Abstract B18: The impact of daily hassles on colorectal cancer screening and other health-seeking behaviors in a low-income, safety net population.
Authors: Jacob Rebekah R. , James Aimee S. 
Published: August 2014

Background: Colorectal Cancer (CRC) screening rates remain low across populations, especially in lower socioeconomic status (SES) populations. While low SES populations are associated with more stress and experienced daily hassles, few studies have looked at associations between hassles and seeking preventive care. The current study explored the distribution of hassles reported by a low income safety net population and any associations of hassles with various health behaviors such as CRC screening and the delay of seeking needed healthcare.

Methods: A cross sectional survey was used. Participants (n=144) were recruited from safety net health centers and were asked about experience with daily hassles, using a modified version of the Daily Hassles and Uplifts Scale. Participants also were asked about their health seeking behavior, especially delay in seeking needed care due to either the cost, transportation problems, or because of the way they felt they would be treated. Participants were also asked about preventative health (i.e. regular place that they receive their healthcare; if they had been screened for cancer).

Results: Participants (average age=51) were predominantly African American and low income. Among the hassles most commonly reported were having enough money for emergencies (76.5%, n=104), taking care of or worrying about personal health (68.8%, n=95), having enough money for food and clothing (68.6%, n=96), and having enough money for housing and utilities (68.4%, n=93). There was an inverse relationship between income and hassle with finding work (p&lt;.05) and hassle with housing and neighborhood (p&lt;.05). Virtually all financial related hassles were associated with the delay of care because of the cost including the hassle of having enough money for food or clothing (p&lt;.001). Delay of care because of transportation issues was associated with the hassle of physical abilities to function and get around (p&lt;.001). Delaying care because of the way the participant felt they would be treated was associated with both the hassle of feeling discriminated against or talked down to (p&lt;.01) as well as the hassle with having enough money for food and clothing (p&lt;.05). Having a regular source where participants receive their medical care was inversely related to the hassle of obtaining medical care (p&lt;.05). An inverse relationship was also found between reported hassles with having enough money for food and clothing ever being screened for CRC and (p&lt;.05), and more specifically with ever having had a colonoscopy (p&lt;.05). The hassle of feeling discriminated against or talked down to was also inversely related to having had any CRC screening (p&lt;.05).

Discussion: The implications are limited because the sample size is relatively small. While the results do not suggest large associations with hassles and the likelihood of being screened for CRC, they do further confirm that individuals who do not have a healthcare home may experience greater hassle in obtaining healthcare. These findings also suggest that hassles faced by the safety net population may contribute generally to the delay of seeking healthcare. This furthers the need for more research on the role of daily hassles and how they might be addressed in holistic and upstream approaches to healthcare home models, especially among safety net populations.

Citation Format: Rebekah R. Jacob, Aimee S. James. The impact of daily hassles on colorectal cancer screening and other health-seeking behaviors in a low-income, safety net population. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B18.