Effectiveness of a Tailored Colorectal Cancer Educational Seminar in Enhancing the Awareness, Knowledge, and Behavior of Korean Americans Living in the Los Angeles Koreatown Area.

Measures for Ascertaining Use of Colorectal Cancer Screening in Behavioral, Health Services, and Epidemiologic Research

Introduction: Colorectal cancer (CRC) screening rates for Chinese and Korean Americans are one of the lowest among all racial and ethnic groups. A lack of knowledge and misconceptions surrounding CRC may be contributing factors of this disparity. Hence in this study, we sought to assess the relationship between knowledge with CRC screening behaviors and confidence among Chinese and Korean Americans. Methods: We recruited Chinese (n=59) and Korean Americans (n=61), 50 years and older, from the Washington, D.C. metropolitan area. CRC screening knowledge, behaviors, and confidence were assessed individually for participants through surveys and discussed in 12 focus group discussions (n=120). Mixed methods were employed to analyze the quantitative survey data and qualitative focus group data. For surveys, associations were analyzed using multivariate-adjusted logistic regression taking into account age, education, income, family history of CRC, having a regular physician, health insurance, and acculturation. Results: Based on both quantitative and qualitative analyses, participants exhibited a general lack of knowledge about CRC and CRC screening. About 7 out of 10 participants believed that CRC is usually fatal, and 3 out of 10 participants believed that there is nothing they could do to prevent CRC. In addition, over 50% of participants did not know that CRC screening is recommended from age 50 and that there are different CRC screening tests. Participants alluded to the lack of culturally and linguistically tailored health information as being a probable cause of low levels of CRC knowledge in these populations. However, family and friends were found to play an important role in encouraging screening behaviors and providing CRC-related information. For instance, one focus group participant shared about an occasion where she insisted that a friend and her husband receive CRC screening. The participant stated, “Her husband still calls me a lifesaver” after several polyps were found and removed during his colonoscopy. Individuals having a family member or friend, who received CRC screening or had a history of CRC, tended to have greater CRC knowledge. Furthermore, quantitative data and focus group discussions revealed misconceptions regarding CRC as being a western disease, ensuing false beliefs of having less susceptibility. Moreover, increased knowledge was associated with having confidence in getting screening and receiving CRC screening. In particular, those who believed that CRC screening will decrease chances of dying from CRC were 10.2 times more likely to get a fecal occult blood test (95% confidence interval: 3.9-26.6) and 10.7 times more likely to have a colonoscopy (95% confidence interval: 2.8-40.9). Conclusions: The combined use of surveys and focus groups provided a more in-depth examination and greater insight into how CRC knowledge impacts screening and confidence. Future efforts to increase CRC screening among Chinese and Korean Americans should (1) utilize family and friends as a channel to increase CRC knowledge and screening and (2) target the identified misconceptions held by these groups. Citation Format: Mary Jung, Xiaoxiao Lu, Julia Cen Chen, Daisy Le, Jingjing Chen, Sunmin Lee. Tell a Friend and Save a Life: Investigating the impact of knowledge on colorectal cancer screening behaviors and confidence among Chinese and Korean Americans using a mixed methods approach. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C67.

Background Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. Methods We performed a multilevel analysis of the Medicare Current Beneficiary Survey data linked to Medicare claims and the Area Resource File to identify determinants of racial and socioeconomic disparities in CRC screening among 9985 Medicare Parts A and B beneficiaries with a usual physician. Recent CRC screening was defined as receipt of either a home fecal occult blood test, flexible sigmoidoscopy, or colonoscopy at recommended intervals. Results Unadjusted rates of screening were 48% for white and 39% for black beneficiaries (P<.001). Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status as measured by income and education. Socioeconomic status disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76; 95% confidence interval, 2.29-3.33) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31; 95% confidence interval, 1.12-1.53) were associated with higher odds of screening, controlling for other factors. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills. Conclusions Racial differences in CRC screening rates among Medicare beneficiaries with a usual physician are explained by differences in socioeconomic status. Beneficiaries with a primary care generalist as their usual physician had higher rates of CRC screening receipt. Increased efforts to make Medicare beneficiaries aware of the benefits of CRC screening may capitalize on the associations found in this study between CRC knowledge, physician information giving, and timely screening.

