US Men Research Articles

Association between the composite dietary antioxidant index and erectile dysfunction in US men: a cross-sectional study.

Erectile dysfunction (ED) is a common issue among adult males. The Composite Dietary Antioxidant Index (CDAI) reflects anti-inflammatory levels and has been linked to various diseases, but its relationship with ED is unclear. This cross-sectional study utilised comprehensive data on clinical factors from the 2001-2004 National Health and Nutrition Examination Survey (NHANES). To investigate the link between variables and ED, we used multivariate regression analysis, univariate analysis, and subgroup analysis. The linear relationship between CDAI and ED was investigated by dose-response curve analysis. For sensitivity analysis, propensity score matching (PSM) was utilised to exclude the influence of potential confounders. Finally, we investigated the association between CDAI and ED using threshold effects analysis. We included in our research a total of 2896 persons with data on CDAI from NHANES 2001-2004. Among these, 2,098 participants were thought to be free of ED, whereas 798 participants had ED. We found that compared to the ED group, men in the non-ED group had higher levels of CDAI (p < 0.0001 before PSM and p = 0.0145 after PSM). Additionally, after adjusting for covariates, it was found that an elevated CDAI was associated with a reduced incidence of ED [OR = 0.65(p = 0.001) before PSM and OR = 0.62(p = 0.002) after PSM]. Subgroup analysis indicated stronger associations in high-risk groups, and dose-response curves confirmed a linear negative correlation between CDAI and ED. This study revealed a negative linear relationship between CDAI and the incidence of ED. The CDAI can be used as an indicator for assessing ED risk and for ED prevention.

Benefits of Tadalafil and Sildenafil on Mortality, Cardiovascular Disease, and Dementia

BackgroundErectile dysfunction and lower urinary tract symptoms, from benign prostatic hyperplasia and bladder neck obstructions, are prevalent in men and associated with an increased risk of cardiovascular diseases. Phosphodiesterase-5 (PDE-5) inhibitors, such as tadalafil and sildenafil, are used to treat erectile dysfunction and may also offer cardiovascular benefits due to their vasodilatory effects. This study evaluates the impact of these PDE-5 inhibitors on all-cause mortality, cardiovascular disease, and dementia in middle-aged men with erectile dysfunction and lower urinary tract symptoms over a 3 year follow-up period. MethodsThis longitudinal study analyzed data from 50 million US men using the TriNetX database. Men at least 40 years of age prescribed tadalafil or sildenafil after an erectile dysfunction diagnosis, or tadalafil after lower urinary tract symptom diagnoses, from 2004 to 2021 were included. Three-year outcomes assessed included all-cause mortality, cardiovascular disease, and dementia, comparing men on PDE-5 inhibitors to those not on these medications. Propensity matching was performed for demographics and eight pre-existing conditions. ResultsThe final cohort included 509,788 men with erectile dysfunction and 1,075,908 with lower urinary tract symptoms. Tadalafil and sildenafil were associated with significantly reduced risks of all-cause mortality (RR 0.66/0.76), myocardial infarction (0.73/0.83), stroke (0.66/0.78), venous thromboembolism (0.79/0.80), and dementia (0.68/0.75) in erectile dysfunction patients, with tadalafil showing more significant benefits. In lower urinary tract symptom patients, tadalafil was similarly associated with reduced mortality, cardiovascular disease, and dementia. ConclusionsIn conclusion, tadalafil and sildenafil use in erectile dysfunction patients reduced mortality, cardiovascular disease, and dementia risks, with tadalafil providing more benefits. Tadalafil also conferred similar benefits to patients with lower urinary tract symptoms.

Telomere Length and Biological Aging: The Role of Strength Training in 4814 US Men and Women

Telomere length is an index of cellular aging. Healthy lifestyles are associated with reduced oxidative stress and longer telomeres, whereas unhealthy behaviors are related to shorter telomeres and greater biological aging. This investigation was designed to determine if strength training accounted for differences in telomere length in a random sample of 4814 US adults. Data from the National Health and Nutrition Examination Survey (NHANES) were employed to answer the research questions using a cross-sectional design. Time spent strength training was calculated by multiplying days of strength training per week by minutes per session. Participation in other forms of physical activity was also calculated based on reported involvement in 47 other activities. Weighted multiple regression and partial correlation were used to calculate the mean differences in telomere length across levels of strength training, adjusting for differences in potential confounders. With the demographic covariates controlled, strength training and telomere length were linearly related (F = 14.7, p = 0.0006). Likewise, after adjusting for all the covariates, the linear association remained strong and significant (F = 14.7, p = 0.0006). In this national sample, 90 min per week of strength training was associated with 3.9 years less biological aging, on average. Regular strength training was strongly related to longer telomeres and less biological aging in 4814 US adults.

