Among adults, men are least likely to use preventive health services,1–3
often delaying blood pressure (BP) and cholesterol screenings and routine check-ups, waiting longer after symptom onset before seeking care, and underutilizing clinically appropriate health services.2,4,5
How such underuse of preventive services impacts men’s health is not fully understood. Yet this underuse coincides with shorter life spans and more preventable deaths among men than women.
Compared to non-Hispanic White men, African-American men attend fewer preventive health visits, are less likely to know their cholesterol levels, have poorer BP control, and face greater morbidity and premature mortality from conditions amenable to early interventions.6–11
African-American men also experience earlier onset and higher death rates from heart disease8,12
and cancers detectable through screening,13,14
and often first present with conditions at more advanced stages.15,16
Recent data suggest the Black-White life-expectancy gap has narrowed,17
yet African-American men’s life-expectancy still lags behind non-Hispanic White women (11.3 years), African-American women (6.8 years), and non-Hispanic White men (6.2 years).18
Timely receipt of preventive health services may reduce this gap.
Studies of African-American men’s preventive health services utilization, primarily qualitative, attribute underutilization to fatalism,19
limited health knowledge or awareness,21
Well-established healthcare utilization models suggest psychosocial factors work with socioeconomic and insurance-related determinants to produce such delays.24,25
The contribution of psychosocial factors is less understood. Quantitative analyses could illuminate these factors while informing development of culturally-relevant clinical and community-based interventions. We focused on two specific psychosocial factors relevant to African-American men’s preventive health services delays: masculinity and medical mistrust.
Previous research links masculinity to men’s mortality, health behavior, and healthcare use26–29
and medical mistrust to African-Americans' use of preventive health services.30,31
Researchers speculate that men delay using preventive health services because of traditional social constructions of masculinity, which prescribe extreme self-reliance, stoicism, and healthcare avoidance for men.27,32,33
Indeed, men who endorse more traditional masculine norms underutilize healthcare.26,29,34,35
Masculinity that manifests as “unmitigated agency” or extreme self-reliance is related to poor health behaviors,36
longer delays in seeking help for a heart attack,35
and noncompliance with physicians’ recommendations.35
Our study focuses on the contribution of traditional masculinity norms around self-reliance to African-American men’s preventive health services delays.
Men’s enactment of masculinity in a healthcare-seeking context varies according to their race and social location, since how men display masculinity depends on how much social power they hold.27
Theorists differ over how masculinity impacts African-American men’s healthcare use, largely because this group has experienced socioeconomic challenges (e.g., joblessness) to fulfilling traditional male provider role expectations37,38
and defines masculinity differently than non-Hispanic White men.39
Some argue that since African-American men hold relatively lower social positions, they may delay healthcare utilization to symbolically exercise masculine dominion over their bodies.27,40,41
Others posit that barriers to traditional male role fulfillment encourage African-American men to reject traditional masculinity, and adopt patterns of healthcare use that contradict dominant male behavioral norms.42–45
African-American men’s enactment of masculinity while seeking healthcare might also depend on how they prioritize traditional male norms. Theorists46
suggest that African-American men must attach a high degree of importance, or salience, to such norms before behavioral by-products of masculinity (i.e., healthcare seeking delays) manifest. Considering masculinity salience permits a more thorough assessment of African-American men’s commitment to traditional masculinity norms.47
Researchers rarely assess both the endorsement of masculinity norms and
the degree of salience attributed to such norms. We address this oversight in the current study.
Empiric research on health care utilization in African-American men has been limited. Prior research has been in populations with limited diversity, treats masculinity as a stable personality or biological characteristic, and rarely considers potential contributions of race and
These constructs, moreover, should be yoked with the role of medical mistrust, which is higher among African-Americans,48
is linked to visible incidents of race-based medical malice towards this group (e.g., the Tuskegee Study of Untreated Syphilis in the Negro Male),49
and is partly a consequence of traditional masculine beliefs.22,50
Strict interpretations of U.S. Preventive Services Task Force (USPSTF) screening guidelines51
and younger adults’ relatively healthy status have also led to a focus on preventive health services among middle-aged and older populations. This focus neglects emergent life-course perspectives52,53
and African-American men’s shorter lifespan and earlier onset of chronic conditions.12,54
Finally, nationally representative datasets rarely include measures assessing social constructions of masculinity and
medical mistrust. Thus, we investigate the role of masculinity and medical mistrust in preventive health services delays among a community-based sample of African-American men.