Masculinity and colorectal cancer screening: a cross-sectional study of men attending state fairs in Minnesota and Wisconsin

Background: Success in community-based interventions addressing colorectal cancer (CRC) disparities among men relies on their active engagement in screening activities, yet traditional masculinity norms may deter men from participating in preventive health behaviors. Purpose: This cross-sectional study examined the association between masculinity barriers to medical care (MBMC) and CRC-screening intent and behaviors among men aged 18-75, attending state fairs in 2 midwestern states. Methods: CRC-screening intent was assessed for all participants. Screening participation and current screening status were also examined among men aged 45-75 years (screening-age eligible). Composite scores were calculated overall and for each MBMC subscale, with higher scores indicating a stronger endorsement of traditional masculine ideologies. Multivariable logistic regression was employed, adjusting for confounders. Results: Our findings highlight a high prevalence of self-reported CRC-screening behaviors among men in our study sample (n = 937), with 78% expressing intentions to obtain screening. Among screening-age eligible men (n = 377), 79% reported having participated in CRC screening, with 72% being up-to-date (UTD) with screening. A strong inverse relationship was observed between CRC-screening intention and behaviors, and the Health Problem Minimization subscale as well as Fear of Being Perceived as Gay subscale. Conversely, higher scores on the Provider Role subscale were associated with higher odds of having ever participated in CRC screening, and of being UTD with screening. Conclusions: Addressing masculinity-related barriers, particularly Health Problem Minimization, could help increase CRC screening uptake among men. Future intervention strategies should consider reframing CRC screening as an act of self-care and strength, emphasizing health empowerment rather than aligning solely with traditional masculine or provider-role ideologies, which may themselves present limitations. By promoting a broader and more inclusive view of masculinity, interventions can better engage men in preventive health behaviors and ultimately improve CRC-screening adherence and outcomes. Lay summary This study explored whether certain traditional masculine beliefs affect men’s colorectal cancer screening plans and actions. We surveyed men at the state fair in 2 Midwestern states. They answered questions about masculine norms, such as whether they tend to ignore health issues, avoid emotional expression, or prefer to handle things on their own, as well as if they planned to get screened for colorectal cancer. For those ages 45-75 (the recommended screening age), we also asked whether they had ever been screened, and how long ago. We found that men who strongly held certain masculine beliefs, like minimizing health concerns or feeling uncomfortable with exams below the waist, were less likely to plan to get screening. Among men eligible for screening, these beliefs were also linked to lower rates of having ever been screened and of getting screened as recommended; however, men who viewed themselves as family providers were more likely to follow screening guidelines. Findings suggest that messages encouraging men to get screened for colorectal cancer may be more effective if they frame screening as a sign of strength and responsibility, while also addressing beliefs that may discourage health checkups.