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.
|Number of pages||10|
|State||Published - May 2018|
Bibliographical noteFunding Information:
This work was supported by National Cancer Institute Grant R01CA171935 and was supported in part by Roswell Park Cancer Institute and National Cancer Institute Grant 3P30CA01605. The authors kindly acknowledge the extensive support of the community members of New York City, the NYC Community Advisory Board, and the First Ladies of Western New York for their contributions to the science and data collection for this study. Special thanks to Veronica Meadows Ray, Bishop James Bowman, and UB Center for the Arts for their contributions to the development of the Witness CARES video. ClinicalTrials.gov Registration Number NCT02100254.
© 2018 American Psychological Association.
- African American
- Early detection of cancer/utilization
- Guideline adherence
- Socioeconomic factors
ASJC Scopus subject areas
- Applied Psychology
- Psychiatry and Mental health