Health Behavior

Psychosocial factors associated with routine health examination scheduling and receipt among African American men

by Derrick Matthews

Hammond, W. P., Matthews, D., & Corbie-Smith, G. (2010). Psychosocial factors associated with routine health examination scheduling and receipt among African American men. Journal of the National Medical Association, 102, 276-289.

INTRODUCTION: African American men often fail to obtain routine health examinations, which increases the probability... more INTRODUCTION: African American men often fail to obtain routine health examinations, which increases the probability of disease detection, yet little is known about psychosocial factors that motivate scheduling and receipt among this group.

METHODS: We used the Andersen model and theory of reasoned action as frameworks to evaluate the relative contribution of psychosocial factors to self-reported routine health examination scheduling and receipt in a cross-sectional sample of African American men (N = 386) recruited from barbershops (65.3%) and academic institutions/events (34.7%) in Michigan, Georgia, and North Carolina between 2003-2004 and 2007-2009. Participants completed measures assessing demographic factors, physical/mental health status, traditional male role norms, health-promoting male subjective norms, health value, and medical mistrust. Pearson's chi(2), analysis of variance, and multivariate logistic regression analyses were used to investigate associations between these study factors and routine health examination scheduling and receipt in the past year.

RESULTS: After final adjustment, the odds of scheduling a routine health examination were increased for men with a usual source of care (OR, 5.48; 95% CI, 3.06-9.78) and more health-promoting male subjective norms exposure (OR, 1.46; 95% CI, 1.02-2.04). Higher medical mistrust (OR, 0.26;; 95% CI, 0.09-0.76) and traditional male role norms (OR, 0.71; 95% CI, 0.52-0.98) reduced the odds of routine health examination receipt. The odds of routine health examination receipt were increased among men who were older (OR=1.05; 95% CI, 1.01-1.10), had a usual source of care (OR, 2.91; 95% CI, 1.54-5.51) and reported more male subjective norms exposure (OR, 1.51; 95% CI, 1.02-2.22).

CONCLUSIONS: Improving African American men's uptake of routine health examinations will require addressing medical mistrust, mitigating traditional masculine concerns about disclosing vulnerability, and leveraging male social networks.

Masculinity, medical mistrust, and preventive health services delays among community-dwelling African American men

by Derrick Matthews

Hammond, W. P., Matthews, D., Mohottige, D., Agyemang, A., & Corbie-Smith, G. (2010). Masculinity, medical mistrust, and preventive health services delays among community-dwelling African American men. Journal of General Internal Medicine, 25, 1300-1308.

BACKGROUND
The contribution of masculinity to men’s healthcare use has gained increased public health interest;... more BACKGROUND
The contribution of masculinity to men’s healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men.

OBJECTIVE
To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays.

DESIGN AND PARTICIPANTS
A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009).

MEASUREMENTS
Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status.

RESULTS
After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60–0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45–0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34–5.20), blood pressure (OR: 3.03; 95% CI: 1.45–6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03–4.23).

CONCLUSIONS
Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men’s blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men’s potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.

Keeping them in “STYLE”: Finding, Linking, and Retaining Young HIV+ Black and Latino Men Who Have Sex With Men in Care

by Derrick Matthews

Hightow-Weidman, L. B., Smith, J. C., Valera, E., Matthews, D. D., & Lyons, P. (2011). Keeping them in “STYLE”: Finding, Linking, and Retaining Young HIV+ Black and Latino Men Who Have Sex With Men in Care. AIDS Patient Care and STDs, 25, 37-45.

