Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men

Abstract

The contribution of medical mistrust to healthcare utilization delays has gained increased public health attention. However, few studies examine these associations among African-American men, who delay preventive healthcare more often and report higher levels of medical mistrust than non-Hispanic White men. Additionally, studies rarely account for other factors reportedly working in tandem with medical mistrust to increase African-American men’s preventive health screening delays (i.e., everyday racism and perceived racism in healthcare). We examined associations between medical mistrust, perceived racism in healthcare, everyday racism, and preventive health screening delays. Analyses were conducted using cross-sectional data from 610 African-American men aged 20 years and older recruited primarily from barbershops in four US regions (2003–2009). Independent variables were medical mistrust (MM), everyday racism (ER), and perceived racism in healthcare (PRH). Dependent variables were self-reported routine checkup, blood pressure screening, and cholesterol screening delays. Using multiple logistic regression and tests for mediation, we calculated odds ratios and 95% confidence intervals to assess associations between the independent and dependent variables. After final adjustment, African-American men with higher MM were significantly more likely to delay blood pressure screenings. Men with more frequent ER exposure were significantly more likely to delay routine checkups and blood pressure screenings. Higher levels of PRH were associated with a significant increased likelihood of delaying cholesterol screening. MM did not mediate associations between ER and screening delays. Increasing preventive health screening among African-American men requires addressing medical mistrust and racism in and outside healthcare institutions.

Keywords:

• African-American men
• medical mistrust
• preventive health screening delays
• racism

Acknowledgements

The first author wishes to thank faculty, student, and community members of the UNC Men's Health Research Lab: Yasmin Cole-Lewis, Travis Melvin, Justin Smith, Allison Mathews, Dr. Keon Gilbert, Melvin R. Muhammad, and Donald Parker for their assistance with data collection for the African-American Men's Health & Social Life Study. The first author also thanks Dr. Amani Nuru-Jeter, Keith Hermanstyne, and Adebiyi Adesina for their assistance with data collection and Dr. Emil Coman for statistical consultation.

Additional information

Funding

This research was supported by a Student Award Program award to the first author from the Blue Cross and Blue Shield of Michigan Foundation (Grant # 657.SAP), The Robert Wood Johnson Foundation Health & Society Scholars Program, and The University of North Carolina Cancer Research Fund. Additional research and salary support during the preparation of this manuscript was provided to the first author from the National Institutes of Drug Abuse (K01 DA032611), National Center for Minority Health and Health Disparities (Award # L60 MD010134). Support for Jennifer Richmond was provided by a grant from the Robert Wood Johnson Foundation Health Policy Research Scholars program (Grant Number 73921).