text:
Examining the influence of social ecological factors on prostate cancer screening in urban African-American men.
ABSTRACT African-American men experience a disparate burden of prostate cancer (PC). Little is known about how social factors influence PC screening in this population.
African-American men over the age of 18 (N = 229) were recruited from a community health fair and anonymously surveyed about their PC screening behavior and conditions of their social environment. Analysis included logistic regression.
Fifty one percent of respondents reported receiving any form of PC screening within the past five years. Older age, higher levels of education, and access to a usual health care provider were associated with PC screening.
Social workers in preventive and community health settings should be increasingly attentive to the PC screening barriers facing African-American men, particularly those who may be undereducated and lack access to care.
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ABSTRACT: Given the benefits of health-related Internet use, we examined whether sociodemographic, medical, and access-related factors predicted this outcome among African American men, a population burdened with health disparities. African American men (n = 329) completed an anonymous survey at a community health fair in 2010; logistic regression was used to identify predictors. Only education (having attended some college or more) predicted health-related Internet use (P < .001). African American men may vary in how they prefer to receive health information; those with less education may need support to engage effectively with health-related Internet use.Preventing chronic disease 03/2014; 11:E43. · 1.96 Impact Factor - [Show abstract] [Hide abstract]
ABSTRACT: Objectives There are conflicting recommendations regarding the use of prostate specific antigen (PSA) as a screening test. Integral to this debate is an understanding of who is currently being tested. The purpose of this study was to provide a detailed account of PSA testing practices in a major Canadian city (Calgary, Alberta) and to identify variables that may affect access to the PSA test. Design and Methods PSA test counts were retrieved from Calgary Laboratory Services' Laboratory Information System from January 1, 2011 to December 31, 2011. A total of 75,914 individual PSA tests were included in our analysis. The frequency of PSA testing was plotted onto a dissemination area map of Calgary using ArcGIS software. Associations with sociodemographic variables were tested using Poisson regression. Results The median PSA value was 0.93 μg/L and the median age at collection was 58 years. Forty-three percent of men aged 60-69 received a PSA test. Visible minority status 'Black' (P = 0.0002) and Métis status (P = 0.0075) were associated with lower PSA testing frequencies, while median household income (P = < 0.0001) and university education (P = < 0.0001) were associated with higher PSA testing frequencies. Conclusion There are areas in Calgary which are significantly over or under tested relative to the mean. The amount of PSA testing in men < 50 years of age is increasing, which is contrary to PSA testing guidelines.Clinical Biochemistry 11/2014; · 2.23 Impact Factor
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Thi s art i cl e w as dow nl oaded by: [W ayne St at e Uni versi t y], [Jam i e M i t chel l ]
On: 15 Sept em ber 2011, At : 09:02
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Publ i cat i on det ai l s, i ncl udi ng i nst r uct i ons f or aut hor s and
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ht t p: //www. t andf onl i ne. com /l oi /wshc20
Exam i ni ng t he I nf l uence of Soci al
Ecol ogi cal Fact ors on Prost at e Cancer
Screeni ng i n Urban Af ri can- Am eri can
Jam i e Mi t chel l MSSW PhD a
a School of Soci al W or k, Wayne St at e Uni ver si t y , Det r oi t , Mi chi gan,
Avai l abl e onl i ne: 15 Sep 2011
To ci t e t hi s art i cl e: Jam i e Mi t chel l MSSW PhD ( 2011) : Exam i ni ng t he I nf l uence of Soci al Ecol ogi cal
Fact or s on Pr ost at e Cancer Scr eeni ng i n Ur ban Af r i can- Am er i can Men, Soci al W or k i n Heal t h Car e,
50: 8, 639- 655
To l i nk t o t hi s art i cl e: ht t p: //dx. doi . or g/10. 1080/00981389. 2011. 589891
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Social Work in Health Care, 50:639–655, 2011
Copyright © Taylor & Francis Group, LLC
ISSN: 0098-1389 print/1541-034X online
Examining the Influence of Social Ecological
Factors on Prostate Cancer Screening in Urban
African-American Men
JAMIE MITCHELL, MSSW, PhD
School of Social Work, Wayne State University, Detroit, Michigan, USA
African-American men experience a disparate burden of prostate
cancer (PC). Little is known about how social factors influence
PC screening in this population. Methods: African-American men
over the age of 18 (N = 229) were recruited from a community
health fair and anonymously surveyed about their PC screen-
ing behavior and conditions of their social environment. Analysis
included logistic regression. Findings: Fifty one percent of respon-
dents reported receiving any form of PC screening within the past
five years. Older age, higher levels of education, and access to
a usual health care provider were associated with PC screening.
Conclusions: Social workers in preventive and community health
settings should be increasingly attentive to the PC screening barri-
ers facing African-American men, particularly those who may be
undereducated and lack access to care.
KEYWORDSprostate cancer, African American men
Prostate cancer is the most commonly diagnosed cancer and the second
leading cause of cancer deaths among men in the United States (Jemal,
Siegal, Xu, & Ward, 2010). It has been estimated that 1 in 6 American men
will develop prostate cancer in their lifetime and that nearly 218,000 new
cases of prostate cancer were diagnosed in the United States in 2010 while
32,000 deaths were attributable to prostate cancer in the same year (Jemal
Received March 16, 2011; accepted May 16, 2011.
Address correspondence to Jamie Mitchell, MSSW, PhD, Assistant Professor, Wayne
State University, School of Social Work, 4756 Cass Avenue, Detroit, MI 48202. E-mail:
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J. Mitchell
et al., 2010). Characteristically diagnosed in males over the age of 60, there
is a significant cost burden to the Medicare system for long-term treatment.
Prostate cancer has been estimated to cost the health care system upwards of
2.5 billion dollars annually for men diagnosed after 2009, and these estimates
only account for treatment of the disease for the initial 6 months after diagno-
sis (Stokes, Black, Benedict, Roehrborn, & Albertsen, 2010). Improvements
in early detection and treatment strategies has lead to a 5-year survival rate
near 100%, but a greater understanding of how intrapersonal factors beyond
the medical system influence prostate cancer prevention could reduce the
loss of life and the economic costs associated with treatment and survival.
identified as older age, having a family history of cancer, and race/ethnicity.
Among White males, the odds of developing prostate cancer by age 70 are
1 in 12 while those odds are 1 in 9 for African-American males of the same
age (American Cancer Society, 2010). Studies have reported a twofold to
threefold increased risk in older men with a first-degree relative (i.e., father
or brother) with prostate cancer, along with an earlier average age at disease
onset for men with a family history compared to men without a family
history (Jones, Underwood, & Rivers, 2007). Although men of every racial
and ethnic background are susceptible to prostate cancer, African- American
men, more so than men of any other ethnic background, experience the
differential burden of earlier age at onset, higher incidence and mortality
rates, and more advanced stages of the disease when diagnosed (Jemal
et al., 2010). Additionally, the rate of death among African- American men
for prostate cancer is higher than any other racial/ethnic group in the United
States (Jemal et al., 2010). For example, African-American men's mortality
rate for prostate cancer between the years of 2002 and 2006 was 56.3 per
100,000 compared to 23.6 per 100,000 for White men (Edwards et al., 2010).
Obtaining the appropriate screening tests and personalized education
on cancer risk (based on family history of disease, individual lifestyle factors,
and the recommendations by a physician) is associated with lower cancer
incidence and lower mortality rates for several cancers, including prostate
cancer (Plowden, 2006). Cancer screening is a type of health-seeking behav-
ior that is influenced by several factors. Although prostate cancer is the most
commonly diagnosed cancer in U.S. men, screening may lead to earlier
detection of the disease in men who are asymptomatic (Davis et al., 2010;
List, Sinner, & Chodak, 1999; Odedina, Campbell, LaRosse-Pierre, Scrivens, &
Hill, 2008). Recent data indicates that 60–70% of American men may develop
prostate cancer in their lifetime yet only 1 in 30 men will die as a direct cause
of prostate cancer (Brawley, Ankerst, & Thompson, 2009). However, higher
mortality rates and poorer prognoses among African-American males require
greater attention to the factors the influence early detection efforts such as
prostate cancer screening (Davis et al., 2010). The American Cancer Society
(2010) recommends that beginning at age 50, a digital rectal exam (DRE),
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Social Ecological Influence on Prostate Screening
and a blood test to detect prostate-specific antigen (PSA), which is a protein
produced by the prostate gland be offered to men of "average risk" (i.e., men
with no symptoms or family history of prostate cancer) while men at higher
risk (African Americans and those with a family history) should be offered
screening at age 45. Screening for prostate cancer has been somewhat con-
troversial because the disease is so common, prevalent mostly in elderly men
and complications of treatment for prostate cancer (i.e. surgery and/or radi-
ation) such as sexual and urinary dysfunction, can severely impact quality
of life for those diagnosed (Brawley et al., 2009).
