Background. Fecal occult blood testing (FOBT) can reduce colorectal cancer (CRC) mortality. Unfortunately, CRC screening is underutilized. Sociocultural mediators of FOBT adherence have not been extensively studied in lower income, minority populations. This study prospectively studied FOBT return in a low-income, multiethnic population. Methods. Participants (N = 298), aged ≥40 years, were surveyed and given FOBT kits with instructions. Those not returning kits within 30 days received a reminder telephone call. Bivariate and multivariate analyses assessed predictors of FOBT card return at 90 days. Results. Participants (median age = 48) were predominately African American (69%), without private insurance (88%), and of low income. The largest group of participants preferred FOBT alone (46%), followed by whatever my doctor recommends (19%), endoscopy + annual FOBT (16%), endoscopy alone (14%), and no screening (5%). In multivariate analyses, FOBT return was predicted by age (OR = 1.05) and lack of reported FOBT barriers (OR = 3.81). Among those ≥50 and not up-to-date with screening, FOBT return was predicted by cancer fatalism (OR = 0.83). FOBT barriers were associated with age (OR = 0.96), less than high school education (OR = 2.05), and less physician trust (OR = 2.12). Endoscopy barriers were associated with age (OR = 0.93), less physician trust (OR = 1.95), and female gender (OR = 3.45). Conclusions. Younger individuals and those with less education, less trust in health care providers, and more fatalistic beliefs are at risk for CRC screening non-adherence. Strategies addressing common misconceptions should improve CRC screening rates in low-income, multiethnic populations.
Bibliographical noteFunding Information:
The authors would like to thank the administration, staff, and patients of Swope Health Services and Swope Central, Kansas City, Missouri, for making this study possible. Thanks also to our indispensable research staff: Nicole Freeman, Daniel Buckles, M.D., Hamid Alhousseini, M.D., Coreen Gunja, and QingJiang Hou, M.S. This study was supported by a Mentored-Clinician Scientist Career Development Award from the University of Kansas Medical Center Research Institute and an American Cancer Society Career Development Award for Primary Care Clinicians (CCCDA-02-223-01), KAG.
- Colorectal cancer
- Minority populations
- Socioeconomic status