ORCID ID
Graduation Date
Spring 5-10-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Programs
Health Promotion and Disease Prevention Research
First Advisor
Regina Ribbons
Abstract
African American men (AAM) experience the highest rates of prostate cancer (CaP) incidence and mortality in the United States. This three-manuscript dissertation is guided by Protection Motivation Theory (PMT), the Socioecological Model (SEM), and the Marriage Protection Hypothesis. Collectively, these frameworks explore how individual, social, and structural factors influence cancer screening behaviors and outcomes among AAM. This work captures the lived experiences and perspectives of the African American community in Omaha, Nebraska, and examines the biological and social determinants that shape CaP outcomes—such as prostate-specific antigen (PSA), Gleason score, and cancer stage at diagnosis.
The first manuscript presents a systematic review of cancer prevention interventions informed by PMT. The findings reveal that coping appraisal constructs—especially self-efficacy and response efficacy—are stronger predictors of screening behaviors across cancer types than threat appraisal constructs like fear and perceived vulnerability. Notably, six of the seven studies reviewed focused on women, with none addressing prostate cancer or targeting AAM. Additionally, the studies were primarily conducted in the Middle East, with only one U.S.-based study involving White women in Washington state. These findings highlight a critical gap in the literature regarding race, geography, and gender and call for expanded research focused on racially diverse populations, particularly in the Midwestern United States.
The second manuscript qualitatively assesses community readiness to address CaP and explores perceptions of the disease among AAM and African American women (AAW) in North Omaha. Participants identified medical mistrust, stigma, and masculinity norms as key barriers to screening. Both AAM and AAW emphasized the importance of trusted relationships and community-based health advocates, with women playing a pivotal role in supporting men’s engagement with the healthcare system. They also highlighted culturally meaningful settings—such as barbershops, churches, and social media—as critical spaces for enhancing awareness and health communication.
The third manuscript uses Surveillance, Epidemiology, and End Results (SEER) data from 2010 to 2021 to examine how marital status influences CaP outcomes among AAM. The analysis reveals that married men are more likely to be diagnosed at earlier stages and have better survival outcomes, reinforcing the protective role of interpersonal support.
Taken together, these three manuscripts emphasize the importance of multilevel, culturally responsive interventions that leverage trusted social relationships and community spaces to reduce prostate cancer disparities among AAM.
Recommended Citation
Johnson, George, "Formative Research Study: Investigating the African American Community Perspective of Prostate Cancer by Triangulating the Association of Marital Status Within a Prostate Cancer Staging From a Population Approach" (2025). Theses & Dissertations. 940.
https://digitalcommons.unmc.edu/etd/940
Comments
2025 Copyright, the authors