The uncertainty about prostate cancer screening among health profes-
sionals has centered around whether the benefit of detecting and treating
prostate cancer at earlier stages of the disease outweighs the cost of screen-
ing the entire population; the impact on one's quality of life from the
complications of treatment; and the potential unnecessary treatment given to
men with prostatic tumors that are asymptomatic or benign (Brawley et al.,
2009; Davis et al., 2010; Jones, Steeves, & Williams, 2009). For example, the
American Urological Association recommends the prostate-specific antigen
test for all men age 40 and over who have been counseled of the risks
and benefits of screening by a health professional (Davis et al., 2010). In
contrast, the American Cancer Society recommends that beginning at age
50, men talk to their doctor about the risks and benefits of prostate can-
cer screening while African-American men and men with a family history of
prostate cancer should receive a prostate-specific antigen test beginning at
age 45 (Brawley et al., 2009). The National Cancer Institute does not directly
issue recommendations on prostate cancer screening but asserts that there
is insufficient evidence of the risks and benefits of prostate cancer screening
for men younger than 75 years old while men older than 75 years should
not be screened (Yao & Lu-Yao, 2011). Despite this controversy surrounding
screening guidelines more than 90% of men diagnosed with prostate cancer
decide to undergo some mode of treatment as opposed to only monitoring
the disease for tumor growth (Brawley et al., 2009).
The proportion of African-American men who report awareness of the
risks of prostate cancer and participate in prostate cancer early detection
activities such as screening is small, yet this population carries the heaviest
burden of disease incidence and has the poorest survival rates in com-
parison to men of other racial or ethnic backgrounds (Weinrich, Weinrich,
Boyd, & Atkinson, 1998). Older African-American men may experience even
greater risk for late diagnosis of prostate cancer, which contributes to poor
prognosis (chances of survival). Gilligan and colleagues (2004) conducted a
randomized study of over 65,000 elderly men with no previous prostate can-
cer diagnosis (with data extracted from a Medicare and Medicaid database)
who underwent prostate-specific antigen (PSA) testing. After controlling for
socioeconomic status, comorbid conditions (other medical conditions), age,
and use of health care services, researchers concluded that "elderly blacks
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J. Mitchell
are substantially less likely to undergo PSA screening than elderly whites"
(Gilligan et al., 2004, p. 1858). Potential reasons for lower screening rates
among elderly African-American men included mistrust of White health care
providers (Odedina et al., 2008), misperceptions about the nature of prostate
exams and about the potential for impotence as a result of treatment (Jones
et al., 2009), and the inconvenience and discomfort associated with the more
invasive forms of screening such as DRE (Sanchez, Bowen, Hart, & Spigner
African-American male's knowledge and perceptions of prostate can-
cer screening have been studied extensively. Studies have indicated that
social norms related to ethnic cultural background play a significant role
in health-related decision making for African-American males and prostate
cancer screening is no exception. A qualitative study focused on design-
ing educational interventions to promote prostate cancer screening among
African-American males found that African-American males preferred inter-
ventions delivered in community settings in contrast to health care provider
offices. The same study also found African-American male patients were
more comfortable with health care providers when they approached screen-
ing decision making in a manner that took into account the cultural
sensitivity surrounding invasive screening tests. Lastly, men in that study
preferred that health care providers attempt to build trust with African-
American male patients who may be reluctant to undergo screening due to
historical abuses by the medical and scientific communities (Allen, Kennedy,
Wilson-Glover, & Gilligan, 2007). Powe et al. (2009) found that African-
American males were more likely to get cancer-related and other health
information from media sources such as television or radio than from health
care providers and concluded that such media outlets may be a culturally
appropriate and effective method of reaching African-American males with
messages about cancer screening (Powe et al., 2009).
A qualitative study by Jones and colleagues (2009) discussed the sup-
portive role that family and friends play in assisting this population with
decision making around prostate cancer. This study reported that African-
American male participants discussed friends and family members in the
context of trusted informal sources of health information; and saw these sig-
nificant others as sources of encouragement to pursue healthy lifestyles and
stay up-to-date with health screenings (Jones et al., 2009). Other factors asso-
ciated with undergoing prostate cancer screening among African-American
men include: perceived risk of developing prostate cancer, awareness and
knowledge of the disease, higher levels of income and education, having
private health insurance, being married, and having a family history of any
cancer (Ross, Meade, Power, & Howard, 2009; Winterich et al., 2009).
These and other related findings indicate that the decision to undergo
prostate cancer screening is complex and influenced by personal, social,
and health system factors. Additional research is needed to examine the
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Social Ecological Influence on Prostate Screening
interplay of these factors and to characterize their role in promoting or
inhibiting prostate cancer screening in African-American men. The current
study builds on previous knowledge by employing a social ecological frame-
work to examine the influence of intrapersonal factors on prostate cancer
screening among African-American males; a theoretical orientation that has
not previously been applied to understanding screening behavior in this
Social ecological theory provides a framework for examining the contextu-
alized nature of health and health behaviors in terms of how individuals,
their health, and their surrounding physical and social environments interact
at multiple levels of a health problem and are interdependent (McLaren
& Hawe, 2005). This theoretical perspective has two key propositions: (1)
Behavior both shapes and is shaped by multiple levels of influence and (2)
Individual behavior affects and is affected by the surrounding social envi-
ronment (Novilla, Barnes, De La Cruz, Williams, & Rodgers, 2006). Those
multiple levels of influence that impact health-related behaviors and con-
ditions are outlined by McLeroy, Bibeau, Steckler, and Glanz (1988) as: (1)
Intrapersonal factors such as individual attitudes, behaviors, knowledge, and
skills; (2) Interpersonal processes such as social networks made of family,
friends, or colleagues that provide support; (3) Institutional factors such as
formal or informal organizations that may have rules or expectations that
impact health behaviors; (4) Community factors such as informal or formal
networks and norms among individuals, families, or groups/organizations;
(5) Public policy such as local, state, and federal laws or regulations that
promote or inhibit certain health practices that impact disease prevention,
control, or management (Gregson et al., 2001; Robinson, 2008).
Numerous studies have drawn on social ecological theory in whole
or part as a widely applicable framework for examining multi-domain cor-
relates of health behavior (Kothari, Edwards, Yanicki, & Hansen-Ketchum,
2007; Lewis, 2005; Novilla et al., 2006; Raneri & Wiemann, 2007; Richard
et al., 2008; Vantamay, 2009; Woody, 2006). This theory is appropriate
for examining the connection between social and environmental con-
ditions or resources and the health behaviors that lead to preventable
disease. Social ecological theory has been applied to several areas of health
research including but not limited to: HIV/AIDS risk behaviors (Lewis,
2005); repeat adolescent pregnancy (Raneri & Wiemann, 2007); alcohol
consumption among college students (Vantamay, 2009); the prevention of
elder abuse and elder falls (Richard et al., 2008); health promotion at the
family and household level (Novilla et al., 2006); smoking cessation and
tobacco control (Kothari et al., 2007); promoting prevention science in
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J. Mitchell
Public Policy
FIGURE 1 Depiction of social ecological framework.
social work practice (Woody, 2006); and expanding community based health
interventions (McLeroy et al., 2003).
The thread of social ecological framework examined in this study is
the intrapersonal level of influence. Focus was placed on intrapersonal
influences on health behaviors in this population because literature has
indicated that more proximate factors such as personal characteristics, fam-
ily and peer relations, and community resources are critical elements in
promoting and maintaining cancer-related preventive health behaviors such
as cancer screening (Abernathy et al., 2005; Blumenthal et al., 2005; Fort,
2007). The purpose of this study was to understand the influence of intrap-
ersonal contextual factors on the prostate cancer screening behaviors of
African-American men, and to identify predictors of screening behavior in
this population (see Figure 1).
This exploratory study utilized a cross-sectional convenience sample of
African-American men who attended a one-day annual community health
fair. Participants were African-American men, age 18 and older, who could
read and write in English; and who self-selected to complete a paper-
based self-reported survey at an annual community health fair hosted by
a large medical system in northeast Ohio. This study was approved by two
Institutional Review Boards, including one at the hosting hospital. The age
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Social Ecological Influence on Prostate Screening
for eligible participation in the survey (18 years) was selected to ensure that
men were of age to consent; however, young adult men were not specifically
recruited for this survey as it is not feasible to expect that they would have
completed prostate screening. As a result, 89% of the survey sample was
over the age of 40. The health fair was specifically targeted toward minor-
ity men's health needs. Responses were received by 229 African-American
males, which represented nearly 20% of the African-American male health
fair attendees; totaling approximately 1,200 men. This sample was chosen
due to ease of access to a population that has been underrepresented in
cancer prevention research (Powe et al, 2009).
