title: Individual- and provider-level factors associated with colorectal cancer screening in accordance with guideline recommendation: a community-level perspective across varying levels of risk.
abstract: BACKGROUND
  Participation rates in colorectal cancer screening (CRC) are low. Relatively little is known about screening uptake across varying levels of risk and across population groups. The purpose of the current study was to identify factors associated with (i) ever receiving colorectal cancer (CRC) testing; (ii) risk-appropriate CRC screening in accordance with guidelines; and (iii) recent colonoscopy screening.
  
  
  METHODS
  1592 at-risk persons (aged 56-88 years) were randomly selected from the Hunter Community Study (HCS), Australia. Participants self-reported family history of CRC was used to quantify risk in accordance with national screening guidelines.
  
  
  RESULTS
  1117 participants returned a questionnaire; 760 respondents were eligible for screening and analysis. Ever receiving CRC testing was significantly more likely for persons: aged 65-74 years; who had discussed with a doctor their family history of CRC or had ever received screening advice. For respondents "at or slightly above average risk", guideline-appropriate screening was significantly more likely for persons: aged 65-74 years; with higher household income; and who had ever received screening advice. For respondents at "moderately or potentially high risk", guideline-appropriate screening was significantly more likely for persons: with private health insurance and who had discussed their family history of CRC with a doctor. Colonoscopy screening was significantly more likely for persons: who had ever smoked; discussed their family history of CRC with a doctor; or had ever received screening advice.
  
  
  CONCLUSIONS
  The level of risk-appropriate screening varied across populations groups. Interventions that target population groups less likely to engage in CRC screening are pivotal for decreasing screening inequalities.
authors.affiliation: The Priority Research Centre for Health Behaviour,School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Australia. r.courtney@unsw.edu.au
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Courtney
authors.forename: Christine L
authors.initials: CL
authors.lastname: Paul
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sanson-Fisher
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.forename: Mariko L
authors.initials: ML
authors.lastname: Carey
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Mark
authors.initials: M
authors.lastname: McEvoy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015179:Colorectal Neoplasms / Q000235:genetics / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data*; D020022:Genetic Predisposition to Disease; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires