The health of aging men, and the particular health concerns that they confront, are commanding greater attention within clinical medicine. Remnants of the biomedical tradition that examines prevention, diagnosis, and treatment of disease states in isolation from the historical, developmental, and cultural contexts in which they occur still predominate even though their impact on the medical care context is slowly becoming recognized. The relations of sociocultural characteristics to patterns of disease risk, health behaviors, symptom responses, delayed diagnosis, and treatment adherence are less well-documented or understood. Empirical evidence supports the role of sociocultural factors in the understanding and management of health among aging men. The essential features of specific ethno-cultural, psychosocial, socio-demographic, and health system variables can offer practical clinical applications for providers. Awareness and understanding of such characteristics will facilitate culturally competent practices that are more likely to engage men in collaborative educational, disease management, and health maintenance efforts throughout their lifespan.
Get full access to this article
View all access options for this article.
References
1.
EckertJ.K., RubinsteinR.L.Older men's health – sociocultural and ecological perspectives. Med Clin N Am, 1999; 83(5):1151.
2.
ArberS., CooperH.Gender differences in health in later life: the new paradox?. Soc Sci Med, 1999; 48(1):61–76.
3.
ConsedineN.S., MagaiC., KrivoshekovaY.S.Sex and age cohort differences in patterns of socioemotional functioning in older adults and their links to physical resilience. Ageing Int, 2005; 30(3):209–243.
4.
SadovskyR.Men's healthcare needs improvement: a recommendation for a midlife men's health assessment visit. jmhg, 2005; 2(3):375–381.
5.
ACS. Cancer facts and figures for African Americans, 2007–2008. Atlanta, GA: American Cancer Society, 2007.
6.
JemalA., MurrayT., SamuelsA., GhafoorA., WardE., ThunM.J.Cancer statistics, 2003. CA Cancer J Clin, 2003; 53(1):5–26.
7.
ACS. Cancer facts and figures, 2004. New York: American Cancer Society, 2004.
8.
O’BrienK., CokkinidesV., JemalA., CardinezC.J., MurrayT., SamuelsA., et al.Cancer statistics for Hispanics, 2003. CA Cancer J Clin, 2003; 53(4):208–226.
9.
ConsedineN.S., MagaiC., ConwayF.Predicting ethnic variation in adaptation to later life: styles of socioemotional functioning and constrained heterotypy. J Cross-Cult Gerontol, 2004; 19:95–129.
10.
ConsedineN.S., MagaiC., Kudadjie-GyamfiE.K., Kaluk LongfellowJ., UngarT.M., et al.Stress versus discrete negative emotion in the prediction of physical complaints: does predictive utility vary across groups. Cult Divers Ethnic Minority Psychol, 2006; 12(3):541–557.
11.
WalterF.M., EmeryJ., BraithwaiteD., MarteauT.M.Lay understanding of familial risk for common chronic diseases: a systematic review and synthesis of qualitative research. Ann Fam Med, 2004; 2(6):583–594.
12.
PengH., HagopianW.Environmental factors in the development of Type 1 diabetes. Rev Endocr Metabol Disord, 2006; 7(3):149–162.
13.
ConsedineN.S., MagaiC.The uncharted waters of emotion: ethnicity, trait emotion and emotion expression in older adults. J Cross-Cult Gerontol, 2002; 17:71–100.
14.
SiegelK., KarusD., SchrimshawE.W.Racial differences in attitudes toward protease inhibitors among older HIV-infected men. AIDS Care - Psychol Socio-Med Aspects AIDS/HIV, 2000; 12(4):423–434.
15.
PoweB.D.Fatalism among elderly African Americans: effects on colorectal cancer screening. Cancer Nurs, 1995; 18(5):385–392.
16.
ConsedineN.S., AdjeiB.A., RamirezP.M., McKiernanJ.An object lesson: differences in source determine the relations that trait anxiety, prostate cancer worry, and fear of screening hold with prostate screening frequency. Cancer Epidemiol Biomarkers Prevent, 2008; 17(7):1631–1639.
17.
McCrackenM., OlsenM., ChenM.S.Jr., JemalA., ThunM., CokkinidesV., et al.Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin, 2007; 57(4):.
18.
MyersH.F., Kagawa-SingerM., KumanyikaS.K., LexB.W., MarkidesK.S.Panel III: Behavioral risk factors related to chronic diseases in ethnic minorities. Health Psychol, 1995; 14:613–621.
