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Abstract

The unequal discussion of Black males’ health is a pressing social problem. This study addressed Black males’ lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men’s health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic–medical settings, (d) hyperactive masculinity fatigue, and (e) the gay–straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.

Keywords

male health Black males lay-health perspectives qualitative research community engagement church-based forum health belief model health promotion community-based participatory research

As it relates to biomedical research, prevention, and treatment, Black males are often referred to as the “hard to reach” population. It is possible that such negative terminology has drawn researchers away from trying to learn more about Black males. The unequal discussion of Black males’ health is a pressing social problem affecting efforts toward developing prevention, intervention, and evaluation programs. Health-related research has highlighted racial disparities within patient care at provider, institutional, and community levels (Adler & Rehkopf, 2008; Mosenifar, 2007; Powell, Bock, Ruterbusch, & Sakr, 2010). The prevalence of chronic disease continues to rise in Black communities, especially in the areas of hypertension, diabetes, heart disease, cancer, and HIV/AIDS (Crawford, 2009; Lloyd-Jones et al., 2010; Maty, James, & Kaplan, 2010; Rosamond et al., 2008; Sutton et al., 2009). Research literature has indicated that Black males have a lower awareness of their chronic disease risk, are more likely not to recognize risk indictors, and are more likely to experience poor health literacy. Furthermore, these individuals are more likely to embody shame about their chronic disease and report higher levels of mistrust about health care providers when compared with other racial/ethnic groups (Centers for Disease Control and Prevention [CDC], 2009; Henshaw & Freedman-Doan, 2009; Kieffer et al., 2006; Steele, Miller, Maylahn, Uhler, & Baker, 2000).

Given the compounded health problems Black males face, along with excessive death rates, social inequalities in health, fatalistic views of health outcomes, and declining life expectancy (Bobak, Pikhart, Rose, Hertzman, & Marmot, 2000; Harper, Lynch, Burris, & Davey Smith, 2007; Jemal et al., 2007; Marmot, 2001; Murray et al., 2006), attempts to address individual disease states are being viewed as both inefficient and ineffective (Downey et al., 2010; Horowitz et al., 2008; Horowitz, Robinson, & Seifer, 2009). In accordance with the growing interest in addressing overlapping health epidemics, termed syndemics (Singer, 2009), there is an equally growing body of research endorsing benefits of using lay health perspectives to elicit information (Jackson & Parks, 1997). Although lay health perspective elicitation is reported to be efficacious in various populations, its benefits in the context of Black males have not been well described and/or studied (Wilson et al., 2008). This clarification is critical given the emerging debate regarding the feasibility of convening and retaining Black males in health-related research and community outreach campaigns seeking to address Black males’ quality of life.

Although researchers have documented the low involvement of Black males in biomedical prevention and treatment research activities, there continues to be gaps in identifying strategies to increase their participation. Toward assessing opportunities for health promotion targeting Black males with multiple disease states, the objective of this study was to explore and document Black males’ lay perspectives on health, illness prevention, and social factors influencing their health beliefs. This objective was addressed via a community-based health forum.

Theoretical Paradigm: Health Belief Model

The Black Male Lay Health Perspective forum was, in part, informed by the Health Belief Model (HBM). The HBM is a theoretical framework that attempts to explain health behaviors based on individuals’ perceptions of threats to their health and benefits of engaging in health and positive health behaviors (Becker, 1974; Rosenstock, 1974). As postulated from the HBM, individuals have beliefs regarding their perceived susceptibility to a health condition, perceived severity of that health condition, perceived benefits involved in taking recommended health-related actions, and perceived barriers to taking action to promote health behavior change. Individuals are also likely to be motivated by internal or external cues to action. The model’s constructs have been shown to be relevant to health issues associated with prostate cancer in African American males living in urban communities (Plowden, 1999, 2003). Furthermore, the HBM has demonstrated utility in an array of chronic disease topics (Holt et al., 2009; Price-Haywood, Roth, Shelby, & Cooper, 2010; Vermeer, Bos, Mbwambo, Kaaya, & Schaalma, 2009). Because of its explanatory nature, the HBM can serve as an aid in designing effective chronic disease interventions for Black males.

