Attachment and health care utilization among middle-aged and older African-descent men: dismissiveness predicts less frequent digital rectal examination and prostate-specific antigen screening

Am J Mens Health. 2013 Sep;7(5):382-93. doi: 10.1177/1557988312474838. Epub 2013 Jan 24.


Although health care utilization occurs in interpersonal contexts, little is known regarding how interpersonal preferences or styles among patients may be relevant. A small body of work has identified links between attachment-a dispositional style of relating to others-and patterns of health care use. The current report examined how attachment characteristics predicted the frequency of digital rectal exam and prostate-specific antigen testing in a sample of African-descent men. Four hundred and fourteen African-descent men aged 45 to 70 years completed measures of prostate screening and attachment, together with measures of traditional predictors of screening (demographics, insurance, family history, physician variables, knowledge, perceived risk, and accessibility). Consistent with predictions, dismissiveness-the most common relational style among older men-predicted less frequent prostate-specific antigen testing and digital rectal examination. However, attachment security-a comfort with intimate relationships-also predicted lower screening frequency. Identifying the interpersonal characteristics predicting screening may help identify men at risk of suboptimal health care use and guide the development of interventions suited to the normative relational preferences of current cohorts of older, African-descent men.

Keywords: attachment; digital rectal exam; emotion; health care utilization; prostate cancer screening; prostate-specific antigen.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans / psychology*
  • Aged
  • Attitude to Health*
  • Digital Rectal Examination / statistics & numerical data*
  • Humans
  • Interpersonal Relations*
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / prevention & control*


  • Prostate-Specific Antigen