Abstract
Although colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., screening rates are low. Understanding the predictors of CRC screening is needed. In 2003, a random sample of patients aged 50 and over from three inner-city health centers was surveyed by computer-assisted telephone interview concerning CRC screening. The questionnaire was based on the Transtheoretical Model and the Theory of Reasoned Action. Factor analysis with Varimax rotation and logistic regression analyses were conducted. Of 319 surveys with data about endoscopy, 148 (46%) met guidelines (19 reported sigmoidoscopy within 5 years, 105 reported colonoscopy within 10 years, and 24 reported both within 5 years). Factor analysis identified three factors associated with increased likelihood of lower endoscopy within guidelines: Social Influence for CRC Screening (Eigenvalue 1.73), Barriers to Lower Endoscopy (Eigenvalue 2.00), and Lower Endoscopy Benefit/Ease (Eigenvalue 1.19). Variables in logistic regression associated with a lower rate of endoscopy include being African American (Odds Ratio (OR) = 0.35, 95% confidence interval = 0.13–0.96), being a current smoker (OR = 0.13, CI = 0.03–0.60), and having a higher score on the Barriers to Lower Endoscopy factor (i.e., viewed the inconvenience and unpleasant aspects as more troubling, OR = 0.33, CI = 0.18–0.60). The perceived inconvenience and unpleasant aspects of lower endoscopy are substantial barriers to screening. Advances in colon preparation procedures and better educational campaigns might lessen this perceived barrier and may be particularly important in disadvantaged and African American communities.
Similar content being viewed by others
References
Centers for Disease Control and Prevention. 2001 cancer data by site and race. http://apps.nccd.cdc.gov/uscs/TableV.asp?group=1a&Year=2001&Gender=MF&RateType=A geadjType&TableType=MORT. 2005. Accessed August 17, 2005.
US Preventive Services Task Force. Screening—colorectal cancer. Update, 2002 release. www.ahrq.gov/clinic/uspstfix.htm. 2002. AHRQ.
American Cancer Society. ACS Cancer Detection Guidelines. http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer, 1–3. 1-6-2004. Accessed May 14, 2005.
Centers for Disease Control and Prevention. Colorectal cancer screening according to the 2002 Behavioral Risk Factor Surveillance System. http://apps.nccd.cdc.gov/brfss/page.asp?yr=2002&state=All&cat=CC#CC. 2005. Accessed August 18, 2005.
Beeker C, Kraft JM, Southwell BG, Jorgensen CM. Colorectal cancer screening in older men and women: qualitative research findings and implications for intervention. J Community Health. 2000;25:263–278.
Guidry JJ, Aday LA, Zhang D, Winn RJ. The role of informal and formal social support networks for patients with cancer. Cancer Pract. 1997;5:241–246.
Shokar NK, Vernon SW, Weller SC. Cancer and colorectal cancer: knowledge, beliefs, and screening preferences of a diverse patient population. Fam Med. 2005;37:341–347.
Harewood GC, Wiersema MJ, Melton LJ. A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol. 2002;97:3186–3194.
Bastani R, Gallardo NV, Maxwell AE. Barriers to colorectal cancer screening among ethnically diverse high-and average-risk individuals. J Psychosoc Oncol. 2001;19:65–84.
Walsh JM, Terdiman JP. Colorectal cancer screening. JAMA. 2003;289:1288–1296.
Powe BD. Cancer fatalism among African Americans: a review of the literature. Nurs Outlook. 1996;44:18–21.
Holmes-Rovner M, Williams GA, Hoppough S, Quillan L, Butler R, Given CW. Colorectal cancer screening barriers in persons with low income. Cancer Pract. 2002;10:240–247.
Messina CR, Lane DS, Grimson R. Colorectal cancer screening attitudes and practices: preferences for decision making. Am J Prev Med. 2005;28:439–446.
Mitchell-Beren ME, Dodds ME, Choi KL, Waskerwitz TR. A colorectal cancer prevention, screening and evaluation program in community black churches. CA Cancer J Clin. 1989;39:115–118.
Greiner KA, James AS, Born W, et al. Predictors of fecal occult blood test (FOBT) completion among low-income adults. Prev Med. 2005;41(2):676–684.
Trauth JM, Ling BS, Weissfeld JL, Schoen RE, Hayran M. Using the transtheoretical model to stage screening behavior for colorectal cancer. Health Educ Behav. 2003;30:322–336.
Gilbert A, Kanarek N. Colorectal cancer screening: physician recommendation is influential advice to Marylanders. Prev Med. 2005;41:367–379.
Tabbarah M, Nowalk MP, Raymund M, Jewell IK, Zimmerman RK. Barriers and facilitators of colon cancer screening among patients at inner-city neighborhood health centers. J Community Health. 2005;30:55–74.
Messina CR, Lane DS, Grimson R. Colorectal cancer screening attitudes and practices: preferences for decision making. Am J Prev Med. 2005;28:439–446.
Zimmerman RK, Nowalk MP, Raymund M et al. Tailored interventions to increase influenza vaccination in neighborhood health centers serving the disadvantaged. Am J Public Health. 2003;93:1699–1705.
Montano DE, Kasprzyk D. The theory of reasoned action and the theory of planned behavior. In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. San Francisco: Jossey-Bass; 2002:67–98.
Prochaska JO, Redding CA, Evers KE. The transtheoretical model and stages of change. In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. San Francisco: Jossey-Bass; 2002:99–120.
Aday LA. Designing and Conducting Health Surveys. San Francisco: Jossey-Bass Inc.; 1989.
Baier M, Calonge N, Cutter G, et al. Validity of self-reported colorectal cancer screening behavior. Cancer Epidemiol Biomarkers Prev. 2000;9:229–232.
DeVellis RF. Scale Development: Theory and Applications. Newbury Park: Sage; 1991.
National Cancer Institute and Center for Disease Control and Prevention. State cancer profiles: screening and risk factors. http://statecancerprofiles.cancer.gov/cgi-bin/risk.pl?09&0&1&1&1. Accessed August 8, 2005.
DiPalma JA, Wolff BG, Meagher A, Cleveland MvB. Comparison of reduced volume versus four liters sulfate-free electrolyte lavage solutions for colonoscopy colon cleansing. Am J Gastroenterol. 2003;98:2187–2191.
Sharma VK, Chockalingham SK, Ugheoke EA, et al. Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation. Gastrointest Endosc. 1998;47:167–171.
Zimmerman RK, Nowalk MP, Tabbarah, M. Predictors of colorectal cancer screening in diverse populations. 2005. Bethesda MD. NCI Small Grant Program for Behavioral Research in Cancer Control Grantee Meeting. Accessed May 8, 2005. Conference Proceeding.
Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–1540.
Leard LE, Savides TJ, Ganiats TG. Patient preferences for colorectal cancer screening. J Fam Pract. 1997;45:211–218.
Montano DE, Phillips WR. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health. 1995;85:795–800.
Schoen RE, Weissfeld JL, Trauth JM, Ling BS, Hayran M. A population-based, community estimate of total colon examination: the impact on compliance with screening for colorectal cancer. Am J Gastroenterol. 2002;97:446–451.
Acknowledgement
This project was funded by P01 HS10864 from the Agency for Healthcare Research and Quality and 1 P60 MD000207-01 from the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zimmerman, R.K., Tabbarah, M., Trauth, J. et al. Predictors of Lower Endoscopy Use Among Patients at Three Inner-City Neighborhood Health Centers. JURH 83, 221–230 (2006). https://doi.org/10.1007/s11524-005-9028-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11524-005-9028-z