Method

Setting and Participants

A 2-day forum was held at a church located in an urban community in North Carolina. The duration of the forum was 1½ hours each day. Participants were primarily recruited through church announcements, media communications, health provider networks, posted flyers, and alliances with community-based organizations (e.g., social service agencies, college Greek letter organizations, churches, and community health centers). Approximately 70 people and 13 organizations provided advance notice of their intention to participate in the forum. To achieve diverse views, participants were recruited to the forum through direct contact, community partnerships, listservs, and other media channels. Prospective participants were encouraged to bring their sons, nephews, grandsons, and mentees. After being informed about the goal and objectives of the forum, all attendees gave verbal consent to have their comments used for this report. Attendees, in general, represented a geographical radius of up to 50 miles covering the North Carolina Piedmont Triad area. The forum was free, open to the public, and held in spring 2010.

Procedure

To fully elicit lay health perspectives as well as psychosocial and cultural information, semistructured questions were developed in line with the HBM. Questions explored participant’s chronic disease knowledge, susceptibility, severity, as well as health behaviors. Topics covered in the forum were informed by the National Institute of Health, Institute of Medicine and the Centers for Disease Control and Prevention, and the North Carolina Office of Minority Health. The topics addressed through the forum were based on health disparity priorities, including prostate cancer, HIV/AIDS, healthy aging, cardiovascular health, and metabolic disease. The agenda was finalized through consensus building among partnerships.

The sequence of events included the following: (a) welcome/introductions, (b) discussion of ground rules, (c) presentation of chronic disease information and discussion, and (d) debriefing with moderator and observer. Forum discussion, moderated by the lead author, relied heavily on encouraging participants to talk to one another, ask each other questions, and commenting on each others’ experiences and viewpoints. The forum was facilitated by the same individuals and monitored by the same independent observer each day. The audio recordings were transcribed, reviewed separately, and checked for accuracy between reviewers. Respondents were assigned unique anonymous identifiers. Resulting transcripts were also verified against the observation notes from forum sessions. The study was approved by the Wake Forest University Health Sciences Institutional Review Board.

Analysis

Qualitative data analysis was conducted by reviewing audio recordings, which were transcribed verbatim from each day of the forum. Using a thematic content analysis approach (i.e., a descriptive presentation of qualitative data in textual form), the data were segmented, coded, and analyzed by two reviewers of the project team to identify the most prominent themes from the community forum. For instance, each reviewer highlighted portions of the text that seemed to illustrate a theme. Each theme was named and written in the margin of the transcript allowing the reviewers in the group process to compare and contrast their . By agreement, each comment was coded into parameters consistent with the HBM. Any differences in content analyses were discussed and a group consensus was reached involving the lead author and other members of the project team. Research seems to suggest that race-concordance is beneficial in promoting patient satisfaction, health outcome, participatory motivation, quality of care, and cultural competence (Cooper et al., 2003; Kasckow et al., 2011; Kumar, Schlundt, & Wallston, 2009; LaVeist & Nuru-Jeter, 2002). There was race-concordance between the people who reviewed the audio recordings and the participants. Both males and females reviewed the audio recordings.

Results

A total of 68 individuals, ranging in age from 15 to 68 years, with an average age of 44 years (SD = 14.5), attended the forum. Several questions were used to guide our inquiry. Specifically, participants were asked to talk about their health beliefs and were asked to define health, illness, and health promotion from their own health perspective. Participants were asked to identify behaviors that they would like to see changed in themselves, to discuss their perceived barriers and benefits of health behavior change, and to discuss the factors that have and continue to influence their perceived threat of disease if changes in health behavior did not change. Next, participants were asked to discuss how they envisioned or defined the health of the community in which lived, worked, and engaged in social activities. Participants were asked to provide their perceptions of health care delivery and to discuss their strengths and liabilities as it related to their ability to actively address psychosocial factors that affect their health behavior lifestyle practices. A final level of inquiry involved asking participants to assess their likelihood of taking preventive health action.

Turning to the aim of this research, we now describe the five most prominent themes emerging from participants’ perspectives: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic–medical settings, (d) hyperactive masculinity fatigue, and (e) the gay–straight divide.

Lack of Chronic Disease Awareness

When commenting about their personal stories, there was a tendency among participants to hold their lack of chronic disease awareness accountable for a lack of perceived susceptibility to the disease and perceived severity of the disease. Some participants indicated more awareness about chronic disease after the death of close relatives or friends.

Like the man says, I didn’t know what a prostate was, I didn’t even know what the danger was. As we talk this evening, you’ll see if we find out that within the African American community it is a lack of awareness. (Participant 65)

I never was sick, I never went to the doctor, never knew what a colonoscopy was, couldn’t even pronounce it you know . . . didn’t know nothing about it. I didn’t never talk about it so I didn’t know that you had to have a colonoscopy exam done when you’re 47 years old. So I never went. The only reason I had a prostate exam is because one day . . . the man I worked for about 25 years said “Man if you don’t go, you won’t get paid today.” So about 100 men went and 5 of them were diagnosed with cancer. And of the five that were diagnosed I’m the only one who is still here. I was diagnosed with cancer of the colon on my 65th birthday. (Participant 3)

My half brother when he had his Stroke I mean all the signs and symptoms are different and that’s what I mean we don’t understand the signs and symptoms. . . . But what we fail to do is we don’t recognize that there is certain numbness and weakness of the face arms and legs. (Participant 11)

My father passed of lung cancer. His father passed of prostate cancer, and my mother’s father passed of prostate cancer. So that’s why I have always been so conscious of going and getting physicals. (Participant 12)

Fatalism

Participants noted that negative experiences for the past were unresolved and that they had no control over addressing ongoing health care injustices. This health care fatalism was frequently highlighted across the 2-day forum. Participants’ comments suggested their beliefs about fatalism are influencing them to think they are going to die or suffer from preventable chronic diseases regardless of their behavior. When participants were asked about the mindset influencing their health care engagement and participation in recommended preventive health and health behavior practices, a participant commented:

The other part of this is, I think we miss something very key from all of this. And that is, we are genetically predisposed to stroke because of the stress that our fore parents carried. (Participant 18)

Fear and Anxiety of the Academic–Medical Setting

There was a sense of fear and anxiety suggested by the Black males’ comments with regard to academic–medical settings. The relationship uncertainty was connected to mistrust around medical advice, types of research conducted, as well as the sociocultural interpersonal disconnect. Forum participants endorsed their concerns that health care professionals have a lack of passion and interest in improving the overall health of Black males.

I went to the doctor later on and said to him . . . what went wrong? And they gave me this beautiful classic answer . . . Well, you know, sometimes it just happen man. We gotta keep doing what we doing, and I’ll tell you the truth if I wasn’t in the sanctuary I’d tell you what I said to him. Because I was livid, you telling me that I been doing all of this stuff, you telling me that my blood was this great, and you gonna tell me to keep doing what I’m doing? Are you out your mind? I just had a stroke! (Participant 18)

I can recall not too long ago, Blacks would openly say they would not go to an academic–medical setting, period. Because you went there-you die! I just heard less than 6 months ago, an elderly gentleman talking about Tuskegee. . . . It’s what we are wrestling with . . . the stench that is still there. (Participant 45)

Hypermasculinity Fatigue

Hypermasculinity is used to represent a psychological term for the exaggeration of male stereotypical behavior and internalized gender assumptions, such as an emphasis on physical prowess, nonemotional invincibility, courage, and risk taking, in comparison with males who may place, and/or are perceived to place, a lesser priority on such characteristics. Participants reported hypermasculinity as a barrier to prevention, screening, and treatment of chronic diseases as influenced by a strong hyperactive masculinity presence in their communities. When asked about Black males social perception and projection of invincibility, male participants noted the following:

I am one of eight boys in my family and now we are down to three. I’m number five so the four under me are gone and it’s just they did not go to the doctor. . . . They absolutely did not go to the doctor. . . . So that is this whole macho thing that we have been sold, certainly is against us. It works against us. (Participant 60)

And his brother said, look, the next time you feel a tingling on your left side call 9-1-1. And he said “I’m a man, I’m tough, I’m you know . . . black man.” (Participant 57)

The Gay–Straight Divide

Participants reported perceptions that health promotion activities do not address heterosexual and homosexual Black males equally. When asked about how to unify Black males of all sexual orientations, participants suggested increased communication efforts between gay and straight males and the need for a nonjudgmental atmosphere. This is highlighted in the following statement:

Having the conversation, and having the conversation and not just among ourselves. But we need to have that conversation in that we invite open gay brothers to the table to talk, to dialogue, to converse not to reprimand, not to fix, not to deliver . . . come on somebody . . . these segregations that we do causes problems with our being able to come together and unify ourselves. I think tonight at this same time at * that they are having the conversation around the gay and straight issues and creating unity within our own community. (Participant 6)

What I am seeing is that all the men that come to my office all of them go to church but they are afraid to go to their pastors. All of them afraid to go to their elders, all of them afraid to go to their assistant pastors. So what is happening is . . . they are going to church and they are perceived as straight men and they are doing the things they are supposed to do but if we can get to the point where we can take the rumors out of the church and then put it in our community. (Participant 23)

It blows my mind the number of churches in this community that have an HIV ministry that is doing nothing, that pack a lunch or bring a lunch over and that’s it. That’s it! I mean when it really comes to meeting people where they are we won’t because we are afraid that 1st we gonna get dirty, 2nd well, they need prayer anyway, 3rd they need to get fixed and 4th if they wasn’t gay or if they hadn’t have been doing that nasty stuff they wouldn’t have gotten it anyhow. So we still come with this almost super pseudo, a over b, I’m better than you let me pray for you mentality. (Participant 6)

Church-Based Health-Promotion Program

The next aim of this research focused on whether participants overall were accepting of a multiple health problems approach. Participants provided several comments regarding the utilization of the church and its leaders as health promotion channels. Specifically, participants indicated that the Black church, with appropriate leadership and health literacy awareness building, could be a resource for a number of health promotion and health information dissemination activities. Participants further endorsed the church as a necessary health promotion partner in the following statements:

I definitely think that it [church] should be the center for getting it [health promotion information] out there via the radio stations and just letting people look at how it’s affecting them. (Participant 5)

If we start at our churches and build from there, go to our schools we will be covering the African American and will be targeting the African American community which you know has the highest death rate. (Participant 34)

I went to all the minister conferences and Black churches trying to get them rallied up to do some HIV awareness in the Black church. Now do you know these pastors don’t support it. Now I do not argue with the pastor because it’s their house. They do what they want in their house. I am letting the members know, you are the member. Talk to your pastor. I tell my clients, go to your pastor, say look, how do you support HIV/AIDS. (Participant 23)

Discussion

This study represents one of the first efforts to convene Black males focusing on multiple disease states in the context of a church setting. Results from the forum identified several barriers related to health beliefs, benefits, and barriers influencing Black males’ lay health perspectives. In addition, participants endorsed church-based health promotion programs as vital to their future health engagement activities. Furthermore, participants voiced a need for church-connected health programs that are inclusive and willing to create a nonjudgmental atmosphere for gay identified men who have sex with men (MSM) and straight identified MSM.

Beliefs and Benefits

There was agreement among participants that Black males lack awareness around chronic disease that influences their perceived susceptibility and severity to these diseases. Lack of awareness influenced their opinion about their chances of getting a certain disease as well as the severity of that disease. These findings support one study involving a small sample of Black males, where perceived risk for prostate cancer was lowest among males having low prostate cancer literacy and lack of exposure to people diagnosed with this condition (Richardson, Webster, & Fields, 2004). Other studies, however, have demonstrated that having a family history of the disease does not always increase a person’s perceived susceptibility to that disease (Bloom, Stewart, Oakley-Girvans, Banks, & Chang, 2006). Our study findings suggest that having a family member or close friend with chronic health problems was a factor increasing their perceived susceptibility and cue to action for seeking preventive care measures.

Another theme influencing participants’ perceived susceptibility and perceived benefits of taking advised actions toward chronic disease was health and health care fatalism. More specifically, there was a belief among our participants that Black males are going to die from chronic diseases regardless of their actions. The assumption that health is dependent on fate was also seen in past research about Black health behaviors (Kemppainen, Kim-Godwin, Reynolds, & Spencer, 2008; Lewis & Green, 2000; Powe, 1996). With regard to susceptibility, a fatalistic mindset seems to decrease an individuals’ sense of personal control over chronic disease. Therefore, it seems that there needs to be a shift in the way Black males think about their susceptibility to chronic diseases for them to feel empowered about influencing their health outcomes.

Threats and Barriers

The most prominent threats and barriers discussed by participants revolved around fear and anxiety of academic–medical setting, hyperactive masculinity fatigue, and the gay–straight divide. During our forum, historical accounts of biomedical research, such as the Tuskegee experiment; a level of apprehension around health care providers; and Black males’ views about doctor’s lack of empathy were all major underlying barriers to their health. Mistrust in the medical setting and a lack of Black doctors were also indicated as underlying barriers to preventive care (Hammond, 2010; Odedina et al., 2004). This seems to suggest that communication issues between Black males and their health care providers, exploitative community engagement research practices, and underrepresentation of Black males in the health professions are all issues that need to be addressed. Therefore, it seems plausible that increasing cultural competency, addressing the community’s perception of community-based participatory research, recruitment of minority male health professions, and emphasizing policies supporting the promotion of diversity in research would serve as important factors when taking these issues into consideration.

Hypermasculinity fatigue was another major concern distracting Black males from engaging in prevention, screening, and treatment of chronic diseases. Prostate cancer research has examined the intersection of disease care decisions, ethnicity, and masculinity (Blocker et al., 2006; Broom, 2004; Odedina et al., 2004; Galdas, Cheater, & Marshall, 2005). In the cardiovascular disease literature, Black male’s concern for their masculinity, or macho appearance, influenced their decisions to not seek aid for managing high blood pressure (Rose, Kim, Dennison, & Hill, 2000). Among White men, the research suggests that higher job status is linked to stronger masculinity beliefs and a reduction in preventive care seeking (Springer & Mouzon, 2009). This literature is emphasized to denote the importance of dealing with the psychological barriers keeping Black males from seeking preventive health care. Therefore, it seems that engaging Black males to share their common health issues with each other would place them a step closer to addressing hypermasculinity. However, this is not yet known.

Strengths and Limitations

Overall, the strengths of this study were the following: our community engagement approach to develop the forum, a focus on multiple disease states, and a utilization of lay health perspectives as a strategy for eliciting input from Black males. Furthermore, participants were able to provide their insider views and detailed comments on forum topics, which enriched our data and results. This study’s limitations were similar to those found in other qualitative research. First, the findings may not be generalized to the entire Black community since forum participants were recruited within a small geographical area. Data were not collected on socioeconomic status. Thus, we were unable to examine how the HBM and the five prominent themes were patterned by socioeconomic status. As this was a forum and open to the public, a convenience sampling strategy was most appropriate. In comparison to probability sampling techniques, the convenience sampling was most advantageous in achieving an inclusive sample of participants from which to elicit information on the range of context germane to this study investigation. For so-called hard to reach populations, a convenience sampling technique is helpful in gathering useful data and information that may not be possible using probability sampling techniques. However, a convenience sample can suffer from a number of biases. For example, our sample may overestimate the willingness of Black males to talk openly about their health and well-being in a forum-type setting. Also, the findings may only reflect the attitudes and beliefs of Black males who are interested in learning more about improving their health. Second, participants were not compensated for participation, which could have narrowed acquired results to a representation of viewpoints from a sample of Black males already motivated to take initiatives toward improving their health, such as community leaders rather than a random representation of Black males with varying degrees of motivation toward their health. It is clear from this research that we must become more socially conscious about the socioecological realities in which Black males find themselves.

Future research will want to consider the influences of the socioecological perspective on how to improve community engagement practices for convening Black males to take health action, with particular attention to how individual factors, contextual, and sociohistorical conditions interactively influence health behavior change action potential. In contrast to the individual-centered approach nested in the HBM, the socioecological approach recognizes people in the context of their sociocultural environment, ranging from family and social network dynamics to social institutions and policy at the local, state, and national levels. The socioecological model could be used to address their intrapersonal experiences, interpersonal processes, organizational structures, community standards, as well as their positive and negative experiences with public policy (DiClemente, Salazar, Crosby, & Rosenthal, 2005; Harburg et al., 1973; King et al., 2010; Robinson, 2008). Despite the study limitations, this study fills a gap in addressing the health of Black males and represents one of the few investigations targeting Black males’ lay health perspectives across multiple health conditions. It is plausible that the findings reported from this research are reflective of a number of contextual and sociohistorical factors. For instance, determining what percentage of the sample was native to North Carolina would have been helpful. Such knowledge could have been used to give insight into how similar studies performed in a different urban area may differ from our study sample. It would have been beneficial to have debriefed with each forum participant to deepen our understanding as it related to their individual experiences and exposure to social structure and social patterns of health and illness. For instance, the complexity of segregation and the broader social forces that affect individuals’ experiences of health and illness may have unique meaning for conducting the type of research proposed in the southeastern part of the United States.

Conclusion

The information gleaned from exploring Black males’ lay health perspective in the context of multiple health problems (i.e., syndemics) provided new insights from Black males’ points of view. As Black males are recruited to be engaged in behavioral- and community-level interventions, program evaluation will be essential in determining how and to what extent interventions are working. Our initial findings and lessons learned could lead to the development of effective health promotion strategies focused on getting Black men involved in prevention, treatment, and research activities. At the center of our findings is the discovery of a mental and emotional drain likely associated with the daily hassles of struggling to remain hopeful while confronting multiple health-related problems. This description was framed during the forum as evidence of a Tired Black Male Health syndrome. This syndrome seems to be attached to physical energy balance, self-image disregulation, emotional vulnerability, medical mistrust, and cognitive–emotional chronic disease desensitization that seek to establish health and wellness priorities once social concerns are addressed. As a form of defensive responsiveness and fatigue, Tired Black Male Health syndrome may be misinterpreted by providers, researchers, and policy makers as a state of health apathy that could be used as justification for explaining the low involvement of Black males in health research, particularly in clinical trials research.

There is a critical need to study and understand the full implications of Tired Black Male Health syndrome. A relevant question for future research is how might prevention and intervention programs work to address chronic disease desensitization, particularly in the areas of type 2 diabetes, cardiovascular disease, and stroke. Further exploration surrounding the determinants of Tired Black Male Health syndrome can help providers, researchers, and policy makers readdress long-held beliefs concerning Black male involvement in health promotion and preventive health behavior change. Without a doubt, there is a pressing need to foster a more supportive atmosphere for Black males to explore the ramifications for health behavior practices and lifestyle decision making. As community health practitioner, scholars, researchers, and policy makers are moving forward to engage Black men in health-related research, the pathway to successful engagement will benefit from exploring social factors predictive of health and health care disparities. More research is needed to further clarify effective strategies for improving proactive preventative health self-management among Black males.

Taken together, the persistent biopsychosocial disparities faced by Black males suggest an ongoing need and priority for community outreach, research, and education efforts focused on Black males. Toward extending this preliminary research, researchers will want to consider how to reach a multiethnic group of males. Such a pursuit may benefit from considering the value and impact of strengthening and mobilize relationships with churches, community health centers, and other social service supporting organizations in their community. This strategy could ensure outreach to a wider audience. For instance, gathering data to compare and contrast lay health perspectives among Black males and Latino males would be helpful in promoting responsive translational research and community outreach. The development of a structured system to increase participation of community members may entail the creation of a database of potential participants, identification of fruitful venues for recruitment of study participants, and promotion of pertinent research studies as a health literacy enhancement strategy. Future research is needed to measure whether a more diversified audience of Black males were equally responsive to community forum engagement. Beyond Black males, we need to determine if the church-based setting is conducive for increasing outreach to Latino males.

Last, fully integrating Black males into biomedical-related research would establish a necessary foundation for finally translating programs that have received federal support into communities of Black males. Once Black males are integrated into the research enterprise, they will enhance our biopsychosocial understandings by demonstrating improved health decision making, health promotion, and community outreach accessibility while informing health promotion and risk reduction policy advocacy.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Adler

N. E.

Rehkopf

D. H.

(2008). U.S. disparities in health: descriptions, causes, and mechanisms. Annual Review of Public Health, 29, 235-252.

Becker

M. H.

(1974). The health belief model and personal health behavior. Health Education Monographs, 2(4).

Blocker

D. E.

Romocki

L. S.

Thomas

K. B.

Jones

B. L.

Jackson

E. J.

Reid

Campbell

M. K.

(2006). Knowledge, beliefs and barriers associated with prostate cancer prevention and screening behaviors among African- American men. Journal of the National Medical Association, 98, 1286-1295.

Bloom

J. R.

Stewart

S. L.

Oakley-Girvans

Banks

P. J.

Chang

(2006). Family history, perceived risk, and prostate cancer screening among African American men. Cancer Epidemiology Biomarkers & Prevention, 15, 2167-2173.

Bobak

Pikhart

Rose

Hertzman

Marmot

(2000). Socioeconomic factors, material inequalities, and perceived control in self-rated health: Cross-sectional data from seven post-communist countries. Social Science & Medicine, 51, 1343-1350.

Broom

(2004). Prostate cancer and masculinity in Australian society: A case of stolen identity? International Journal of Men’s Health, 3, 73-91.

Centers for Disease Control and Prevention. (2009). Fact sheet: HIV/AIDS among African Americans. Retrieved from http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm

Cooper

L. A.

Roter

D. L.

Johnson

R. L.

Ford

D. E.

Steinwachs

D. M.

Powe

N. R.

(2003). Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine, 139, 907-915.

Crawford

E. D.

(2009). Understanding the epidemiology, natural history, and key pathways involved in prostate cancer. Urology, 73(Suppl 1), S4-S10.

10.

DiClemente

R. J.

Salazar

L. F.

Crosby

R. A.

Rosenthal

S. L.

(2005). Prevention and control of sexually transmitted infections among adolescents: The importance of a socio-ecological perspective—A commentary. Public Health, 119, 825-836.

11.

Downey

L. H.

Cuy Castellanos

Yadrick

Avis-Williams

Graham-Kresge

Bogle

(2010). Perceptions of community-based participatory research in the Delta Nutrition Intervention Research Initiative: An academic perspective. Health Promotion Practice. Advance online publication. 10.1177/152483990935374310.1177/1524839909353743

12.