Subject-level spinal osteoporotic fracture prediction combining deep learning vertebral outputs and limited demographic data.

Osteoporotic vertebral fractures are common and morbid. Automated opportunistic screening for incidental vertebral fractures from radiographs, the highest volume imaging modality, could improve osteoporosis detection and management. We consider how to form patient-level fracture predictions and summarization to guide management, using our previously developed vertebral fracture classifier on segmented radiographs from a prospective cohort study of US men (MrOS). We compare the performance of logistic regression (LR) and generalized additive models (GAM) with combinations of individual vertebral scores and basic demographic covariates. Subject-level LR and GAM models were created retrospectively using all fracture predictions or summary variables such as order statistics, adjacent vertebral interactions, and demographic covariates (age, race/ethnicity). The classifier outputs for 8663 vertebrae from 1176 thoracic and lumbar radiographs in 669 subjects were divided by subject to perform stratified fivefold cross-validation. Models were assessed using multiple metrics, including receiver operating characteristic (ROC) and precision-recall (PR) curves. The best model (AUC-ROC = 0.968) was a GAM using the top three maximum vertebral fracture scores and age. Using top-ranked scores only, rather than all vertebral scores, improved performance for both model classes. Adding age, but not ethnicity, to the GAMs improved performance slightly. Maximal vertebral fracture scores resulted in the highest-performing models. While combining multiple vertebral body predictions risks decreasing specificity, our results demonstrate that subject-level models maintain good predictive performance. Thresholding strategies can be used to control sensitivity and specificity as clinically appropriate.

Association between the atherogenic index of plasma and erectile dysfunction in US men: a population-based cross-sectional study.

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and involves risk factors such as atherosclerosis and endothelial dysfunction. Since the atherogenic index of plasma (AIP) may be potentially valuable in predicting cardiovascular risk, we conducted a comprehensive analysis of the relationship between AIP and ED using large-scale data, as well as exploring its potential implications for clinical and future research. We screened the National Health and Nutrition Examination Survey (NHANES) database using R software, selected datasets from two study cycles for cross-sectional analysis, enrolled covariates and performed statistical analyses using multivariate logistic regression. Furthermore, sensitivity analyses were performed and the relationship between the AIP index and ED was further assessed using generalized additive model regression and smoothed curve fitting. After an initial filter of 21,161 participants, 1503 participants were included, and the AIP level in the ED group was 0.21 ± 0.02 compared with 0.08 ± 0.01 in the group without ED, which was analyzed to show a statistically significant difference between them (P < 0.0001), and the difference was further confirmed in the sensitivity analyses. We suggest that early assessment, intervention, and individualized treatment of ED in people with high AIP levels is warranted, as it not only improves sexual function but also reduces the risk of CVD. However, it was a limitation of this study that the study population was all from the US, and more research is needed in the future to elucidate the causal relationship between AIP and ED and the association in a wider population.

