Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites.

A challenge for health behavior science is to develop theory and best practices that take cultural diversity into account. Using data from Black, Hispanic, and White respondents to the 2003 Health Information National Trends Survey, we examined racial/ethnic differences in: (1) breast cancer risk perceptions/worry; (2) the associations between perceived risk/worry and ever having received a mammogram; and (3) perceived risk/worry and having had at least 2 mammograms over a 4-year period (consecutive mammography). Compared to White race/ethnicity, Black race/ethnicity was associated with lower perceived absolute risk and comparative risk for developing cancer. For the sample as a whole, higher perceived risk (both absolute risk and comparative risk) and worry predicted greater odds of mammography use; however, this was not true for Hispanics. In stratified analyses, perceived risk and worry were not associated with mammography use for either Hispanics or Blacks whereas they were for Whites; however, this interaction effect was significant only for Hispanics vs. Whites. Results support the need for formative research to identify determinants of health behavior prior to cancer prevention message planning for diverse audiences in order to accommodate racial/ethnic differences not only in the level of perceived risk, but also the association between risk perception to behavior change in that community.

A population-based study of therapy and survival for patients with head and neck cancer treated in the community.

BACKGROUND: The objective of this study was to examine patterns of care and survival in a population-based sample of patients with head and neck cancer (HNC) who were treated in the community or in hospitals that had residency training programs. METHODS: Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program were used to sample 1317 patients aged ≥20 years with invasive squamous HNC who were diagnosed during 2004 and who had vital status available through 2008. RESULTS: Treatment and survival were influenced by tumor site and disease stage. Patients who had stage I/II cancer of the oral cavity generally underwent surgery; patients with stage III oral cavity disease underwent surgery and received radiation; and patients with stage IV oral cavity disease underwent surgery and received chemoradiation. Patients with early stage cancer of the oropharynx either underwent surgery or received radiation and chemotherapy, and patients with late/unstaged oropharyngeal disease primarily received radiation and chemotherapy. Patients with early stage cancer of the larynx mainly received radiation alone, and patients with late stage laryngeal disease generally received chemoradiation. Cisplatin-based regimens were used most frequently. Overall, taxanes were used in 32% of regimens, and cetuximab was used in <3% of regimens. Patients aged ≥50 years, those with a Charlson comorbidity score ≥1, those with stage IV disease, and those with cancer located in the oral cavity or larynx had poorer survival. Although facilities with residency training programs treated more black patients and more patients with late stage disease, when adjusted for other factors, survival rates were similar to those reported in facilities with no such programs. CONCLUSIONS: Therapy generally followed accepted standards for 2004. Findings in particular tumor sites and stages may reflect the variability that still exists for the treatment of HNC. The use of taxanes and cetuximab is expected to increase based on new evidence of benefit. Reducing treatment-related toxicities and long-term functional deficits will be critical and especially important with the increase in human papillomavirus-related cancers. In addition, further attempts to improve survival for older patients are needed.

The role of worksite and home smoking bans in smoking cessation among U.S. employed adult female smokers.

PURPOSE: Examine the association of work and home smoking bans with quitting behaviors among employed female smokers in the United States. DESIGN: Secondary analyses using cross-sectional data from the 2006/2007 Tobacco Use Supplement to the Current Population Survey. SUBJECTS: Nationally representative sample of 7610 U.S. employed female smokers, aged 18 to 64 years, who reported working indoors. Setting . N/A. METHODS: Multivariate logistic regression analyses were conducted to examine the association of smoking ban policies (complete work and home bans, complete work ban only, complete home ban only, and no complete work or home ban) with intention to quit in the next 30 days, at least one quit attempt in the past year, and sustained abstinence of at least 3 months in the past year. RESULTS: Twenty-nine percent of women reported complete work and home smoking bans. Smoking bans were not associated with intention to quit and were marginally associated with sustained abstinence. Regardless of intention to quit, women with complete work and home bans were significantly more likely than those without complete work and home bans to report quit attempts. Among women with no intention to quit, the odds of having a quit attempt were significantly higher among women who had a complete home ban only compared with women without complete work and home bans. CONCLUSIONS: Efforts to promote quitting behaviors among employed female smokers may be facilitated by increasing rates of complete smoking bans at both work and home settings.

