The knowledge and use of screening tests for colorectal and prostate cancer: Data from the 1987 national health interview survey

doi:10.1016/0091-7435(90)90054-N

Preventive Medicine

Volume 19, Issue 5, September 1990, Pages 562-574

https://doi.org/10.1016/0091-7435(90)90054-N Get rights and content

Abstract

Data based on the 1987 National Health Interview Survey are presented depicting factors associated with the knowledge and use of three tests for the early detection of colorectal and prostate cancer: digital rectal examination, fecal occult blood tests, and flexible sigmoidoscopy. The percentage of the at risk adult population who have ever heard of or had these tests is reported. The association of demographic, personal resource, and health system factors with knowledge of these tests is explored using multivariate logistic regression. Health system factors are most consistently associated with use of the tests and with knowledge. Family income, family size, education, knowledge of cancer early warning signs, and measures of encounters with the health care system are associated both with knowledge of and, independent of knowledge, with use of the tests. Residency in the non-South, being white or female, and having an optimistic attitude about cancer prevention are all factors associated with greater knowledge of the tests, but not greater use among those aware of the tests. Membership in a health maintenance organization is more strongly associated with knowledge and use of fecal occult blood tests than the other tests. No association was found between current smoking status and knowledge of or use of any of the tests.

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Cited by (139)

