title: Decisional stage distribution for colorectal cancer screening among diverse, low-income study participants.
abstract: Colorectal cancer (CRC) screening uptake among minorities and those with lower incomes is suboptimal. Behavioral interventions specifically tailored to these populations can increase screening rates and save lives. The Precaution Adoption Process Model (PAPM) allows assignment of a decisional stage for adoption of a behavior such as CRC screening. Here, we characterize the PAPM decisional stage distribution among 470 low income, racially and ethnically diverse study participants at intake into a behavioral intervention study designed to increase CRC screening uptake. We staged participants for stool blood test (SBT) and colonoscopy separately and used the highest stage for the two tests as the 'overall' stage for CRC screening. For SBT, sex, language (English versus Spanish) and doctor recommendation were significantly related to PAPM stage for CRC screening. For colonoscopy, language, education level, doctor recommendation and self-efficacy were related to stage. For overall CRC screening stage, all the variables associated with either SBT or colonoscopy, with the exception of language were significant. This study suggests attending to these key variables in designing interventions to promote CRC screening, particularly with respect to medically underserved populations.
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA chester@kumc.edu.
authors.forename: C M
authors.initials: CM
authors.lastname: Hester
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: W K
authors.initials: WK
authors.lastname: Born
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Yeh
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Young
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: James
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Daley
authors.affiliation: Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA, University of Kansas Cancer Center, Kansas City, KS 66160, Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA, Department of Epidemiology, Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514, USA, Department of Surgery, Washington University in Saint Louis, Saint Louis, MO 63110, USA and Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Greiner
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011203:Poverty; D011795:Surveys and Questionnaires