The mean age of this sample was 52.2 years old with 89% of the par-
ticipants being over the age of 40. Nearly 60% of African-American males
in this sample were unmarried; 91.3% of participants had at least a high
school diploma while 20.1% of participants had an undergraduate degree
or higher level of education. Further, 48.5% of this sample was unem-
ployed compared to 17% of African-American males nationwide in 2009
(Sum, Khatiwada, McLaughlin, & Palma, 2010). Also, 44.6% of participants
reported household income levels below $25,000 per year while 55.5%
reported having no form of health insurance. A comparison of this sam-
ple to a nationally representative sample of African-American males taken
from the Current Population Survey (U.S. Department of Commerce. Bureau
of the Census, and U.S. Department of Labor. Bureau of Labor Statistics,
2008) found that the current sample is demographically similar to a national
sample of African-American men in terms of marital status, educational
attainment, and household income while significantly more men in the cur-
rent sample were over the age of 40, unemployed, and lacking any type
of health insurance coverage when compared to African-American males
Undergraduate student volunteers were trained to solicit participation by
African-American male attendees of the health fair and participants gave
oral consent following a script read by volunteers. Volunteers were not
matched to the demographic characteristics of the study population. All sur-
veys were anonymous and collected by volunteers after completion. The
102-item survey took approximately 10 minutes to complete and there was
no compensation for participation. Following the survey, information was
made available to the participants on prostate cancer risk and early detec-
tion along with directions for where screening and physician consultation
could be obtained at the health fair if desired. Survey questions were com-
prised of a combination of Likert-type, multiple choice, and open-ended
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J. Mitchell
Intrapersonal measures included age, education, household income,
employment status, insurance status, access to a usual source of health care
(e.g., health provider), and number of delays in accessing medical care.
Selected data on intrapersonal measures is summarized in Table 1. Health
insurance status was assessed using a single item that asked participants "Are
you covered by any of the following types of health insurance?" Response
categories included Medicare, Medicaid, employer-based insurance; health
insurance purchased directly; and self-pays (no insurance coverage). A
dummy variable was created to capture participants who were insured
(coded as "1") and uninsured (coded as "0").
Having a usual source of care was measured with a single item ask-
ing participants "Do you have a regular doctor or health care provider?"
Responses were coded as follows: 1 = yes and 2 = no and a dummy vari-
able was created which recoded the responses as 1 = yes and 0 = no.
Number of delays in medical care was measured by a single multiple-choice
item that asks respondents to select any reasons they may have delayed
obtaining necessary medical care in the past 12 months. A composite score
was created by summing all delays in medical care with values ranging from
"0" when a participant did not indicate any delays in care to "3" when a
TABLE 1 Selected Study Measures and Participant Characteristics
Variable nameVariable typeScale range
Age Single-item,
1–99 Mean age, 52.2 years
Marital status 1–6Unmarried = 60%
Married = 40%
Some college or
more = 52.8%
High school or
less = 47.2%
$25,000 or
more = 55.4%
Less than
25,000 = 44.6%
Employed = 51.5%
Unemployed = 48.5%
Insured = 44.5%
Uninsured = 55.5%
Usual doctor =48%
No usual doctor = 52%
0 delays = 43.7%
1 delay = 43.2%
2 delays = 7.9%
3 delays = 5.2%
Level of education 1–6
Household incomeSingle-item,
Employment statusSingle-item
1 = Employed
0 = Unemployed
1 = Insured
0 = Uninsured
1 = Usual doctor
0 = No usual doctor
Health insurance
Access to usual
source of care
Sum of delays in
accessing medical
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Social Ecological Influence on Prostate Screening
participant indicated 3 delays in care. No participant indicated more than
three delays in care.
The outcome variable, receipt of prostate cancer screening in the past
5 years was assessed by asking: "Have you had any form of prostate can-
cer screening in the past 5 years?" This question was coded 1 = received
any form of prostate cancer screening and 0 = no prostate cancer screening
received. Screening modalities were listed beside the question to aid in iden-
tification (e.g., prostate specific antigen test or PSA or digital rectal exam);
51% of respondents reported having received any form of prostate cancer
screening in the previous five years.
Data was processed using SPSS 17 (SPSS Inc., IBM). Univariate (descrip-
tive) analysis was performed with frequency distributions on each pertinent
variable to determine a profile on the sample population of African-American
men. Potential relationships between demographic variables and the key
outcome variable (i.e., cancer screenings) were analyzed. Bivariate analysis
with cross-tabulations and chi-squared tests of significance was performed to
determine if any significant differences, associations or other relationships
exist between the independent(s) and outcome variable. Bivariate logistic
regression was performed to determine which intrapersonal variables best
predict the prostate cancer screening outcome variable while controlling
for any demographic variables significantly associated with key outcome
Missing Value Analysis
Data was received by 229 African-American men. Data was screened for
missing values to determine if non-responsiveness among survey partici-
pants was associated with any essential study variables. The SPSS missing
values analysis (MVA) module was utilized to determine whether or not miss-
ing values were randomly distributed across all observations. Imputation
methods were not utilized for item non-response; instead, cases with any
missing data on variables under analysis were deleted (i.e., listwise deletion);
after listwise deletion, N = 229. Listwise deletion of cases is an acceptable
statistical method if missing response values are independent of one another
and missing completely at random (Van Der Ark & Vermunt, 2010).
Bivariate Analysis
Bivariate analyses were conducted to evaluate the linear relationships
between intrapersonal factors and prostate cancer screening. Receiving any
form of prostate cancer screening test was positively associated with age
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J. Mitchell
(r =.39, p < .001), having any form of health insurance (r =.21, p < .01),
having a regular health care provider (r = .48, p < .001), level of education
(r =.20, p < .01), and household income (r =.15, p < .05). Results from the
correlational analysis along with available theoretical knowledge were exam-
ined and used as a foundation for decision making regarding which factors
to include in subsequent logistic regression analyses. Due to the significant
correlation between health insurance and employment status (r =.34, p <
.001), employment status was dropped from subsequent regression analyses
to avoid issues with multicollinearity. Having a usual health care provider
and insurance status was also significantly correlated (r =.51, p < .001).
This finding confirms what current literature indicates, which is that having
health insurance increases access to primary health care providers and spe-
cialists outside of care received in an emergency department (Card, Dobkin,
& Maestas, 2008). Multicollinearity was not an issue for usual source of care
and insurance status because health insurance status did not significantly
contribute to the final logistic regression model.
The goal of this study was to identify a set of predictor variables for the
binary outcome that predicts target group membership for most individuals
in the sample. Binary logistic regression was performed for the outcome
of interest, receipt of any prostate cancer screening test in order to assess
the contribution of intrapersonal predictor variables to the outcome. The
outcome variable was coded 1 or 0 with 1 indicating the receipt of prostate
cancer screening by any modality in the past five years.
Nonlinearity was assessed for the only continuous independent vari-
able, participant age, using the Box-Tidwell method; age was found to
be nonlinear in relation to the prostate cancer screening outcome because
prostate cancer is most often diagnosed in individuals aged 40 and over.
Participant age was then dichotomized into participants aged 39 and below
(0), and age 40 and over (1), which corrected the issue of nonlinearity.
Collinearity was assessed by regressing each independent variable on all
other independent variables in a linear regression analysis after which a
group of multicollinearity diagnostic statistics were evaluated. These diag-
nostic statistics include the r-squared (r2) value, tolerance, and variance
inflation factor (VIF). No issues with collinearity were detected. An exami-
nation of the influence of each case on the estimated model was conducted;
results indicate that on average, influential cases did not significantly influ-
ence regression coefficients and individual observations with absolute values
above the Dfbeta cutoff were not omitted from the subsequent analyses.
Dfbeta is a measure for identifying outliers or highly influential observations
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Social Ecological Influence on Prostate Screening
in a dataset. An examination of leverage values indicated that any outlying
cases did not unduly influence regression coefficients.
During the model building process, independent predictor variables
were selected based on significant associations in the correlation matrix
and information from literature on potential predictive factors. Factors that
were significant bivariate correlates but were not significant predictors in
this model were excluded with the goal of building the strongest and most
informative model for this outcome. Independent predictor variables were
entered simultaneously as opposed to stepwise because there was no clear
theoretical knowledge concerning which predictors were more important.
A binary logistic regression analysis was conducted to predict the
receipt of any type of prostate cancer screening for African-American male
participants. The outcome variable was coded 0 = no prostate cancer
screening and 1 = any form of prostate cancer screening tests. Four pre-
dictor variables were entered simultaneously into the model; these were the
responses to the survey questions about current age, having a usual doctor
or source of health care, insurance status, highest level of attained educa-
tion, and sum of delays in medical care. Data from 229 cases was included
in this analysis. A test of the full model (with age, usual source of care,
insurance, education, and sum of delays in care as predictor variables) com-
pared to null model was statistically significant, χ2= 76.58, p < .001 Age
(β = 2.609, p < .001). Usual source of care (β = 2.063, p < .001) and
educational attainment (β = 0.737, p < .01) were significant predictors of
prostate cancer screening while health insurance status and sum of delays in
medical care were not significantly associated with prostate cancer screen-
ing. Increased age, access to a regular health care provider, and educational
attainment were all positively associated with the receipt of prostate cancer
screening. The error ratio was 0.915, which can be interpreted as a 91.5%
reduction in error for the full model over the constant model. The proba-
bility of the receipt of prostate cancer screening given the three significant
predictor variables is reflected by Cox and Snell's R2= .271 and Nagelkerke's
R2= .38; representing an improvement of the full model over the intercept
African-American men experience disproportionately high death rates for
prostate cancer. Screening is a critical preventive strategy to detect prostate
cancer early when treatment can significantly increase the odds of survival.
