (47.2) 69 (22.6) 154 (50.5) 246 (80.7) 133 (43.6) 166 (54.4) N (%) Incorrect 179 (58.7) 151 (49.5) 152 (49.8) 239 (78.4) 53 (17.4) 196 (64.3) 161 (52.8) 236 (77.4) 151 (49.5) 59 (19.3) 172 (56.4) 139 (45.6)

Categories General knowledge of Prostate cancer Mean =10.73 (sd ±3.43) Ever screen for prostate cancer with PSA YES Interested in screening for prostate CA using PSA YES Interested in screening for prostate CA by digital exam YES Agep = p = 0.661p = < 50 years %12.1%14.9% ≥ 50 years and above %87.9%85.1% Marital Statusp = 0.019p = 0.510p = 0.290p = Never married %22.5%24.0% Ever married %77.5%76.0% Educational Statusp = 0.004*p = 0.04*p = 0.388p = High school or lower %21.4%21.1% Some college/trade school %37.6%37.7% Bachelor’s degree & higher %41.0%41.1% Incomep = 0.010*p = 0.694p = 0.312p = < $20, %3.5%2.9% $20,000 - $34, %19.1%18.3% $35,000 - $49, %34.7%33.1% $50,000 and above %42.8%45.7% Family History of prostate Cancer Yes No p = % 10.72% p = 0.035* 27.0% 73.0% p = 0.001* 28.9% 71.1% p = % 74.3% Table 8 : Statistical Analysis of demographic variables and prostate cancer knowledge and screening..

18 Specific Questions on Prostate Cancer Do you have brother or father who has had prostate cancer? No Yes Have you ever tested for prostate cancer? Yes No

19 Discussions 1.Overall low knowledge even though sample were well educated 2.Marriage is supposed to be protective factor, but the married scored less than those who were never married Why? 3.Very few people got information about the disease from billboards/buses/trains

20 Limitations 1.Cross sectional study (point in time measurement) 2.Issue of temporality 3.Volunteers (self selection) 4.Sample generally well educated and it is likely there may be dearth of knowledge in the overall population. 5.Descriptive study