Abstract B93: Colorectal cancer screening patterns among residents living in Ohio Appalachia
Authors: Paskett Electra D. , Katz Mira L. , Young Gregory , Murray David M. , Lee Chul-joo , Pennell Michael , Tatum Cathy , Krieger Janice , Slater Michael 
Published: June 2012

Purpose: The purpose of this study was to document colorectal cancer (CRC) screening rates among residents of Appalachia Ohio who were average-risk for CRC prior to the implementation of a mass media campaign to improve CRC screening in this population which experiences increased CRC incidence and mortality rates.

Methods: A commercial list of Ohio Appalachia residents 50+ years of age was obtained for the 12 counties. Residents from each county were randomly selected and sent a letter of invitation to complete a telephone survey. Participants were called, consented, and interviewed. A medical record release form was requested to confirm self-report of CRC screening. Rate of within CRC screening guidelines was considered for any of the following: fecal occult blood test within the last year, flexible sigmoidoscopy within the last five years, or colonoscopy within the last ten years. The odds ratios (and 95% CIs) for being within guidelines by self-report were calculated for each covariate via univariate logistic regression. We conducted a path analysis using Mplus 5.0 to assess the relationship between factors leading to a CRC screening test.

Results: A total of 1,106 interviews were completed. A medical record release form was provided by 795 (71.9%) of respondents and CRC screening information was returned by clinics for 91.4% of these participants. Overall, the majority of individuals were female (59%), White (97%), and were married (77%). The mean age was 61 years old, 38% were retired, 44% had less than a college education, 17% had annual household incomes less than $20,000, 91% had health insurance, and 12% were current smokers. Among the respondents, 93% reported that they had a healthcare provider, 82% had a check-up in the last year, and 54% rated their health as excellent or very good. Being within CRC screening guidelines by self-report was 61.4% in the entire sample, and among those with a medical record review (MRR) available, 68% were within guidelines by self-report and 49% by MRR.

The following characteristics were significantly (p&lt;0.05) related to being within CRC screening guidelines: a) demographics: age 65+ years old (OR=1.86), greater than a high school education (OR=1.79), being currently married (OR=1.54); &gt;$50,000/year income vs. &lt;$20,000 (OR=1.61); and being a current smoker (OR=0.48); b) health care: having health insurance (OR=5.27); a regular doctor (OR=5.45); and having had a check-up in the last two years (OR=5.24); and c) CRC-related variables: better knowledge of CRC tests (OR=2.03), doctor recommendation for a CRC screening test (OR=14.7), encouraged to have a CRC screening test (OR=3.12), or asked provider for a screening test (OR=5.41). Additionally, 51% of the respondents were not worried about getting CRC, 86% were willing to have a test if their doctor recommended it, and 11% intended to complete CRC screening in the next six months. Path analyses found that those who asked their doctors for CRC screening and were asked to complete a CRC screening by their doctors were more likely to be within CRC screening guidelines (β = .85, p&lt; .001; β = .57, p&lt; .001, respectively).

Conclusions: Low CRC screening rates among a random sample of residents of Appalachia Ohio show evidence to support increased CRC mortality rates among residents of Appalachia, documented in recent publications.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B93.