Racial/ethnic differences in receipt of pelvic lymph node dissection among men with localized/regional prostate cancer.

BACKGROUND: Black and Hispanic men have a lower prostate cancer (PCa) survival rate than white men. This racial/ethnic survival gap has been explained in part by differences in tumor characteristics, stage at diagnosis, and disparities in receipt of definitive treatment. Another potential contributing factor is racial/ethnic differences in the timely and accurate detection of lymph node metastases. The current study was conducted to examine the association between race/ethnicity and the receipt of pelvic lymph node dissection (PLND) among men with localized/regional PCa. METHODS: Logistic regression was used to estimate the adjusted odds of undergoing PLND among men who were diagnosed during 2000 to 2002 with PCa, who underwent radical prostatectomy or PLND without radical prostatectomy, and who were diagnosed in regions covered by the Surveillance, Epidemiology, and End Results database (n = 40,848). RESULTS: Black men were less likely to undergo PLND than white men (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84-0.98). When the analysis was stratified by PCa grade, black men with well differentiated PCa (OR, 0.48; 95% CI, 0.27-0.84) and poorly differentiated PCa (OR, 0.73; 95% CI, 0.60-0.89) were less likely to undergo PLND than their white counterparts, but racial differences were not observed among men with moderately differentiated PCa (OR, 0.96; 95% CI, 0.88-1.05). CONCLUSIONS: Among men with poorly differentiated PCa, failure to undergo PLND was associated with worse survival. Racial disparities in the receipt of PLND, especially among men with poorly differentiated PCa, may contribute to racial differences in prostate cancer survival.

Nicotine dependence and quitting behaviors among menthol and non-menthol smokers with similar consumptive patterns.

AIMS: This study examines the associations between usual cigarette brand (i.e. menthol, non-menthol) and markers for nicotine dependence and quitting behaviors. DESIGN: The 2003 and 2006/07 Tobacco Use Supplements to the Current Population Surveys were pooled to conduct secondary data analysis. SETTING: National data were collected using in-person and telephone computer-assisted interviews by the United States Census Bureau among civilian, non-institutionalized people aged 15 years and older. PARTICIPANTS: Data were analyzed among daily current smokers aged 18+ (n = 46,273). MEASUREMENTS: The associations between usual cigarette brand and time to first cigarette within 5 and 30 minutes after waking, quit attempts in the past 12 months and length of smoking abstinence in the past 12 months were examined. Bivariate and multivariate logistic regression models were stratified by smoking intensity: ≤5, 6-10, 11-19 and 20+ cigarettes per day. FINDINGS: Menthol smokers reported a mean of 13.05 compared with 15.01 cigarettes per day among non-menthol smokers (P < 0.001). Multivariate results showed that among smokers consuming 6-10 cigarettes per day, menthol smokers were significantly more likely than non-menthol smokers to consume their first cigarette within 5 minutes after waking (odds ratio = 1.22, 95% confidence interval = 1.05,1.43). The multivariate models did not show significant associations between usual cigarette brand and quit attempts in past 12 months or duration of smoking abstinence >2 weeks in the past 12 months. CONCLUSIONS: Findings from this national survey of daily smokers demonstrate that menthol smokers in the United States who report consuming 6-10 cigarettes per day show greater signs of nicotine dependence than comparable non-menthol smokers.

Racial/ethnic patterns of uptake of colorectal screening, National Health Interview Survey 2000-2008.

