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

  • Chanita Hughes Halbert
  • Frances K. Barg
  • Carmen E. Guerra
  • Judy A. Shea
  • Katrina Armstrong
  • Monica Ferguson
  • Benita Weathers
  • James Coyne
  • Andrea B. Troxel
Original Research



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.


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).


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


colonoscopy racial economic predictors national survey 


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Chanita Hughes Halbert
    • 1
    • 2
    • 7
  • Frances K. Barg
    • 2
    • 3
  • Carmen E. Guerra
    • 2
    • 4
  • Judy A. Shea
    • 4
  • Katrina Armstrong
    • 2
    • 4
  • Monica Ferguson
    • 4
  • Benita Weathers
    • 1
  • James Coyne
    • 2
    • 5
  • Andrea B. Troxel
    • 6
  1. 1.Department of Psychiatry, Center for Community-Based ResearchUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Abramson Cancer CenterUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Family Medicine and Community HealthUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Medicine, Division of General Internal MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Department of Psychiatry, Center for Community-Based Research and Health DisparitiesUniversity of PennsylvaniaPhiladelphiaUSA

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