Background: Chinese, Vietnamese, and Korean Americans, three of the largest Asian American (AA) subgroups, have particularly high rates of colorectal cancer (CRC) incidence and mortality. However, CRC screening rates among these Asian Americans remain very low. Increased knowledge of CRC has been shown to be positively correlated with a person’s inclination to undergo screening. Purpose: This study estimated the prevalence of up to date CRC screening and examined the predictors of CRC knowledge and screening compliance among Chinese, Korean, and Vietnamese Americans living in the Baltimore-Washington metropolitan area. Methods: A cross-sectional sample was employed in this study and included 274 Chinese, Korean, and Vietnamese Americans between ages 50-75 years old. A questionnaire was given to participants in either their preferred native language or in English. Data was collected in person. Results: Data from the 2009 California Health Interview Survey (CHIS) indicates that Chinese Americans had higher rates of FOBT at 32.2% than Vietnamese Americans (27.3%) and Korean Americans (24.8%). Compared to these rates from CHIS, we had significantly lower rates of up to date FOBT: less than 10% (9.1%) reported having FOBT in the past year. Vietnamese had the highest rate (13.8%) followed by Korean (7.5%) and Chinese (6.9%). For the prevalence of up to date colonoscopy (&amp;lt;10 years), CHIS data disaggregated by ethnicity among AA shows that Vietnamese Americans (63.7%) had highest rates of having colonoscopy followed by Korean Americans (51.1%) and Chinese Americans (48.7%). In our study, Chinese had higher rates of up to date colonoscopy (63.3%) than Vietnamese (47.5%) and Korean (43.0%). The average CRC Knowledge Score was 6.10 out of 9 (SD=2.91). In bivariate analysis, education, marital status, and self-rated health were highly correlated with CRC knowledge. Those with higher education levels, those married, and those rated with good physical health had increased CRC knowledge. In multivariate analysis, education, health insurance, and CRC knowledge were significantly related to having colonoscopy. Those with high CRC knowledge were more likely to have colonoscopy than those low knowledge (aOR=2.74, 95% CI, 1.13, 6.64). Those who had health insurance had higher likelihood of having colonoscopy than those without health insurance (aOR=4.40, 95% CI, 2.33, 8.32). Those more than high school education were less likely to have colonoscopy than those with less than high school education (aOR=0.37, 95% CI, 0.16, 0.84). Conclusions: The findings of this study suggest that CRC knowledge is a strong predictor of CRC screening behavior in Asian Americans. Lack of CRC screening knowledge still remains an important barrier to screening, and future strategies to increase public awareness on CRC is necessary to achieve greater screening compliance amongst AA populations. Citation Format: Jenny Guo, Hee-Soon Juon, Sunmin Lee. Colorectal cancer knowledge and screening among Asian Americans aged 50-75 years old [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4223. doi:10.1158/1538-7445.AM2017-4223

Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. We performed a multilevel analysis of the Medicare Current Beneficiary Survey data linked to Medicare claims and the Area Resource File to identify determinants of racial and socioeconomic disparities in CRC screening among 9985 Medicare Parts A and B beneficiaries with a usual physician. Recent CRC screening was defined as receipt of either a home fecal occult blood test, flexible sigmoidoscopy, or colonoscopy at recommended intervals. Unadjusted rates of screening were 48% for white and 39% for black beneficiaries (P<.001). Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status as measured by income and education. Socioeconomic status disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76; 95% confidence interval, 2.29-3.33) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31; 95% confidence interval, 1.12-1.53) were associated with higher odds of screening, controlling for other factors. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills. Racial differences in CRC screening rates among Medicare beneficiaries with a usual physician are explained by differences in socioeconomic status. Beneficiaries with a primary care generalist as their usual physician had higher rates of CRC screening receipt. Increased efforts to make Medicare beneficiaries aware of the benefits of CRC screening may capitalize on the associations found in this study between CRC knowledge, physician information giving, and timely screening.

