Social Determinants Associated with Colorectal Cancer Screening in an Urban Community Sample of African American Men

Problem/Purpose: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States as well as the third leading cause of cancer death for both men and women. Routine cancer screening represents a critical avenue for the early detection of CRC. Likewise, the detection and removal of pre-cancerous polyps or early-stage tumors is a protective factor against colorectal cancer mortality. African American men suffer disproportionately from CRC and there is evidence that a number of complex social, economic, and health system barriers exist that prevent African American men from completing CRC screenings.  Despite this, research on the social determinants that influence CRC screening practices among African American men is limited.

Methods: African American men 18 years of age or older who attended an annual community health fair hosted by a large Midwest hospital system completed a paper-based survey. The outcome measure, completion of any form of colorectal cancer screening (CRC) at any time, was assessed by asking: “Have you ever had any type of medical test to screen for colon cancer or colorectal cancer such as colonoscopy, sigmoidoscopy, stool test or fecal occult blood test”? Covariates included demographic and socioeconomic variables, ability to care for oneself, social support, healthcare access, health provider interactions, and church membership. The social ecological theoretical framework was used to identify intrapersonal, interpersonal, organizational, and community predictors of colorectal cancer screening that may correlate with social determinants of health and health behaviors. Analysis included correlations and logistic regression. Participants (N=558) had a mean age of 54 years with nearly 47% of men being older than 55 years old. The majority of men were unmarried (63%) and at least high school graduates (89%). Nearly 39% of respondents reported household income levels below $20,000 per year.

Results: Regarding CRC screening, 50.5% (n=282) of participants had received any type of colorectal cancer screening at any time. Positive predictors of CRC screening included: being over the age of 55 (odds ratio [OR] of 3.65, 95% confidence interval [95% CI], 2.42-5.60, p<.001), having health insurance (OR of 2.01; 95% CI, 1.29-3.12, p<.01), having a regular doctor (OR of 1.60; 95% CI, 1.03-2.48, p<.05), and having ever spoken to a doctor about one’s family history of cancer (OR of 3.22; 95% CI, 2.12-4.9, p<.01). Men were less likely to have ever been screened for CRC is they were employed (OR of .634; 95% CI, .42-.95, p<.05) and if they had poor or very poor self-rated health (OR of .60; 95% CI, .38-.97, p<.01).

Implications: Findings underscore the need to examine the relationship between African American men and their health care provider as a significant pathway to CRC screening completion. These findings have implications for designing clinical and community-based interventions that promote increased access to and utilization of the healthcare system and cancer screening practices for African American men as a medically underserved population.