There are risk factors for developing prostate cancer such as family history
that are not amenable to change; however, screening represents a health
behavior that can be undertaken at the intrapersonal level to affect can-
cer mortality risk. This study sought to identify social ecological factors that
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Page 13
J. Mitchell
influence prostate cancer screening in African-American men. Findings indi-
cated that for every one year increase in age, additional year of education,
and access to a usual health care provider, the odds of having received any
form of prostate cancer screening also increased. These findings suggest that
the action of receiving a prostate cancer screening test is associated with
both intrapersonal factors that cannot be modified such as age, and factors
that can be altered such as level of education and access to a health care
provider. Findings from this study are also consistent with the literature on
factors the influence prostate cancer screening in this population (Fitzpatrick,
Schulman, Zlotta, & Schroder, 2007; Jones et al., 2009; Winterich et al., 2009).
The following section will provide context for the factors shown in this study
to predict prostate cancer screening among African-American men.
Age and Education
Prostate cancer is a disease that characteristically affects older men.
Consistent with the literature and clinical findings, this study identified older
age as a predictor prostate cancer screening in the sample studied. Previous
studies have identified psychosocial, behavioral, and health system factors
that pose particular barriers for older African-American men to accessing
prostate cancer screening such as: lack of knowledge and confusion about
prostate cancer diagnostic tests (Weinrich et al., 1998); mistrust of health care
providers and difficulty navigating complicated health systems (Odedina
et al., 2008); and limited access to timely and accurate health information
about screening and prostate cancer risk among other factors (Sanchez et al.,
For African-American men, there is a critical link between educational
attainment and prostate cancer survival. Studies conducted by the American
Cancer Society have found that African-American males with 12 or fewer
years of education were more than twice as likely to die of prostate cancer
as African-American males with more than 12 years of education (Albano
et al., 2007). Likewise, declines in prostate cancer mortality rates between
1993 and 2001 were greater for both African-American and White males
who had more than 13 years of education (American Cancer Society, 2010).
While additional studies are needed to elucidate the link between lower edu-
cational attainment and higher prostate cancer mortality, it can be inferred
that African-American men with fewer years of formal education may have a
lower awareness of the risks, symptoms, and/or preventive strategies asso-
ciated with prostate cancer, potentially leading to delayed diagnoses and
higher mortality rates.
Social workers, nurses, and other practitioners on the health care team
are in a position to work alongside physicians to identify age-appropriate
African-American male patients in the health care setting with lower edu-
cational attainment for targeted information on prostate cancer risk and
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Page 14
Social Ecological Influence on Prostate Screening
screening recommendations. Likewise, clinicians in community health set-
tings or who partner with social agencies with African-American male clients
over the age of 40 with fewer than 12 years of education could provide addi-
tional health informational materials that stress the heightened importance
of engaging in cancer-related preventive health behaviors among African-
American males such as prostate cancer screening; along with encouraging
these clients to talk with their physicians about their individual cancer risk.
Health and social care professionals should focus on creating multiple points
of contact for African-American males with lower educational attainment.
Each point of contact represents an opportunity for African-American men
to hear the message that cancer screening is a critical preventive strategy for
reducing the risk of death from prostate cancer.
Access to Care
Studies examining the cancer prevention needs of lower income urban pop-
ulations have shown that professional facilitation of the health care and
health insurance systems in the form of case management or patient nav-
igation significantly increases patient completion of cancer screening tests
(Jandorf et al., 2006). Patient navigation services have also been shown to
reduce the follow-up time to biopsy for patients whose initial cancer screen-
ing tests were concerning (Freeman, Muth, & Kerner, 1995). Practitioners
who are in a position to directly provide or advocate for patient navigation
services play a critical role in reducing confusion that can be associated with
finding one's way through what can be a disorienting health care system.
African-American men as an underserved population at high risk for
undetected cancers face significant barriers to accessing information on can-
cer prevention and engaging in preventive health behaviors, particularly
cancer screening tests. Studies indicate that patient navigators are uniquely
trained to assist clients in overcoming barriers to accessing education and
care while being well informed of community resources to assist under-
served patients (Dohan & Schrag, 2005). Cost has been identified as a
substantial barrier to cancer screening among the uninsured leading to later
cancer diagnoses and poorer prognoses (Freeman, 2006). Social workers
and other practitioners in community health settings have an opportunity to
include in their scope of services; outreach, education, and assistance access-
ing financial resources for preventive health to populations facing economic
barriers to preventive cancer care. Additionally, patient or client navigators
can assist with accessing transportation to health services, providing written
or phone reminders for medical appointments, mobilizing social support,
and act as a bridge between health providers to ensure continuity of care
(Dohan & Schrag, 2005; Gottlieb, 2009). This type of comprehensive service
is necessary for underserved populations such as African-American men who
face several barriers to quality consistent health care.
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Page 15
J. Mitchell
Strengths and Limitations
This study did not employ random sampling, so selection bias is a potential
threat to the validity of the data. In addition, the convenience sampling strat-
egy utilized somewhat limits the generalizability of the findings, although
replication in future years or in other studies could improve upon the reli-
ability of the findings. The associational and correlational nature of this
research along with the cross-sectional research design severely limits the
ability to establish causality or make predictions beyond a limited scope of
time. This sample is also potentially unique from the general population
of adult African-American men in that these men were particularly moti-
vated in some way to seek out health information or health services, and
may be demographically more similar due to the geographic location of the
health fair.
Despite these limitations, this study fills a gap in the health disparities
literature by applying a multi-domain framework to understanding factors
that hinder and promote utilization of prostate cancer screening as a can-
cer prevention strategy in this sample of urban African-American males.
Also, having a sample size of over 200 African-American men is a strength
as African-American men are understudied in health behavior research.
Furthermore, the conceptualization of social ecological influences on cancer
screening behaviors among African-American men introduced in this study
provide a schema that can be easily translated into interventions to increase
cancer prevention practices among underserved African-American males and
similar medically underserved populations.
Social work practitioners and clinicians from other health-promoting fields
play a key role in carrying the message of cancer prevention to high risk
communities as well as partnering with individuals, families, and communi-
ties to manage their risk of disease by altering behavior, accessing resources,
and appropriately utilizing the health care system. Findings from this study
demonstrate that preventive health behaviors do not occur in a vacuum, but
are influenced by social and ecological conditions along with individual fac-
tors that shape health decision making, particularly among unrepresented
and vulnerable populations. Clinicians working closely with communities,
primary health care, and other health-related settings may be in a position
to advocate for and provide the type of interventions that reduce barriers to
cancer preventive care for African-American males, particularly those who
are older, uneducated, and uninsured. For example, the promotion of more
comprehensive patient navigation services have shown promise for reducing
barriers to accessing the health care system in general, and cancer screening
Downloaded by [Wayne State University], [Jamie Mitchell] at 09:02 15 September 2011


text:
Green UCL News publication
- Green Impact 2013-14 is now live!
- UCL wins Green Gown Award for Technical Innovation
- UCLoo Festival (Nov 19th - Dec 3rd)
- UCL achieves gold standard in environmental audit
- Mayor's Low Carbon Prize
- Green Impact end of term league table
- Give your feedback and get a £10 Waterstones voucher
- Green Impact February League Table
- Green Volunteering Fair
- WARPit Competition Now On
- UCL achieves Ska Gold rating for Whittington Hospital refurbishment
- Big Easter Switch Off: the results!
- Get Cycling Event: Wednesday 14th May, South Quad
- UCL action for sustainability celebrated at the Green Impact Awards
- Students: give your feedback and get a £10 Waterstones voucher
- Green UCL Annual Report published
- New bike racks installed around UCL
- UCL engineers work with contractors to boost biodiversity
- A new approach to recycling at UCL
- Will your department take part in UCL Green Impact?
- UCL's response to Transport for London's proposed Cycle Superhighways
- Gearing up for a new year
- Become an ambassador for the Mayor of London's Low Carbon Entrepreneur
- UCL backs proposed Cycle Superhighways
- UCL achieves Highly Commended for Sustainable Facilities Management
- The Sustainability Team is recruiting!
- Free hydrogen-powered mulled apple juice and switching off stickers
- Cut down on waste and get an extra £200 in your pocket
- The Christmas Switch Off: your impact
- Free environmental auditor training for students and staff
- Pop-up cycling cafes from London By Cycle
- UCL's People & Planet University League 2015 score
- Share your images of sustainability
- Attend the VSU Green Volunteering Fair
- Celebrate Fairtrade Fortnight 2015
- Come for a free cycling adventure around London
- Green Impact Spring League Table
Green Impact Spring League Table
The results of Green Impact (so far) are in! Huge congratulations to
everyone involved for a high number of actions taken
already. Green Impact veterans PALS are in the lead, but there's still plenty of time to catch up and challenge them. And don't be put off if your team hasn't taken many actions yet - there are still almost three months to go until the final deadline for this year's programme (on 25/05/15).
Published: Mar 6, 2015 4:50:00 PM
Come for a free cycling adventure around London
Join the London by Bike team on a free cycling adventure around London; discover new routes, boost your cycling confidence and enjoy a free lunch or dinner on us when you finish.
Published: Feb 16, 2015 10:27:00 AM
Celebrate Fairtrade Fortnight 2015
Fairtrade Fortnight is 23rd February - 8th March, and all staff and students are encouraged to get involved.