Colorectal Cancer Testing Among People Over Age 50

Background: Among Asian Americans, colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death. Although screening has been found to significantly reduce CRC mortality, Chinese and Korean Americans continue to report lower CRC screening rates than White and African Americans. Therefore, this study aims to examine the barriers and facilitators of CRC screening, taking into account a cultural perspective, in these underserved populations. Methods: We employed a mixed methods study to gain further understanding regarding CRC screening behaviors among Asian Americans. Specifically, we collected quantitative data through surveys from 120 participants, who were self-identified Chinese and Korean Americans, aged 50 years and over. Multivariable-adjusted logistic regression was conducted to analyze survey data, independently assessing for receipt of colonoscopy and fecal occult blood test (FOBT). In addition, qualitative data from 17 key informant interviews (with physicians, health department employees, patient navigators, and community leaders) and 12 focus groups (n=120) were transcribed, translated to English, back-translated to ensure accuracy, coded, and analyzed for salient themes. Results: Based on focus group findings, major cultural themes influencing CRC screening included language- and health-related attitudes and beliefs. In particular, participants identified having limited English proficiency, low health literacy, and reliance on children for translation as being key barriers. Thus, participants emphasized the importance of having linguistically appropriate services, such as patient navigators. Additional barriers included fearing a CRC diagnosis, having fatalistic views of CRC, and facing stigma towards cancer. In addition, quantitative analysis found that individuals who believed screening is not needed when asymptomatic were less likely to receive a colonoscopy (Odds Ratio (OR): 0.02; 95% Confidence Interval (CI): 0.002-0.23) and FOBT (OR: 0.16; 95% CI: 0.03-0.72). These findings were supported by key informants and focus group participants, who expressed that Chinese and Koreans often times do not prioritize preventive healthcare and believe that seeking healthcare is not necessary when symptoms are not noticeable. Moreover, this study corroborated previous findings of non-cultural factors influencing CRC screening such as cost, insurance, knowledge, and time -some of which were influenced by underlying cultural attitudes and beliefs. Patient-physician communication was another key influential factor. For instance, those having a doctor talk about [(OR: 6.1; 95% CI: 2.4-15.4) for colonoscopy; (OR: 3.1; 95% CI: 1.1-8.5) for FOBT)] or recommend CRC screening [(OR: 6.6; 95% CI: 2.6-16.7) for colonoscopy; (OR: 4.0; 95% CI: 1.4-11.2) for FOBT)] were more likely to have received screening. Conclusions: Receipt of CRC screening is influenced by cultural and non-cultural factors, both of which need to be addressed in order to increase screening uptake among Chinese and Korean Americans. These findings can inform the development of more effective CRC screening programs and interventions that are culturally and linguistically tailored to these populations. Citation Format: Sunmin Lee, Mary Jung, Xiaoxiao Lu, Jamie Sim, Diane Ng. Examining colorectal cancer screening barriers and facilitators though a cultural lens: A mixed methods study of Chinese and Korean Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B73.

Colonoscopy capacity: Can we build it? Will they come?

Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States?

