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Background: Professional societies recommend shared decision making (SDM) for prostate cancer screening, however, most efforts have promoted informed rather than shared decision making. The objective of this study is to 1) examine the effects of a prostate cancer screening intervention to promote SDM and 2) determine whether framing prostate information in the context of other clearly beneficial men's health services affects decisions., Methods: We conducted two separate randomized controlled trials of the same prostate cancer intervention (with or without additional information on more clearly beneficial men's health services). For each trial, we enrolled a convenience sample of 2 internal medicine practices, and their interested physicians and male patients with no prior history of prostate cancer (for a total of 4 practices, 28 physicians, and 128 men across trials). Within each practice site, we randomized men to either 1) a video-based decision aid and researcher-led coaching session or 2) a highway safety video. Physicians at each site received a 1-hour educational session on prostate cancer and SDM. To assess intervention effects, we measured key components of SDM, intent to be screened, and actual screening. After finding that results did not vary by trial, we combined data across sites, adjusting for the random effects of both practice and physician., Results: Compared to an attention control, our prostate cancer screening intervention increased men's perceptions that screening is a decision (absolute difference +41%; 95% CI 25 to 57%) and men's knowledge about prostate cancer screening (absolute difference +34%; 95% CI 19% to 50%), but had no effect on men's self-reported participation in shared decisions or their participation at their preferred level. Overall, the intervention decreased screening intent (absolute difference -34%; 95% CI -50% to -18%) and actual screening rates (absolute difference -22%; 95% CI -38 to -7%) with no difference in effect by frame., Conclusions: SDM interventions can increase men's knowledge, alter their perceptions of prostate cancer screening, and reduce actual screening. However, they may not guarantee an increase in shared decisions., Trial Registration: #NCT00630188.

Methyl mercury is a potent neurotoxin that causes developmental delays in young and unborn children and has been linked to neurological and cardiovascular degeneration in adults. Methyl mercury is the basis of a state-sponsored fish advisory to limit consumption of local fish in North Carolina. This study employed methods and analytic constructs from the behavioral and social sciences to assess the determinants of subsistence fishing and to promote informed fish consumption among culturally distinct and lower income subsistence fishers in southeastern North Carolina. Formative research revealed that Native American and African American were more likely than Latino residents to know of the fish advisory, and to practice procurement and preparation strategies that are mistakenly believed to render locally caught fish safe for consumption. Fish advisories were developed for each community to promote informed fish consumption intentions among residents who consume local fish. The interventions were successful in increasing knowledge and healthy intentions among most residents. Adherence to some safe fish consumption practices were constrained by cultural and economic factors. These results demonstrate the utility of multidisciplinary approaches for assessing and reducing human exposure to methyl mercury through subsistence fish consumption.

Background: This community-based intervention study examined the effects of 2 different message strategies for presenting information about the prostate specific antigen (PSA) test., Methods: A quasi-experimental longitudinal design with 2 intervention and 1 control group., Results: Knowledge increased significantly among participants who received either version of the intervention message and remained elevated at 12 months. Presenting information in the context of other men's health issues was associated with greater increases in knowledge relative to PSA only., Conclusions: Community-based interventions can increase knowledge about prostate cancer screening. Clinicians need to take careful account of what their patients understand and correct misperceptions.