BACKGROUND: Lower access and/or utilization of colorectal screening are thought to be major contributors to the higher proportion of cancers among African Americans and Hispanics that are diagnosed at advanced stages of disease and the poorer outcomes observed among Hispanics and African Americans compared with non-Hispanic whites. We examine rates of initiation, utilization of specific screening modalities, adherence tocolorectal screening guidelines, and rate of uptake of colonoscopy among age-eligible African Americans, Hispanics and non-Hispanic whites. METHODS: Data on 46145 African American, Hispanic, and non-Hispanic white survey respondents to the 2000 and 2005 Cancer Control Modules and the 2003 and 2008 Sample Adult Cores of the National Health Interview Surveys are examined in these analyses. RESULTS: There was a modest increase in the initiation of colorectal screening among non-Hispanic whites, only and racial/ethnic disparities colorectal screening utilization persisted. The proportion of respondents for whom colonoscopy was the most complete guideline consistent exam received increased over time, while use of other modalities decreased among all racial/ethnic groups. CONCLUSION: More effort must be made to increase colorectal screening among the U.S. population in general but particularly among racial/ethnic minority populations. With the increased attention on prevention, there is also a need to increase knowledge of the strengths and limitations of specific screening modalities and the need to receive screening exams within recommended time intervals among both patients and providers making screening recommendations.

Perceived cancer risk: why is it lower among nonwhites than whites?

BACKGROUND: We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians. METHODS: Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS). RESULTS: Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = -0.40, -0.34, and -0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites. CONCLUSIONS: Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of one's family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information.

Race/ethnicity, risk perception, and receipt of prostate-specific antigen testing.

BACKGROUND: Men who do not perceive themselves to be at risk of developing and dying from prostate cancer may be less likely to utilize prostate cancer screening. This, coupled with variation among organizations in recommendations about screening with prostate-specific antigen (PSA), may contribute to confusion for providers and/or patients making prostate cancer screening decisions. METHODS: Data on 1075 African American, Hispanic, and non-Hispanic white male respondents to the 2003 Health Information National Trends Study (HINTS) were analyzed to examine the association among demographic characteristics, perception of the risk of developing prostate cancer, and PSA test utilization among men aged 45 or older. RESULTS: African American men less frequently, while Hispanic men more frequently, perceived their risk of developing prostate cancer to be higher than the average same-age man compared to non-Hispanic white men. Overall, men who perceived their likelihood of getting prostate cancer as very low to moderate (OR, 0.42; 95% CI, 0.24-0.73) or perceived the likelihood compared to the average same age man as less or about as likely (OR, 0.47; 95% CI, 0.27-0.81) were significantly less likely to have received a PSA test in a model adjusted for age, marital status, education, and health insurance coverage. CONCLUSIONS: These findings suggest that all men, but particularly African American and Hispanic men, could benefit from information regarding their specific risk of developing prostate cancer before making a decision about prostate cancer screening.

Racial/ethnic patterns of care for pancreatic cancer.

INTRODUCTION: The small proportion of cancers diagnosed at the local disease stage, resectable at the time diagnosis, and responsive to chemotherapy contribute to poor survival making pancreatic cancer the fourth leading cause of cancer death among Americans. This emphasizes the importance of receiving appropriate palliative care. Racial/ethnic cancer treatment disparities have been observed for many cancer sites. We examine patterns of care in a population-based sample of African American, Hispanic and non-Hispanic white patients diagnosed with pancreatic cancer. METHODS: Eligible cases were age 20 or older and newly diagnosed in 1998 with primary adenocarcinoma of the pancreas reported to the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program and selected for the NCI Patterns of Care/Quality of Care (POC/QOC) project (n = 697). RESULTS: Chemotherapy, the most frequently received treatment was less frequently received by African American patients (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.37-0.95) and radiation less frequently received by Hispanic compared to non-Hispanic white white patients (OR 0.50, 95% CI, 0.27-0.95) after adjustment for age, stage, size of tumor, and insurance status in a multivariate regression model. Cancer-directed surgery of the primary site was received by 14.1% of patients, which did not significantly differ by race/ethnicity. Uninsured patients less often were recommended for or received surgery (OR 0.09, 95% CI 0.01-0.62) and (OR 0.07, 95% CI, 0.01-0.49), respectively. CONCLUSION: Differences in primary tumor size, stage and insurance status contributed to racial/ethnic differences in the receipt of cancer-directed surgery but did not explain differences in the receipt of chemotherapy for African American or radiation for Hispanic patients. More population-based research is needed to examine race/ethnicity, insurance status and receipt of treatment and palliative care for pancreatic cancer.

Race/ethnicity and the perception of the risk of developing prostate cancer.

BACKGROUND: Although the higher risk of prostate cancer for African-American men is well known in the medical community, it is not clear how prevalent this knowledge is among African-American men themselves. Both the side effects of treatment and the lack of a demonstrated mortality benefit of routine screening with the prostate-specific antigen test among men in the general population have increased the focus on patient participation in decision making about prostate cancer screening. METHODS: Data on 1075 male respondents to the 2003 Health Information National Trends Study were collected from October 2002 to April 2003 and analyzed in 2008 to examine the associations among race/ethnicity, demographic characteristics, and the perception of the risk of developing prostate cancer for African-American, Hispanic, and non-Hispanic white men aged >or=45 years without a history of prostate cancer. RESULTS: Nearly 50% of African-American men, 47.4% of Hispanic men, and 43.3% of non-Hispanic white men perceived their likelihood of getting prostate cancer as somewhat or very low. Nearly 18% of African-American men, 21.6% of Hispanic men, and 12.9% of non-Hispanic white men perceived themselves to be more likely to get prostate cancer than the average man of the same age. CONCLUSIONS: Despite statistics to the contrary, few African-American men perceived themselves to have a higher-than-average risk of prostate cancer, while a higher percentage of Hispanic men perceived their risk to be higher than that of the average man of the same age. These findings suggest that all men, but particularly African-American and Hispanic men, could benefit from information regarding their specific risk of developing prostate cancer before making a decision about prostate cancer screening.

Employment characteristics and socioeconomic factors associated with disparities in smoking abstinence and former smoking among U.S. workers.

PURPOSE: This study examines the associations among employment and socioeconomic factors and the outcomes, current smoking, cigarette abstinence and former smoking among adult U.S. workers ages 18-64 (n=288,813). METHODS: Multivariate logistic regression was used to examine the associations among the variables using cross-sectional data from the 1998-1999 and 2001-2002 Tobacco Use Supplements to the Current Population Survey. RESULTS: Lower odds of current smoking was observed among part-time workers compared to those working variable hours and multiple job holders compared to persons holding one job. The self-employed, part-time workers and multiple job holders had higher odds of former smoking than comparison groups. Employment factors were not associated with short-term abstinence or 12-month abstinence from smoking, but income, education, marital status, and duration of smoking were associated with 12-month abstinence. CONCLUSIONS: These data suggest that while employment factors are associated with current and former smoking, socioeconomic factors are associated with long-term quitting.

A biopsychosocial approach to examining tobacco-related health disparities among racially classified social groups.

AIMS: To articulate a broader, multi-causal model that incorporates psychosocial and environmental factors that can differ systematically across racially classified social groups (RCSGs) and impact biological pathways related to the development of tobacco-related diseases. METHODS: This paper is built upon a review of the existing scientific literature on selected biopsychosocial factors (diet/nutrition, obesity, alcoholic intake, psychosocial stress, occupational/environmental exposures and exposure to other diseases and illnesses) and tobacco use in examining the biological contributions to differences in tobacco-related health outcomes among RCSGs. FINDINGS: Recent work has focused on RCSG genetic variations as a possible explanation for differences in tobacco-related health disparities. It is argued in this paper that, given the genetic heterogeneity 'within' RCSGs, it is unlikely that across RCSG genetic variations are likely to be the major source of differences impacting biological pathways in tobacco-related health outcomes. The evidence shows that results, even at the level of within-population genetic variations, have been limited and often inconsistent. A conceptual framework is proposed to account for biological pathways related to the development of tobacco-related diseases. CONCLUSIONS: Determinants of tobacco-related health disparities are not understood clearly. The contribution of biological factors may be important. Current efforts to determine biological differences in tobacco use and related diseases among RCSGs have focused primarily on genetic variations. However, this approach has limitations. An alternative biopsychosocial framework that examines the potential biological mechanisms through which life experiences and behavior might affect tobacco use and health outcomes in these population groups is needed, including those of life-style (e.g. diet/nutrition, obesity, physical exercise, alcohol consumption), psychosocial (e.g. stress and coping), occupational/environmental exposures and the presence of other diseases/illnesses.

