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Jessica Krug maintained her masquerade by appealing to the worst Hollywood stereotypes about people of color. L ast week the historian Jessica Krug confessed that she had spent years engaged in a racial masquerade, taking on a North African, Black American, and later a Black Caribbean identity when she was in fact a white Jewish woman from Kansas City.


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Metrics details. Health disparities in prostate cancer PC are thought to reflect the complex interplay of socioeconomics, environment and biology. The potential impact of beliefs and perceptions about PC among Black and Latino populations on clinical disparities are not well understood.

This qualitative study was conducted to assess current prevalent and pervasive stigma, beliefs and perceptions regarding PC among Blacks and Latinos living in a large metropolitan area, thereby identifying potentially modifiable barriers to care. Qualitative data were collected through four separate focus groups of self-identified Black and Latino adult men and women living in Philadelphia to better understand their perceptions of PC diagnosis, screening and treatment.

Audio recordings were transcribed verbatim by trained research assistants and qualitative data analysis was conducted using modified grounded theory. Median age was 57 years range: 18 to 85 years. While the majority of participants acknowledged the importance of PC screening and early detection, discussion centered around the barriers to both the interest in seeking medical care and the likelihood of securing it.

Men expressed substantial confusion about PC screening guidelines.

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In the Black female group, the role of faith and religion in the course of disease was a major theme. Both Black and Latina females discussed the role of fear and avoidance around PC screening and treatment, as well as the prevalence of misinformation about PC in their familial and social communities. Black and Latino focus groups revealed the existence of cultural beliefs, misunderstandings and fears pertaining to PC which could influence health-related behaviors.

Some themes were common across groups; others suggested racial and gender predilections. Future targeted efforts focused on directly addressing prevalent misperceptions among underserved communities in urban settings could help to improve health literacy and equity in PC outcomes in these populations. Peer Review reports. Prostate cancer PC is the most prevalent non-skin malignancy and the third most common cause of cancer death in American men, with roughly one in ten men diagnosed with PC during their lifetime [ 1 ].


It has long been established that Black men are also more likely to develop cancer at a younger age and to present with high-grade, high-risk prostate adenocarcinoma [ 3 ]. Although this increased PC incidence and aggressiveness has not been documented in Latino men, PC is still the most commonly diagnosed male cancer in the Latino population [ 24 ]. Latinos are in turn recognized as the largest and most rapidly growing minority group in the United States US [ 5 ].

Although a hereditary predisposition has been suggested by the identification of several genetic variants in Black and Hispanic men that confer an increased risk of PC incidence, the clinical utility of these markers remains under investigation given their absence in the majority of PC patients [ 6789 ]. While research to date has not clearly elucidated the biological mechanisms that underlie the disparate PC incidence and mortality rates observed in various subgroups, studies have consistently implicated the intricate contributory role of socioeconomic factors.

For example, members of ethnic minority groups in the US are the least likely to have insurance coverage [ 11 ], often due to un- or underemployment. Limited access to healthcare contributes to lower rates of PC screening, more advanced stage of disease at diagnosis, and ultimately higher mortality rates [ 11 ].

However, even with provision of better healthcare access, Blacks and Latinos, relative to Whites, face more challenging circumstances regarding social determinants of health, such as income and residence location [ 13 ]. Furthermore, for those men who are diagnosed and seeking consultation on treatment options, lower educational levels are associated with decreased use of strategies such as shared decision making, which can help patients better understand of their treatment options [ 14 ].

Delving into these issues further, there is extensive evidence documenting broad mistrust, fear, and generally negative opinions of healthcare providers among Blacks and Latinos [ 11151617181920 ]; lower rates of screening practices among minority populations relative to Whites are thus hardly surprising [ 21 ]. Additionally, minority group members are more likely than non-minority members to seek informal health advice from family members, friends, community centers, and churches, and often do not feel comfortable speaking with healthcare providers from different racial or ethnic groups [ 181922 ].

Feelings of fear and shame associated with a PC diagnosis further compound the issue of open communication with healthcare professionals, especially when a cancer that can affect physiological bowel, bladder and sexual function is involved [ 23 ]. When patients are uncomfortable talking about causes, symptoms, and side effects of PC, misinformation, misperceptions, and myths may be perpetuated.

In light of the above, researchers have long voiced the need for culturally-sensitive and diverse interventions to address these myths and underlying barriers, and to ultimately increase health-seeking behavior among these at-risk minority groups [ 24 ]. This study aimed to better characterize stigma, beliefs, and perceptions pertaining to PC among Black and Latino men and women residing in an urban community, thereby identifying potentially modifiable barriers to care.

Eligible participants were adult males and females aged 18 years or older who attended a large and diverse Center City Philadelphia church with predominantly Latino and Black membership. Inclusion criteria included identifying as Latino or Black, and not working in the medical field.