Published: Feb 10, 2015 1:15:00 PM
Attend the VSU Green Volunteering Fair
UCLU Volunteering Services Unit present the Green Volunteering Fair. Come along to find out about a world of opportunities to get involved. More...
Published: Feb 9, 2015 9:41:00 AM
Get Cycling Event: Wednesday 14th May, South Quad
12 May 2014
This Wednesday (14th May) from 11am-3pm in the South Quad, London Cycling Campaign and friends will be hosting a free cycling event.
Come to the South Quad for:
- Free bike checks and maintenance
- Competitions to enter
- Free tea and coffee
- Opportunities to find out more about free cycle training
- A short led ride
- A workshop on cycle maintenance
Activity times:
- 12.30pm: cycle maintenance workshop - learn how to fix your own bike!
- 1.00pm: led ride around Bloomsbury. London Cycling Campaign have got a lovely easy route planned, led by experienced instructors. You don't need to be a regular or confident cyclist, and you don't even need to have a bike! You can borrow one of theirs – take your pick from our selection of Dutch style bikes, single speeds and Bromptons. Meet at their stand at 12.45pm for a 1pm start – you should be back at UCL by 2pm.
If you have any questions about this event, please get in touch with Green UCL.

subset: commoncrawl


text:
1950 Ford Deluxe Sedan - Original V8 flathead engine with standard transmission. 75% original interior. Absolutely NO RUST! Original fender skirts. Runs and drives... More
1947 Ford Woody Wagon, original V8 flathead, standard transmission, excellent wood and original wood grain dash. Very solid, no rust. Runs excellent.... More
1951 Ford Club Coupe. ALL STEEL. Original body, no patch panels-including inner rockers. Built 1961. 56 Olds. 324 CI engine. 3 duces. 3spd. overdrive... More
1940 Ford Deluxe Convertible - Car will be at Auto Fair at Charlotte Motor Speedway Sept 20-21, with the Southern Performance Ford Club The following... More
1939 Ford Deluxe Convertible Sedan, The flowing lines of the 1939 Ford Convertible Sedan is one of he prettiest Fords ever made. This is... More
1940 Ford Deluxe Convertible Maroon with tan leather interior, 2014 AACA First JR and SR awards. All original, V8 3-spd, first year for column shift,... More
Going to Mecum Auction in Anaheim, California, November, 2014. 1940 Ford Deluxe Coupe, Over the Top! 40 Ford Deluxe Coupe built by Lonnie Gilbertson in... More
1947 Ford Woody Wagon Deluxe, V-8, Restored Frame-Off Approximately 20 Years Ago, the car has all 3 Original Seats, All the Wood is SOLID,... More
1939 Ford Deluxe Jefferson Blue, one of 3,561 produced, rust-free southern car. Radio, heater deleted, Columbia 2-speed rear end, skirts, road lamps, & directionals. ... More
One of the greatest things to come out of the explosion in vintage rodding is the rebirth of the flathead Ford V8. This 1939... More
At first glance, your instinct might be to call this a hot rod. After all, it has a 302 Ford V8 under the pointed... More
This 1940 Ford Deluxe Street Rod Coupe features a 351 V-8 8cyl Gasoline engine. It is equipped with a 3 Speed Automatic transmission. The... More
This 1940 Ford Deluxe Suicide Coupe features a Boss 302 V-8 8cyl Gasoline engine. It is equipped with a 3 Speed Automatic transmission. The... More
One Family Owned / Recent Cosmetic Restoration... More


text:
Apply Now | Make a Gift
02.26.2015 All-School Mass
02.27.2015 10:25 am - 11:00 am Daily Mass
02.28.2015 Deanery Instrumental Festival
03.02.2015 10:25 am - 11:00 am Daily Mass
03.03.2015 10:25 am - 11:00 am Daily Mass
Come Experience Guerin Catholic!
Click HERE to pre-register or contact us at firstname.lastname@example.com
Rising 8th graders are invited to take the HSPT Prep Class. Online registration opens March 1st
Wow your children this summer! Registration and catalog open on March 1st... athletics and enrichment opportunities await!
Click HERE to apply for admission to Guerin Catholic!
Lead with Humility † Serve with Love † Trust in Providence
Honor Roll schools receiving this designation are marked by the integration of Catholic identity throughout all aspects of their programs and excellence in academics.
Guerin Catholic has received this honor each year since 2007.
Click HERE to view the lunch menu.


text:
Comedians Kurt Metzger and Tony Camin at the Punch Line
* Additional fees apply. No coupon or promo codes necessary to enjoy the displayed discount price.
The last date listed for Comedians Kurt Metzger and Tony Camin was Saturday May 22, 2010 / 8:00pm.
Currently at Punch Line Comedy Club
Will Durst: Legendary Political Comic at Punch Line Comedy Club
- Full Price:
- $16.00 - $20.00
- Our Price:
Hailed by The New York Times as "possibly the best political comic in the country," Will Durst co … More
Venue Details
Besides regularly performing in many a NYC comedy club, Kurt Metzger's credits include performing on Comedy Central's Live at Gotham, Showtime's White Boys in the Hood and as a regular on VH1's Best Week Ever. Kurt has filmed a half-hour special for Comedy Central and appeared on Comedy Central's Important Things with Demetri Martin, IFC's Z-Rock and is a star the new Comedy Central program Ugly Americans. In 2007, he was the stand out comedian at the Montreal Comedy Festival's New Faces showcase. He has also written for Chappelle's Show on Comedy Central and several other SpikeTV, VH1 and Comedy Central Programs.
One of the stars and creators of the off-Broadway smash hit 'The Marijuanalogues,' also starring Arj Barker and Doug Benson, Tony Camin is one of the funniest people alive. He has appeared on 'Jimmy Kimmel Live' and 'Real Time with Bill Maher' with the Logues and on 'Late Night with Conan O'Brien' and Comedy Central's 'Premium Blend' with his stand-up.


text:
Browns pass on franchise tag, could lose all unrestricted free agents
That means the Browns have until March 10 to sign their free agents or they will hit the market with complete freedom.
It also is appearing more and more likely that the team may not retain any of its unrestricted free agents. The tea leaves say the Browns may try to keep one or two, but the players will at least test the market first.
One name to watch who was not tagged by his team is linebacker Jerry Hughes of Buffalo. He blossomed in Mike Pettine's system, with 10 sacks each of the last two seasons, and he could be a target for the Browns.
Running down the Browns' most prominent unrestricted free agents:
- Tight end Jordan Cameron was the only player who might have been franchised, in part because the tight end franchise cost of $8.347 million is lower than that of even a safety ($9.618 million). The Browns declined to tag Cameron, and he will head elsewhere. Cameron grew weary of the revolving door at the quarterback and at coach and in the front office in his four years in Cleveland. He is ready for a change.
- Cornerback Buster Skrine is a player the team would like back, but he wasn't worth a franchise cost of $13.07 million that would have put him in Joe Haden territory. Skrine improved every season with the Browns, but he has gone on record saying he will test the market before considering staying in Cleveland.
- Quarterback Brian Hoyer and the team cut ties when Josh McCown was signed. The Browns preferred McCown, so Hoyer will go to a new team.
- Linebacker Jabaal Sheard is an underrated player who is well-respected in the locker room. His numbers are not glittering, but a team that wants a professional and productive role player would do well to sign him.
- Defensive lineman Ahtyba Rubin played through an ankle issue a year ago, but the team gives every indication they feel Rubin's best years in Cleveland are in the past.
- Wide receiver Miles Austin was a dependable pro in his one year in Cleveland. Even with that, the Browns interest in him seems tepid at best.
Pro Bowl free safety Tashaun Gipson is the most important restricted free agent. The Browns have until March 10 to tender him an offer that would give the team the right to match an offer sheet he could sign with another team, or receive compensation if he leaves. The Browns are likely to place a high tender on Gipson, probably one that would bring a first-round draft pick as compensation.
The other prominent restricted free agents are special-teamer/safety Johnson Bademosi and defensive lineman Ishmaa'ily Kitchen.
Browns likely not done in quarterback search
After asking around, I'm hearing Cleveland plans to add at least one more quarterback to the 2015 meetings rooms, a role filled through the draft or free agency.
The Browns are intrigued by Sam Bradford, but many believe he won't be attainable without -- once again -- valuable draft picks. Giving up first- or second-rounders is difficult for a build-through-the-draft team such as Cleveland.
Free agency plays for Ryan Mallett or Jake Locker seem unlikely at this point.
Save Bradford, a home-run quarterback signing doesn't really exist for Cleveland. But they can dig through the bargain bins and hope for the best.
A plausible rotation for Cleveland's quarterback room is Josh McCown, Johnny Manziel, Connor Shaw and a rookie quarterback such as Colorado State's Garrett Grayson or Baylor's Bryce Petty.
The Browns have been burned by spread quarterbacks before, but I'm told they had productive meetings with the former Baylor star at the Senior Bowl.
McCown, who last week signed a three-year deal worth $14 million, seems ready to support any quarterback in the Browns' facility.
"Whatever I can do to help somebody, I can do that," McCown said.
