Colorectal Cancer Screening among Low-Income African Americans in East Harlem: A Theoretical Approach to Understanding Barriers and Promoters to Screening

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Abstract
African Americans (AAs) have the highest incidence rates of colorectal cancer (CRC) among all races in the US. These disparities may be attributed to lower participation in CRC prevention and control activities [e.g., flexible sigmoidoscopy (FS), fecal occult blood testing (FOBT)]. This is a current issue in East Harlem where less than half the residents in this area participate in CRC screening and mortality rates due to CRC are higher than the national average. We examined correlates of FS and FOBT screening among AAs based on the transtheoretical model (TTM) of behavior change. One hundred and eleven AA men and women, 50 years and older (51–92), low-income, and at average risk for CRC were recruited at an ambulatory care center in East Harlem. Assessments focused on sociodemographic, medical, psychosocial and TTM variables. The first logistic regression model showed that higher levels of education (p < 0.05), greater knowledge of FS (p < 0.05), and greater endorsements of Thinking Beyond Oneself (p < 0.05) were associated with adherence to FS screening guidelines. The second model showed that only greater knowledge of FOBT (p < 0.05) and receiving a physician’s recommendation (p < 0.01) were significant correlates of adherence to FOBT screening guidelines. This study supported the application of components of the TTM for FS and FOBT screening among low-income AAs receiving care in an urban medical center and illustrated the need for interventions targeting both patients and their providers.

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