title: Pathways to colonoscopy in the South: seeds of health disparities.
abstract: OBJECTIVE
  We aimed to highlight sociodemographic differences in how patients access colonoscopy.
  
  
  METHODS
  We invited all eligible patients (n = 2500) from 2 academy-affiliated colonoscopy centers in Alachua County, Florida (1 free standing, 1 hospital based), to participate in a precolonoscopy survey (September 2011-October 2013); patients agreeing to participate (n = 1841, response rate = 73.6%) received a $5.00 gift card.
  
  
  RESULTS
  We found sociodemographic differences in referral pathway, costs, and reasons associated with obtaining the procedure. Patients with the ideal pathway (referred by their regular doctor for age-appropriate screening) were more likely to be Black (compared with other minorities), male, high income, employed, and older. Having the colonoscopy because of symptoms was associated with being female, younger, and having lower income. We found significant differences for 1 previously underestimated barrier, having a spouse to accompany the patient to the procedure.
  
  
  CONCLUSIONS
  Patients' facilitators and barriers to colonoscopy differed by sociodemographics in our study, which implies that interventions based on a single facilitator will not be effective for all subgroups of a population.
authors.affiliation: At the time of the study, Barbara A. Curbow, Evelyn C. King-Marshall, and Tracy E. Barnett were with the Department of Behavioral Science and Community Health, University of Florida, Gainesville. Jessica R. Schumacher was with the Department of Health Services Research, Management & Policy, Gainesville. Shahnaz Sultan was with the North Florida/South Georgia Veterans Affairs Medical Center, Department of Medicine, Gainesville. Thomas J. George Jr was with the Department of Medicine, University of Florida, Gainesville. Amy B. Dailey was with the Department of Health Sciences, Gettysburg College, Gettysburg, PA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Curbow
authors.forename: Amy B
authors.initials: AB
authors.lastname: Dailey
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: King-Marshall
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Barnett
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Sultan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: George
mesh_terms: D001741:Black or African American; D000367:Age Factors; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D044469:Racial Groups / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors