title: Barriers and facilitators to digital rectal examination screening among African-American and African-Caribbean men.
abstract: OBJECTIVE
  To examine the effect of race/ethnicity and fear characteristics on the initiation and maintenance of digital rectal examination (DRE) screening.
  
  
  METHODS
  A total of 533 men from Brooklyn, New York, aged 45-70 years, were classified into 4 race/ethnic groups: U.S.-born whites, U.S.-born African-American, Jamaican, and Trinidadian/Tobagonian. The participants recorded the number of DREs in the past 10 years. The demographics and structural variables and prostate cancer worry and screening fear were measured using validated tools.
  
  
  RESULTS
  Overall, 30% of subjects reported never having a DRE, and 24% reported annual DREs. African-American, Jamaican, and Trinidadian/Tobagonian men had greater prostate cancer worry and screening fear scores than did the white men (all P < .05). African-American, Jamaican, and Trinidadian/Tobagonian men were less likely to maintain annual DREs than white men (odds ratio 0.17, 0.26, and 0.16, respectively, all P < .05). The men with low screening fear were more likely to have had an initial DRE (OR 2.3, P < .05 vs high screening fear) but were no more or less likely to undergo annual DREs. Having a regular physician, comprehensive physician discussion, and annual visits were also associated with undergoing DREs.
  
  
  CONCLUSIONS
  We identified several ethnically varying barriers and facilitators to DRE screening. African-American and African-Caribbean men undergo DRE less often and have greater prostate cancer worry and screening fear scores than did white men. Screening fear predicts the likelihood of undergoing an initial, but not annual, DRE screening. Access to a physician and annual visits facilitate DRE screening. Interventions that include both culturally sensitive education and patient navigation and considered whether patients should be initiating or maintaining screening might facilitate guideline-consistent screening.
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. Daniel.Lee@hsc.stonybrook.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lee
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Consedine
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Spencer
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data*; D051517:Digital Rectal Examination / Q000523:psychology* / Q000706:statistics & numerical data; D005239:Fear; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D014900:West Indies / Q000208:ethnology