Background Several initiatives have focused on increasing colorectal cancer (CRC) screening rates, but national rates still fall below 70% for many groups, particularly those in underserved communities. Examining CRC screening determinants in groups who have completed screening for other cancer sites may provide useful information to support future initiatives. In 2015, 71.6% of women nationally completed mammograms in the past two years, while only 63% completed any CRC screening procedures. Purpose We examined data from the 2015 National Health Interview Survey to identify determinants of CRC screening completion among women adherent to breast cancer (BrCa) screening guidelines. We hypothesized that race, income, and psychosocial factors would explain CRC screening non-adherence. Methods The sample contained women (N=1206), aged 50-74 years, BrCa free, who completed a mammogram in the past two years, and were of average CRC risk (no first degree relative with cancer, history of polyps or inflammatory bowel disease). Bivariate associations between sociodemographic, health access, perceived BrCa risk, perceived CRC risk variables, and CRC screening status were examined using chi-square tests. Multivariate logistic regression analysis was used to examine factors associated with CRC screening completion. Results Prevalence of CRC screening in this sample was 55.52% including: Sigmoidoscopy (1.47%), colonoscopy (50.33%), fecal occult blood test (10.81%). Significant differences in CRC screening (p &amp;lt;.01) by education, income, insurance, foreign birth status, and language regularly spoken were revealed. Having insurance (OR:4.52, CI:2.20-9.31) and being foreign-born (OR: 1.77, CI:1.17-2.66) were independently associated with CRC screening completion after controlling for all other factors. Conclusion CRC screening rates among women completing breast cancer screening were lower than the national average for women. Neither perceived BrCa risk nor perceived CRC risk explained CRC screening behavior. Income and health insurance variables appear to drive sociodemographic differences in screening completion. However, foreign-born status had a direct impact on CRC screening behavior. Differences in the availability of free or low-cost screening programs for BrCa and CRC may explain these findings. More research is needed to understand how sociodemographic factors interact to impact CRC screening rates in this group. Citation Format: Deeonna E Farr, Leslie E Cofie, Alison T Brenner, Ronny A Bell, Daniel S Reuland. Sociodemographic determinants of colorectal cancer screening completion among women adherent to mammography screening guidelines [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C108.

Colon Cancer Screening in 2005: Status and Challenges

Impact of Comorbidity on Colorectal Cancer Screening in the Veterans Healthcare System

Purpose: The purpose of this study was to document colorectal cancer (CRC) screening rates among residents of Appalachia Ohio who were average-risk for CRC prior to the implementation of a mass media campaign to improve CRC screening in this population which experiences increased CRC incidence and mortality rates. Methods: A commercial list of Ohio Appalachia residents 50+ years of age was obtained for the 12 counties. Residents from each county were randomly selected and sent a letter of invitation to complete a telephone survey. Participants were called, consented, and interviewed. A medical record release form was requested to confirm self-report of CRC screening. Rate of within CRC screening guidelines was considered for any of the following: fecal occult blood test within the last year, flexible sigmoidoscopy within the last five years, or colonoscopy within the last ten years. The odds ratios (and 95% CIs) for being within guidelines by self-report were calculated for each covariate via univariate logistic regression. We conducted a path analysis using Mplus 5.0 to assess the relationship between factors leading to a CRC screening test. Results: A total of 1,106 interviews were completed. A medical record release form was provided by 795 (71.9%) of respondents and CRC screening information was returned by clinics for 91.4% of these participants. Overall, the majority of individuals were female (59%), White (97%), and were married (77%). The mean age was 61 years old, 38% were retired, 44% had less than a college education, 17% had annual household incomes less than $20,000, 91% had health insurance, and 12% were current smokers. Among the respondents, 93% reported that they had a healthcare provider, 82% had a check-up in the last year, and 54% rated their health as excellent or very good. Being within CRC screening guidelines by self-report was 61.4% in the entire sample, and among those with a medical record review (MRR) available, 68% were within guidelines by self-report and 49% by MRR. The following characteristics were significantly (p&amp;lt;0.05) related to being within CRC screening guidelines: a) demographics: age 65+ years old (OR=1.86), greater than a high school education (OR=1.79), being currently married (OR=1.54); &amp;gt;$50,000/year income vs. &amp;lt;$20,000 (OR=1.61); and being a current smoker (OR=0.48); b) health care: having health insurance (OR=5.27); a regular doctor (OR=5.45); and having had a check-up in the last two years (OR=5.24); and c) CRC-related variables: better knowledge of CRC tests (OR=2.03), doctor recommendation for a CRC screening test (OR=14.7), encouraged to have a CRC screening test (OR=3.12), or asked provider for a screening test (OR=5.41). Additionally, 51% of the respondents were not worried about getting CRC, 86% were willing to have a test if their doctor recommended it, and 11% intended to complete CRC screening in the next six months. Path analyses found that those who asked their doctors for CRC screening and were asked to complete a CRC screening by their doctors were more likely to be within CRC screening guidelines (β = .85, p&amp;lt; .001; β = .57, p&amp;lt; .001, respectively). Conclusions: Low CRC screening rates among a random sample of residents of Appalachia Ohio show evidence to support increased CRC mortality rates among residents of Appalachia, documented in recent publications. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B93.

