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Adherence to prostate cancer screening among older African American men, a population group at high risk for the disease, has been reported to be low. However, little is known about factors associated with adherence to screening or about effective approaches which may be used to increase screening in this high-risk group. The proposed study should result in an improved understanding of barriers to Screening among African American men and should also inform the future development and application of methods for increasing adherence to prostate cancer screening in this and other high-risk populations.

The proposed three-year study will be conducted by the Fox Chase Cancer Center together with the University of Chicago Urologic-Oncology Group (UOG) and the University of Chicago Health Service (UHS). Older (50 to 70 years of age) African American men will be offered two consecutive rounds of free screening (digital rectal examination (DRE) and prostate specific antigen (PSA) testing) at a one-year interval (i.e., serial screening). Initially, 715 subjects will be identified in the UHS patient population. A telephone survey will be administered to study subjects. Overall, we estimate that 500 (70%) subjects in the sample will complete the survey. Subjects who complete the survey will be randomly assigned either to a CONTROL GROUP (N=250) or TREATMENT GROUP (N=250). Ml of these individuals will be mailed a Screening invitation letter two months after being surveyed. CONTROL GROUP subjects will receive Normal Care. A letter will be mailed which invites them to schedule an appointment for free prostate screening offered at the UOG office. Subjects who contact the UOG will be given a time, date, and location for the screening examination. Screening results will be sent to the patient and his physician. TREATMENT GROUP subjects will receive Normal Care plus a set of behavioral interventions (i.e., an educational booklet (ProRecord), an instruction telephone call (ITC), and a mailed reminder letter (RL). Adherence will be defined as undergoing DRE and PSA testing within 90 days of the date on which the screening invitation letter was mailed. Screening results will be sent to each subject and his physician.

Descriptive analyses will serve to characterize study subjects in terms of sociodemographic background, medical history, risk factors, and knowledge, attitudes and beliefs (KABs) about prostate cancer and screening. Bivariate associations between these factors and adherence will be assessed. Finally, factors that are significantly associated (alpha=0.05) with adherence in will be used in multivariate analyses to identify independent predictors of adherence. As part of these analyses, the independent effect of subject exposure to the behavioral intervention will be evaluated.
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