title: Predictors of fecal occult blood test (FOBT) completion among low-income adults.
abstract: 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 > or =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 > or =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.
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA. agreiner@kumc.edu
authors.forename: K Allen
authors.initials: KA
authors.lastname: Greiner
authors.forename: Aimee S
authors.initials: AS
authors.lastname: James
authors.forename: Wendi
authors.initials: W
authors.lastname: Born
authors.forename: Sandra
authors.initials: S
authors.lastname: Hall
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Engelman
authors.forename: Kolawole S
authors.initials: KS
authors.lastname: Okuyemi
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
mesh_terms: D000328:Adult; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007615:Kansas; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D009780:Occult Blood; D011203:Poverty; D011446:Prospective Studies