HanH., KimK., KangJ., JeongS., KimE.Y., KimM.T.Knowledge, beliefs, and behaviors about hypertension control among middle-aged Korean Americans with hypertension. J Commun Health, 2007; 32(5):324–342.
21.
Sanchez-VaznaughE.V., KawachiI., SubramanianS.V., SanchezB.N., Acevedo-GarciaD.Do socioeconomic gradients in body mass index vary by race/ethnicity, gender, and birthplace?. Am J Epidemiol, 2009; 169(9):1102–1112.
22.
GoelM.S., McCarthyE.P., PhillipsR.S., WeeC.C.Obesity among US immigrant subgroups by duration of residence. J Am Med Assoc, 2004; 292(23):2860–2867.
23.
ConsedineN.S., MagaiC., ChinS.Hostility and anxiety fear differentially predict coronary heart disease in men and women. Sex Roles, 2004; 50(1–2):63–75.
24.
IronsonG., O’CleirighC., FletcherM.A., LaurenceauJ.P., BalbinE., KlimasN., et al.Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med, 2005; 67(6):1013–1021.
25.
JacksonJ.S.What can resolve the paradox of mental health disparities. APA Monitor Psychol, 2002; 33:46.
26.
TealC.R., StreetR.L.Critical elements of culturally competent communication in the medical encounter: a review and model. Soc Sci Med, 2009; 68(3):533–543.
27.
StewartA.L., Nápoles-SpringerA., Pérez-StableE.J., PosnerS.F., BindmanA.B., PinderhughesH.L., et al.Interpersonal processes of care in diverse populations. Milbank Quart, 1999; 77(3):305–339.
28.
WilcoxB.J., HeQ., ChenR.Midlife risk factors and healthy survival in men. J Am Med Assoc, 2006; 296(16):2343–2350.
29.
Naslindh-YispangarA., SilivonenM., KekkiP.Health, utilization of health service, ‘core’ information, and reasons for non-participation: a triangulation study amongst non-respondents. J Clin Nurs, 2008; 17:2972–2978.
30.
VerbrugeL.Gender and health: an update on hypotheses and evidence. J Health Soc Behav, 1985; 26(3):156–182.
31.
BrownV.A., BartholomewK., NaikA.D.Management of chronic hypertension in older men: an exploration of patient goal-setting. Patient Educat Counseling, 2007; 69:93–99.
32.
HallR.H.Promoting men's health. Aust Fam Physician, 2003; 32(6):401–407.
33.
KreuterM.W., LukwagoS.N., BuckholtzD.C., ClarkE., Sanders-ThompsonV.Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav, 2003; 30(2):133–146.
34.
BrownR.L., BaumannL.J., HelbergC.P., HanY., FontanaS.A., LoveR.R.The simultaneous analysis of patient, physician and group practice influences on annual mammography performance. Soc Sci Med, 1996; 43:315–324.
35.
KleinmanA.The illness narratives: Suffering, healing, and the human condition. New York: Basic Books; 1988.
36.
WhiteA., BanksI.Help seeking in men and the problems of late life diagnosis. 2nd edition In: KirbyR., CarsonC., KirbyM., FarahR., editors. Men's health, London: Martin Dunitz and Parthenon Publishing; 2004:. p. 1–7.
37.
ChrismanN.The health seeking process: an approach to the natural history of illness. Cult Med Psychiatr, 1977; 62:291–298.
38.
ConsedineN.S., KrivoshekovaY.S., HarrisC.R.Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: psychometric development and links to treatment-seeking outcomes. Br J Health Psychol, 2007; 12:439–462.
39.
BrownC., SchulbergH.C., MadoniaM.J.Clinical presentations of major depression by African Americans and Whites in primary medical care practice. J Affect Disord, 1996; 41:181–191.
40.
ShaversV.L., UnderwoodW., MoserR.P.Race/ethnicity and the perception of the risk of developing cancer. Am J Prevent Med, 2009; 37(1):64–67.
41.
KirklandS.A., MacLeanD.R., LangilleD.B., JoffresM.R., MacPhersonK.M., AndreouP.Knowledge and awareness of risk factors for cardiovascular disease among Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992. Can Med Assoc J, 1999; 161(8 Supp. 3):S10–S16.
42.
ImE., CheeW., GuevaraE., LiuY., LimH., TsaiH., et al.Gender and ethnic differences in cancer pain experience: a multiethnic survey in the United States. Nurs Res, 2007; 56(5):296–306.
43.
KlatzkinRR, MechlinB, GirdlerSS. Menstrual cycle phase does not influence gender differences in experimental pain sensitivity Eur J Pain. 2009: in press.
44.
FillingimR.B., MaixnerW.Gender differences in the responses to noxious stimuli. Pain Forum, 1995; 4(4):209–221.
45.
ConsedineN.S., MoscowitzJ.T.The role of discrete emotions in health outcomes: a critical review. J Appl Prevent Psychol, 2007; 12:59–75.
46.
ShawC., WilliamsK., AssassaP.R., JacksonC.Patient satisfaction with urodynamics: a qualitative study. J Adv Nurs, 2000; 32(6):1356–1363.
47.
Moller-LeimkuhierA.M.Barriers to help-seeking by men: a review of the sociocultural and clinical literature with particular reference to depression. J Affect Disord, 2002; 71:1–9.
48.
LeventhalH., DiefenbachM., LeventhalE.A.Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cog Therapy Res, 1992; 16(2):143–163.
49.
GaldasP.M., CheaterF., MarshallP.Men and health help-seeking behaviour: literature review. J Adv Nurs, 2005; 49(6):616–623.
50.
ACS, Cancer prevention and early detection, 2007–2008. New York: American Cancer Society; 2007.
51.
Kudadjie-GyamfiE.K., ConsedineN.S., MagaiC.On the importance of being ethnic: coping with the threat of prostate cancer in relation to prostate cancer screening. Cult Divers Ethnic Minority Psychol, 2006; 12(3):509–526.
52.
WalshJ.M.E., KaplanC.P., NguyenB., GildengorinG., McPheeS.J., Perez-StableE.J.Barriers to colorectal cancer screening in Latino and Vietnamese Americans. J Gen Intern Med, 2004; 19:156–166.
53.
ConsedineN.S., ChristieM.A., NeugutA.I.Physician, affective, and cognitive variables differentially predict “initiation” versus “maintenance” PSA screening profiles in diverse groups of men. Br J Health Psychol, 2009; 14:303–322.
54.
WoodsV.D., MontgomeryS.B., HerringR.P., GardnerR.W., StokolsD.Social ecological predictors of prostate-specific antigen blood test and digital rectal examination in Black American men. J Natl Med Assoc, 2006; 98(4):492–504.
55.
AndrioleG.L., CrawfordE.D., GrubbR.L., BuysS.S., ChiaD., ChurchT.R., et al.Mortality results from a randomised prostate-cancer screening trial. New Engl J Med, 2009; 360(17):1310–1319.
56.
SlovicP., PetersE., FinucaneM.L., MacGregorD.G.Affect, risk, and decision making. Health Psychol, 2005; 24(4):S35–S40.
57.
BlackhallL.J., FrankG., MurphyS.T., MichelV., PalmerJ.M., AzenS.P.Ethnicity and attitudes towards life sustaining technology. Soc Sci Med, 1999; 48(12):1779–1789.
58.
BoberS.L., HokeL.A., DudaR.B., ReganM.M., TungN.M.Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors. J Clin Oncol, 2004; 22(24):4951–4957.
59.
DaleW., HemmerichJ., BylowK., MohileS., MullaneyM., StadlerW.M.Patient anxiety about prostate cancer independently predicts early initiation of androgen deprivation therapy for biochemical recurrence in older men: a prospective cohort study. J Clin Oncol, 2009; 27(10):1557–1563.
60.
GordonH.S., StreetR.I., ScharfB.F., SouchekJ.Racial differences in doctors’ information-giving and patients’ participation. Cancer, 2006; 107(6):1313–1320.
61.
de HaesH.Dilemmas in patient centeredness and shared decision making: a case for vulnerability. Patient Educ Counseling, 2006; 62:291–298.
62.
GolinC., DiMatteoR., DuanN., LeakyB., GelbertI.Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care. J Gen Intern Med, 2002; 17:866–875.
63.
HeislerM., BouknightR.R., HaywardR.A., SmithD.M., KerrE.A.The relative importance of physician communication, participatory decision making, and patient understanding in diabetic self management. J Gen Intern Med, 2002; 17(4):243–252.
64.
LermanI., LozanoL., VillaA.R., Hernández-JiménezS., WeingerK., CaballeroA.E., et al.Psychosocial factors associated with poor diabetes self-care management in a specialized Center in Mexico City. Biomed Pharmacother, 2004; 58(10):566–570.
65.
