Abstract B94: Social networks as predictors of colorectal cancer screening in African Americans
Authors: Alema-Mensah Ernest , Smith Selina , Claridy Mechelle , Ede Victor , Ansa Benjamin , Blumenthal Daniel 
Published: May 2016

Abstract
Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. However, African Americans have disproportionately low screening rates compared to whites. Factors that seem to facilitate CRC screening include higher income, higher education, older age, and male sex, strong social ties and supportive relationships. Individual social networks reduce emotional and/or logistical barriers to colorectal cancer screening participation. The aim of this study was to examine social network interactions, and its impact on colorectal cancer screening among African Americans. We hypothesized that a positive association is expected between social network index scores and colorectal cancer screening.
Methods: Our preliminary published literature (Blumenthal Daniel S; Smith Selina A; Majett Charlye D; Alema-Mensah Ernest. A trial of 3 interventions to promote colorectal cancer screening in African Americans. Cancer, Feb2010;116(4): 922-9) showed that small groups (4-15 participants trained with CRC educational resources from the National Cancer Institute and the American Cancer Society) were significantly more likely to have CRC screening. Three hundred sixty-nine African-American men and women aged 50 years and above were enrolled in this randomized, controlled community intervention trial. Social networks were assessed using the Social Network Index (SNI) based on the index developed by Berkman (1979) [28]. The SNI consists of four domains: marriage or partnership, friends and relatives, religious activity, and voluntary associations. Categories were scored as follows: married (married = 1, widowed, divorced, separated, or never married = 0); contact with friends and relatives (≥156 contacts per year = 1, &lt;156 contacts per year = 0); frequency of church or religious service attendance (attended four or more services per year = 1, attended less than four = 0); group (such as church groups, unions, fraternal or athletic groups, or school groups) participation (yes = 1, no = 0). Scores were summed for the four dichotomized variables with a range of 0 to 4. Scores of 0 and 1 indicate the fewest ties and a score of 4 the most ties. Cronbach's alpha for the SNI scale was 0.25 in this study. Descriptive statistics and bivariate analyses were run. T-test statistics was used to determine differences between the small group (intervention) and other groups (control, financial incentive and one on one).
Results: There was a statistically significant difference in the network diversity among the groups. Small group participants had a higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) compared to the other groups. Total number of people in social network score was significantly higher among the small group than the other groups (Mean difference, 9.29; 95% CI, 3.96-14.62; p=0.0004).
Conclusions: Group education in small groups could foster strong social networks which may improve CRC screening rates among African Americans. Strong and positive network diversity and optimal number of people in social networks may enhance CRC screening rates. However, the screening rate of less than 35% in a group of individuals who participated in an educational program through multiple sessions over a period of several weeks indicated that there still are barriers to overcome.
Citation Format: Ernest Alema-Mensah, Selina Smith, Mechelle Claridy, Victor Ede, Benjamin Ansa, Daniel Blumenthal. Social networks as predictors of colorectal cancer screening in African Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B94.