Lignan Intake and Type 2 Diabetes Incidence Among US Men and Women

Lignans are phytoestrogens abundant in Western diets and may be associated with type 2 diabetes (T2D) risk. To prospectively investigate associations between lignan intake and T2D incidence. Population-based cohort study of US men and women enrolled in the Nurses' Health Study (NHS, 1984-2018), NHSII (1991-2019), and Health Professionals Follow-Up Study (HPFS, 1986-2020), as well as 496 participants from the Men's Lifestyle Validation Study (MLVS). Participants were free of T2D, cardiovascular disease, and cancer at baseline. Data were analyzed from November 2022 to July 2023. Total and individual lignans were assessed using a validated food frequency questionnaire, which was updated every 2 to 4 years. In the MLVS, lignan intake was measured using 2 sets of 7-day diet records (7DDRs). Incident T2D cases were confirmed using American Diabetes Association diagnostic criteria. Cox proportional hazards models were used to assess multivariable-adjusted associations. The current study included 201 111 participants (mean [SD] age, 44.7 [10.1] years; 161 169 female participants [80.2%]; 2614 African American participants [1.3%], 1609 Asian participants [0.8%], 2414 Hispanic and other race or ethnicity participants [1.2%], and 194 474 White participants [96.7%]) from the HPFS, NHS, and NHSII studies. The median (IQR) total lignan intake of the highest quintile ranged from 355.1 (330.2-396.9) μg/d in NHS to 459.9 (422.2-519.5) μg/d in HPFS at the median follow-up time. Over 5 068 689 person-years, 20 291 incident cases of T2D were identified. Higher lignan intake was inversely associated with T2D incidence, except for lariciresinol. The multivariable-adjusted pooled hazard ratios (HRs) for the highest vs lowest quintiles were 0.87 (95% CI, 0.83-0.91) for total lignans, 0.72 (95% CI, 0.69-0.76) for secoisolariciresinol, 0.92 (95% CI, 0.87-0.96) for pinoresinol, 0.93 (95% CI, 0.89-0.98) for matairesinol, and 0.99 (95% CI, 0.94-1.04) for lariciresinol. Secoisolariciresinol intake exhibited a significant inverse association with T2D risk among individuals with obesity (HR, 0.75 for body mass index [BMI] ≥30; 95% CI, 0.71-0.79 vs HR, 0.82 for BMI <25; 95% CI, 0.81-0.83; P < .001 for interaction) and premenopausal women (HR, 0.67 for premenopausal women; 95% CI, 0.65-0.69 vs HR, 0.82 for the past use of hormones; 95% CI, 0.76-0.88; P = .003 for interaction). Dietary lignan assessed with 7DDRs was associated with lower HbA1c levels (percentage change range from -0.92% to 1.50%), as well as lower C-reactive protein levels and better lipid profiles. This cohort study found that long-term lignan consumption was associated with a lower T2D risk, particularly among individuals with obesity and premenopausal women.

Prevalence and trends in overactive bladder among men in the United States, 2005–2020

The purpose of present study was to examine the current prevalence and recent trends of overactive bladder (OAB) among US adult men and examine the correlations between OAB and several potential risk factors. The study used the nationally representative data between 2005 and 2020 from the National Health and Nutrition Examination Survey in the US. A total of 18,386 participants aged ≥ 20 years were included in the study. We divided the data into three groups: 2005–2008, 2009–2014 and 2015–2020 to investigate the trends in OAB prevalence. The weighted prevalence and corresponding 95% confidence intervals (CI) of OAB were calculated. The differences (95% CI) in prevalence between the surveys were calculated and multivariate-adjusted weighted logistic regression analysis was performed to determine the correlates of OAB. Among all US adult men, the overall prevalence of OAB increased slightly from 11.3% in 2005–2008 to 11.7% in 2009–2014 and significantly increased to 14.5% in 2015–2020 (difference, 3.2% [95% CI (1.9–4.4%)]; P < 0.05). Increases in OAB prevalence especially concentrated on those who were 40–59 years, non-Hispanic White, non-Hispanic Black and those who were overweight and obese. Older age, non-Hispanic Black, lower educational level and family poverty ratio, diabetes, depression, sleep disorder, other chronic comorbidities, less intense recreational activity, poorer health condition and unsafe food were independent risk factors of OAB. The contemporary prevalence of OAB was high, affecting 14.5% US men and the estimated overall prevalence significantly increased from 2005 to 2020. Therefore, future research should be focused to prevent and remedy this growing socioeconomic and individually troublesome malady.

Association between the C-reactive protein-triglyceride glucose index and erectile dysfunction in US males: results from NHANES 2001-2004.

