title: Understanding Barriers to Colorectal Cancer Screening in Kentucky.
abstract: BACKGROUND
  Colorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers.
  
  
  METHODS
  The state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening.
  
  
  RESULTS
  The most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system.
  
  
  CONCLUSIONS
  Barriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.
authors.affiliation: 119 E. Markham St, Apartment D309, Little Rock, AK 72201. Email: jredknight@kycancerc.org.
authors.forename: Jennifer Redmond
authors.initials: JR
authors.lastname: Knight
authors.affiliation: Kentucky Department for Public Health, Frankfort, Kentucky.
authors.forename: Sarojini
authors.initials: S
authors.lastname: Kanotra
authors.affiliation: Kentucky Department for Public Health, Frankfort, Kentucky.
authors.forename: Seth
authors.initials: S
authors.lastname: Siameh
authors.affiliation: University of Kentucky, Lexington, Kentucky.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jones
authors.affiliation: Kentucky Department for Public Health, Frankfort, Kentucky.
authors.forename: Becki
authors.initials: B
authors.lastname: Thompson
authors.affiliation: Kentucky Department for Public Health, Frankfort, Kentucky.
authors.forename: Sue
authors.initials: S
authors.lastname: Thomas-Cox
mesh_terms: D000367:Age Factors; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003113:Colonoscopy / Q000523:psychology / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004522:Educational Status; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006293:Health Promotion / Q000592:standards*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007629:Kentucky / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D057566:Self Report; D012812:Sigmoidoscopy / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires