title: Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men.
abstract: 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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors: Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA. wizdom.powell@unc.edu
authors: Wizdom Powell
authors: WP
authors: Hammond
authors: Derrick
authors: D
authors: Matthews
authors: Dinushika
authors: D
authors: Mohottige
authors: Amma
authors: A
authors: Agyemang
authors: Giselle
authors: G
authors: Corbie-Smith
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology* / Q000523:psychology*; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D057228:Masculinity; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011314:Preventive Health Services; D012111:Residence Characteristics; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult