title: Screening for colorectal cancer: using data to set prevention priorities.
abstract: BACKGROUND
  Adherence to colorectal cancer screening recommendations is known to vary by state, but less information is available about within-state variability. In the current study, we assess county-level screening rates for Missouri, with the goal of better targeting public health efforts to increase screening.
  
  
  METHODS
  Prevalence of colorectal cancer screening among Missouri adults between the ages of 50 and 74 was obtained from 2008 and 2010 Behavioral Risk Factor Surveillance System data. We used multilevel logistic regression to generate county-specific estimates. After excluding 77 counties with fewer than 30 respondents, information was available about 3,739 individuals in 37 counties, representing 78.5 % of the state population.
  
  
  RESULTS
  Across counties, the prevalence of being up-to-date with recommended colorectal cancer screening ranged from 25 to 70 %.
  
  
  CONCLUSIONS
  State-level information about colorectal cancer screening masks substantial within-state variability. Assessing and monitoring county-level disparities in screening can guide public health efforts to increase screening and reduce colorectal cancer mortality. More complete population survey data will make such analysis possible.
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA, colditzg@wustl.edu.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.forename: Lucy D'Agostino
authors.initials: LD
authors.lastname: McGowan
authors.forename: Aimee S
authors.initials: AS
authors.lastname: James
authors.forename: Kari
authors.initials: K
authors.lastname: Bohlke
authors.forename: Melody S
authors.initials: MS
authors.lastname: Goodman
mesh_terms: D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015995:Prevalence; D011314:Preventive Health Services / Q000379:methods; D011634:Public Health / Q000379:methods