Racial/ethnic variation in the anatomic subsite location of in situ and invasive cancers of the colon.

INTRODUCTION: Approximately 145,000 Americans were diagnosed with colorectal cancer and 56,000 died from colorectal cancer in 2006. Although colorectal screening can reduce mortality and incidence, U.S. screening rates are particularly low for racial/ethnic minorities. Racial differences in the subsite location of colon cancers could have implications for colorectal screening. This study examines the anatomic subsite distribution of tumors among African-American, Hispanic, Asian-American/Pacific-Islander and non-Hispanic white (NHW) patients with colon cancer. METHODS: Surveillance and End Results program data for 254,469 primary in situ and invasive colon cancers for patients from 1973-2002 are included in this analysis. Descriptive analyses and logistic regression are used to describe and examine variations in the proportion of colon cancers diagnosed at sites proximal to the sigmoid colon or proximal to the splenic flexure over three successive time periods. RESULTS: The proportion of colon cancers diagnosed at the sigmoid colon was 15.6-21.3% lower, while diagnoses at the descending colon were 40.5.0-45.3.0% higher for African Americans than NHWs over the three time periods. In logistic regression analyses adjusted for gender, age group and year of diagnosis, the odds of a diagnosis of cancer proximal to the sigmoid colon or proximal to the splenic flexure was significantly higher for African Americans but lower for Hispanics and Asian Americans/Pacific Islanders compared to NHWs. DISCUSSION: The higher proportion of cancers among African Americans diagnosed at sites that are generally attempted but not always reached with a sigmoidscope suggest that African Americans may benefit from screening colonoscopy. They also highlight the need for systems that collect data that would allow a direct examination of the role that the differential use of specific colon screening tests and polypectomy play in racial/ethnic variation in colon cancer incidence and in the anatomic subsite distribution of colon cancers.

Workplace and home smoking restrictions and racial/ethnic variation in the prevalence and intensity of current cigarette smoking among women by poverty status, TUS-CPS 1998-1999 and 2001-2002.

STUDY OBJECTIVE: Recognition of the health consequences of exposure to environmental tobacco smoke has led government agencies and many employers to establish policies that restrict cigarette smoking in public and workplaces. This cross sectional study examines the association of workplace smoking policies and home smoking restrictions with current smoking among women. DESIGN: Participants were employed US women ages 18-64 who were self respondents to the 1998-1999 or 2000-2001 tobacco use supplement to the current population survey supplements. Cross tabulations and multivariate logistic regression analyses examine the association of selected demographic characteristics, occupation, income, workplace and home smoking policies/restrictions with current smoking, consumption patterns, and quit attempts among women by poverty level for five race/ethnic groups. MAIN RESULTS: The prevalence of either having an official workplace or home smoking policy that completely banned smoking increased with increased distance from the poverty level threshold. A complete ban on home smoking was more frequently reported by African American and Hispanic women although Hispanic women less frequently reported an official workplace smoking policy. In general, policies that permitted smoking in the work area or at home were associated with a higher prevalence of current smoking but this varied by poverty level and race/ethnicity. Home smoking policies that permitted smoking were associated with lower adjusted odds of having a least one quit attempt for nearly all poverty level categories but there was no association between having one quit attempt and workplace policies. CONCLUSION: Home smoking policies were more consistently associated with a lower prevalence of current smoking irrespective of poverty status or race/ethnicity than workplace policies. These findings underscore the importance of examining tobacco control policies in multiple domains (work and home) as well as by race/ethnicity and socioeconomic position.

