Abstract C69: Predicting colonoscopy screening behavior and future intentions in a diverse sample of African Americans in New York State
Authors: Klasko Lynne B. , Jandorf Lina M. , Erwin Deborah O. , Kiviniemi Marc T. 
Published: March 2017

Objectives: Colorectal cancer is a leading cause of death in the United States; African Americans experience a disproportionate colorectal cancer burden in both its incidence and mortality. Colonoscopy is one of several screening tests recommended to detect disease early, but screening rates are lower among African Americans than non-Hispanic whites. Given the need to address disparities, it is important to understand factors that increase and decrease the likelihood of colonoscopy completion for African Americans. This cross-sectional study examines cognitive and affective decision-making factors as predictors of colonoscopy uptake in a sample of African American New York State residents, ages 50 and older.

Methods: Participants were 1687 African American adults aged 50 and older living in the New York City and Buffalo, New York metropolitan areas attending a group educational program. Participants completed surveys assessing positive and negative affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, colorectal cancer knowledge, fear of colonoscopy, perceived risk, cancer worry, and cancer fear. They also reported past screening behavior and future screening intentions. Linear and logistic regressions were used to model decision-making constructs as predictors of past screening behavior and future screening intentions.

Results: All of the assessed decision making constructs except for perceived risk were associated with past screening behavior. Perceived benefits (OR=1.25, p&lt;0.01), positive affective association with colonoscopy (OR=1.23, p&lt;0.001), self-efficacy to screen (OR=1.69, p&lt;0.001), and knowledge (OR=1.20, p&lt;0.001) were associated with increased likelihood of screening, while perceived barriers (OR=0.44, p&lt;0.001), negative affective associations (OR=0.86, p&lt;0.05), fear of colonoscopy (OR=0.50, p&lt;0.001), cancer worry (OR=0.89, p&lt;0.05), and cancer fear (OR=0.85, p&lt;0.01) were associated with decreased likelihood of past colonoscopy completion. For the 562 participants eligible for colonoscopy in the next year (never screened or previously screened between seven and ten years prior to data collection), perceived benefits (β=0.15, p&lt;0.01), self-efficacy (β=0.18, p&lt;0.001), knowledge (β=0.12, p&lt;0.01), perceived risk (β=0.11, p&lt;0.05), cancer worry (β=0.12, p&lt;0.05), and cancer fear (β=0.15, p&lt;0.01) were associated with greater future screening intentions and perceived barriers were associated with decreased intentions (β =-0.18, p&lt;0.001).

Conclusions: Cognitive and affective factors predicted both past colonoscopy screening behavior and future screening intentions. These findings suggest that both cognitive and affective factors impact colonoscopy screening decision-making among age eligible African Americans in New York State. Most interventions only target cognitive components. Thus, future interventions aimed at reducing screening disparities may need to address both cognitive beliefs as well as screening attitudes.

Citation Format: Lynne B. Klasko, Lina M. Jandorf, Deborah O. Erwin, Marc T. Kiviniemi. Predicting colonoscopy screening behavior and future intentions in a diverse sample of African Americans in New York State. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C69.