Factors Associated with Racial/Ethnic Differences in Colorectal Cancer Screening

Shokar, Navkiran K.; Carlson, Carol A.; Weller, Susan C.

doi:10.3122/jabfm.2008.05.070266

Cited by 84 publications

(85 citation statements)

References 64 publications

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“…This gap is smaller in magnitude than most prior studies, which have documented Black/White differences in CRCS ranging from 6% to 18%, 14,16,18,19,[65][66][67] but is consistent with more recent results from national surveys and a prior VA study that used a nationally representative sample. 68 In addition, this observed disparity was no longer present when we adjusted for demographic and health factors.…”

Section: Discussionsupporting

confidence: 86%

“…[21][22][23][24] This study builds upon prior studies examining racial disparities in adherence to CRCS, only a few of which have examined the extent to which cognitive and environmental factors contribute to disparities. 19,66 Counter to our hypotheses, race differences in adherence to CRCS were explained by race differences in demographic/health-related factors and social/medical environmental factors, but not by cognitive factors. Although more research is needed to fully understand this pattern of results, it is likely that race differences in utilization of the VA as a source of care is a contributing factor.…”

Section: Discussionmentioning

confidence: 65%

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Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

et al. 2010

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OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS: In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION: We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men. These disparities are partially attributable to lower rates of CRC screening (CRCS) by Blacks, 3-5 which has been shown to significantly reduce CRC mortality. [6][7][8][9] To understand what factors contribute to CRCS adherence, researchers have drawn on health behavior theories and have examined such factors as cognitions about screening, social and medical environmental factors, and demographic and health-related factors. [10][11][12] Few studies, however, have explored the extent to which racial disparities in adherence to CRCS are a function of these underlying factors, leaving unanswered questions about the best approaches to promote screening among populations with greater disease burden. [13][14][15][16][17][18][19][20] This study contributes to the broader literature on race differences in CRCS by examining the relative contribution of demographic and health factors, cognitive factors, and environmental factors to racial disparities in CRCS in a nationally representative survey of Veterans Health Affairs (VHA) patients aged 50-75.The VHA is a particularly interesting system within which to examine racial disparities in CRCS because it provides equal access to care to all qualifying veterans, and mandates that all patients be assigned to a primary care provider, both of which diminish barriers to screening that might disproportionally affect r...

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 65%

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

et al. 2010

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“…[1][2][3][4] However, its effectiveness for reducing CRC mortality for vulnerable populations is unclear, given the barriers to colonoscopy, including cost, transportation problems, preparing for the procedure, and fear of invasive tests. [5][6][7][8][9][10][11][12] Expanded use of FOBT, a modality with fewer barriers, may be a viable approach to address CRC screening disparities, especially with single-sample fecal immunochemical tests (FIT), which do not require dietary restrictions. 13 Several randomized trials have reported that outreach with FOBT can improve CRC screening rates.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

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“…1 There is limited information on the role of CRC knowledge and other factors that influence willingness to be screened in age appropriate diverse women. Most persons respond that their physician's recommendation is essential to obtain a screening test, 2,3 and facilitating access to health care and screening tests becomes a dominant factor. However, individual factors such as age, knowledge of risks and benefits of screening, belief in following screening guidelines and risk perception may also affect intent to screen.…”

Section: Introductionmentioning

confidence: 99%

“…However, individual factors such as age, knowledge of risks and benefits of screening, belief in following screening guidelines and risk perception may also affect intent to screen. 2,4 Finally, since screening benefits in terms of mortality reduction are measured at the population level, most women who are screened do not receive individual benefit other than the knowledge of being disease free. Our goal was to understand the factors associated with willingness to undergo and continue CRC screening, and to ask whether or not women are willing to have CRC screening with the accompanying personal risk to achieve a public health benefit of decreasing population cases.…”

Section: Introductionmentioning

confidence: 99%

Colorectal Cancer Screening: What Do Women From Diverse Ethnic Groups Want?

et al. 2012

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BACKGROUND:Little is known about factors associated with willingness to undergo colorectal cancer (CRC) screening for personal or public health benefit among women from diverse race/ethnic groups. OBJECTIVE: To evaluate factors associated with willingness to undergo CRC screening for personal and public health benefit among women from diverse race/ ethnic groups. METHODS: We interviewed women aged 50 to 80 from four racial/ethnic groups from primary care clinics in [2003][2004][2005]. We asked about demographics, CRC screening knowledge and history, perceived risk of colon cancer, and about the outcomes of intention to be screened for personal benefit and for public health benefit. RESULTS: Of the 492 women who completed the interview, 32 % were White, 16 % were African American, 21 % were Latina and 32 % were Asian. Up-to-date screening was reported by 77 % of women, with similar numbers obtaining fecal occult blood test (FOBT) within 2 years or colonoscopy within 10 years. The majority of women were "likely or very likely" to get FOBT or colonoscopy after learning the benefits and risks. Multivariate models showed that compared to Whites, fewer Asians would undergo colonoscopy (OR=0.28; 95 % CI: 0.12, 0.63), while more Latinas would undergo colonoscopy (OR=6.14; 95 % CI: 1.77, 21.34) and obtain regular CRC screening (OR = 4.47; 95 % CI: 1.66, 12.04). The majority would obtain CRC screening even if they would not personally benefit; those who perceived themselves to be at higher than average cancer risk were more likely to participate in CRC screening for public health benefit (OR=2.32; 95 % CI: 1.32, 4.09). CONCLUSIONS: The majority of women are willing to undergo screening for personal benefit. Asians were less likely, and Latinas more likely, to accept colonoscopy. Most are also willing to undergo screening for public health benefit. Self-perceived risk of CRC was the most consistent predictor of willingness and intention to be screened for either personal or public health benefit KEY WORDS: colonoscopy; fecal occult blood test; colorectal cancer screening; racial/ethnic groups; women.

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Factors Associated with Racial/Ethnic Differences in Colorectal Cancer Screening

Cited by 84 publications

References 64 publications

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Colorectal Cancer Screening: What Do Women From Diverse Ethnic Groups Want?

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