Background: Disparities in colorectal cancer incidence and mortality rates exist among racial/ethnic minorities, especially those living in rural areas. There is an urgent need to implement interventions to improve colorectal cancer screening behaviors among such groups, particularly those living in rural areas in the United States.Methods: From a rural community of Hispanics, we recruited participants to attend home-based promotor(a)-led "home health parties" in which participants were taught about colorectal cancer screening; participants ages 50 and older were given a free fecal occult blood test (FOBT) kit to complete on their own. A pre- and posttest design was used to assess changes in colorectal cancer awareness, knowledge, and screening at baseline and at 1-month follow-up after the intervention.Results: We observed a statistically significant increase in colorectal cancer screening awareness and knowledge among participants. Colorectal cancer screening rates with FOBT increased from 51.0% to 80%. There was also a statistically significant increase in social engagement, that is, the intent to speak to friends and relatives about colorectal cancer screening.Conclusions: Findings indicate that culturally tailored colorectal cancer education facilitated by promotores in a rural environment, coupled with free stool-based test for colorectal cancer screening, is an effective way to increase colorectal cancer screening awareness, knowledge, and screening among Hispanics living in a rural area in Washington State. Impact: Culturally tailored home health interventions have the potential to achieve Healthy People 2020 colorectal cancer screening goals in Hispanic rural communities. Cancer Epidemiol Biomarkers Prev; 27(11); 1283-8. ©2018 AACR.

Background:Chinese and Korean Americans have lower colorectal cancer (CRC) screening rates than other racial/ethnic groups, which may be explained by a low level of CRC knowledge and a high level of misconceptions. This study explores the role of knowledge in CRC screening among these groups.Methods:Chinese (N=59) and Korean (N=61) Americans older than 50 were recruited from the Washington D.C. Metropolitan area. They completed a detailed survey and participated in focus groups to discuss their knowledge on CRC and CRC screening. Seventeen physicians, community leaders, and patient navigators participated in key informant interviews. Using a mixed methods approach, data were analyzed quantitatively and qualitatively.Results:Participants lacked knowledge about CRC and CRC screening. More than half did not know that screening begins at age 50 and there are several types of tests available. More than 30% thought CRC screening was not necessary if there were no symptoms or there was nothing they could do to prevent CRC. Focus group findings suggested understanding about CRC was limited by an inadequate source of linguistically and culturally relevant health information. For example, many participants considered CRC a western condition mainly caused by unhealthy diet. This led to under-estimations about their susceptibility to CRC. Knowledge was positively associated with self-reported screening. Participants who had higher knowledge scores were more likely to report ever having had a colonoscopy and confidence in ability to have CRC screening.Conclusions:Mixed-methods analysis provides multi-faceted perspectives on CRC knowledge and its influence on screening. Study findings can help inform interventions to increase CRC screening among Chinese and Korean Americans.