Colorectal Cancer Screening Practices Among Asian Americans, Native Hawaiians and Pacific Islanders

Purpose: Asian Americans, Native Hawaiians, and other Pacific Islanders experience high mortality rates due to colorectal cancer compared to other ethnic groups. Despite the fact that several screening options are available and maintaining regular screening can significantly reduce the incidence of colorectal cancer, these minority groups continue to experience disproportionately low screening rate. Furthermore, because Asian Americans, Native Hawaiians, and other Pacific Islanders are often aggregated as a homogenous group, gaps exist in identifying the unique ethnic variances in screening practices. This study disaggregates the groups and examines colorectal cancer screening practices (CCSP) among self-reported Asian Americans (AA) and Native Hawaiian & other Pacific Islanders (NHPI) residing in Hawai'i. This study also examines the association between CCSP and having a healthcare plan, as well as sociodemographic covariates.

Methods: We used data from the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) in Hawai'i for the analysis. Sample sizes included: AA, n=394; NHPI, n=792; and Whites, n=485. CCSP were determined by 1) ever had blood stool test (BST) using home kit (model 1) and 2) ever had sigmoidoscopy/colonoscopy (model 2). Using STATA, logistic regression analyses were used to examine the associations between CCSP and race/ethnicity (AA vs. Whites, NHPI vs. Whites), healthcare plan, and other sociodemographic variables (i.e., gender, marital status, education level, and employment status).

Results: Both AA and NHPI are less likely to have ever had a BST (odds ratio [OR] = .559; p = .001; OR = .523, p < .001, respectively) and less likely to have ever had a sigmoidoscopy/colonoscopy (OR = .553, p < .001; OR = .611, p < .001) when compared to Whites. Among AA and Whites, having a healthcare plan significantly increased the likelihood of ever having a BST and sigmoidoscopy/colonoscopy respectively (OR = 2.449, p < .05; OR = 4.35, p < .001). Among NHPI and Whites, having a healthcare plan also significantly increased the likelihood of screening practices (OR = 2.909, p = .001; OR = 4.603, p< .001). In addition, being married (AA vs. White & NHPI vs. White) significantly increased the likelihood of ever having a BST and sigmoidoscopy/colonoscopy and female gender (NHPI vs White) significantly increased the likelihood of ever having a BST. Interestingly, having employment significantly decreased the likelihood of CCSP. Educational level (below college) did not have significant associations with screening practices.

Implications: These findings support existing knowledge that AA and NHPI are less likely to ever have received a BST or sigmoidoscopy/colonoscopy when compared to Whites. Disaggregating the groups revealed unique ethnic group and gender variance in CCSP. This indicates the importance of facilitating tailored approaches to reduce colorectal cancer screening disparities experienced among these ethnic groups. Having a healthcare plan substantially increased the likelihood of CCSP. As such, the inclusion of this significant factor should be highly considered when developing approaches to promote CCSP among these ethnic groups.