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People whose primary language was either English or Spanish were included. Women, even those without male partners, were eligible since their opinions are relevant to understanding the cultural beliefs and stigmas in the study population as a whole. Study staff recruited participants via advertising flyers and word-of-mouth, with permission from the church leaders. Given that this is a pilot study, we sought to have four groups to gather initial data on opinions, but not to reach saturation [ 27 ].

Separate focus groups sessions were held for males and females, and for Blacks and Latinos, for a total of four sessions. Each group was peer-led e. Each focus group was held on a Sunday afternoon in the church building following church services. Two trained research team members moderator and a note-taker conducted the focus group sessions.

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All moderators participated in an intensive two-day workshop focusing on effective communication skills and led by an experienced qualitative research team. For example, moderators learned how to handle dominant respondents as well as how to ask questions that would elicit the best quality responses without introducing bias.

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During focus groups, the moderator reminded participants that the sessions were voluntary, confidential, and would be audio recorded. The participants completed and provided written informed consent before the group discussion began and each focus group session lasted approximately 90 minutes. Lunch was provided to participants. All participants completed a brief survey about demographic characteristics and personal and immediate family history of cancer.

A four-part, semi-structured focus group guide was created to help direct the discussion. The first section included an explanation of the research and ground rules for the group. The second part asked general questions about health, such as current health practices, where respondents receive information about health, and when they visit healthcare professionals, while the third section focused more specifically on PC. Participants were then given forms with a series of statements about PC e.

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Confronting these statements allowed the participants to reflect on their opinions and this helped bring to mind what the participants thought about these issues. The focus group leaders then led the respondents through discussion on each of the topics. At the end of the group, participants were invited to ask questions about PC and share what they felt were the most important topics discussed during the group.

This final, closing segment of the group, after initial discussion had taken place, was primarily for participants to ask questions and did not provide the data analyzed below. Data analysis was conducted using modified grounded theory [ 30 ], in which thematic codes were developed both a priori from study research questions and the focus group guide Table 1 and de novo from the focus group transcripts Table 2.

A team of three study team members trained in qualitative analysis coded each transcript using NVivo11 [ 31 ] and met regularly to review emerging themes, ensure inter-rater reliability, and establish consensus on any discrepancies through coding comparison queries. Final coding comparison queries of the four transcripts showed no major discrepancies between coders. Codes were systematically ranked and used to develop key themes.

Two study team members examined relationships among and across codes to develop theories about emerging themes. The team recorded background survey data in a REDCap database and performed descriptive analyses.

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There were a total of 34 participants. The four groups ranged in size from participants. Ages ranged from 18 to 85 years, with a median age for all participants of 57 years and a mean of 52 years. Almost all participants For marital status, Six There was also a diverse report of working status. While four participants did not share their incomes, ten Black women reported the highest household incomes, with Participants were asked about their personal history of cancer, the history of cancer in any immediate blood relatives, whether they smoke, and, for men, whether they had ever been screened for PC.

The only other cancer family history commonly reported across all groups was colorectal cancer.

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All groups endorsed lifestyle as a risk factor for PC. Black men and women mentioned diet as a possible cause. Women both Latina and Black suggested that sexual activity was related to PC, with one Black woman speaking of masturbation and one Latina woman believing that PC is sexually transmissible.

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While there were members of all groups who endorsed non-white race and ethnicity as a risk factor for PC development, there were differing views on the reasons why Blacks and Latinos have higher rates of PC. Black women also discussed the role of diet in increasing or decreasing risk of PC, but did not link this to a difference in PC outcomes between racial and ethnic groups. Latino men see lifestyle factors as important in affecting the likelihood of getting cancer; some asserted that it matters more than race or ethnicity.

Latina women mentioned a good diet and exercise as ways to keep healthy in general but do not link the lifestyle factors to PC specifically. Members of all four groups endorsed the importance of screening for PC and its role in prevention. Nonetheless, both groups of men expressed incorrect facts regarding PC screening. Screening tests themselves were discussed, with Black men endorsing mistrust of PSA tests and a belief that they are unreliable, suggesting that there is a high likelihood of false positives.

Black men were also unsure about screening recommendations specifically, at what age to begin screening and whether screening can actually prevent PC rather than just detect it. Latino men were uncertain about whether the DRE is a screening test for PC or just a test for assessing the size of the prostate.

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Both of the Black groups endorsed misperceptions related to PC treatment and they disagreed about its curability. Specifically, Black men were unsure about what types of treatments are available and what side effects are associated with these treatments.

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Black women and men both spoke of cultural differences in healthcare-seeking behaviors. Specifically, Black men discussed historical mistreatment by medical professionals both as something they have experienced personally and as something that has happened to the Black community at large. Much differently.

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Cost is another issue that the focus group members mentioned. Black men and women and Latina women identified finances as a major barrier to healthcare seeking, particularly insurance coverage. Black women shared that providers can be a source of assistance around this issue.

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