Journal of Community Health

, Volume 38, Issue 1, pp 31–39 | Cite as

Factors Associated with Never Being Screened for Colorectal Cancer

  • Sandte L. Stanley
  • Jessica B. King
  • Cheryll C. Thomas
  • Lisa C. Richardson
Original Paper

Abstract

Colorectal cancer (CRC) screening is underused in the United States, and non-adherence with screening recommendations is high in some populations. This study describes the characteristics of people who have never been screened for CRC. In addition, we use the health belief model to examine the constructs associated with screening behavior. We used data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) to create three study outcomes: people who have been screened for CRC and are up-to-date with current recommendations, people who have been screened but are not up-to-date, and people who have never been screened. We used multivariate logistic regression modeling to calculate predicted marginal estimates examining the associations between the screening outcomes and demographic and Health Belief Model (HBM) characteristics. Overall 29 % of respondents had never been screened for CRC. In the adjusted model, 36.6 % of US adults age 50–59 years and 29.1 % of US men reported never being screened for CRC. More Asian/Native Hawaiian/Pacific Islander, non-Hispanics (38.2 %) reported never being screened than members of other racial and ethnic groups. Nearly 37 % of people with less than a high school diploma reported never being screened. We found statistically significant differences among screening outcomes for all demographics and HBM constructs except could not see a doctor because of costs in the last 12 months, where approximately 29 % reported no CRC screening. New interventions should focus on those subpopulations that have never been screened for CRC.

Keywords

Colorectal cancer screening Health disparities Never screened Health belief model 

References

  1. 1.
    United States Cancer Statistics Workgroup. United States Cancer Statistics: 1999–2007 Incidence and mortality web-BASED report. Atlanta. 2010. www.cdc.gov/uscs.
  2. 2.
    Centers for Disease Control and Prevention. (2011). Vital Signs: colorectal cancer screening, incidence, and mortality-United States, 2002–2010. MMWR Morbidity Mortality Weekly Report, 60(26), 884–889.Google Scholar
  3. 3.
    Jemal, A., Siegel, R., Xu, J., & Ward, E. (2010). Cancer statistics, 2010. A Cancer Journal for Clinicians, 60(5), 277–300.CrossRefGoogle Scholar
  4. 4.
    United States Department of Health and Human Services. Clinical Preventive services. Healthy People, Washington, D.C. 2011. http://www.healthypeople.gov/2020/LHI/clinicalPreventive.aspx.
  5. 5.
    Gorin, S. S. (2005). Correlates of colorectal cancer screening compliance among urban Hispanics. Journal of Behavioral Medicine, 28(2), 125–137.PubMedCrossRefGoogle Scholar
  6. 6.
    Shi, L. Y., Lebrun, L. A., Zhu, J. S., & Tsai, J. N. (2008). Cancer screening among racial/ethnic and insurance groups in the United States: A comparison of disparities in 2000 and 2008. Journal of Health Care for the Poor and Underserved, 22(3), 945–961.CrossRefGoogle Scholar
  7. 7.
    Shelton, R. C., Jandorf, L., Ellison, J., Villagra, C., & DuHamel, K. N. (2011). The influence of sociocultural factors on colonoscopy and FOBT screening adherence among low-income Hispanics. Journal of Health Care for the Poor and Underserved, 22(3), 925–944.PubMedCrossRefGoogle Scholar
  8. 8.
    Carcaise-Edinboro, P., & Bradley, C. J. (2008). Influence of patient-provider communication on colorectal cancer screening. Medical Care, 46(7), 738–745.PubMedCrossRefGoogle Scholar
  9. 9.
    Bass, S. B., Gordon, T. F., Ruzek, S. B., et al. (2011). Perceptions of colorectal cancer screening in Urban African American Clinic patients: Differences by gender and screening status. Journal of Cancer Education, 26(1), 121–128.PubMedCrossRefGoogle Scholar
  10. 10.
    Peterson, N. B., Murff, H. J., Ness, R. M., & Dittus, R. S. (2007). Colorectal cancer screening among men and women in the United States. Journal of Womens Health (Larchmt), 16(1), 57–65.CrossRefGoogle Scholar
  11. 11.
    Shavers, V. L., Jackson, M. C., & Sheppard, V. B. (2010). Racial/Ethnic Patterns of Uptake of Colorectal Screening, National Health Interview Survey 2000–2008. Journal of the National Medical Association, 102(7), 621–635.PubMedGoogle Scholar
  12. 12.
    Cokkinides, V. E., Chao, A., Smith, R. A., Vernon, S. W., & Thun, M. J. (2003). Correlates of underutilization of colorectal cancer screening among US adults, age 50 years and older. Preventive Medicine, 36(1), 85–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Harewood, G. C., Wiersema, M. J., & Melton, L. J., 3rd. (2002). A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. American Journal of Gastroenterology, 97(12), 3186–3194.PubMedCrossRefGoogle Scholar
  14. 14.
    Kiviniemi, M. T., Bennett, A., Zaiter, M., & Marshall J. R. (2010) Individual-level factors in colorectal cancer screening: A review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psychooncology.Google Scholar
  15. 15.
    James, A. S., Campbell, M. K., & Hudson, M. A. (2002). Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior? Cancer Epidemiology, Biomarkers and Prevention, 11(6), 529–534.PubMedGoogle Scholar
  16. 16.
    Janz, N. K., Champion, V. L., Strecher, V. J. (2008). Health behavior and health education: Theory, research, and practice. The health belief model (pp. 45–66). San Francisco, CA: Jossey-Bass.Google Scholar
  17. 17.
    Beydoun, H. A., & Beydoun, M. A. (2008). Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes and Control, 19(4), 339–359.PubMedCrossRefGoogle Scholar
  18. 18.
    Nelson, D. E., Holtzman, D., Bolen, J., Stanwyck, C. A., & Mack, K. A. (2001). Reliability and validity of measures from the behavioral risk factor surveillance system (BRFSS). Soz Praventiv med, 46(Suppl 1), S3–42.Google Scholar
  19. 19.
    Behavioral Risk Factor Surveillance System. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://www.cdc.gov/brfss. Accessed May 2, 2012.
  20. 20.
    United States Preventive Services Task Force. (2008). Screening for colorectal cancer: US preventive services task force recommendation statement. Annals of Internal Medicine, 149(9), 627–637.Google Scholar
  21. 21.
    Zauber, A. G., Winawer, S. J., O’Brien, M. J., et al. (2012). Colonoscopic polypectiomy and long-term prevention of colorectal cancer deaths. New England Journal of Medicine, 366(8), 687–696.PubMedCrossRefGoogle Scholar
  22. 22.
    Corbie-Smith, G., Flagg, E. W., Doyle, J. P., & O’Brien, M. A. (2002). Influence of usual source of care on differences by race/ethnicity in receipt of preventive services. Journal of General Internal Medicine, 17(6), 458–464.PubMedCrossRefGoogle Scholar
  23. 23.
    Baron, R. C., Rimer, B. K., Coates, R. J., et al. (2008). Client-directed interventions to increase community access to breast, cervical, and colorectal cancer screening—A systematic review. American Journal of Preventive Medicine, 35(1), S56–S66.PubMedCrossRefGoogle Scholar
  24. 24.
    National Center for Health Statistics. NCHS Data on Racial and Ethnic Disparities. Atlanta, GA: Centers for Disease Control and Prevention 2011.Google Scholar
  25. 25.
    Robinson, J. M., & Shavers, V. (2008). The role of health insurance coverage in cancer screening utilization. Journal of Health Care for the Poor and Underserved, 19(3), 842–856.PubMedCrossRefGoogle Scholar
  26. 26.
    Jerant, A. F., Fenton, J. J., & Franks, P. (2008). Determinants of racial/ethnic colorectal cancer screening disparities. Archives of Internal Medicine, 168(12), 1317–1324.PubMedCrossRefGoogle Scholar