Checking the internet for opinions on the Josh McCown signing
There are other opinions out there, though, some negative, some more positive.
Peter King of SI.com wrote in Monday Morning Quarterback that the Browns feel McCown is a better bridge than Hoyer. "If Hoyer had been re-signed, he'd have expected to play every game, and the Browns weren't convinced that he's an NFL starter. With McCown, he can fill almost any role."
ESPN CLeveland's Tony Grossi asks: "What in name of Jake Delhomme is going on here?" Then add: "A history lesson: The Browns have a sordid history of adding washed-up quarterbacks since they returned as an expansion franchise in 1999."
Tom Reed, a noted international soccer enthusiast as well as a Browns writer for the Northeast Ohio Media Group, wrote: "If the plan is heading to training camp with McCown and Johnny Manziel, who's in rehab, then fans must be grateful American football doesn't relegate its bottom teams the way they do elsewhere in the world."
Terry Pluto of the Plain Dealer says the McCown signing "has to be setting up another move." Or at least, he adds, it should be.
The NEOMG's Bud Shaw asks: "Is McCown more attractive because he's willing to mentor young quarterbacks while Hoyer and whomever else -- Jake Locker, Mark Sanchez -- would want to start? God help all Browns fans if that's the case."
Zac Jackson of FoxSportsOhio offers that McCown's signing did not bring much rejoicing. "The Browns are moving on from Brian Hoyer -- a hometown guy who won a little -- for an older version of a game manager like Hoyer who has more bruises and a better completion percentage."
Marc Sessler of NFL.com says McCown gives Manziel "an example to follow under center." He adds: "It's a strong sign the team still believes Johnny can make something out of a career that currently floats upon troubled waters."
The Cleveland Browns last week signed Josh McCown to a three-year deal worth $14 million, including $6.25 million guaranteed and $6 million in incentives, which is better than typical backup money.
McCown is taking a starter's mentality to Cleveland too.
"That's my expectation right now," McCown told ESPN Radio's "Mike & Mike" on Monday about his goal to start for the Browns. "We'll see, as things unfold, what their plan is, but that's my expectation. I'm going to compete as such to do that."
McCown signed a bigger deal after going 1-10 as the Tampa Bay Buccaneers' starter last year than he did the previous offseason, when he signed a two-year, $10 million deal coming off a 13-touchdown, one-interception performance with the Chicago Bears.
Released by the Bucs on Feb. 11, McCown used the following 16 days to create a market. The Bills, Jets and Bears were all reportedly involved. In what's considered a weak free-agency market for quarterbacks, McCown capitalized.
The Browns have started 22 quarterbacks since 1999. McCown seems to understand the inherent skepticism of the potential No. 23 on that list, especially since he is coming off an 11-touchdown, 14-interception season. McCown supporters can point to a thumb injury, shaky offensive line play and the September leave of absence of offensive coordinator Jeff Tedford as reasons for his struggles.
Speaking with local media Monday afternoon, McCown said he understands the "tall order" of succeeding in Cleveland but isn't discouraged by past results.
Still scratching my head over the Browns signing Josh McCown
1. Ponder the chronology: Ray Farmer drafts Johnny Manziel. Brian Hoyer barely wins the job out of training camp, then holds onto it by playing well early. Eventually he leads the Browns to a 7-4 record. Farmer, though, sends in-game texts to assistant coaches as early as the New Orleans game. It was the second game of the season and a win for the Browns. He continues to text during games throughout the season, some of it about the quarterback play, and only acknowledges his mistake after the season when the texting becomes public. Farmer clearly was part of the front office effort that undermined Hoyer, and had him playing while wearing a straightjacket. The more Hoyer learned the front office was not supportive, the more he pressed. So the guy who undermined Hoyer by texting during games winds up, with the full support of the owner, ushering Hoyer out of town and signing a 35-year-old to replace him.
3. The Browns have maintained as they built their team that what was most important to them was they wanted to drive competition at every position. It's been a mantra, right up there with "play like a Brown." In signing McCown, the Browns let Hoyer go because he wanted to start and they felt he was not their guy for the long-term. In signing McCown, they added a guy who will start, but is willing to be a mentor. How exactly is this driving competition?
4. McCown was good with the Bears two years ago, going 3-2 in games he started. But that was the only year in his career he was above .500 as a starter. His second-best mark: 3-3 in 2005 and 1-1 in 2011. Take away the Bears season, and McCown is 14-30 as a starter, with 44 starts in 12 seasons.
5. McCown went 1-10 in Tampa Bay. There he had two big and talented receivers and a poor offensive line, and he faced the NFC South, the NFL's worst division. Carolina made the playoffs with a 7-8-1 record.
6. Kyle Shanahan preferred the Browns draft Jimmy Garapolo last year. In signing McCown, the Browns made a point that new coordinator John DeFilippo worked with him in Oakland. So the team gave a first-time coordinator who -- has never called plays -- his quarterback while denying the veteran coordinator his.
7. It's worth noting that DeFilippo worked with McCown as quarterback coach in 2007. That was seven years ago when DeFIlippo was a first-year quarterback coach.
8. Relying on past performance seems to really matter with this organization. Farmer said he believes Manziel can succeed because of the way he played in college. Two years ago. The Browns signed McCown, presumably because he played well in Chicago. Two years ago.
9. In fairness, the draft remains an option. A developmental guy like Garrett Grayson could fit. If Marcus Mariota falls to No. 12, the Browns would be nuts not to take him (which of course, based on history, means they'll take a running back). But if it comes to trading up to acquire Mariota, the Browns would have to surrender both their first-round picks and presumably another to get him. Which means they'd be giving up everything they acquired to build a team that could sustain winning. Which would be continued madness.
10. This of course shrugs off that Mariota will need time to adjust to the NFL game and might not be ready as a rookie. Mariota said at the combine he hadn't called plays in a huddle since high school, so Kevin O'Connell had him practicing reading plays at night. He also didn't huddle in college, or take NFL drops. So … he'll go through the same on-field adjustment Manziel went through.
And, because winter is almost over, a bonus No. 11.
11. The Browns seem to be the only team that believes Manziel and McCown can be a starter. Buffalo was negotiating, but not to the effort the Browns did. What the Browns saw that 31 other teams did not is open to question. Though the draft could reduce the fuzziness, at this point it seems like Farmer simply did not want Hoyer. When McCown became available he became the most attractive quarterback to Farmer who wasn't Hoyer. Signing a 35-year-old who went 1-10 a year ago, a guy much of the league felt was more ready to be a Matt Hasselbeck type backup than a starter, shows little long-term thinking. It seems more like the Browns are making it up as they go.
Browns MailBag: Focusing mainly on the quarterbacks
#Brownsmail If the Browns wanted to trade up to get Cooper or White at 8 or 9, what would they have to give up?
— Brandon Brown (@BrownDawg17) February 27, 2015
@patmcmanamon: The starting point would be one of their first-round picks. If they traded the 12th overall, they would have to throw in at least this year's third-round choice. If they traded the 19th overall, they would have to include this year's second-round choice, and perhaps more. I don't see this as realistic. I disagree with my good friend and colleague Tony Grossi -- I believe there will be a good receiver available at the 12th spot.
@PatMcManamon Farmer/Pettine don't want to draft WR early. So why will everyone lose their minds when they stick to philosophy? #BrownsMail
— Tom Moore (@Tom_RedRight88) February 27, 2015
McManamon: Well, I believe this is more Ray Farmer than Mike Pettine. Why would everyone lose it if it happens? It doesn't necessarily make sense to say a receiver doesn't impact a game because he only touches the ball 10 times on a good day. A talented receiver can have a huge impact on a game. Those 10 touches could be for 150 yards, and a touchdown or two.
@PatMcManamon Will all of the issues this off-season, will the Browns operate any diff in the future, ie draft or FA time #BrownsMail
— Michael (@mebrownie) February 27, 2015
McManamon: Well, owner Jimmy Haslam said they would not be major players in free agency. Which is different from a year ago. It's also odd given the team's overflowing cap space. Which means if they do something like Haslam said, it would be odd, so it would be very much like the Browns' approach for the past 15 years. Which wouldn't be different at all..
Did Browns sign Josh McCown with Johnny Manziel in mind?
McCown's three-year deal with Cleveland reinforces Johnny Manziel's place in the Browns' plans: McCown should be the favorite to start the season opener. He might be the Browns' best option all year. But McCown also seems an ideal eventual handoff option to Manziel or another young quarterback.
The Browns needed a new quarterback plan after Manziel entered a treatment facility, but they weren't moving on.
Re-signing Brian Hoyer, after the clunky competition between him and Manziel in Cleveland, wouldn't have made sense. If Hoyer had come back, he would have been the starter. Despite winning seven of his first 11 games for Cleveland last season, apparently the Browns had seen enough.
McCown can be a starter or backup and adapt either way.
Support existed -- in Berea and from fans -- for Hoyer as a Brown. But Hoyer isn't much different from McCown. Both are reliable and have shown flashes of good quarterback play, but haven't sustained it.
Manziel might never be the answer. The Browns still want to find out for sure -- with more than two games as a sample.
