Abstract B15: Colorectal cancer knowledge and adherence among Hispanic workers
Authors: Ou Judy Y. , Kirchhoff Anne C. , Warner Echo L. , Martel Laura , Kepka Deanna 
Published: February 2019

Background: Hispanics report the lowest CRC screening rate of any ethnic group in the United States. Hispanics comprise 14% of Utah's population and are growing rapidly. Most of the Hispanics in Utah are foreign-born immigrants who work low-wage jobs that do not offer health benefits, making them a high-risk population for low CRC screening rates. We partnered with companies in Salt Lake County with a large Hispanic employee population to implement an educational intervention to improve knowledge of and adherence to cancer screenings. We identify demographic predictors of CRC knowledge and adherence pre-intervention, and of improvements in adherence post-intervention.

Methods: Current and previous employees of service/manual labor companies (e.g., professional cleaning, restaurants, construction) were recruited by local businesses and community organizations. Promotoras held educational sessions at the local businesses. Pre- and post-interviews measured CRC screening knowledge, adherence, demographics, and perceptions of CRC risk. Interviews were conducted in person or on the phone within 10 months of the intervention. Participants aged ≥50 were given FOBT/FIT tests. Chi-square tests examined differences in knowledge among participants and adherence preintervention. Multivariable logistic regression models identified predictors of knowledge, awareness, and adherence preintervention, and identified characteristics associated with improvements in adherence post-intervention.

Results: We recruited 307 Hispanic employees. 95% of our population were Hispanic immigrants, 88% speak Spanish, 64% make $25,000 or less a year, and 70% do not have health insurance. 40% of adults aged ≥50 were adherent to CRC screening guidelines before the intervention; after the intervention, 66% of eligible adults were adherent, with the majority of the improvement in FOBT/FIT tests. We found significant differences in initial knowledge of CRC among participants aged 18 to 49 years (51%) vs age ≥50 years (85%, p&lt;0.01) and among English speakers (60%) compared to Spanish speakers (78%, p=0.03). Higher education was correlated with greater recognition of a CRC test (&lt;High school=43%, ≥High school=75%, p=0.01), and identification of one guideline (&lt;High school=79%, ≥High school=90%, p=0.02). Adherence significantly differed by insurance status (No insurance=28%, Insured=55%, p=0.01). In the regression models, older age (31-39 years: OR=4.53 [95%CI=1.46-14.01]; ≥50= 8.90 [2.61-30.35]; ref = 18-30 years) and personal risk for CRC were significantly associated with increased odds of having heard of CRC (Somewhat likely: OR=4.48 [1.94-10.34]; Likely= 3.06 [1.40-6.67]; ref = Not likely). Recognition of one CRC screening was only significantly associated with education (≥High school=3.21 [1.78-5.80]; ref = &lt;High school). Identification of one CRC guideline was only associated with insurance (Insured=2.88 [1.05-7.90]). The only characteristic associated with adherence preintervention was insurance (Insured=3.00 [1.10-8.12]; ref = No insurance). Improvement in adherence postintervention was significantly associated with higher-income participants ($25,000 to ≥$55,000=9.59 [2.20-42.22]; $10,000 to &lt;$25,000=2.39 [0.66-8.66]; ref=$5,000 to &lt;$10,000), with nonsignificant improvements in males (1.88 [0.54-6.51]) compared to females.

Conclusions: Knowledge of CRC screenings among Hispanics is related to older age, education, and insurance. Providing FOBT/FIT yielded significant improvements in adherence. Ensuring that Hispanics have access to health insurance and affordable CRC screenings is a critical factor in improving CRC screenings in this vulnerable population.

Citation Format: Judy Y. Ou, Anne C. Kirchhoff, Echo L. Warner, Laura Martel, Deanna Kepka. Colorectal cancer knowledge and adherence among Hispanic workers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B15.