  27. 27.
    Crawford, N. D., Jones, C. P., & Richardson, L. C. (2004). Understanding racial and ethnic disparities in colorectal cancer screening: Behavioral Risk Factor Surveillance System, 2002 and 2004. Ethnicity and Disease, 20(4), 359–365.Google Scholar
  28. 28.
    Jandorf, L., Fatone, A., & Borker, P. V., et al. (2006) Creating alliances to improve cancer prevention and detection among urban medically underserved minority groups. The East Harlem Partnership for Cancer Awareness. Cancer, 107(8 Suppl), 2043–2051.Google Scholar
  29. 29.
    Jo, A. M., Maxwell, A. E., Rick, A. J., Cha, J., & Bastani, R. (2009). Why are Korean American physicians reluctant to recommend colorectal cancer screening to Korean American patients? Exploratory interview findings. Journal of immigrant and minority health/Center for Minority Public Health, 11(4), 302–309.PubMedCrossRefGoogle Scholar
  30. 30.
    Lee, H. Y., Lundquist, M., Ju, E., Luo, X., & Townsend, A. (2011). Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: Which groups are most vulnerable? Ethnicity & Health, 16(6), 501–518.CrossRefGoogle Scholar
  31. 31.
    Guadagnolo, B. A., Cina, K., Helbig, P., et al. (2009). Assessing cancer stage and screening disparities among Native American cancer patients. Public Health Reports, 124(1), 79–89.PubMedGoogle Scholar
  32. 32.
    Steele, C. B., Cardinez, C. J., Richardson, L. C., Tom-Orme, L., & Shaw, K. M. (2008). Surveillance for health behaviors of American Indians and Alaska Natives-findings from the behavioral risk factor surveillance system, 2000–2006. Cancer, 113(5 Suppl), 1131–1141.PubMedCrossRefGoogle Scholar
  33. 33.
    Cobb, N., Wingo, P. A., & Edwards, B. K. (2008). Introduction to the supplement on cancer in the American Indian and Alaska Native populations in the United States. Cancer, 113(5 Suppl), 1113–1116.PubMedCrossRefGoogle Scholar
  34. 34.
    Robillard, A. G., & Larkey, L. (2009). Health disadvantages in colorectal cancer screening among African Americans: Considering the cultural context of narrative health promotion. Journal of Health Care for the Poor and Underserved, 20(2 Suppl), 102–119.PubMedCrossRefGoogle Scholar
  35. 35.
    Percac-Lima, S., Grant, R. W., Green, A. R., et al. (2009). A culturally tailored navigator program for colorectal cancer screening in a community health center: A randomized, controlled trial. Journal of General Internal Medicine, 24(2), 211–217.PubMedCrossRefGoogle Scholar
  36. 36.
    Garcia-Dominic, O., Lengerich, E. J., Wray, L. A., et al. (2012). Barriers to CRC screening among Latino adults in Pennsylvania: ACCN results. American Journal of Health Behavior, 36(2), 153–167.PubMedCrossRefGoogle Scholar
  37. 37.
    Weber, E. J., Showstack, J. A., Hunt, K. A., Colby, D. C., & Callaham, M. L. (2005) Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Annals of Emergency Medicine, 45(1), 4–12.44.Google Scholar
  38. 38.
    Zuckerman, S., & Shen, Y. C. (2004). Characteristics of occasional and frequent emergency department users: Do insurance coverage and access to care matter? Medical Care, 42(2), 176–182.PubMedCrossRefGoogle Scholar
  39. 39.
    Joseph, D. A., DeGroff, A. S., Hayes, N. S., Wong, F. L., & Plescia, M. (2011). The Colorectal Cancer Control Program: Partnering to increase population level screening. Gastrointestinal Endoscopy, 73(3), 429–434.PubMedCrossRefGoogle Scholar
  40. 40.
    Ashida, S., Hadley, D. W., Goergen, A. F., Skapinsky, K. F., Devlin, H. C., & Koehly, L. M. (2011). The importance of older family members in providing social resources and promoting cancer screening in families with a hereditary cancer syndrome. Gerontologist, 51(6), 833–842.PubMedCrossRefGoogle Scholar
  41. 41.
    Fowler, B. A. (2007). The influence of social support relationships on mammography screening in African-American women. Journal of National Black Nurses Association, 18(1), 21–29.Google Scholar
  42. 42.
    Larkey, L. K., Ogden, S. L., Tenorio, S., & Ewell, T. (2008). Latino recruitment to cancer prevention/screening trials in the Southwest: Setting a research agenda. Applied Nursing Research, 21(1), 30–39.PubMedCrossRefGoogle Scholar
  43. 43.
    Mokuau, N., Braun, K. L., Wong, L. K., Higuchi, P., & Gotay, C. C. (2008). Development of a family intervention for Native Hawaiian women with cancer: A pilot study. Social Work, 53(1), 9–19.PubMedCrossRefGoogle Scholar
  44. 44.
    McQueen, A., Bartholomew, K., Greisinger, A. J., Medina, G. G., Hawley, S. T., et al. (2009). Behind closed doors: Physician-patient discussions about colorectal cancer screening. Journal of General Internal Medicine, 24(11), 1228–1235.PubMedCrossRefGoogle Scholar
  45. 45.
    Warnecke, R. B., Johnson, T. P., Chávez, N., Sudman, S., O'Rourke, D. P., Lacey, L., & Horm, J. (1997). Improving question wording in surveys of culturally diverse populations. Annals of Epidemiology, 7(5), 334–42.Google Scholar
  46. 46.
    Blumberg, S. J., Luke, J. V., Ganesh, N., Davern, M. E., Boudreaux, M. H., & Soderberg K. (2011). Wireless substitution: state-level estimates from the National Health Interview Survey, January 2007–June 2010. National Health Statistics Reports, 39, 1–26.Google Scholar
  47. 47.
    Edwards, B. K., Ward, E., Kohler, B. A., et al. (2010). Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer, 116(3), 544–573.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2012

Authors and Affiliations

  • Sandte L. Stanley
    • 1
  • Jessica B. King
    • 1
  • Cheryll C. Thomas
    • 1
  • Lisa C. Richardson
    • 1
  1. 1.Centers for Disease Control and PreventionAtlantaUSA

Personalised recommendations