Young men who have sex with men (YMSM) of color are at particularly increased risk for HIV infection compared to white... more Young men who have sex with men (YMSM) of color are at particularly increased risk for HIV infection compared to white MSM. National data highlight the need to link YMSM of color to care to improve their overall health and stem further infections, yet, there is limited data on interventions and clinical outcomes focused on engaging and retaining youth, specifically HIV-infected YMSM of color in care. To address the medical care needs of this underserved population, in 2005, the Health Research and Services Administration (HRSA) created the YMSM of Color Initiative. Utilizing a social marketing campaign targeting youth and members of their sexual and social networks, testing and outreach on college campuses and within the broader community, and a tightly linked medical–social support network, we created STYLE (Strength Through Youth Livin’ Empowered), a novel intervention that sought to diagnose, engage, and retain HIV-positive black and Latino YMSM in HIV primary care services. Over a 3-year period, 81 men were either newly diagnosed or reengaged in care. Overall, 63% of the cohort was retained in clinical care; defined as attending at least one medical visit every 4 months. Compared to the 3 years prior to STYLE, the odds ratio for whether or not someone attended a clinic visit was 2.58 (95% confidence interval [CI] 1.34–4.98) if enrolled in STYLE. We conclude that compared to a pre-STYLE cohort, STYLE was an effective intervention that increased HIV diagnoses, provided efficient and timely engagement in care for both those newly diagnosed and those who had fallen out of care and improved overall retention.

Sex with Older Partners is Associated with Primary HIV Infection among Men Who Have Sex with Men in North Carolina

by Derrick Matthews

Hurt, C. B., Matthews, D. D., Calabria, M. S., Green, K. A., Adimora, A. A., Golin, C. E., & Hightow-Weidman, L. B. (2010). Sex with Older Partners is Associated with Primary HIV Infection among Men Who Have Sex with Men in North Carolina. Journal of Acquired Immune Deficiency Syndromes, 54, 185-190.

Studies from the 1990s suggested sex with older partners was associated with HIV infection. We evaluated the... more Studies from the 1990s suggested sex with older partners was associated with HIV infection. We evaluated the hypothesized association between primary HIV infection (PHI) and having older sexual partners among men who have sex with men (MSM). Methods: MSM with PHI and HIV-uninfected MSM completed audio computer-assisted self-interviews exploring behaviors involving their 3 most recent sexual partners before enrollment (if uninfected) or diagnosis (if PHI). Results: Of 74 men reporting any lifetime sex with men, 20 had PHI (27%). Demographics (including age) were similar between groups; 39% were non-white and 74% identified as gay. The mean age of sex partners differed significantly: men with PHI had partners on average 6 years older than themselves, whereas uninfected men's partners were 4 months their junior (P < 0.001). After adjusting for race, sex while intoxicated, and having a serodiscordant/serostatus unknown partner, a participant had twice the odds of PHI if his sex partner was 5 years his senior (odds ratio 2.0, 95% confidence interval: 1.2 to 3.3). Conclusions: Among a sample of young MSM, the odds of HIV infection increased significantly as the age of sexual partners increased. These findings can inform behavioral interventions in communities of at-risk MSM and secondary prevention efforts among those already living with HIV.

Authors’ Reply: Age Disparity Between Sex Partners of Men Who Have Sex With Men Is Only Marker of HIV Risk

by Derrick Matthews

Hurt, C.B., Hightow-Weidman, L. B., & Matthews, D.D. (2011). Authors’ Reply: Age Disparity Between Sex Partners of Men Who Have Sex With Men Is Only Marker of HIV Risk. Journal of Acquired Immune Deficiency Syndromes, 56, e36.

Can the Behavioral Model Explain Immigrant Status and Ethnic Differences In US Adults' COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) Use?

by Georgiana Bostean

Published in Vol. 28 of Research in the Sociology of Health Care

Immigrants’ access to health services is a widely researched topic, yet few studies examine
immigrants’ use of... more Immigrants’ access to health services is a widely researched topic, yet few studies examine
immigrants’ use of Complementary and Alternative Medicine (CAM). This study uses the
Behavioral Model to compare overall CAM use and use of acupuncture, chiropractic, herbs,
yoga, and relaxation by immigrant status (nativity and time in the U.S.). It then explains the
nativity gap in use by assessing knowledge, cost, and need as potential reasons for not using
these modalities. Results show that controlling for predisposing, enabling and need factors,
recent immigrants use CAM less than the U.S.-born. Lack of knowledge of CAM modalities
partially explains why some recent immigrants do not use acupuncture, chiropractic, or
relaxation, while established immigrants cite lack of need as a reason for not using yoga. Cost
does not explain immigrants’ lower use of these five modalities. Finally, ethnicity moderates the
association between immigrant status and reasons for not using CAM.