Correlates of Colorectal Cancer Screening Among Residents of Ohio Appalachia

Abstract

There is an excess burden of colorectal cancer (CRC) in the Appalachian region of the U.S., which could be reduced by increased uptake of CRC screening tests. Thus, we examined correlates of screening among Appalachian residents at average-risk for CRC. Using a population-based sample, we conducted interviews with and obtained medical records of Appalachian Ohio residents 50–75 years between September 2009 and April 2010. Using multivariable logistic regression, we identified correlates of being within CRC screening guidelines by medical records. About half of participants were within CRC screening guidelines. Participants who were older (OR=1.04, 95% CI: 1.01, 1.07), had higher income ($30,000–$60,000, OR=1.92, 95% CI: 1.29, 2.86; ≥$60,000, OR=1.80, 95% CI: 1.19, 2.72), a primary care provider (OR=4.22, 95% CI: 1.33, 13.39), a recent check-up (OR=2.37, 95% CI: 1.12, 4.99), had been encouraged to be screened (OR=1.57, 95% CI: 1.11, 2.22), had been recommended by their doctor to be screened (OR=6.68, 95% CI: 3.87, 11.52), or asked their doctor to order a screening test (OR=2.24, 95% CI: 1.36, 3.69) had higher odds of being screened within guidelines in multivariable analysis. Findings suggest that access to and utilization of healthcare services, social influence, and patient-provider communication were the major factors associated with CRC screening. Researchers and healthcare providers should develop and implement strategies targeting these barriers/facilitators to improve CRC screening rates and reduce the CRC burden among residents of Appalachia.

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

“…These studies showed that PCP visits [4][5][6][7][8] and physician recommendation were strong predictors of prevalent CRC screening (mostly with colonoscopy). 2,6,8 Our study extends prior work by demonstrating an independent association between prior primary care visits and subsequent Bincident^CRC screening, including outreach screening not linked directly to the primary care visit. This work is particularly important in the modern era, where large private and public health systems have extensive CRC screening outreach programs and are promoting annual FIT/FOBT as a dominant strategy.…”

“…Conversely, patients who are more prevention-oriented may be both more motivated to follow up abnormal screening tests and more engaged in primary care. Previous research in primary care settings 5,6,28 and the general population 4,8 that have examined predictors of CRC screening have focused primarily on Bprevalent^screening (having ever been screened) and in settings where colonoscopy (which offers 10 years of protection) was the predominant screening modality. These studies showed that PCP visits [4][5][6][7][8] and physician recommendation were strong predictors of prevalent CRC screening (mostly with colonoscopy).…”

“…Previous research in primary care settings 5,6,28 and the general population 4,8 that have examined predictors of CRC screening have focused primarily on Bprevalent^screening (having ever been screened) and in settings where colonoscopy (which offers 10 years of protection) was the predominant screening modality. These studies showed that PCP visits [4][5][6][7][8] and physician recommendation were strong predictors of prevalent CRC screening (mostly with colonoscopy). 2,6,8 Our study extends prior work by demonstrating an independent association between prior primary care visits and subsequent Bincident^CRC screening, including outreach screening not linked directly to the primary care visit.…”

“…3 Primary care providers (PCP) traditionally initiate cancer screening, and prior work has shown that patients seen by PCPs are more likely to receive CRC screening. [4][5][6][7][8] However, CRC screening rates remain suboptimal, even after decades of public health campaigns, public reporting of health plan CRC screening rates, and implementation of visitbased preventive service reminders in electronic health records (EHRs). 4,7,[9][10][11] Therefore, a growing number of private and public health systems are taking a population health perspective and using outreach approaches to promote CRC screening that do not require a face-to-face primary care visit.…”

Analysis of Barriers to Cognitive Screening in Rural Populations in the United States

“…39,[56][57] It would be helpful to know whether culturally based education regarding dementia and cognitive screening would increase knowledge, perceptions of risk, and screening behaviors. Engaging experimental research designs to test culturally tailored educational programs based on persons' AD knowledge, beliefs, and perceptions would likely uncover the most effective methods to increase interest in screening.…”