Browns hoping for the McCown from Chicago, not the one from Tampa Bay: McCown's 1-10 record and 14 interceptions with Tampa Bay are curious after he played so well in five starts for Chicago in 2013, throwing 13 touchdowns to one interception.
But McCown dealt with a thumb injury, a struggling offensive line and the abrupt departure of offensive coordinator Jeff Tedford in September. Those factors shouldn't excuse his stats, but they help explain them.
The Browns know they aren't getting Aaron Rodgers. They'll get better than a starter with a 1-10 record.
Browns clearly unimpressed with quarterback market: The Bucs cut McCown 16 days ago, which allowed four quarterback-hungry teams -- the Jets, Bills, Browns and Bears -- to jockey for the services of the only available quarterback on the market.
The Browns must have believed that the group available at the March 10 start of free agency -- Mark Sanchez, Jake Locker, Hoyer and more -- wasn't worth the wait.
There was never a home run for the Browns to hit. The Rams are unlikely to unload Sam Bradford. Save Hoyer, McCown was one of the best available.
Another move to come? Doubtful: The Browns' quarterback picture has come into focus. They'll have McCown, Manziel, Connor Shaw and possibly a draft pick (second round or beyond) for training camp.
It's early, but after asking around, the prospect of trading up for Marcus Mariota seems unlikely at best. Giving up several top picks is a lot to ask for a self-proclaimed build-through-the-draft team.
The Browns can exhaust every option with Bradford, though they probably knew that wasn't going to be fruitful before they signed McCown.
Browns add great guy in Josh McCown, but who is quarterback?
The Cleveland Browns added a mentor to their roster when they signed Josh McCown.
How much of a player they added remains to be seen.
The Browns gave him a three-year deal. The team can explain its reasons, and those reasons could turn out to be correct. But at this point, this move seems to make as much sense as so many moves of the post-1999 Browns, which is to say very little.
The team will make its case. McCown can be a mentor. He doesn't have to start to do that; he wants that role. He worked with new offensive coordinator John DeFilippo in 2007 in Oakland. And the team concluded it does not see Brian Hoyer as a long-term starter.
They're entitled to those decisions, just as fans are entitled to throw their hands up and scream at the thought of McCown and Johnny Manziel as the team's quarterbacks in 2015.
So many questions follow, which isn't supposed to be the case when a team makes a signing at its most important position.
Do the Browns think McCown can start? Does what he showed in Tampa Bay give more belief than what Hoyer showed in Cleveland? Do they believe Manziel will be available to play this year? And if he is, do they believe, based on what they saw in the seven quarters he played, that he can be a starter? If they felt the need to sign McCown, what does it say about how the team feels about the available quarterbacks in free agency? Will they add anyone in free agency, and at what price?
At this point, the signs don't point to another major addition, except perhaps through the draft (has Marcus Mariota ever looked better?)
McCown was good two years ago as the backup to Jay Cutler. He had a positive effect on Cutler. Maybe he can do the same with Manziel.
But that doesn't eliminate the concerns about whether Manziel can succeed in the NFL, at his height and with his style and his commitment -- remember, he didn't know the plays when he finally started in Game 14 of the past season -- and whether McCown is even a starting quarterback in the NFL.
McCown actually falls into a pattern long established by the ever-changing organization that is the Cleveland Browns. That would be the pattern of the veteran quarterback signed late in his career -- too late to make a positive impact on the Browns.
Go down the list.
Jake Delhomme. Jeff Garcia. Trent Dilfer. They're all on the infamous jersey that no doubt will have a 23rd name (and second McCown) added to it in 2015.
All were going to be saviors. They all lasted one year.
Only in Cleveland.
At 6-3, then 7-4 the past season, the Browns seemed headed in the right direction. But things have unraveled wildly since.
An offensive coordinator left two years' pay on the table to get out, the general manager admitted to texting assistant coaches during games in violation of league rules, Manziel entered rehab, ticket prices went up, Josh Gordon was suspended and ... well ... it almost seems pointless to go on.
Except through it all, the Browns and owner Jimmy Haslam said things were fine and dandy. Now he has a 35-year-old quarterback to prove his point.
To which the only response seems to be: Seriously?
Veteran quarterback Josh McCown has agreed to terms with the Cleveland Browns, the team announced Friday.
The deal is for three years, a source told ESPN.com's Jeremy Fowler.
"Josh is your consummate professional," Cleveland general manager Ray Farmer said. "He's known to be a great guy in the locker room and will be great for the quarterback room. He knows how to get an entire offense on the same page and get a team to rally behind him. He has been exposed to a lot of different types of offenses and we think still has the drive and skill set to be a successful quarterback in this league.
"We are excited to get him and believe he will help continue to move us in the right direction and help us build the type of team that will bring winning football to Cleveland."
McCown, 35, went 1-10 as a starter last season in Tampa Bay before he was released this month. He started seven games the previous five seasons, and has played for the Cardinals, Lions, Raiders, Panthers, Bears and Bucs in a 12-year career.
McCown also had visited the Bills, Jets and Bears. He had been negotiating with the Browns and Bills.
McCown is the first step for the Browns toward resolving their uncertain quarterback situation.
Brian Hoyer is headed to free agency, and last year's first-round pick, Johnny Manziel, is in rehab.
"I just want to serve our team and help everybody in that locker room, do my best to help everybody in the locker room be better at their job and they're going to help me, too. It's a two-way street," McCown said. "I'm just excited about coming in and being a part of a team.
"Year 1 was a solid first year for coach (Mike) Pettine, and to see the vision with what he's got going on is exciting to me. In my room, I want to be able to help those young guys and pass along my knowledge and experiences I've had and help them grow."
McCown completed 184 of 327 passes for 2,206 yards with 11 touchdowns and 14 interceptions for Tampa Bay, but the veteran has shown success as a starter, throwing 13 touchdowns and just one interception for the Bears in 2013.
He started nine games for the Raiders in 2007, when new Browns offensive coordinator John DeFilippo coached their quarterbacks. The two still have a good relationship.
McCown wants to compete for the starting job but would be willing to accept the backup role.
"Josh is a high-character, savvy, veteran quarterback that has a lot to offer to our team," Pettine said. "When you hear from people that have been around Josh, they speak of the leadership qualities and the positive impact he has on a locker room. I really enjoyed spending time with him during his visit. He has great passion for playing the quarterback position and wants to show that he can still be successful in this league.
"Obviously, he is a quarterback that has been in a number of systems and he has worked with (DeFilippo), so there is some good familiarity between the two. We are excited to have him become part of our team and we look forward to him playing an important role in our offense."
Hoyer, who won seven games for Cleveland in 2014 but faltered late in the year, had been waiting to meet with Farmer before talks began between the team and his representative. A team official reached out to Hoyer in January to express interest in re-signing the quarterback, but that seems unlikely to happen now. Pettine called Hoyer to let him know of McCown's agreement a few minutes before the team announced the move. Hoyer and Farmer talked after the news was public.
A possible Browns quarterback lineup in 2015 is McCown, Manziel, Connor Shaw
Browns money guide: How to manage $53 million in cap space
Nice, sensible, necessary, not overly exciting.
If Cleveland Browns fans are looking for good news after a brutal two months, it's this -- a team with a pretty good roster has $53,777,486 in cap space as of this week, according to ESPN stats and info. The Browns have a cap value of $106,604,471, with the adjusted cap value sitting at $161,908,285.
With help from J.I. Halsell (@SalaryCap101), a former Redskins salary-cap analyst, here is Cleveland's exact spending situation:
Because the CBA requires NFL teams to spend at least 89 percent of the cumulative salary caps from 2013-16, which, for the Browns, projects to $492.17 million in spending by the end of the 2016 league year.
How much have the Browns spent during that span?
To date, Cleveland has spent or committed to $420.99 million. Splitting in half, the Browns could spend $35.5 million in each of the next two years. Or, if they are feeling aggressive, spend a cool $50 million before September. The Browns likely want a larger cushion of space for next year.
For argument's sake, let's say the Browns are entering March with plans to spend about $40 million in the next eight months. There is a reasonable plan for such spending. All free agency deals are one-year totals while assuming the signing bonus is prorated over the length of the deal.
Rookie draft picks: $7.9 million.
This takes into account the Browns' two first-round picks and the rest of the lot. This is essentially money all teams must pay, give or take a few picks.
Free agent quarterbacks: $4 million (was originally $8 million earlier today)
(UPDATE): The Browns signed Josh McCown to a three-year deal on Friday night. McCown likely won't make $8 million per year, which was my original forecast for the position, but McCown will earn a respectable contract.
Sorry, Sam Bradford fans. Don't expect the Rams to part with him without at least a second-round pick in their hands, maybe more. I'm not expecting the Browns to offer more than a third. They want to stay true to the build-through-the-draft plan.
No quarterback on the open market was going to command enough to stress the team's books.
Splashy free agent signing: $8-9 million -- Buffalo outside linebacker Jerry Hughes
Mike Pettine is a fan of Hughes, who acquitted himself well against Joe Thomas in the Bills' Week 13 win against Cleveland. Thomas had three penalties in that game. Pettine, a former Buffalo coordinator, spent one season with Hughes, who seems the perfect complement to Paul Kruger's strength game and Barkevious Mingo's lateral speed.
