Colorectal Cancer Screening Among Mexican Americans at a Community Clinic

Yepes-Rios, Monica; Reimann, Joachim O. F.; Talavera, Ana C.; Esparza, Antonio Ruiz de; Talavera, Gregory A.

doi:10.1016/j.amepre.2005.11.002

Cited by 37 publications

(42 citation statements)

References 32 publications

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“…Studies have found physicians' recommendation is one of the greatest predictors of colorectal cancer screening. [15][16][17][18][19][20][21][22] Our fi ndings also support that most people in the United States want a medical home, even though a medical home was not specifi cally addressed in the 2004 BRFSS. 23 Although having a personal health care provider (or medical home) and a physician recommendation may be closely related factors, they may function as 2 distinct constructs.…”

Section: Discussionsupporting

confidence: 52%

Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

Cardarelli¹,

Thomas²

2009

The Annals of Family Medicine

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PURPOSE We wanted to assess the relationship between having a personal health care provider and receiving colorectal cancer testing.METHODS Self-reported data were obtained from the United States 2004 Behavioral Risk Factor Surveillance System. Men and women aged 50 years and older were included, and associations of having a personal health care provider, age, sex, race/ethnicity, education, income, and health insurance status with colorectal cancer testing were examined. Multiple logistic regression was performed on a fi nal sample of 120,221 individuals. RESULTSHaving at least 1 personal health care provider signifi cantly predicted up-to-date colorectal cancer testing in both the univariate (odds ratio [OR] = 3.96; 95% confi dence interval [CI] 3.56-4.41) and multiple regression models (OR = 2.91; 95% CI 2.58-3.28). Age, sex, race/ethnicity, education, income, and health insurance were also signifi cantly associated with up-to-date colorectal cancer testing.CONCLUSIONS Having a personal health care provider was associated with up-todate colorectal cancer testing. Efforts to increase and support the primary care workforce are needed to improve up-to-date colorectal cancer screening rates. INTRODUCTIOND ebate in the United States over health care reform is rampant, with many advocates claiming reform is a necessary step to revitalize a current nonfunctional health care system. 1 This debate has been a central focus for many Americans since reports ranked the US health care system last, or close to last, in satisfaction, health equity, access to care, and various health indicators, even though the United States is among the highest of all industrialized nations in spending for health care.2 One component being promoted is universal health coverage in which a primary care workforce provides fi rst-line health care services.That primary care has a positive effect on population health has been shown in a landmark study by Starfi eld et al, 3 who found access to primary care prevents illness and death and results in more equitable health. In a preventive health care delivery system that some believe is fragmented and fundamentally fl awed, 4 the Starfi eld et al fi ndings lend support to improving rates of preventive health care screening. One such preventive screening test is for colorectal cancer. Colorectal cancer has garnered particular attention because it has low screening rates among men and women (approximately 50% in the United States) and accounts for 1 of the top 3 causes of cancer deaths. [5][6][7] Moreover, persistent colorectal cancer disparities exist, with African Americans suffering 15% and 40% higher incidence of and mortality from colorectal cancer, respectively, than whites. [8][9][10][11][12][13] Further studies with a sample representative of the US population are needed to assess whether access to primary care clinicians improves colorecRoberto Cardarelli, DO PER S ONA L CL INICIA N A ND COLOR EC TA L C A NC ER T ES T INGtal cancer screening rates beyond changes in socioeconomic fac...

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Section: Discussionsupporting

confidence: 52%

Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

Cardarelli¹,

Thomas²

2009

The Annals of Family Medicine

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“…Intentions were also reasonably high, with 66% of the sample reporting intentions to be screened at age 50. Both awareness and intentions were higher than we had expected and than has been found in other studies [45,46], although more recent studies suggest higher levels of awareness and intentions to be screened, [47] and nationally screening rates are starting to increase [48]. It is possible that our findings reflect sampling bias, and that we reached those who were most likely to be aware.…”

Section: Discussioncontrasting

confidence: 55%

“…324 (73) 120 (27) 266 (67) 128 (33) Education ≤Eighth grade 59 (6) 37 (65) 20 (35) 38 (68) 18 (32) Some high school 159 (16) 84 (53) 74 (47) 89 (63) 53 (37) Completed high school/vocational 322 (32) 237 (74) 83 (26) 190 (65) 103 (35) At least some college 462 (46) 343 (74) 119 (26) 271 (67) 135 (33) Immigrant No…”

