Development of a theory-based framework and measures of acculturation for African immigrants.

Project Summary/Abstract Men of African ancestry are disproportionately burdened by prostate cancer (CaP) compared to other racial/ethnic groups, yet the main drivers of disparate outcomes are poorly understood. Research studies often categorize men of African ancestry in the United States (US) as a homogenous group (Blacks) which hinders

understanding about the unique health practices, behaviors and culture of subpopulations that contribute to or exacerbate disparities. For example, a recent study found that sub-Saharan African immigrants (SSAI) compared to US-born Blacks have a 1.5 times higher incidence rate for prostate cancer. Therefore, it is important to

understand the unique health practices and behaviors that may contribute to disparities in health outcomes. Acculturation or the nature and extent to which SSAI modify their, beliefs, values, diet and other lifestyle patterns may impact early detection of prostate cancer. For the purposes of this study, we define SSAI as individuals

immigrating from the region of the African continent located south of the Saharan desert. To date, three measures exist to assess acculturation among African-descent populations. However, none of these measures incorporate lifestyle factors despite research that suggest a change in environment and diet is associated with prostate

cancer risk. Moreover, existing scales on acculturation do not capture the contextual features of acculturation, such as events and circumstances preceding immigration and the political and social climate of the US upon arrival. The specific aims of this study are: 1) develop conceptual frameworks illuminating acculturation, CaP

screening and lifestyle factors among first-generation SSAI men in the US diagnosed with CaP and healthy first- generation SSAI men; 2) Create measures to assess acculturation, CaP screening and early detection among SSAI men in the US; and 3) train a cadre of student-researchers in behavioral research aimed at reducing health

disparities. To address Aim 1, we will conduct in-depth interviews with 32 SSAI men aged 40-70-years to identify and illuminate specific components of acculturation and how they affect health behaviors. We will identify acculturation constructs missing in current scales. To achieve Aim 2, we will generate content and items for a

scale informed by the categories that we develop in Aim 1. We will seek input from an advisory board of content experts and refine the scale before field testing and pilot testing of the measures. To achieve Aim 3, we will involve students in data collection, data analysis, field and pilot testing of the instrument. We will employ mixed-

methods combining qualitative and quantitative approaches to gain a deeper understanding of the mechanisms that underlie links between acculturation and health behavior among SSAI men in the US. The short-term goal of this study is a contribution to the literature of theory-guided measures to assess acculturation, CaP screening

and behavioral factors among SSAI men in the US. The long-term goal is that knowledge gained from this research will translate to the development of new, innovative, and culturally-based interventions aimed at reducing prostate cancer disparities.