The C-reactive protein-triglyceride glucose index (CTI) is emerging as a novel indicator for comprehensively assessing the severity of both inflammation and insulin resistance. However, the association between CTI and erectile dysfunction (ED) remains largely unexplored. Participant data for this study were sourced from NHANES 2001-2004, with exclusion criteria applied to those lacking information on clinical variables. The CTI was defined as 0.412*Ln (CRP) + ln [T.G. (mg/dL) × FPG (mg/dL)/2]. Weighted univariable and multivariable logistic regression models were utilized to examine the correlation between the CTI and ED, assessing the CTI as both a continuous and categorical variable (quartile). Moreover, subgroup analyses were conducted to pinpoint sensitive populations, and interaction analysis was performed to validate the findings. A total of 1502 participants were included in the final analysis, encompassing 302 with ED and 1200 without ED. After adjusting for potential confounders, the CTI was positively associated with ED incidence (OR = 1.56, 95% CI: 1.27-1.90, P = 0.002). The fourth quartile of the CTI significantly increased the incidence of ED (OR = 2.69, 95% CI: 1.07-6.74, P = 0.04), and the lowest quartile of CTI was used as the reference. The dose-response curve revealed a positive linear relationship between the CTI and the incidence of ED. Subgroup analysis confirmed the consistent positive relationship between the CTI and ED. The interaction test indicated no significant impact on this association. Finally, a sensitivity analysis was performed to verify the significant positive correlation between the CTI and severe ED (OR = 1.44, 95% CI: 1.19-1.76, P = 0.004). Our national data indicate that a greater CTI is positively linked to an increased risk of ED in US men, suggesting its potential for use in clinical practice for ED prevention or early intervention. Additional large-scale prospective studies are warranted to substantiate the causative relationship between CTI and ED.

Associations Between Perceived Threats and Firearm Behaviors Among U.S. Adults

IntroductionThe number of US adults who own and carry a firearm for self-defense is rising. Research has established that owning or carrying a firearm increases the risk of injury and death for firearm owners and the people in their lives. The present study sought to better understand this paradox by estimating associations of perceived specific and diffuse threats with firearm behaviors among US adults. MethodsThe team used data from the 2023 National Firearm Attitudes and Behaviors Study, a nationally representative cross-sectional survey of US adults. Binary and ordinal logistic regression estimated associations of perceived specific (fear of attack in the community, fear of someone breaking into the home) and diffuse threats (belief in a dangerous world) with firearm ownership and carriage frequency, overall and stratified by gender. Adjusted models controlled for violence exposures and demographic characteristics. The team conducted analyses in 2024. ResultsAmong all US adults, the perceived specific threat of someone breaking into the home was associated with firearm ownership (aORs: 1.09[0.98, 1.23]). Among firearm-owning adults, the diffuse threat of belief in a dangerous world was associated with firearm carriage frequency (1.11[0.98, 1.25]). Both associations persisted among men (aORs=1.27[1.05-1.52] and 1.15[1.01-1.31], respectively), and analyses found no associations between perceived threats and firearm behaviors among women. ConclusionsPerceived threats are associated with firearm behaviors among US men, even after accounting for the actual violence they report experiencing or witnessing.

Association between life's essential 8 and testosterone deficiency in US men: findings from national health and nutrition examination survey (NHANES) 2011-2016.

Testosterone deficiency (TD) is closely associated with cardiovascular diseases (CVD). We intended to explore the association of Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health, with the prevalence of TD among US male adults. The population-based cross-sectional study selected male adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. According to the American Heart Association definitions, the LE8 score was measured on a scale of 0-100, and divided into health behavior and health factor scores, simultaneously. Furthermore, these scores were categorized into low (0-49), moderate (50-79), and high (80-100) classifications. TD is defined as a total testosterone level below 300ng/dL. Correlations were investigated by weighted multivariable logistic regression, and the robustness of the results were verified by subgroup analysis. A total of 4971 male adults with an average age of 47.46 ± 0.41 years were eligible for the final analyses, of whom 1372 were determined to have TD. The weighted mean LE8 score of the study population was 68.11 ± 0.41. After fully adjusting potential confounders, higher LE8 scores were significantly associated with low risk of TD (odd ratio [OR] for each 10-point increase, 0.79; 95% CI, 0.71-0.88) in a linear dose-response relationship. Similar patterns were also identified in the association of health factor scores with TD (OR for each 10-point increase, 0.74; 95% CI, 0.66-0.83). These results persisted when LE8 and health factor scores was categorized into low, moderate, and high groups. The inversed association of LE8 classifications and TD remained statistically significant among older, obese, and men without CVD. LE8 and its health factor subscales scores were negatively associated with the presence of TD in linear fashions. Promoting adherence to optimal cardiovascular health levels may be advantageous to alleviate the burden of TD.