Section: (51)mentioning

confidence: 99%

Colorectal cancer screening awareness and intentions among low income, sociodemographically diverse adults under age 50

Emmons

Puleo

McNeill

et al. 2008

Cancer Causes Control

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Colorectal cancer (CRC) screening rates in the US are suboptimal, particularly among lower income and racial/ethnically diverse groups. If specific populations have limited awareness of screening when they reach age 50, there may be delays in screening adoption. This study investigated sociodemographic and social contextual factors associated with awareness of CRC and intentions to be screened at age 50 among 692 low income, racial, and ethnic minority adults living in low income housing. The majority of respondents (62%) were between ages 30 and 49, and 94% had some form of health insurance (e.g., Medicaid). About 70% reported having heard about CRC screening; 66% reported intentions to be screened at age 50. In multivariable analyses, screening awareness was associated with age and education. Immigrants who had English as a second language had lower awareness. Females tended to have higher awareness if they had private insurance; there were no differences among males. Multivariable analyses found that screening intentions were higher among men, those with more role responsibilities, more role conflicts, and higher levels of social cohesion. It is important to identify opportunities for maximizing screening uptake among those who become age-eligible for screening if we are to make a significant impact on CRC disparities.

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“…15,43 We found it to have an odds ratio similar in magnitude to that of perceived susceptibility, but it was not statistically significant. Overall, less is known about the relationship between beliefs and CRC screening in Hispanic populations, although a recent study found no belief variables were related to screening in multivariate analyses 18 and another found that only fatalism was associated. 42 Our findings are significant in that they suggest that cultural or psychosocial differences between groups may be less important contributors to differences in screening rates and that provider or system initiatives will have greater impact on improving screening rates in minority groups.…”

Section: Discussionmentioning

confidence: 99%

“…24 Work in Hispanic populations is limited and has revealed conflicting findings about this topic. One study 42 found that, in a breast and cervical screening program of Hispanic women, there was no association between doctor recommendation and CRC screening, whereas another study 18 found that doctor recommendation was associated with CRC screening when controlling for other factors in a community population of Mexican-Americans. Our findings are consistent with the latter study and suggest that a doctor recommendation is likely to be important in primary care Hispanic populations.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Racial/Ethnic Differences in Colorectal Cancer Screening

Shokar¹,

Carlson²,

Weller³

2008

The Journal of the American Board of Family Medicine

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Introduction: Racial/ethnic differences in colorectal cancer (CRC) screening rates are thought to account, in part, for the racial/ethnic differences in CRC disease burden. The purpose of this study was to examine which factors mediate racial/ethnic differences in CRC screening.Methods: Five hundred sixty participants attending a primary care clinic, aged 50 to 80 years, and of African-American, Hispanic, or non-Hispanic white race/ethnicity were interviewed. The goal was to assess the contribution of sociodemographic characteristics, knowledge, beliefs about CRC, and the health care experience with their primary care doctor to racial/ethnic differences in CRC screening. The outcome variable was self-reported screening. All analyses were weighted; bivariate testing and multivariate logistic regression was conducted.Results: The response rate was 55.7%, with no sociodemographic differences noted between respondents and nonrespondents. Respondents were African-American (n ‫؍‬ 194), Hispanic (n ‫؍‬ 162), and non-Hispanic white (n ‫؍‬ 204); 64.5% were aged 50 to 64 years; 63.1% were women; 96.9% were insured; and over half reported a total annual income of less than $25,000. Overall 62.5% were current with CRC screening: 67.5% of non-Hispanic whites, 54.3% of African-Americans, and 48.6% of Hispanics (P < .001). A doctor's recommendation (odds ratio, 3.86); awareness of screening (odds ratio, 3.32); older age (odds ratio, 2.88); greater education (odds ratio, 2.02); and perceived susceptibility (odds ratio, 1.74) contributed to racial/ethnic differences in CRC screening.Conclusions: Interventions to address CRC screening disparities among racial/ethnic groups should focus on the health care setting and patient education about CRC screening; differences in attitudes and beliefs seem to be less important.

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Colorectal Cancer Screening Among Mexican Americans at a Community Clinic

Cited by 37 publications

References 32 publications

Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

Having a Personal Health Care Provider and Receipt of Colorectal Cancer Testing

Colorectal cancer screening awareness and intentions among low income, sociodemographically diverse adults under age 50

Factors Associated with Racial/Ethnic Differences in Colorectal Cancer Screening

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