Social and Cultural Factors Affecting African-American Colorectal Cancer Screening Behaviors

Background: African-Americans have higher incidence and mortality rates of colorectal cancer (CRC) than all other ethnic/racial groups. This has been attributed to many factors, but low CRC screening rates make a contribution. Literature suggests that various factors contribute to low screening rates. Demographic characteristics like income, insurance status, and educational attainment have been shown to be associated with screening rates. Cultural beliefs and social influences have also been hypothesized to influence whether people screen. This presentation describes participants' self-reported CRC screening, adherence, and attitudes to determine what factors may influence whether African-Americans screen for CRC.

Method: African-American men and women (ages 45-75), residing in a Midwest metropolitan area, participated in a two-armed randomized community intervention trial (N = 771). Each participant completed a baseline survey that contained questions regarding CRC screening habits and variables representing selected constructs in the Health Belief Model (HBM). The survey also included questions about sociocultural (SC) variables that previous research and focus group data showed were relevant to this population. Baseline data were analyzed to determine rates of screening and adherence, by gender and type of screening test. Additional analyses examined demographic variables (income, insurance status, educational level, and marital status) and SC variables (fatalism, mistrust, collectivism, spirituality, assimilation, humanism, oppression, and nationalism) to determine their relative influence on CRC screening.

Results/Conclusions: Analyses indicated that study participants had higher screening rates when compared to rates reported nationally or in other studies with this population. The colonoscopy was the most frequently obtained test (62.9% and 42.5% for women and men, respectively). Participants receiving this test were more likely to be adherent (97.3% and 89.8% for women and men, respectively) when compared to other CRC screening tests, such as the FOBT and sigmoidoscopy. Logistic regression analyses indicated that marital status, personal history, CRC screening benefits, and educational level significantly influenced CRC screening status (p<0.05). These variables varied in statistical significance when examined by gender. The SC variables collectivism, humanism, and oppression were statistically significant for type of screening test, specifically the colonoscopy.