Galdas

P. M.

Cheater

Marshall

(2005). Men and health help-seeking behaviour: Literature review. Journal of Advanced Nursing, 49, 616-623.

13.

Hammond

(2010). Psychosocial correlates of medical mistrust among African American men. American Journal of Community Psychology, 45, 87-106.

14.

Harburg

Erfurt

John

Hauenstein

L. S.

Chape

Schull

W. J.

Schork

M. A.

(1973). Socio-ecological stress, suppressed hostility, skin color, and black-white male blood pressure: Detroit. Psychosomatic Medicine, 35, 276-296.

15.

Harper

Lynch

Burris

Davey Smith

(2007). Trends in the Black-White life expectancy gap in the United States, 1983-2003. Journal of the American Medical Association, 297, 1224-1232.

16.

Henshaw

E. J.

Freedman-Doan

C. R.

(2009). Conceptualizing mental health care utilization using the health belief model. Clinical Psychology: Science and Practice, 16, 420-439.

17.

Holt

C. L.

Shipp

Eloubeidi

Clay

K. S.

Smith-Janas

M. A.

Janas

M. J.

Fouad

M. N.

(2009). Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies. Health Education Research, 24, 876-889.

18.

Horowitz

C. R.

Goldfinger

J. Z.

Muller

S. E.

Pulichino

R. S.

Vance

T. L.

Arniella

Lancaster

K. J.

(2008). A model for using community-based participatory research to address the diabetes epidemic in east Harlem. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 75(1), 13-21.

19.

Horowitz

C. R.

Robinson

Seifer

(2009). Community- based participatory research from the margin to the mainstream: Are researchers prepared? Circulation, 119, 2633-2642.

20.

Jackson

E. J.

Parks

C. P.

(1997). Recruitment and training issues from selected lay health advisor programs among African Americans: A 20-year perspective. Health Education & Behavior, 24, 418-431.

21.

Jemal

Siegel

Ward

Murray

Thun

M. J.

(2007). Cancer statistics, 2007. CA: A Cancer Journal for Clinicians, 57, 43-66.

22.

Kasckow

Ingram

Brown

Tew

J. D.

Conner

K. O.

Morse

J. Q.

Oslin

D. W.

(2011). Differences in treatment attitudes between depressed African-American and Caucasian veterans in primary care. Psychiatric Services, 62, 426-429.

23.

Kemppainen

Kim-Godwin

Y. S.

Reynolds

N. R.

Spencer

V. S.

(2008). Beliefs about HIV disease and medication adherence in persons living with HIV/AIDS in rural southeastern North Carolina. Journal of the Association of Nurses in AIDS care, 19, 127-136.

24.

Kieffer

E. C.

Sinco

B. R.

Rafferty

Spencer

M. S.

Palmisano

Watt

E. E.

Heisler

(2006). Chronic disease-related behaviors and health among African Americans and Hispanics in the REACH Detroit 2010 communities, Michigan, and the United States. Health Promotion Practice, 7(Suppl. 3), 256S-264S.

25.

King

D. K.

Glasgow

R. E.

Toobert

D. J.

Strycker

L. A.

Estabrooks

P. A.

Osuna

Faber

A. J.

(2010). Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care, 33, 751-753.

26.

Kumar

Schlundt

D. G.

Wallston

K. A.

(2009). Patient-physician race concordance and its relationship to perceived health outcomes. Ethnicity & Disease, 19, 345-351.

27.

LaVeist

T. A.

Nuru-Jeter

(2002). Is Doctor-patient race concordance associated with greater satisfaction with care? Journal of Health and Social Behavior, 43, 296-306.

28.

Lewis

R. K.

Green

B. L.

(2000). Assessing the health attitudes, beliefs, and behaviors of African Americans attending church: A comparison from two communities. Journal of Community Health, 25, 211-224.

29.

Lloyd-Jones

Adams

R. J.

Brown

T. M.

Carnethon

Dai

De Simone

American Heart Association Statistics Committee and Stroke Statistics Subcommittee. (2010). Heart disease and stroke statistics—2010 update: A report from the American Heart Association. Circulation, 121, e46-e215.

30.

Marmot

(2001). Inequalities in health. New England Journal of Medicine, 345, 134-136.

31.

Maty

S. C.

James

S. A.

Kaplan

G. A.

(2010). Life-course socioeconomic position and incidence of diabetes mellitus among Blacks and Whites: The Alameda County study, 1965-1999. American Journal of Public Health, 100, 137-145.

32.

Mosenifar

(2007). Population issues in clinical trials. Proceedings of the American Thoracic Society, 4, 185-188.