Unregulated male sexual enhancement treatments: Perils and pitfalls for patients and providers

ABSTRACT As the demand for “quick-fixes” and instant gratification intensifies among consumers of the US health care delivery system, health care providers remain essential to ensuring patients receive safe, evidenced-based care. Erectile dysfunction is a common health condition affecting as many as 42% of US men. As such, it is unsurprising that American health care consumers affected by erectile dysfunction (ED) may be tempted by “quick fixes” to ameliorate their symptoms—particularly if such fixes are perceived to be less embarrassing, more accessible, and/or more affordable. Although multiple therapies for the treatment of ED are approved by the US Food and Drug Administration, unregulated and/or counterfeit treatments are abundantly available to health care consumers on the Internet and US retail settings. These unregulated treatments may take the form of over-the-counter supplements or tainted prescription medications from illegal Internet pharmacies. This clinical brief is a call to action for health care professionals to advocate for patient safety, educate patients, and champion evidence-based therapies approved for the treatment of erectile dysfunction.

Drinking patterns among US men and women: Racial and ethnic differences from adolescence to early midlife.

Drinking patterns among young adult men and women in the United States have been understudied, especially among racial and ethnic groups such as Asian Americans and Hispanics. Because alcohol-related racial and ethnic health disparities persist or increase in midlife, identifying peak ages of hazardous drinking could help to reduce disparities. We used the National Longitudinal Study of Adolescent to Adult Health to examine: (1) past 12-month heavy episodic drinking (HED) and total alcohol volume consumption among non-Hispanic White (NHW), Black, Hispanic, and Asian men and women from ages 12 through 41, and (2) age-varying associations of race and ethnicity with drinking. Hispanic and Asian ethnic groups were disaggregated by historical drinking patterns. Time-varying effect models accounted for major demographic confounders. NHW men and women experienced elevated drinking rates in their early 20s, with a second elevation in their 30s. Black men and women did not have elevated drinking until their 30s. Among Hispanic men and women, peak drinking periods varied by gender and subgroup drinking pattern. Peak HED and total consumption emerged in the early 30s for Asian men, while peak HED occurred in the early 20s for Asian women. Drinking at certain ages for some racial and ethnic minoritized men and women did not differ from that in their NHW counterparts. Age periods during which subgroups in the U.S. population experience elevated alcohol consumption vary by ethnicity and gender. Recognition of these group differences could enhance our understanding of intervention timing.

Improving health service design and delivery for men: does gender targeting matter?

PurposeConsumer well-being in health-care settings is often undermined by information asymmetries, uncertainty and complex choices. Men are generally less motivated to adopt support tools designed to facilitate shared decision-making (SDM) and increase involvement in health service delivery. This study aims to examine the effects of sports team metaphors in a male-centered decision aid on empowerment and preparedness within a sleep apnea treatment context, a common disease among men. Individual-level factors that influence the decision aid experience are also considered.Design/methodology/approachAn online panel sample of 296 US men was randomly assigned to a generic or gender targeted decision aid. The scenario-based method was used to simulate the decision aid experience. A one-way MANOVA tested the effects of gender targeting on SDM-related outcomes. Structural equation modeling was then undertaken to analyze relationships between self-construal and these outcomes.FindingsParticipants who experienced the gender-targeted decision aid reported higher levels of empowerment and preparedness. The positive relationship between collective interdependence and empowerment was stronger among those who received the targeted decision aid. The positive relationship between empowerment and preparedness was also significantly stronger in the targeted group. Empowerment mediated the effect of self-construal on preparedness.Originality/valueLittle to no research has evaluated the effectiveness of sports team metaphors in improving SDM and facilitating health-care value cocreation. Results provide insight into how to enhance service design and delivery for men facing medical decisions.

