title: Determinants of non-participation in a mass screening program for colorectal cancer in Finland.
abstract: BACKGROUND
  For an effective colorectal cancer (CRC) screening program, high participation rate is essential. However, non-participation in CRC screening program has increased in Finland.
  
  
  METHODS
  The study was based on a population-based nationwide cohort of persons invited for CRC screening in 2004-2011. Information on the first round of the CRC screening participation and related background factors was obtained from the Finnish Cancer Registry, and information about health behavior factors from the Health Behavior Survey (HBS) in 1978-1999. Non-participation in CRC screening was analyzed with Poisson regression as incidence rate ratios (IRR) with 95% confidence intervals (95% CI).
  
  
  RESULTS
  Of all persons invited for CRC screening (79 871 men and 80 891 women) 35% of men and 21% of women refused. Of those invited for screening, 2456 men (3.1%) and 2507 women (3.1%) were also invited to the HBS. Persons, who declined HBS, were also more likely to refuse CRC screening (men IRR 1.40, 95% CI 1.26-1.56, women 1.75, 1.52-2.02) compared to HBS participants. Never married persons had about a 75% higher risk for refusing than married ones. The youngest age group (60 years) was more likely to refuse screening than the older age groups (62 or >64 years). Smoking was associated with non-participation in screening (current smokers, men: IRR 1.32, 95% CI 1.05-1.67, women: 2.10, 1.61-2.73).
  
  
  CONCLUSIONS
  Participation in CRC screening was affected by gender, age, and marital status. Persons, who refused the HBS, were also more likely to refuse CRC screening. Smoking was a risk factor for non-participation in CRC screening.
authors.affiliation: a Finnish Cancer Registry , Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ;|b School of Health Sciences, University of Tampere , Tampere , Finland ;
authors.forename: M
authors.initials: M
authors.lastname: Artama
authors.affiliation: a Finnish Cancer Registry , Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ;
authors.forename: S
authors.initials: S
authors.lastname: Heinävaara
authors.affiliation: a Finnish Cancer Registry , Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ;
authors.forename: T
authors.initials: T
authors.lastname: Sarkeala
authors.affiliation: c National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: R
authors.initials: R
authors.lastname: Prättälä
authors.affiliation: a Finnish Cancer Registry , Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ;|b School of Health Sciences, University of Tampere , Tampere , Finland ;
authors.forename: E
authors.initials: E
authors.lastname: Pukkala
authors.affiliation: a Finnish Cancer Registry , Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ;|b School of Health Sciences, University of Tampere , Tampere , Finland ;
authors.forename: N
authors.initials: N
authors.lastname: Malila
mesh_terms: D001294:Attitude to Health; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D017533:Marital Status; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data