Original Research

Journal of General Internal Medicine

, Volume 26, Issue 11, pp 1311-1316

Cultural, Economic, and Psychological Predictors of Colonoscopy in a National Sample

  • Chanita Hughes HalbertAffiliated withDepartment of Psychiatry, Center for Community-Based Research, University of PennsylvaniaAbramson Cancer Center, University of PennsylvaniaDepartment of Psychiatry, Center for Community-Based Research and Health Disparities, University of Pennsylvania Email author 
  • , Frances K. BargAffiliated withAbramson Cancer Center, University of PennsylvaniaDepartment of Family Medicine and Community Health, University of Pennsylvania
  • , Carmen E. GuerraAffiliated withAbramson Cancer Center, University of PennsylvaniaDepartment of Medicine, Division of General Internal Medicine, University of Pennsylvania
  • , Judy A. SheaAffiliated withDepartment of Medicine, Division of General Internal Medicine, University of Pennsylvania
  • , Katrina ArmstrongAffiliated withAbramson Cancer Center, University of PennsylvaniaDepartment of Medicine, Division of General Internal Medicine, University of Pennsylvania
  • , Monica FergusonAffiliated withDepartment of Medicine, Division of General Internal Medicine, University of Pennsylvania
  • , Benita WeathersAffiliated withDepartment of Psychiatry, Center for Community-Based Research, University of Pennsylvania
  • , James CoyneAffiliated withAbramson Cancer Center, University of PennsylvaniaDepartment of Psychiatry, University of Pennsylvania
  • , Andrea B. TroxelAffiliated withDepartment of Biostatistics and Epidemiology, University of Pennsylvania

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Abstract

Background

Although colorectal cancer (CRC) is the second leading cause of cancer death among adults in the US and colonoscopy is efficacious in reducing morbidity and mortality from CRC, screening rates are sub-optimal. Understanding the socioeconomic, cultural, and health care context within which decisions about colonoscopy are made allows physicians to address patients’ most salient beliefs and values and other constraints when making screening recommendations.

Objective

To evaluate the direct and interactive effects of socioeconomics, health care variables, psychological characteristics, and cultural values on colonoscopy use.

Design, Setting, Participants

National survey completed between January-August 2009 in a random sample of African American, white, and Hispanic adults ages 50–75 without cancer (n = 582).

Main Measure

Self-reported colonoscopy use.

Key Results

Only 59% of respondents reported having a colonoscopy. The likelihood of colonoscopy increased with having health insurance (OR = 2.82, 95% CI = 1.24, 6.43, p = 0.004), and increasing age (OR = 1.40, 95% CI = 1.11, 1.77, p = 0.001). In addition, respondents with greater self-efficacy were more likely to have a colonoscopy (OR = 2.41, 95% CI = 1.35, 4.29, p = 0.003).

Conclusions

Programs that help patients to overcome access and psychological barriers to screening are needed.

KEY WORDS

colonoscopy racial economic predictors national survey