33.

Murray

C. J. L.

Kulkarni

S. C.

Michaud

Tomijima

Bulzacchelli

M. T.

Iandiorio

T. J.

Ezzati

(2006). Eight Americas: Investigating mortality disparities across races, counties, and race—Counties in the United States. PLoS Medicine, 3, e260.

34.

Odedina

F. T.

Scrivens

Emanuel

LaRose-Pierre

Brown

Nash

(2004). A focus group study of factors influencing African-American men’s prostate cancer screening behavior. Journal of the National Medical Association, 96, 780-788.

35.

Plowden

(1999). Using the health belief model in understanding prostate cancer in African American men. ABNF Journal: Official Journal of the Association of Black Nursing Faculty in Higher Education, 10(1), 4-8.

36.

Plowden

(2003). A theoretical approach to understanding Black men’s health-seeking behavior. Journal of Theory Construction and Testing. Retrieved from http://www.allbusiness.com/professional-scientific/scientific-research/5972971.html

37.

Powe

B. D.

(1996). Cancer fatalism among African-Americans: A review of the literature. Nursing Outlook, 44(1), 18-21.

38.

Powell

I. J.

Bock

C. H.

Ruterbusch

J. J.

Sakr

(2010). Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in Black than in White American men, and influences racial progression and mortality disparity. Journal of Urology, 183, 1792-1797.

39.

Price-Haywood

Roth

Shelby

Cooper

(2010). Cancer risk communication with low health literacy patients: a continuing medical education program. Journal of General Internal Medicine, 25, 126-129.

40.

Richardson

J. T.

Webster

J. D.

Fields

N. J.

(2004). Uncovering myths and transforming realities among low-SES African-American men: Implications for reducing prostate cancer disparities. Journal of the National Medical Association, 96, 1295-1302.

41.

Robinson

(2008). Applying the socio-ecological model to improving fruit and vegetable intake among low-income African Americans. Journal of Community Health, 33, 395-406.

42.

Rosamond

Flegal

Furie

Greenlund

Haase

American Heart Association Statistics Committee and Stroke Statistics Subcommittee. (2008). Heart disease and stroke statistics—2008 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 117, e25-e146.

43.

Rose

L. E.

Kim

M. T.

Dennison

C. R.

Hill

M. N.

(2000). The contexts of adherence for African Americans with high blood pressure. Journal of Advanced Nursing, 32, 587-594.

44.

Rosenstock

(1974). Historical origins of the health belief model. Health Education Monographs, 2(4).

45.

Singer

(2009). Introduction to syndemics: A critical systems approach to public and community health (1st ed.). San Francisco, CA: Jossey-Bass.

46.

Springer

K. W.

Mouzon

D. M.

(2009). Masculinity and health care seeking among midlife men: Variation by adult socioeconomic status. Paper presented at the American Sociological Association Annual Meeting.

47.

Steele

Miller

Maylahn

Uhler

Baker

(2000). Knowledge, attitudes, and screening practices among older men regarding prostate cancer. American Journal of Public Health, 90, 1595-1600.

48.

Sutton

M. Y.

Jones

R. L.

Wolitski

R. J.

Cleveland

J. C.

Dean

H. D.

Fenton

K. A.

(2009). A review of the Centers for Disease Control and Prevention’s response to the HIV/AIDS crisis among Blacks in the United States, 1981-2009. American Journal of Public Health, 99(Suppl 2), S351-S359.

49.

Vermeer

Bos

A. E. R.

Mbwambo

Kaaya

Schaalma

H. P.

(2009). Social and cognitive variables predicting voluntary HIV counseling and testing among Tanzanian medical students. Patient Education and Counseling, 75(1), 135-140.

50.

Wilson

T. E.

Fraser-White

Feldman

Homel

Wright

King

Browne

(2008). Hair salon stylists as breast cancer prevention lay health advisors for African American and Afro-Caribbean women. Journal of Health Care for the Poor and Underserved, 19, 216-226.

Preliminary Findings Exploring the Social Determinants of Black Males’ Lay Health Perspectives

Abstract

Keywords

Theoretical Paradigm: Health Belief Model

Method

Setting and Participants

Procedure

Analysis

Results

Lack of Chronic Disease Awareness

Fatalism

Fear and Anxiety of the Academic–Medical Setting

Hypermasculinity Fatigue

The Gay–Straight Divide

Church-Based Health-Promotion Program

Discussion

Beliefs and Benefits

Threats and Barriers

Strengths and Limitations

Conclusion

Footnotes

References