The role of self-efficacy, self-esteem and optimism for using routine health check-ups in a population-based sample. A longitudinal perspective
2017, Preventive Medicine
While several cross-sectional studies have shown that self-efficacy, self-esteem and optimism are associated with the use of routine health check-ups, little is known about this relationship based on longitudinal studies. Consequently, the purpose of this study was to examine whether these factors are associated with routine health check-ups longitudinally. Data were retrieved from a population-based longitudinal study of individuals (≥ 40 years of age) residing in private households in Germany (two waves: 2008 and 2011). Widely established scales were used to quantify self-efficacy, self-esteem, and optimism. Respondents reported whether they used a health check-up in the last two years. Conditional fixed-effects logistic regressions were used (n = 1504), adjusting for socio-demographic, lifestyle and health-related variables. After adjusting for various potential confounders, regression analysis revealed that the use of routine health check-ups increased with self-efficacy [OR: 1.71 (95%-CI: 1.14–2.55)], self-esteem [OR: 1.78 (1.16–2.73)], and optimism [OR: 1.37 (1.01–1.86)]. Furthermore, the use of routine health check-ups increased with changes from employment to retirement [OR: 2.60 (1.34–5.03)], whereas it was not associated with changes in age, marital status, smoking status, the number of physical illnesses, self-rated health and body-mass index. The current study stresses the importance of an association between screening behavior and self-efficacy, self-esteem and optimism longitudinally. Interventions aiming at modifying these psychological factors might help to increase the use of routine health check-ups.
Randomized controlled dissemination study of community-to-clinic navigation to promote CRC screening: Study design and implications
2017, Contemporary Clinical Trials
Citation Excerpt :
Even in the context of primary care system contact, there continue to be a number of barriers to CRC screening, including insurance and cost issues [16,17]; transportation and other logistical (family, time off work) challenges [18–22]; ineffective doctor-patient communication [23]; lack of knowledge, misconceptions, and fear [17,22–27]. Absence of symptoms have been shown to be significant reasons for non-adherence with both stool blood testing and flexible sigmoidoscopy [21,28,29–32]. Most importantly, health care provider failure to recommend CRC screening or not having a usual source of care also hinders early detection and prevention efforts [21,25,30,33–37].
Regular screening facilitates early diagnosis of colorectal cancer (CRC) and reduction of CRC morbidity and mortality. Screening rates for minorities and low-income populations remain suboptimal. Provider referral for CRC screening is one of the strongest predictors of adherence, but referrals are unlikely among those who have no clinic home (common among poor and minority populations).
This group randomized controlled study will test the effectiveness of an evidence based tailored messaging intervention in a community-to-clinic navigation context compared to no navigation. Multicultural, underinsured individuals from community sites will be randomized (by site) to receive CRC screening education only, or education plus navigation. In Phase I, those randomized to education plus navigation will be guided to make a clinic appointment to receive a provider referral for CRC screening. Patients attending clinic appointments will continue to receive navigation until screened (Phase II) regardless of initial arm assignment. We hypothesize that those receiving education plus navigation will be more likely to attend clinic appointments (H1) and show higher rates of screening (H2) compared to those receiving education only. Phase I group assignment will be used as a control variable in analysis of screening follow-through in Phase II. Costs per screening achieved will be evaluated for each condition and the RE-AIM framework will be used to examine dissemination results.
The novelty of our study design is the translational dissemination model that will allow us to assess the real-world application of an efficacious intervention previously tested in a randomized controlled trial.
The role of education in colorectal cancer screening participation: Updated evidence from Canadian Community Health Survey (2011–2012)
2017, Cancer Treatment and Research Communications
Citation Excerpt :
Compared to “less than secondary graduation” group, the “post-secondary graduation” group had a significant increase in screening practice. Although multiple studies of explanatory variables of colorectal cancer participation have been performed [15,17,18,25], and low educational attainment has been reported previously as predictors of inadequate colorectal cancer screening [15,17,18,25,26], this study has the advantage of being most recent, nationally representative, and large enough to allow accurate comparisons of colorectal cancer screening participation among subgroups with difference education level. Secondly, language was controlled as a confounder for the first time, because it was associated with both the frequency of regular health examination (including cancer screening), and education level [27,28].
In the context of conflicting evidence, this study was designed to investigate the association between education and colorectal cancer screening participation.
Data from the Canadian Community Health Survey (2011-12) was analyzed using multivariable logistic regression among 38,863 respondents. The outcome was derived from: 1) Fecal Occult Blood Test participation, and 2) colonoscopy or sigmoidoscopy participation.
Compared to those with education of less than secondary school level, people with post-secondary graduation (OR=1.44, 95%CI 1.25, 1.67), some post-secondary (OR=1.16, 95%CI 0.88, 1.52), or secondary graduation (OR=1.22, 95%CI 1.04, 1.44) had an increase in odds of colorectal cancer screening participation, adjusting for age, sex, income, language, and ethnicity.
The evidence found in this study reinforces the positive association between educational level and colorectal cancer screening, which could be useful in designing interventions aimed at improving participation in colorectal cancer screening.
Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends
2010, Gastrointestinal Endoscopy
Citation Excerpt :
Other sources included Australia (n = 2),55,56 Austria (n = 2),57,58 Canada (n = 5),59-63 France (n = 1),64 Germany (n = 1),65 and Greece (n = 1).66 See Appendix I67-126 (available online at www.giejournal.org) for a list of excluded studies with rationale. The U.S. data were based on 3 major national health surveys: the BRFSS,13-17,19,23,24,36,38,42,47 the National Health Interview Survey (NHIS),12,31,33-35,41,43,45,48,50 the Health Information National Trends Survey (HINTS),22,27,29,32,46 or other, often regional surveys.18,20,21,25,26,28,30,37,39,40,44,49,51-54
Lower GI endoscopy, such as colonoscopy or sigmoidoscopy, is thought to have a substantial impact on colorectal cancer incidence and mortality through detection and removal of precancerous lesions and early cancers. We aimed to review prevalence estimates of history of colonoscopy or sigmoidoscopy in the general population and to analyze recent trends.
A systematic review of the medical literature, including MEDLINE (1966 to August 2008) and EMBASE (1980 to August 2008), was undertaken, supplemented by searches of the European Health Interview & Health Examination Surveys database and bibliographies. Detailed age-specific and sex-specific prevalence estimates from the United States were obtained from the Behavioral Risk Factor Surveillance System surveys 2002, 2004, and 2006.
The search yielded 55 studies that met our inclusion criteria. The majority of the reports (43) originated from the United States. Other countries of origin included Australia (2), Austria (2), Canada (5), France (1), Germany (1), and Greece (1). Estimates from the United States were generally increasing over time up to 56% (2006) for lifetime use of colonoscopy or sigmoidoscopy in people aged 50 years and older. Analysis of national survey data showed higher prevalences among men aged 55 years and older than for women of the same age. Prevalences were highest for people aged 70 to 79 years.
Data from outside the United States were extremely limited. Prevalence estimates from the United States indicate that a considerable and increasing proportion of the population at risk has had at least 1 colonoscopy or sigmoidoscopy in their lives, although differences between age and sex groups persist. Prevalences of previous colonoscopy or sigmoidoscopy need to be taken into account in the interpretation of time trends in, and variation across, populations of colorectal cancer incidence and mortality.
Provider recommendation for colorectal cancer screening: Examining the role of patients' socioeconomic status and health insurance
2009, Cancer Epidemiology
Background: Provider recommendation for colorectal cancer (CRC) screening test has been shown as a strong predictor of patients’ decision to be screened. Evidence of factors associated with provider recommendation remains limited and inconsistent. The present study sought to examine the association between provider recommendation for colorectal cancer screening and patients’ socioeconomic status (SES) and insurance status using national survey data for 2005. Methods: Analyses were based on 2948 adult aged 50 and older who participated in the 2005 Health Information National Trend Survey (HINTS). Multivariate logistic regression models were used to determine whether the indicators of SES (income and educational level) and insurance status have any impact on provider recommendation. Results: Our study found a strong association between recall of health care provider recommendation and reported recent screening testing after controlling for other patient characteristics. When all the study population were included in the analysis, those who had lower than high school education and high school graduates were less likely to have received provider recommendation than those with higher than high school education (OR = 0.49; 95%CI = 0.32–0.73 and OR = 0.60; 95%CI = 0.47–0.78 respectively). Income and insurance were not significant predictors. Education remained significantly associated with provider recommendation when only those who had made one or more medical visits in the past year were included in the analyses. Conclusions: Patient's educational level – but not income or insurance status – was related to provider recommendation for CRC screening. To increase awareness of colorectal cancer risks and the benefit of screening, health care providers need to make a concerted effort to recommend colorectal cancer screening to all relevant patients, regardless of socioeconomic status and other personal characteristics.
A multimedia patient education program on colorectal cancer screening increases knowledge and willingness to consider screening among Hispanic/Latino patients
2009, Patient Education and Counseling
To test a multimedia patient education program on colorectal cancer (CRC) screening that was designed specifically for the Hispanic/Latino community, and developed with input from community members.
A total of 270 Hispanic/Latino adults, age 50–80 years, participated in Spanish for all phases of this pretest–posttest design. Patients were randomly assigned to a version of the multimedia program that opened with either a positive or negative introductory appeal. Structured interviews assessed screening relevant knowledge (anatomy and key terms, screening options, and risk information), past screening behavior, willingness to consider screening options, intention to discuss CRC screening with the doctor, and reactions to the multimedia patient education program.
The multimedia program significantly increased knowledge of anatomy and key terms (e.g., polyp), primary screening options (FOBT, flexible sigmoidoscopy, colonoscopy), and risk information as well as willingness to consider screening (p < .001 for all). No significant differences emerged between positive and negative introductory appeals on these measures, intention to discuss CRC screening with their doctor, or rating the multimedia program.
Multimedia tools developed with community input that are designed to present important health messages using graphics and audio can reach Hispanic/Latino adults across literacy levels and ethnic backgrounds. Additional research is needed to determine effects on actual screening behavior.
Despite promising results for engaging a difficult-to-reach audience, the multimedia program should not be considered a stand-alone intervention or a substitute for communication with physicians. Rather, it is a priming mechanism intended to prepare patients for productive discussions of CRC screening.

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General articleThe knowledge and use of screening tests for colorectal and prostate cancer: Data from the 1987 national health interview survey

Abstract

Lancet

Prev Med

Prev Med

Prev Med

Cancer statistics, 1990

CA

Routine screening for prostate cancer using the digital rectal examination

Prog. Clin Biol Res

Screening for colorectal cancer

Colon cancer control study: An interim report

Screening and rescreening for colo-rectal cancer

Prostate, Lung and Colorectal Cancer Screening Trial

Working Guidelines for Early Cancer Detection, Rationale and Supporting Evidence to Decrease Mortality

Cancer of the colon and rectum: Summary of a public attitude survey

CA

Occult blood screening for colorectal cancer

JAMA

General article
The knowledge and use of screening tests for colorectal and prostate cancer: Data from the 1987 national health interview survey