Decision-making and socioeconomic disparities in colonoscopy screening in African Americans

Marc T. Kiviniemi, Lynne B. Klasko-Foster, Deborah O. Erwin, Lina Jandorf

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Socioeconomic status (SES) disparities in colorectal cancer screening are persistent. Lower education and income are both associated with lower screening rates. Both cognitive (e.g., perceived barriers) and affective (e.g., disgust, fear) decision-making constructs are known determinants of colorectal cancer screening behavior. This study tests the hypotheses that SES may be related to decision-making constructs and that this SES-decision-making construct relation may contribute to explaining the SES-screening behavior disparity. Method: Surveys assessing perceived benefits and barriers to screening, self-efficacy, positive and negative affective associations with colonoscopy, fear of colonoscopy, colorectal cancer knowledge, past screening behavior, and demographics including education and income were completed by 2,015 African American participants ages 50 and older. Both univariable and multivariable relations of SES to decisionmaking constructs were examined, as were univariable and multivariable models of the indirect effect of SES on screening via decision-making constructs. Results: Socioeconomic status was related to both screening compliance and the decision-making constructs. Bootstrap modeling of the indirect effect showed that the total effect of the SES-screening behavior relation included an indirect effect via social cognitive decision-making constructs. Conclusion: These findings suggest that cognitive and affective decision-making constructs account for at least some of the SES disparities in colorectal cancer screening behavior. As such, more reseach is needed to explore the intra individual-level influences of disparities in colorectal cancer screening. In addition, work is needed to develop effective intervention approaches to address the relation of SES to decision-making constructs.

Original languageEnglish
Pages (from-to)481-490
Number of pages10
JournalHealth Psychology
Issue number5
StatePublished - May 2018

Bibliographical note

Publisher Copyright:
© 2018 American Psychological Association.


  • African American
  • Colonoscopy/utilization
  • Early detection of cancer/utilization
  • Guideline adherence
  • Socioeconomic factors

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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