Adherence to Healthy and Unhealthy Plant-Based Diets and the Risk of Gout

Plant-based diets are increasing in popularity due, in part, to their health benefits for selected cardiometabolic diseases as well as favorable environmental impact. Little is known about how such a diet is related to gout risk. To examine associations between adherence to a plant-based diet (including healthy and unhealthy versions of this diet), as well as its 18 individual food groups, and incident gout. This prospective cohort study used data from population-based cohorts of US men and women enrolled in the Health Professionals Follow-Up Study (1986-2012) and Nurses' Health Study (1984-2010). Participants were men and women free of gout at baseline. Statistical analyses were performed over March 2020 to August 2023. An overall plant-based diet index (PDI), as well as healthy (hPDI) and unhealthy (uPDI) versions of this index that emphasize healthy and less healthy plant-based foods, respectively. These diet indices were comprised of 18 food groups, assessed using a validated semiquantitative food frequency questionnaire. Incident cases of gout that were confirmed with a supplementary questionnaire to meet the preliminary American College of Rheumatology survey criteria for gout. Cox proportional hazards regression models were used to evaluate multivariable-adjusted associations of all 3 PDIs with incident gout using quintiles (Q) of adherence. Among a total of 122 679 participants (mean [SD] age, 53.8 [9.8] years among 43 703 men; mean [SD] age, 50.9 [7.2] years among 78 976 women) over 2 704 899 person-years of follow-up, 2709 participants experienced incident gout. The overall PDI was not significantly associated with gout in either cohort (Q5 vs Q1 pooled hazard ratio [HR], 1.02 [95% CI, 0.89-1.17]; P for trend = .63). In the pooled analysis, hPDI was significantly inversely associated with risk of gout (Q5 vs Q1 HR, 0.79 [95% CI, 0.69-0.91]; P for trend = .002), while the uPDI was positively associated with risk of gout (Q5 vs Q1 HR, 1.17 [95% CI, 1.03-1.33]; P for trend = .02), particularly in women (Q5 vs Q1 HR, 1.31 [95% CI, 1.05-1.62]; P for trend = .01). In analysis of individual food groups, higher intakes of certain healthy plant foods, such as whole grains (pooled HR per 1 serving/d, 0.93 [95% CI, 0.89-0.97]) and tea and coffee (pooled HR per 1 serving/d, 0.95 [95% CI, 0.92-0.97]), as well as dairy (pooled HR per 1 serving/d, 0.86 [95% CI, 0.82-0.90]), were independently associated with a lower risk of gout, while selected unhealthy plant foods, such as fruit juice (pooled HR per 1 serving/d, 1.06 [95% CI, 1.00-1.13]) and sugar-sweetened beverages (pooled HR per 1 serving/d, 1.16 [95% CI, 1.07-1.26]) were associated with increased risk of gout. The findings of this prospective cohort study of PDIs and gout support current dietary recommendations to increase consumption of healthy plant foods while lowering intake of unhealthy plant foods to mitigate gout risk.

Increases in Awareness and Uptake of Dating Apps’ Sexual Health Features Among US Men Who Have Sex with Men, 2018 to 2021

Dating apps are now used by the majority of MSM to meet sexual and romantic partners. While research has demonstrated an association between app use and greater number of sex partners and STIs, dating apps also pose an opportunity for intervention. By advocating for new and improved sexual health features on dating apps, Building Healthy Online Communities (BHOC) aims to increase communication about sexual health on the apps. As a follow-up to our previous paper assessing the uptake of sexual health-related profile options on dating apps through Emory’s annual survey of 10,000 MSM in the US, BHOC and Emory partnered to explore the change in uptake over time, again through their annual survey. Among survey participants in 2021, 85% reported using dating apps to meet a partner in the past year, and among this group, 93% reported awareness of sexual health features, up from 77% in 2018 (p < 0.0001). 71% of app users who were aware of features in 2021 reported using one or more sexual health feature, up from 61% in 2018 (p < 0.0001). BHOC will continue to advocate for increased uptake of these features, especially among subgroups with lower levels of uptake.

Prevalence and determinants of shared decision-making for PSA testing in the United States.

Shared decision-making (SDM) is recommended for prostate-specific antigen (PSA) testing but appears underutilized. This population-based study assessed the prevalence and determinants of SDM for PSA testing among US men. We assessed PSA testing rates and SDM engagement in men aged 40 and older without prostate cancer history using the 2019 National Health Interview Survey. SDM was defined as discussing the advantages and disadvantages of PSA testing with a physician. We used multivariable logistic regression with machine learning to identify factors associated with lack of SDM. Among 9723 eligible participants (mean age 58 years), lifetime PSA testing prevalence was 45.9% and the 1-year testing incidence was 29.1%. Only 24.1% reported engaging in SDM with a physician, while 62.9% never discussed PSA testing. Younger age and lower education levels were the primary determinants of decreased SDM engagement. Men with less education engaged in SDM less than half as often as those with higher education levels across all age groups. Societal guidelines recommend SDM for PSA testing. However, most men, regardless of age, have never engaged in SDM conversations with a healthcare provider about PSA testing, especially those with less education. More efforts are needed to improve patient-provider conversations about the potential benefits and harms of PSA testing.