BrachC., FraserirectorI.Can cultural competency reduce racial and ethnic health disparities?. Med Care Res Rev, 2000; 57:181–217.
66.
BennettI.M., ChenJ., SorouiJ.S., WhiteS.The contribution of health literacy to disparities in self-related health status and preventive health behaviors in older adults. Ann Family Med, 2009; 7(3):204–211.
67.
KutnerM., GreenbergE., JinY., PaulsenC.The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy. New York: National Center for Education Statistics; 2006.
68.
DavisT.C., WilliamsM.V., BranchW.T., GreenK.W.Explaining illness to patients with limited literacy. In: WhaleyB.B., editor. Explaining illness. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.
69.
LeeJ.K., GraceK.A., TaylorA.J.Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. J Am Med Assoc, 2006; 296(21):2563–2571.
70.
WensJ., VermeireE., Van RoyenP., SabbeB., DenekensJ.GPs’ perspectives of type 2 diabetes patients’ adherence to treatment: a qualitative analysis of barriers and solutions. BMC Family Practice, 2005; 6.
71.
JackeviciusC.A., MamdaniM., TuJ.V.Adherence with statin therapy in elderly patients with and without acute coronary syndromes. J Am Med Assoc, 2002; 288(4):462–467.
72.
NicholM.B., KnightT.K., WuJ., BarronR., PensonD.F.Evaluating use patterns of and adherence to medications for benign prostatic hyperplasia. J Urol, 2009; 181(5):2214–2222.
73.
HyreA.D., Krousel-WoodM.A., MuntnerP., KawasakiL., DeSalvoK.B.Prevalence and predictors of poor antihypertensive medication adherence in an urban health clinic setting. J Clin Hypertension, 2007; 9(3):179–186.
74.
KalichmanS.C., RamachandranB., CatzS.Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med, 1999; 14(5):267–273.
75.
ApterA.J., BostonR.C., GeorgeM., NorfleetA.L., TenhaveT., CoyneJ.C., et al.Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white. J Allergy Clin Immunol, 2003; 111(6):1219–1226.
76.
MagaiC., ConsedineN.S., NeugutA.I., HerschmanD.L.Commmon psychosocial factors underlying breast cancer screening and breast cancer treatment adherence: a conceptual review and synthesis. J Women's Health, 2007; 16(1):11–23.
77.
PereiraD.B., AntoniM.H., DanielsonA., SimonT., Efantis-PotterJ., O'SullivanM.J.Inhibited interpersonal coping style predicts poorer adherence to scheduled clinic visits in human immunodeficiency virus infected women at risk for cervical cancer. Ann Behav Med, 2004; 28(3):195–202.
78.
DiMatteoM.R.Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol, 2004; 23(2):207–218.
79.
KaplanR.C., BhalodkarN.C., BrownE.J., WfliteJ., BrownD.L.Race, ethnicity, and sociocultural characteristics predict noncompliance with lipid-lowering medications. Prevent Med, 2004; 39(6):1249–1255.
80.
GallantM.P., SpitzeG.D., ProhaskaT.R.Help or hindrance? How family and friends influence chronic illness self-management in older adults. Res Aging, 2007; 29:375–409.
81.
RoseL.E., KimT.K., DennisonC.R., HillM.N.The contexts of adherence for African Americans with high blood pressure. J Advan Nurs, 2000; 32(2):587–594.
82.
LeeM.M., ChangJ.S., JacobsB., WrenschM.R.Complimentary and alternative medicine use among men with prostate cancer in four ethnic populations. Am J Public Health, 2002; 92(10):1606–1609.
83.
ConsedineNS, FioriKL. Gender moderates the associations between attachment and discrete emotions in middle age and later life. Aging Mental Health 2009: in press.
84.
AndersonL.M., ScrimshawS.C., FulliloveM.T., FieldingJ.E.Task Force on Community Preventive Services. The Community Guide's model for linking the social environment to health. Am J Prevent Med, 2003; 24(9S):12–20.
85.
United States Department of Health and Human Services – Office of Minority Health. A physician's practical guide to culturally competent care. Office of Minority Health, 2007.
86.
American Medical Association Council on Ethical and Judicial Affairs. Gender disparities in medical decision making, 1992.
87.
KleinmanA., BensonP.Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med, 2006.
88.
BetancourtJ.R., GreenA.R., CarilloE.J.Defining cultural competence: a practical framework for addressing racial/ethnic disparities in heatlh and health care. Public Health Rep, 2003; 3:293–302.
