title: Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older.
abstract: OBJECTIVE
  Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening.
  
  
  METHODS
  Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households.
  
  
  METHODS
  New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico.
  
  
  METHODS
  Ethnically diverse sample of 454 adults ≥50 years of age.
  
  
  METHODS
  Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening.
  
  
  METHODS
  Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening.
  
  
  RESULTS
  Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15-53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48-30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03-11.35), and older age (OR = 1.10; 95% CI, 1.04-1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03-.57) and medical mistrust (OR = .19; 95% CI, .06-.60) were negatively associated with unwillingness to screen.
  
  
  CONCLUSIONS
  Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.
authors.affiliation: Moffitt Cancer Center, Tampa, Florida 33612-9416, USA. Shalanda.Bynum@moffitt.org
authors.forename: Shalanda A
authors.initials: SA
authors.lastname: Bynum
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Davis
authors.forename: B Lee
authors.initials: BL
authors.lastname: Green
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Katz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health / Q000208:ethnology; D015142:Baltimore; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006304:Health Status; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009519:New York City; D009780:Occult Blood; D010349:Patient Compliance; D011647:Puerto Rico; D011795:Surveys and Questionnaires; D035502:Trust