Preferences for a community pharmacy-based pre-exposure prophylaxis (PrEP) delivery program: A discrete choice experiment

BackgroundCommunity pharmacies are ideal venues for pre-exposure prophylaxis (PrEP) delivery. Pharmacists and pharmacy-based PrEP delivery programs have the potential to improve access. ObjectivesThis study elicited preferences for attributes of a hypothetical community pharmacy-based PrEP delivery program among US men who have sex with men (MSM) and assessed predictors of their preferences. MethodsData were collected via a cross-sectional anonymous survey of US MSM, who were aged 18-65 years, not transgender, reported HIV status negative/unknown, and PrEP eligible. A discrete choice experiment was conducted with seven attributes of a pharmacy-based PrEP program: initial PrEP eligibility screening mode, location for human immunodeficiency virus (HIV) tests, timing for HIV test results, PrEP decision-making style, location of PrEP consultations, PrEP medication fill method, and mode for ongoing monitoring. Latent class analysis was performed to analyze preference heterogeneity. Multinomial logistic regression assessed predictors of latent class membership. ResultsThis study included 390 MSM. Time to receive HIV test results was the most important attribute; receiving results on the same day had the highest preference. The next most important attribute was PrEP screening mode; online questionnaires were the most preferred. Respondents’ preferences clustered into four classes: 1) “Same day results and online monitoring” (SDROM) group (63.1%), 2) “Consumerist decision-making” (CDM) group (16.2%), 3) “Self-screening (online questionnaire)” (SOQ) group (11.3%), and 4) “Same day results preferring” (SDRP) group (9.5%). Hispanic MSM (adjusted odds ratio [aOR] =0.31, 95% confidence interval [CI] [0.12-0.84], P = 0.020), MSM of other races (aOR=0.38, 95% CI [0.15-0.97], P = 0.044) vs. White MSM; and those having a sexually transmitted disease recently (aOR=0.37, 95% CI [0.16-0.85], P = 0.018), had lower odds of being in the CDM group vs. the SDROM group. ConclusionsMSM’s preferences for a pharmacy-based PrEP program are heterogeneous. Same day results for HIV tests and online PrEP screening are key components when designing a community pharmacy-based PrEP program.

Prostate cancer characteristics in Black septuagenarian men

Prostate cancer is the most common (non‐cutaneous) cancer and the second leading cause of cancer death in US men. Both Black men and men 70–80 years old are at high risk for high‐grade prostate cancer. Despite that some groups recommend against PSA‐ and DRE‐based prostate cancer screening in men 70 years of age and older without regard to high‐risk factors. The authors present results of a study of prostate biopsy characteristics of men 70–80 years of age to determine whether they harbor a concerning incidence of high‐grade prostate cancer and should be offered screening.

Spatial-temporal Bayesian accelerated failure time models for survival endpoints with applications to prostate cancer registry data

Prostate cancer is the most common cancer after non-melanoma skin cancer and the second leading cause of cancer deaths in US men. Its incidence and mortality rates vary substantially across geographical regions and over time, with large disparities by race, geographic regions (i.e., Appalachia), among others. The widely used Cox proportional hazards model is usually not applicable in such scenarios owing to the violation of the proportional hazards assumption. In this paper, we fit Bayesian accelerated failure time models for the analysis of prostate cancer survival and take dependent spatial structures and temporal information into account by incorporating random effects with multivariate conditional autoregressive priors. In particular, we relax the proportional hazards assumption, consider flexible frailty structures in space and time, and also explore strategies for handling the temporal variable. The parameter estimation and inference are based on a Monte Carlo Markov chain technique under a Bayesian framework. The deviance information criterion is used to check goodness of fit and to select the best candidate model. Extensive simulations are performed to examine and compare the performances of models in different contexts. Finally, we illustrate our approach by using the 2004-2014 Pennsylvania Prostate Cancer Registry data to explore spatial-temporal heterogeneity in overall survival and identify significant risk factors.

Willingness and preferences for long-acting injectable PrEP among US men who have sex with men: a discrete choice experiment

IntroductionCabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition,...