Fatalistic Beliefs About Cancer Prevention Among Older African American Men Enrolled in Medicare
Although African American men are disproportionately burdened by cancer, they are less likely to receive appropriate cancer screenings compared to other populations. Fatalistic beliefs about cancer prevention (FBCP) are one potential barrier and are defined as confusion, pessimism, and helplessness about one’s ability to prevent cancer. Such beliefs may be a response to limitations in one’s capacity to adequately address health needs. There is evidence that minority and underserved groups are more likely to exhibit FBCP. We aim to determine the contextual factors that predict FBCP in this population.
Participants were 1,666 older African American men enrolled in Medicare and participating in a longitudinal randomized trial on behavioral health interventions. The study was approved and conducted by a large Midwestern health system. Data were collected using a baseline participant questionnaire. Measures included one item to assess each of the three FBCP constructs; demographics (age, income, education, partner status); physical and mental health variables (self-rated health, perceived cancer risk and worry, anxiety/depression, and downheartedness); and perceptions about health provider interactions (the degree to which physicians listened to, respected, explained things, and spent enough time with participants). Binary logistic regression was performed for each of the three FBCP outcome variables (confusion, pessimism, and helplessness). Predictors that were significant in bivariate analyses were included in the models.
Study participants were on average 73.6 years old (SD = 10.9);33.3% had a household income below $20,000; 31% had completed at least one year of college education; and 45.4% were married. The first model accounted for 5% of variance in helplessness (x2=63.76, p<.001, df=4) whereby being married, having some college education or more, having one or more co-morbid health conditions, and feeling downhearted and blue all increased the odds of helplessness. The model predicting pessimism accounted for 4.5% of the variance (x2=54.25, p<.001, df=4 ) with some college, self-reported anxiety/depression, being over age 75, and poor self-rated health all being significant predictors. In the model predicting confusion, participants who were downhearted and blue most or all of the time were 2.4 times more likely report confusion (95% CI 1.2, 2.1); other significant predictors included: any co-morbid conditions, expressing a high likelihood of developing cancer in the future, worrying about cancer often, and feeling that one’s doctor never listened to concerns. The overall model predicted 7.7% of the variance in confusion, (x2= 99.22, p<.001, df =5). Each model contributed only modestly to our understanding of cancer fatalism, but self-reported depression or feeling downhearted and living with co-morbid conditions was consistently significant
Conclusions and Implications
Although multiple factors may contribute to fatalistic beliefs about cancer prevention among older African Americans men, this study highlights the contribution of mental and physical health concerns. Because of disparities in cancer incidence and screening uptake for this group, it is critical for social workers and other practitioners to be aware of how biopsychosocial challenges may impede cancer prevention efforts. Further research is needed better understand how fatalistic beliefs influence cancer prevention uptake for older African American men.