title: Predictors of Colorectal Cancer Screening: Does Rurality Play a Role?
abstract: OBJECTIVE
  The purpose of this study was to explore the associations between sociodemographic factors such as residence, health care access, and colorectal cancer (CRC) screening among residents of Texas.
  
  
  METHODS
  Using the 2012 Behavioral Risk Factor Surveillance Survey, we performed logistic regression analyses to determine predictors of CRC screening among Texas residents, including rural versus urban differences. Our outcomes of interest were previous (1) CRC screening using any CRC test, (2) fecal occult blood test (FOBT), or (3) endoscopy, as well as up-to-date screening using (4) any CRC test, (5) FOBT, or (6) endoscopy. The independent variable of interest was rural versus urban residence; we controlled for other sociodemographic and health care access variables such as lack of health insurance.
  
  
  RESULTS
  Multivariate analysis showed that individuals who were residents of a rural/non-Metropolitan Statistical Area (MSA) location (OR = 0.70, 95% CI = 0.51-0.97) or a suburban county (OR = 0.61, 95% CI = 0.39-0.95) were less likely to report ever having any CRC screening compared to residents of a center city of an MSA. Residents of a rural/non-MSA location were less likely (OR = 0.49, 95% CI = 0.28-0.87) than residents of a center city of an MSA to be up-to-date using FOBT. There was decreased likelihood of ever being screened for CRC among the uninsured (OR = 0.43, 95% CI = 0.31-0.59).
  
  
  CONCLUSIONS
  Effective development and implementation of strategies to improve screening rates should aim at improving access to health care, taking into account demographic characteristics such as rural versus urban residence.
authors.affiliation: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Chinedum O
authors.initials: CO
authors.lastname: Ojinnaka
authors.affiliation: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Yong
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Hye-Chung
authors.initials: HC
authors.lastname: Kum
authors.affiliation: Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, Texas.
authors.forename: Jane N
authors.initials: JN
authors.lastname: Bolin
mesh_terms: D000328:Adult; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010358:Patient Participation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: access to care; colorectal cancer; health disparities; policy; rural