Using population data to reduce disparities in colorectal cancer screening, Arkansas, 2006.
BACKGROUND
Colorectal cancer is a common disease, and incidence and death rates are higher in medically underserved populations. The colorectal cancer death rate in Arkansas exceeds the national rate. The objective of this study was to examine population characteristics relevant to the design and implementation of a state-sponsored colorectal cancer screening program that is responsive to medically underserved populations.


METHODS
Trained interviewers in 2006 conducted a random-digit-dialed telephone survey comprising items selected from the Health Information National Trends Survey to characterize demographic factors, health care variables, and colorectal screening history in a sample (n = 2,021) representative of the Arkansas population. Univariate and multivariate analyses identified associations among population characteristics and screening status.


RESULTS
Participants who were aged 50 to 64, who did not have health insurance, or who had an annual household income of $15,000 or less were significantly less likely than their counterparts to be in compliance with screening guidelines. Those who reported having a health care provider, having 5 or more health care visits during the past year, and receiving physician advice for colorectal screening were more likely to be in compliance with screening guidelines. Although a larger percentage of white participants were in compliance with screening guidelines, blacks had higher screening rates than whites when we controlled for screening advice.


CONCLUSIONS
Survey results informed efforts to decrease disparities in colorectal cancer screening in Arkansas. Efforts should focus on reimbursing providers and patients for screening costs, encouraging the use of physicians as a point of entry to screening programs, and promoting a balanced approach (ie, multiple options) to screening recommendations. Our methods established a model for developing screening programs for medically underserved populations.
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham no. 820, Little Rock, AR 72205, USA. pggreene@uams.edu
Paul
P
Greene
Paulette
P
Mehta
Karen Hye-cheon Kim
KH
Yeary
Zoran
Z
Bursac
Jianjun
J
Zhang
Geoff
G
Goldsmith
Ronda
R
Henry-Tillman
D001131:Arkansas; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000382:microbiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006296:Health Services / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011159:Population Surveillance; D011933:Reagent Kits, Diagnostic; D012812:Sigmoidoscopy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D011933:Reagent Kits, Diagnostic