title: Prostate cancer screening and health care system distrust in Philadelphia.
abstract: OBJECTIVE
  We aim to examine whether distrust of health care system (hereafter distrust) is associated with prostate cancer screening and whether different dimensions of distrust demonstrate similar relationships with prostate cancer screening.
  
  
  METHODS
  With data on 1,784 men aged 45 to 75 from the Philadelphia metropolitan area, we first applied factor analysis to generate factor scores capturing two distrust subscales: competence and values. We then implemented logistic regressions to estimate the relationships between distrust and prostate cancer screening, controlling for covariates related to demographics (e.g., race and age), socioeconomic status (e.g., poverty status and education), health care resources (e.g., insurance status), and health status (i.e., self-rated health).
  
  
  RESULTS
  Without considering any other covariates, both competence and values distrust were negatively associated to the receipt of prostate cancer screening. After accounting for other covariates shown above, values distrust remained negatively associated with the odds of receiving prostate cancer screening (OR = 0.89, 95% CI [0.81, 0.98]) but competence distrust was not a significant predictor.
  
  
  CONCLUSIONS
  Values distrust was independently associated with prostate cancer screening. Macro-level change in the health care system may influence men's health behaviors. Our findings suggested that efforts to make the health care system more transparent and enhanced communications between men and health providers may facilitate prostate cancer screening.
authors.affiliation: Department of Sociology, Center for Social & Demographic Analysis, University at Albany, State University of New York, USA. tsechuan.yang@gmail.com
authors.forename: Tse-Chuan
authors.initials: TC
authors.lastname: Yang
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Matthews
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
mesh_terms: D000368:Aged; D001294:Attitude to Health; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011471:Prostatic Neoplasms / Q000517:prevention & control*; D012959:Socioeconomic Factors; D035502:Trust
keywords: Philadelphia; health care system distrust; prostate cancer screening