Abstract B65: Colorectal cancer screening in nonadherent black Americans
Authors: Wang Hsiao-Lan , Christy Shannon M. , Skinner Celette S. , Champion Victoria L. , Champion Victoria L. , Springston Jeffrey K. , Perkins Susan M. , Perkins Susan M. , Tong Yan , Krier Connie , Gebregziabher Netsanet , Rawl Susan M. , Rawl Susan M. 
Published: May 2015

Background: Compared with other racial groups, Black Americans have higher incidence and mortality from colorectal cancer (CRC) and lower screening rates. Theory-based tailored interventions to increase screening are more likely to be successful, especially those tailoring on stage of adoption. The purpose of our study was to examine predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy screening among non-adherent Black Americans.

Methods: We analyzed baseline data from 817 Black primary care patients enrolled in a randomized clinical trial. Participants were categorized into precontemplation, contemplation, or preparation groups. Predictor variables examined included: demographics (age, gender, education, employment, income, health insurance, and clinical site), clinical variables (body mass index, family history of CRC, and personal history of cancer), CRC health beliefs and knowledge (perceived risk, perceived benefits, perceived barriers, self-efficacy, cancer fatalism, and knowledge), and social support (marital status, family/friend encouragement, and doctor recommendation). Hierarchical modeling was used to identify significant predictors with p value equal to or less than 0.01.

Results: Participants who: were older (OR = 1.04, p = .003); male (OR = 1.70, p = .007); seen at a VA site (OR = 2.80, p &lt; .001); had greater perceived FOBT self-efficacy (OR = 1.59, p = .007), had family or friend encouragement of CRC testing (OR = 1.64, p = .004), and had a provider recommendation for FOBT (OR = 2.05, p &lt; .001) had higher odds of being at a more advanced stage for FOBT (closer to action). Participants with a personal history of cancer (OR = 0.37, p = .002) and with greater perceived FOBT barriers (OR = 0.79, p = .042) had higher odds of being at an earlier stage of adoption for FOBT (away from action). Higher perceived colonoscopy benefits (OR = 1.56, p &lt; .001); higher perceived colonoscopy self-efficacy (OR = 1.66, p &lt; .001); family or friend encouragement of CRC tests (OR = 1.71, p = .001), and a doctor recommendation for colonoscopy (OR = 2.47, p &lt; .001) had higher odds of being at a more advanced stage for colonoscopy. Compared to participants with incomes less than $15,000, those with incomes greater than $30,000 (OR = 0.46, p = .005) had higher odds of being at an earlier stage of adoption for colonoscopy.

Conclusion: Enhancing self-efficacy and encouragements from family and friends may be important components of interventions to promote CRC screening among Black Americans. Healthcare providers can utilize knowledge of the characteristics associated with stage of adoption to educate and motivate their primary care Black American patients to complete CRC screening tests.

Citation Format: Hsiao-Lan Wang, Shannon M. Christy, Celette S. Skinner, Victoria L. Champion, Victoria L. Champion, Jeffrey K. Springston, Susan M. Perkins, Susan M. Perkins, Yan Tong, Connie Krier, Netsanet Gebregziabher, Susan M. Rawl, Susan M. Rawl. Colorectal cancer screening in nonadherent black Americans. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B65. doi:10.1158/1538-7755.DISP13-B65