In this case, filling the outside linebacker need in free agency allows the Browns to attack nose tackle, wide receiver, and tight end high in the draft.
If Hughes commands $10 million a year, that is probably too steep for a draft-precedent team. Getting him for $8 million would be a win for the Browns.
(Free agent fallback: Baltimore WR Torrey Smith at $7-8 million)
Restricted free agent tenders: $6 million
The restricted tender numbers aren't out yet, but my guess is a first-level tender -- a placeholder where an opposing team must relinquish a first-round pick to cut a deal with the player -- will be somewhere in the $3.5 million range, with a second-level tender around $2.4 million, and a third-level in the $1.5-million range (just projections).
If the Browns truly believe safety Tashaun Gipson is a cornerstone in the defensive backfield, they will either slap him with a first-round tender or cut a long-term deal now. If the Browns give him a second-level deal, no doubt Gipson's camp will shop him around.
Linebacker Craig Robertson could get a second-level tender. Both players are valued, and it makes sense to keep them.
In-house free agents: $7.5 million -- Cornerback Buster Skrine at $5 million a year (possibly higher) and Miles Austin at a one-year, $2.5-million deal.
Coaches have made clear they would like Shrine to return. Skrine will have a good market, but the Browns should be able to make a competitive play for him.
Austin would be a reasonable re-sign. The offense was better with him in the lineup.
Otherwise, I'm suspecting the team will let most free agents walk.
Special teams: $2 million for Ted Ginn
Give Ginn, an effective returner and Cleveland native, a two-year deal with a couple of million up front in signing and roster bonuses.
Total cap spending: $40.4 million (changed to $36.4 million)
Bottom line: The Browns could spend on a receiver, but it's hard to imagine Dez Bryant, Randall Cobb or Jeremy Maclin leaving their current spots. Smith might command closer to $8-9 million, a bit pricey for the Browns' taste. Hughes is a safer play. Draft a receiver in the first and fourth rounds, re-sign Austin, and ride with what you have.
Brian Hartline a fit for the Browns?
Though that might not be a totally bad thing.
Ted Ginn Jr. would fill a glaring need as a returner and could compete at wideout as well. He still has speed, which always is an asset. Carolina and the Browns both have interest in Ginn, a Cleveland native, and there is some thinking from Carolina that the Browns have the edge.
That has to play out.
Friday, word broke that the Dolphins are releasing Brian Hartline.
While Ginn, 29, seems to be a natural, Hartline would take discussion. But he's worth discussing. Hartline, a native of Canton, Ohio, is 6-foot-2, 28 years old and he's caught 189 passes the last three seasons in Miami.
He does not have blazing speed, but he's a tall target with good hands. Word also broke Friday that Atlanta was releasing Harry Douglas, but he seems to have similar skills as Andrew Hawkins. Douglas is a good player, but he might not add to what Hawkins and even Taylor Gabriel do. Hartline might.
The point, too, isn't that the Browns receivers can't play. They can, and they (Hawkins, Gabriel, Travis Benjamin) give everything they have. They play with heart, effort and professionalism.
But to think the position doesn't need upgrading via depth also isn't realistic.
The Browns always talk about "driving competition" at every position, so adding more capable players will do just that. Drive competition and let the playing time sort itself out.
More players will be released, more opportunities will be available, but it's clear the Browns can address the receiver spot this offseason — if they choose to address it. They will have more than $50 million in salary-cap space. Money isn't an issue. How the money is doled out is, but many NFL teams seem to be able to do that and win.
Adding a veteran free agent or two — be they Ohio State guys or guys from Guam — would help. (Cecil Shorts might be interested in playing for his hometown.) So would drafting a receiver -- with Louisville's DeVante Parker a personal preference.
The position suddenly wouldn't look so barren.
Browns still in discussions with Josh McCown
It's natural to assume the Browns, if they sign McCown, won't re-sign Brian Hoyer or make a bigger play for a Sam Bradford or Mike Glennon.
I'm not necessarily doing that.
McCown is simply a good player to have on the roster, starter or not. There are a few reasons for this. McCown has seen a bit of everything in 12 years. He's started 49 games and watched from the sidelines for many more. He's got a good relationship with new offensive coordinator John DeFilippo. At worst, McCown helps the Browns' transition and becomes a good influence for younger quarterbacks. At best, he starts and wins games.
The Tampa Bay experiment went terribly wrong for McCown, but it's noteworthy that the Bucs' offensive line was brutal at the beginning of the season and offensive coordinator Jeff Tedford's leave of absence in September disrupted continuity. McCown didn't play well, throwing 14 interceptions to 11 touchdowns, but he was dealt a losing hand in Tampa. He's had success as a starter in the past.
Even if McCown signs something close to his two-year, $10-million deal with Tampa a year ago, that wouldn't hamstring the Browns, who have $53.77 million in cap space as of this week. If they wanted to make additional quarterback moves, they can.
McCown is a versatile quarterback option, that simple.
For as much as the NFL discusses quarterback play in absolutes, the Texans won nine games with the Ryan Fitzpatrick-Ryan Mallett-Case Keenum-Tom Savage combination. The Browns won seven of their first 11 last season with Hoyer. There are no quarterback home runs available for Cleveland, but that doesn't mean they can't make the AFC North interesting.
Earnest Byner tries to help ease Brandon Bostick's anguish
Published in 2014, it is the ultimate statement by Earnest Byner, the former Cleveland Browns running back involved in the play that has gone down in Browns history as merely "The Fumble."
But in time he recovered.
Byner now wants to make sure another player does not go through what he did for as long as he did. Byner watched the end of this season's NFC Championship Game and saw the Green Bay Packers' Brandon Bostick misplay an onside kick, helping Seattle complete an improbable comeback.
When Byner heard Bostick talk after the game and then a couple of days later, saying that he had let an entire team and fan base down, Byner knew he had to reach out -- even though he had never met Bostick and had never talked to him.
"I didn't want him to feel like he was alone," Byner said in a phone interview on Thursday.
Bostick made Byner's role clear in a first-person story written on SI.com on Thursday, a story in which Bostick revealed he still lives with his mistakes and that he received death threats on Twitter.
"Sometimes I wake up in the morning and it's the first thing on my mind," Bostick wrote. "There are nights when I dwell on it before falling asleep. Sometimes the thought creeps up on me when I'm lifting weights, or eating dinner, or sitting on my couch at home."
"That's one of the reasons I'm calling him and we're talking," Byner said. "I'm trying to make it so it's not a difficult process for him."
Bostick was supposed to block on the kick and let teammate Jordy Nelson catch the ball. Instead, Bostick tried to catch it and lost it.
Byner heard Bostick's anguish after the game and reached out through Packers assistant coach Sam Gash, who played for the Ravens when Byner was an assistant coach in Baltimore.
Byner would hear people yell, "Hey don't fumble." He'd hear other barbs, snide remarks. He'd notice people looking at him, then looking away. He felt love from many Browns fans, but the weight from the negative, he said, became heavier every day.
"It was almost like a drowning," Byner said.
Byner played for the Browns for one season after the fumble but was not himself. He said it took a trade to Washington to bring him out of his dark state.
"It took a spiritual conversation for me to actually get past the fumble," Byner said. "I'm not preaching to [Bostick]. But to me the spiritual impact is crucial. The spirit has a way of freeing you up a lot."
Since then, Byner has helped several players in several sports. Bostick is the latest, as the two have talked several times since the championship game. The ex-Brown feels that Bostick will benefit from being released by Green Bay. Going to Minnesota will help him start fresh.
"The next step," Byner said, "is to get together. I need to look him in his eyes. I need to feel what he's feeling. That way I can make a difference in the process. Not just that process, but in his life. Because the better the person, the better the player you will have."
As Byner says when describing his book on a video on his website earnestbyner21.com: "Mistakes are critical to learning, understanding what happened and how it happened. And being able to go to the next level. Being able to ultimately become a champion, not just in sports, but also in life."
Finally healthy, DT Ahtyba Rubin awaits free agency, Browns' plans
Playing hurt -- as a result, not able to maximize his ability on the field -- could affect his free agency. There's a good chance the Browns will move on from Rubin after his 28-tackle, one-sack performance last season.
The way Rubin saw it, sitting wasn't an option. He wasn't playing for March dollars, he said.
Rubin, who twice injured his ankle during the season, is working out in Florida and expects to make a full recovery. He wore a protective boot for a while but did not need surgery.
"I didn't even think about my scenario -- if you're able to play, you should play," said Rubin about 2014. "I never even thought about not playing. I've just got to do the best I can now, making sure I'm in complete football shape when that time comes and perform at my best."
Rubin first injured his ankle in an early-season practice going against Alex Mack, Rubin said. The problem persisted, and Rubin got injured again in Week 16.
This will be Rubin's first time hitting the open market. He's played seven years and wants to log many more.
"This is a new situation for me," Rubin said. "I'm just letting my agent take care of everything. I want to get a good 12, 13 years in there."
Whether with the Browns or elsewhere, Rubin said he believes his team will get more of the player who earned the contract extension in 2011.
"I know what I can do," Rubin said. "For me to be struggling [last year], it was frustrating."