Investigating Racial Differences in Allostatic Load by Educational Attainment among Non-Hispanic Black and White Men.

Education continues to be a key factor contributing to increased access to critical life-improving opportunities and has been found to be protective against Allostatic Load (AL). The purpose of this study was to assess AL among Non-Hispanic (NH) White and NH Black men with the same level of education. We used 1999-2016 National Health and Nutrition Examination Surveys (NHANES) data with an analytical sample of 6472 men (1842 NH Black and 4630 NH White), and nine biomarkers to measure AL, controlling for various demographic and health-related factors. NH Black men had a higher AL score than NH White men (39.1%, 842 vs. 37.7%, 1,975). Racial disparities in AL between NH Black and NH White men who have a college degree or above (PR: 1.49, CI: [1.24-1.80]) were observed. Models posited similar AL differences at every other level of education, although these were not statistically significant. The findings reveal that socioeconomic returns to education and the societal protective mechanisms associated with education vary greatly between White and Black men.

The Black Panther, Masculinity Barriers to Medical Care, and Colorectal Cancer Screening Intention Among Unscreened American Indian/Alaska Native, Black, and White Men.

Objective: To determine if masculinity barriers to medical care and the death from colorectal cancer (CRC) of actor Chadwick Boseman (The Black Panther) influenced CRC early-detection screening intent among unscreened American Indian/Alaska Native (AIAN) and Non-Hispanic-Black (Black) men compared with Non-Hispanic-White (White) men. Methods: Using a consumer-panel, we surveyed U.S. men aged 18-75 years (N = 895) using the 24-item Masculinity Barriers to Medical Care (MBMC) scale. We calculated the median score to create binary exposures to evaluate associations with CRC screening intent and conducted multivariable logistic regression to evaluate independent associations stratified by race/ethnicity. Results: Overall, Black respondents were most likely to have a high MBMC score (55%) compared to White (44%) and AIAN (51%) men (p = 0.043). AIAN men were least likely to report CRC screening intent (51.1%) compared with Black (68%) and White men (64%) (p < 0.001). Black men who reported the recent death of Chadwick Boseman increased their awareness of CRC were more likely (78%) to report intention to screen for CRC compared to those who did not (56%) (p < 0.001). Black men who exhibited more masculinity-related barriers to care were more likely to intend to screen for CRC (OR: 1.76, 95% CI: 0.98-3.16) than their counterparts, as were Black men who reported no impact of Boseman's death on their CRC awareness (aOR: 2.96, 95% CI: 1.13-7.67). Conversely, among AIAN men, those who exhibited more masculinity-related barriers to care were less likely to have CRC screening intent (aOR: 0.47, 95% CI: 0.27-0.82) compared with their counterparts. Conclusions: Masculinity barriers to medical care play a significant role in intention to screen for CRC. While Black men were most likely to state that The Black Panther's death increased their awareness of CRC, it did not appear to modify the role of masculine barriers in CRC screening intention as expected. Further research is warranted to better understand how masculine barriers combined with celebrity-driven health-promotion interventions influence the uptake of early-detection screening for CRC. Impact: Our study provides formative data to develop behavioral interventions focused on improving CRC screening completion among diverse men.

Factors Associated with Colorectal Cancer Prevalence Among Long-Haul Truck Drivers in the United States.

PURPOSE: To determine the age-adjusted association between colorectal cancer (CRC) risk factors and CRC prevalence among long-haul truck drivers (aged 21-85), after adjustment for age. DESIGN: Pooled cross-sectional analysis using Commercial Driver Medical Exam (CDME) data. Setting. National survey data from January 1, 2005, to October 31, 2012. PARTICIPANTS: 47,786 commercial motor vehicle drivers in 48 states. MEASURES: CRC prevalence was the primary outcome; independent variables included demographics, body mass index (BMI), and concomitant medical conditions. ANALYSIS: Kruskal-Wallis tests to analyze continuous variables; Fischer's exact tests to analyze categorical variables; univariate and multivariable logistic regression for rare events (Firth method) to quantify the association between the independent variables of interest and CRC prevalence. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, gender, years with current employer, year of exam, and BMI in a multivariate logistic regression. RESULTS: Many factors were statistically significant. Obesity (OR = 3.14; 95% CI = 1.03-9.61) and increasing age (OR = 1.10 per year; 95% CI = 1.07-1.13) were significantly associated with CRC prevalence. Truckers with 4 or more concomitant medical conditions were significantly more likely to have CRC (OR = 7.03; 95% CI = 1.83-27.03). CONCLUSIONS: Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers, a unique population in the United States estimated to live up to 16 years less than the general population.

Masculinity Barriers to Ever Completing Colorectal Cancer Screening among American Indian/Alaska Native, Black, and White Men (Ages 45-75).

Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers to medical care are associated with lower rates of ever completing CRC screening, a survey-based study was employed from December 2020-January 2021 among 435 White, Black, and AIAN men (aged 45-75) who resided in the US. Logistic regression models were fit to four Masculinity Barriers to Medical Care subscales predicting ever completing CRC screening. For all men, being strong was associated with 54% decreased odds of CRC screening completion (OR 0.46, 95% CI 0.23 to 0.94); each unit increase in negative attitudes toward medical professionals and exams decreased the odds of ever completing CRC screening by 57% (OR 0.43, 95% CI 0.21 to 0.86). Black men who scored higher on negativity toward medical professionals and exams had decreased odds of ever screening. Consideration of masculinity in future population-based and intervention research is critical for increasing men's participation in CRC screening, with more salience for Black men.

