Older American Indian Men's Prostate Cancer Screening Behavior and the Role of Cultural Health Beliefs

Background and Purpose:While American Indians were known to have the lowest reported rates of prostate cancer among all U.S. ethnic groups, the mortality rates of prostate cancer were higher than Hispanics and Asian Americans and almost comparable to Whites. Several studies suggested that these differences may come from lack of relevant treatment of prostate cancer and lower rates of cancer screening test such as prostate-specific antigen (PSA) testing. Many empirical studies consistently suggested that the introduction and stabilization of PSA can increase the survival rate of prostate cancer patients. Although several factors were addressed as one of main obstacles of early prostate cancer screening test for American Indians, empirical studies on prostate cancer among American Indian males are still few in number, and there has been little investigation of cultural influences on their health behaviors. The purpose of this study is to examine what factors including demographic, socioeconomic, health care accessibility, and culture-specific health beliefs are related with prostate cancer screening test among older American Indian males.

Methods:Data were collected from a cross-sectional survey with community-dwelling older American Indian males (N=191) aged 40 or older in two Midwestern states in 2013. Participants’ recruitment sources included various places such as local American Indian churches, other religious organizations, senior housing facilities, senior centers, and three powwows (refers to Sundance, which is an annual event). Their mean age was 51.2, and 45.5 % had an monthly household income below $1,000. Hierarchical logistic regressions were conducted to examine the associations between PSA screening test and culture-specific health beliefs controlling for the effects of other confounding variables.

Results: About 30% of participants reported that they had received a PSA test at some point. Among the demographic and socioeconomic constructs, marital status (OR= 2.68, p=.03) and employment (OR=.344, p=.02) were significantly related with the PSA screening. When adding the health care accessibility constructs in the model, the likelihood of PSA screening of those who have a particular place for regular medical care was more than six times greater than their counterparts without a regular medical care place (OR=6.143, p=.009). Finally, culture-specific health beliefs about cancer were also found to be significant determinants of uptake of a PSA test. For example, those who rely on traditional American Indian medicine and treatment for health care was associated with greater likelihood of PSA screening (OR=2.26, p=.037). Further analysis showed a significant interaction effect between use of traditional American Indian medicine and age in predicting PSA screening uptake.

Conclusions and Implications: To reduce the mortality rates of cancer among American Indians, future studies need to investigate how traditional cultural beliefs among American Indians are embedded in their health behaviors, and show whether those beliefs may help or hinder their access to preventive care. Furthermore, cultural competency training for social workers needs to be more emphasized because it can not only facilitate American Indians’ access to health care services, but help social workers provide quality of services with a better understanding of American Indian clients.