title: Determinants of variations in self-reported barriers to colonoscopy among uninsured patients in a primary care setting.
abstract: Colorectal cancer (CRC) is the third most common type of cancer among both males and females in the United States and the second leading cause of cancer-related deaths. Although largely preventable through screening, early detection and removal of polyps, screening rates are considered sub-optimal. Perceived barriers to screening have been reported to influence screening rates. This paper examines variations in the extent to which uninsured patients identified barriers to CRC screening using colonoscopy based on race/ethnicity, educational attainment, age, gender, marital status and prior colonoscopy. Multivariate analyses showed that compared to Caucasians, African Americans had an increased likelihood of identifying lack of transportation as a barrier [odds ratio (OR) 2.68; 95 % confidence interval (CI) 1.35-5.32] while Hispanics were more likely to identify fear of finding cancer as a barrier (OR 2.09; 95 % CI 1.19-3.66). Compared to those with more than a high school education, there was increased likelihood of identifying lack of knowledge as a barrier among individuals with high school education (OR 3.51; 95 % CI 1.94-6.36) or less than a high school education (OR 2.16; 95 % CI 1.04-4.50). Our findings suggest that strategies aimed at increasing colonoscopy screening rates among underserved populations should take into consideration race/ethnicity, educational attainment, age, and prior colonoscopy experience when developing education and outreach plans to reduce barriers to colonoscopy.
authors.affiliation: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX, 77843-1266, USA, Ojinnaka@sph.tamhsc.edu.
authors.forename: Chinedum
authors.initials: C
authors.lastname: Ojinnaka
authors.forename: Ann
authors.initials: A
authors.lastname: Vuong
authors.forename: Janet
authors.initials: J
authors.lastname: Helduser
authors.forename: Philip
authors.initials: P
authors.lastname: Nash
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
authors.forename: David A
authors.initials: DA
authors.lastname: McClellan
authors.forename: Jane N
authors.initials: JN
authors.lastname: Bolin
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People
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