Investigation of Differences in Allostatic Load among Black Men by Level of Educational Attainment: High School Graduates Experience the Highest Levels of Stress.

Allostatic load (AL)-the biological assessment of long-term exposure to stress-may explain mortality-rate disparities among non-Hispanic Black (Black) men. We aimed to investigate AL among Black men with equivalent education status after controlling for income. A cross-sectional study was employed to investigate AL among 4113 Black men who participated in the National Health and Nutrition Examination Survey between 1999-2018. A summation of 8 biomarker factors were used to compute AL, differences in socio-demographic characteristics by education status were evaluated, and health behaviors that may influence AL were examined. To determine the high-risk thresholds for each AL component, we examined each component's distribution among NHB men for whom complete biomarker data were available in the NHANES sample. High-risk thresholds were determined as either (1) above the 75th percentile for body mass index (BMI), diastolic blood pressure (DBP), glycated hemoglobin, systolic blood pressure (SBP), total cholesterol, and serum triglycerides; or (2) below the 25th percentile for serum albumin and serum creatinine. Modified Poisson regression models were used to estimate prevalence ratios and their associated 95% confidence intervals for high AL risk while adjusting for potential confounders. Black men with a high school diploma/GED had a greater prevalence of high AL compared with Black men who had other levels of education, and a slightly higher prevalence of high AL compared with Black men who had less than a high school education. Black men with college degrees had a lower prevalence of high AL than Black men with the lowest levels of educational attainment. Researchers must further examine the hidden costs stemming from the interplay between discrimination associated with being Black in America and systemic racism in the educational system-which may be preventing Black men from achieving optimal health.

Protocol for #iBeatCRC: a community-based intervention to increase early-onset colorectal cancer awareness using a sequential explanatory mixed-methods approach.

INTRODUCTION: Th last two decades have seen a twofold increase in colorectal cancer (CRC) incidence among individuals under the recommended screening age of 50 years. Although the origin of this early-onset CRC (EOCRC) spike remains unknown, prior studies have reported that EOCRC harbours a distinct molecular and clinical phenotype in younger individuals. The sharp increase in EOCRC incidence rates may be attributable to a complex interplay of factors, including race; lifestyle; and ecological, sociodemographic and geographical factors. However, more research that address psychosocial experiences and accounts for lifestyle-related behaviours before, during and after an EOCRC diagnosis are warranted. This study aims to develop and pilot test a theory-driven, community-based intervention to increase awareness of EOCRC, reduce its associated risk factors and improve early detection among adults aged 18-49 years. METHODS AND ANALYSIS: Guided by the Behaviour Change Wheel, we will use a multistage mixed-methods study design. We will pilot a sequential mixed-methods intervention study as follows: (1) First, we will analyse linked quantitative data from the Utah Cancer Registry and National Cancer Institute Surveillance, Epidemiology and End Results registry, linked to state-wide demographic and vital records in the Utah Population Database to identify EOCRC hotspots in Utah by examining the EOCRC incidence and survival variance explained by personal and county-level factors. (2) Next, we will conduct one-on-one interviews with 20 EOCRC survivors residing in EOCRC hotspots to ascertain psychosocial and lifestyle challenges that accompany an EOCRC diagnosis. (3) Finally, we will consider existing evidence-based approaches, our integrated results (quantitative +qualitative) and community action board input to design a community-based intervention to increase EOCRC awareness that can feasibly be delivered by means of outdoor mass media, and via social media. We will pilot the multicomponent media campaign with a quasiexperimental design among 17 EOCRC hotspot residents and 17 EOCRC 'coldspot' residents. ETHICS AND DISSEMINATION: Ethics approval was obtained from the University of Utah Institutional Review Board (IRB_00138357). Signed informed consent will be obtained from all participants prior to any data collection. Study results will be disseminated through CRC community blogs, targeted infographics, conference presentations at national and international professional conferences and publications in peer-reviewed journals. Final intervention-specific data will be available on reasonable request from the corresponding author. TRIAL REGISTRATION NUMBER: NCT04715074.

Psychometric Properties and Analysis of the Masculinity Barriers to Medical Care Scale Among Black, Indigenous, and White Men.

Non-Hispanic (NH) Black, American Indian/Alaska Native (Indigenous), and NH-White men have the highest colorectal cancer (CRC) mortality rates among all other racial/ethnic groups. Contributing factors are multifaceted, yet no studies have examined the psychometric properties of a comprehensive survey examining potential masculinity barriers to CRC screening behaviors among these populations. This study assessed the psychometric properties of our Masculinity Barriers to Medical Care (MBMC) Scale among NH-Black, Indigenous, and NH-White men who completed our web-based MBMC, Psychosocial Factors, and CRC Screening Uptake & Intention Survey. We conducted exploratory factor analysis on a sample of 254 men and multivariate analysis of variance (MANOVA) on a separate sample of 637 men nationally representative by age and state of residence. After psychometric assessment, the MBMC scale was reduced from 24 to 18 items and from six to four subscales. NH-Black men's mean scores were lowest on three of four subscales (Being Strong, Negative and Positive Attitudes) and highest on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-White men, NH-Black men had significantly lower Negative Attitudes subscale scores and significantly higher scores on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-Black men, NH-White men had significantly higher Being Strong and Positive Attitudes subscales scores. This study expands on previous research indicating that, among racialized populations of men, endorsement of traditional masculine ideologies influences engagement in preventive health behaviors. Our scale can be tailored to assess attitudes to screening for other cancers and diseases that disproportionately burden medically underserved populations.

Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men.

Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.