title: The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries.
abstract: OBJECTIVE
  We examined the association between socioeconomic status (SES) and prostate-specific antigen (PSA) cancer screening among older African American men.
  
  
  METHODS
  We analyzed baseline data from a sample of 485 community-dwelling African American men who participated in the Cancer Prevention and Treatment Demonstration Trial. The outcome was receipt of PSA screening within the past year. SES was measured using income and educational attainment. Sequential multivariate logistic regression models were performed to study whether health care access, patient-provider relationship, and cancer fatalism mediated the relationship between SES and PSA screening.
  
  
  RESULTS
  Higher educational attainment was significantly associated with higher odds of PSA screening in the past year (odds ratio (OR) 2.08 for college graduate compared to less than high school graduate, 95 % confidence interval (CI) 1.03-4.24); income was not. Health care access and patient-provider communication did not alter the relationship between education and screening; however, beliefs regarding cancer fatalism partially mediated the observed relationship.
  
  
  CONCLUSIONS
  Rates of prostate cancer screening among African American men vary by level of educational attainment; beliefs concerning cancer fatalism help explain this gradient. Understanding the determinants of cancer fatalism is a critical next step in building interventions that seek to ensure equitable access to prostate cancer screening.
authors: University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA. hararah@wisc.edu.
authors: Mohammad Khalid
authors: MK
authors: Hararah
authors: Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. cpollac2@jhmi.edu.
authors: Craig Evan
authors: CE
authors: Pollack
authors: Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA.
authors: Mary A
authors: MA
authors: Garza
authors: Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. hyeh1@jhmi.edu.
authors: Hsin-Chieh
authors: HC
authors: Yeh
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. dmarkak1@jhmi.edu.
authors: Diane
authors: D
authors: Markakis
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Darcy F
authors: DF
authors: Phelan-Emrick
authors: Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA. jwenzel@jhu.edu.
authors: Jennifer
authors: J
authors: Wenzel
authors: Health Partners Cancer Program and Institute for Education and Research, Minneapolis, MN, USA. grshapiro@gmail.com.|Institute for Advanced Studies in Aging (IASIA), Falls Church, VA, USA. grshapiro@gmail.com.
authors: Gary R
authors: GR
authors: Shapiro
authors: Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. lbone@jhsph.edu.
authors: Lee
authors: L
authors: Bone
authors: Park West Health Systems, Baltimore, MD, USA.
authors: Lawrence
authors: L
authors: Johnson
authors: Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA. jgf9001@nyp.org.
authors: Jean G
authors: JG
authors: Ford
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004522:Educational Status; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000208:ethnology / Q000517:prevention & control; D012923:Social Class; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Cancer screening: African American; Education; Prostate cancer; Prostate-specific antigen; Socioeconomic status