Racial/ethnic variation in cigarette smoking among the civilian US population by occupation and industry, TUS-CPS 1998-1999.

BACKGROUND: Although observational research studies have shown variance in the prevalence of smoking among occupations and industries, few have examined the role of race/ethnicity. This study examined racial/ethnic variation in the prevalence of current smoking and cigarette consumption patterns by occupation, industry and workplace smoking policy. METHODS: Data were examined for 9095 African American (AA), 1025 American Indian/Alaska Native, 3463 Asian/Pacific Islander (AAPI), 8428 Hispanic, and 86,676 white participants in the 1998-1999 Tobacco Use Supplement to the Current Population Survey. Race-stratified multivariate logistic regression analyses, Chi-square tests, and ANOVA were used to examine the association between the covariates and smoking prevalence and cigarette consumption patterns. RESULTS: Current smoking prevalence ranged from a high of 35.1% for AI/AN to 15.2% for AAPI. Occupation was not significantly associated with current smoking for Hispanics, AI/ANs, and AAPIs while neither occupation nor industry was associated with current smoking among African Americans after adjustment for gender, age group, education, income, or workplace smoking policies. DISCUSSION: These data confirm results of previous studies that show occupation and industry variation in smoking prevalence and also highlight the importance of examining racial/ethnicity as a covariate in studies of smoking prevalence.

Race/ethnicity and the intensity of medical monitoring under 'watchful waiting' for prostate cancer.

BACKGROUND: Previous studies have found that racial/ethnic minority patients with prostate cancer are more frequently managed with "watchful waiting." Little, however, is known about the medical care received among men managed with watchful waiting. We examine the type and intensity of medical monitoring received by African American, Hispanic, and white patients with prostate cancer managed with "watchful waiting" in fee-for-service systems. METHODS: Surveillance Epidemiology and End Results-Medicare data for men diagnosed with prostate cancer 1994-1996 were used in this study. Men were determined to have initially received watchful waiting if they did not receive surgery, radiation, or hormone treatment within the first 7 months of diagnosis. Crosstabulations, multivariate logistic, and Cox regressions were used to examine the association between clinical and sociodemographic variables and the receipt of a primary care, urology visit, prostate-specific antigen test, or bone scan. RESULTS: In general, Hispanic and African American men received less medical monitoring and had longer median times from diagnosis to receipt of a medical monitoring visit or procedure than white men. Furthermore, nearly 6% of African American, 5% of Hispanic, and 1% of white men did not have any medical monitoring visits or procedures during the 60-month follow-up period (P<0.001). Differences in observed clinical or sociodemographic characteristics did not explain variations in medical monitoring. CONCLUSION: Regular medical monitoring is considered by most medical authorities to be a necessary component of management with watchful waiting. The disproportionately low receipt of medical monitoring visits and procedures observed for African American and Hispanic men managed with watchful waiting in this study suggest that there are racial/ethnic disparities in the receipt of appropriate prostate cancer management.

Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer.

INTRODUCTION: Several recent studies have noted that African Americans disproportionately receive "watchful waiting" for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. METHODS: Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men. RESULTS: African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but not Hispanic men. The odds of receiving watchful waiting were also higher for African-American and Hispanic men who resided in census tracts where a large percentage of residents had not completed high school than for white men who resided in similar census tracts. CONCLUSION: The disproportionate receipt of watchful waiting among African Americans and Hispanics is not completely explained by racial/ethnic variation in clinical characteristics or life expectancy as measured in this study. These data suggest that there are other factors that contribute to racial/ethnic differences in receipt of watchful waiting that warrant investigation.