The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries

Mohammad Khalid Hararah, Craig Evan Pollack, Mary A. Garza, Hsin Chieh Yeh, Diane Markakis, Darcy F. Phelan-Emrick, Jennifer Wenzel, Gary R. Shapiro, Lee Bone, Lawrence Johnson, Jean G. Ford

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


PURPOSE: 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.

CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)176-183
Number of pages8
JournalJournal of Racial and Ethnic Health Disparities
Issue number2
StatePublished - Jun 1 2015


  • Cancer screening: African American
  • Education
  • Prostate cancer
  • Prostate-specific antigen
  • Socioeconomic status

ASJC Scopus subject areas

  • Health(social science)
  • Anthropology
  • Sociology and Political Science
  • Health Policy
  • Public Health, Environmental and Occupational Health


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