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Socio‐demographic correlates of screening intention for colorectal cancer

Socio‐demographic correlates of screening intention for colorectal cancer Objective: To assess the relationship between socio-demographic factors and screening intention for colorectal cancer (CRC). Methods: A cross-sectional survey of a random sample of 884 Queenslanders aged 40-80 years was conducted using a computer-assisted telephone interviewing system. The factors measured included socio-demographic characteristics, personal history of CRC, knowledge of others with CRC and perceived symptom status. Chi-squared and Monte Carlo estimates of Fisher Exact Tests were performed to determine the associations between socio-demographic factors and screening intention. In multivariate analyses, multinomial logistic regression (MNLR) was utilised to examine potential determinants of screening intention. Results: 77.5% (95% CI 74.0%-80.7%) of the respondents indicated their intention to participate in CRC screening if it were recommended by their doctor or health authorities. The likelihood ratio chi-squared tests in the MNLR analyses show that age (χ(df=6)2= 15.0; p=0.02), education (χ(df=8)2= 19.4; p=0.01), perceived symptom status (χ(df=4)2= 22.9; p=0.00), sex (χ(df=2)2= 4.5; p=0.11), income (χ(df=14)2= 19.6; p=0.14) and personal history of CRC (χ(df=2)2= 4.3; p=0.12) were potential determinants of screening intention. Other sociodemographic factors, including country of birth, private health insurance status, Socio-economic Index for Areas, and Rural and Remote Areas Classification codes, were not associated with screening intention. Conclusions and implications: The results indicate that a variety of socio-demographic factors are associated with screening intention and need to be considered in the future development of a population-based screening program for CRC. (Aust N Z J Public Health 2000; 24: 610-4) Shilu Tong, Karen Hughes, Brian Oldenburg Centre for Public Health Research, Queensland University of Technology Christopher Del Mar Department of Social and Preventive Medicine, University of Queensland Bryan Kennedy Health Information Centre, Queensland Health olorectal cancer (CRC) is the most common internal malignancy affecting both men and women, and the second leading cause of cancer-related death in Australia.1-3 Reducing mortality from CRC has therefore become a national priority.2,4 Secondary prevention strategies, namely CRC screening, have been advocated as an effective method for the early identification of CRC.2,5,6 Randomised controlled trials have reported that the faecal occult blood test (FOBT) screening can reduce mortality rates by 15-33% in average-risk populations.7-11 An examination of Australian data and screening outcomes for FOBT indicate that screening for CRC is comparable in cost to breast cancer screening.12 Based on such evidence, the Australian Health Technology Advisory Committee (AHTAC) report has called for urgent research into the feasibility of FOBT for a population-based CRC screening program.2 Screening participation rates of approximately 70% would be required to achieve sufficient benefits in terms of health and economic costs.13,14 However, the median adherence rate in programs offering FOBT screening is between 40% and 50%.15 Three Australian population-based surveys found that 10-28% of respondents intended to screen for CRC.16-18 Two Australian surveys reported associations between screening intention for CRC and a number of socio-demographic and CRC experience factors.17,18 However, these studies are limited because they were not designed to address the socio-demographic correlates of screening intention in a systematic and extensive manner. The aims of this study were two-fold: to examine current acceptance of populationbased CRC screening using FOBT; and to conduct a systematic and extensive assessment of the associations between screening intention and socio-demographic and CRC experience factors. Methods According to previous research,16-18 approximately 1,130 eligible participants were required to be contacted, with the estimated screening intention rate of 0.28 (95% CI to be 0.015 on either side) and response rate of 0.75. A random sample of Queensland residents aged 40-80 years was stratified to include equal numbers of men and women and a rural-urban distribution proportional to the population. Of the 3,918 telephone numbers attempted, 2,782 were discarded (2,322 ineligible [not in the age range, etc] and 460 uncontactable). Some 884 interviews were completed from a total of 1,136 eligible participants, resulting in a response Submitted: April 2000 Revision requested: September 2000 Accepted: October 2000 Correspondence to: Shilu Tong, Centre for Public Health Research, Queensland University of Technology, Kelvin Grove, Queensland 4059. Fax: (07) 3864 5941 or 3864 3369; e-mail: s.tong@qut.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2000 VOL. 24 NO. 6 Brief Report Socio-demographic correlates of screening intention for colorectal cancer rate of 77.8%. The sample was representative of the Queensland population aged 40-80 years in terms of sex, age and education.19 A computer-assisted telephone interviewing (CATI) survey was conducted in April 1999, utilising a random digit dialling system. A household resident, aged 40 to 80 years of age, and of a particular sex (depending on stratification procedures), was requested. If there was more than one eligible resident in the household, the individual with the most recent birthday was requested for the interview. Brief definitions of ‘bowel cancer’ and ‘FOBT’ were included in the protocol to ensure respondents were clear on and/or aware of these terms. Piloting of the instrument was conducted over a five-hour period and subsequent modifications were made on the questionnaire to assist clarity. Each interview took approximately 10-15 minutes to complete. A series of chi-squared tests were conducted to assess the associations between socio-demographic factors and screening intention. If the assumptions of the chi-squared test were not met (i.e. more than 20% of the cells had expected values less than five, or the minimum expected frequency was less than one), the Monte Carlo estimate of the Fisher Exact Test (FET) was utilised. Multinomial logistic regression (MNLR) was performed to examine potential determinants of screening intention. Finally, increasing household income appeared to be associated with a greater likelihood of a positive screening intention (p=0.00). However, other socio-demographic factors, including country of birth, private health insurance status, Socio-economic Index for Areas, and Rural and Remote Areas Classification codes, were not significantly associated with screening intention. CRC experience Approximately one-tenth of respondents had a first-degree relative (i.e. parent, sibling or child) with CRC (10.6%; 95% CI 8.413.4%). An additional 1.1% (95% CI 0.5-2.4%) had two or more first-degree relatives with CRC. Respondents reporting a personal history of bowel cancer were more likely to say no to screening than those without a CRC history (p=0.04) (see Table 1). In a gauge of personal symptom status, those respondents whom strongly agreed or agreed with the statement: “Sometimes I have had symptoms that I thought might be bowel cancer”, seemed more likely to say yes to screening than the remainder of the sample (p=0.00). The percentage of respondents reporting past participation in CRC testing (other than FOBT) increased as the number of first-degree relatives with CRC increased (p=0.00). However, no significant association was observed between screening intention and knowledge of a friend/relative with bowel cancer or number of first-degree relatives with CRC (p≥0.31). Multivariate analyses Results Screening intention Of the 884 respondents in this sample, 77.5% (95% CI 74.0%80.7%) thought they would participate in screening if recommended by doctors or health authorities. Of the remaining sample, 12.9% (10.4%-15.8%) of respondents were ‘unsure’ and 9.6% (7.5%-12.3%) indicated they would not participate. Bivariate analyses Demographics Analyses indicated that several socio-demographic variables were significantly associated with screening intention (see Table 1). Persons aged 40-49 and 50-59 years appeared to be more likely to express a positive screening intention than persons aged 60-69 and 70-80 (p=0.00). A positive screening intention was more common among respondents who were in a married or de facto relationship, or divorced or separated, when compared to their widowed and single counterparts (p=0.00). Persons completing senior education seemed more likely to say yes to screening than persons with other educational backgrounds (p=0.01). The percentage of persons reporting a positive screening intention was higher for persons employed on either a full-time or parttime/casual basis, and for those reporting home duties as primary occupation, in comparison to the remainder of the sample (p=0.03). 2000 VOL. 24 NO. 6 The likelihood ratio chi-squared tests in the MNLR analyses showed that age (χ(df=6)2= 15.0; p=0.02), education (χ(df=8)2= 19.4; p=0.01) and perceived symptom status (χ(df=4)2= 22.9; p=0.00) were significantly associated with screening intention. Sex (χ(df=2)2= 4.5; p=0.11), income (χ(df=14)2= 19.6; p=0.14) and personal history of CRC (χ(df=2)2= 4.3; p=0.12) were marginally associated with screening intention. Significant associations for marital status and employment situation observed in bivariate analyses were not evident in the multivariate model (p≥0.21). There was a clear pattern for some variables. For example, respondents aged 40-49 years (odds ratio: 6.1; 95% CI 2.1-17.8), 50-59 years (5.5; 2.0-15.4) and 60-69 years (2.3; 1.1-4.9) exhibited more positive responses to screening compared to those aged 70-80 years (see Table 2). Discussion This is the first study since the AHTAC recommendations were made to systematically evaluate current community acceptance of CRC screening by FOBT and socio-demographic correlates of screening intention. The high proportion of respondents reporting a screening intention (77.5%) observed in this study is inconsistent with the findings of previous Australian surveys, in which only 10-28% of respondents reported a positive screening intention.16-18 There are three possible explanations for this inconsistency. First, the characteristics of the samples among these studies are quite different. For example, only 37% of the sample in the earlier Queensland survey were aged 50 years or more.18 It is reasonable to AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Tong et al. Brief Report assume that the proportion of respondents willing to screen was low among younger people (e.g. <40 years) because they correctly viewed screening as unnecessary at this point in their lives. Second, the question measuring screening intention in this study was different to questions utilised in other research. The present survey queried intention within the context of a recommendation Table 1: Screening intention and socio-demographic factors. Variable Study sample Yes na Demographics Sex Male Female Age category 70-80 60-69 50-59 40-49 Marital status Married/de facto Single/never married Separated/divorced Widowed Education University/college degree Trade/ tech. cert./dip. Seniorb Junior Primary Some primary or less Employment statusc Full-time Part-time/casual Home duties Unemployed Student Retired Household income < $10,000 $10,001-$20,000 $20,001-$40,000 $40,001-$60,000 $60,001-$80,000 > $80 000 Don’t know/ No response CRC experience Personal history of CRCc No/not sure Yes Perceived symptom status Strongly agree/agree Disagree/strongly disagree Unsure/don’t know by health authorities or doctors, while previous surveys have asked about screening intention without relating it to a possible health recommendation.16,17 Third, people may be becoming more aware over time of the impact of CRC and the importance of cancer screening in general. Therefore, the community is likely to be more positive towards CRC screening. Intention to screen No n % Significance Not sure n % Note: (a) Total numbers varied due to the missing values. (b) Senior high school (ie, completed 12 years’ education). (c) Monte Carlo estimate of Fisher’s exact statistic. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2000 VOL. 24 NO. 6 Brief Report Socio-demographic correlates of screening intention for colorectal cancer In this study, a person’s age, income, education, personal history of CRC and perceived symptom status were found to be potential determinants of screening intention. The analyses showed that older persons seemed less likely to express a positive screening intention when compared to younger participants, which was consistent with the South Australia survey.17 This is of particular concern given CRC incidence increases with age and populations in many countries (including Australia) are ageing. Multivariate analyses found that there was a curvilinear trend between intention to screening and education or income. Further analyses showed that a higher proportion of respondents with university/college degrees (or incomes above $80,000), compared to the remainder of the sample, stated that they were too busy or lacked the time to participate in screening. Utilisation of test kits requiring one rather than three samples, and a promotional campaign emphasising the time efficiency of FOBT, may serve to increase testing compliance in this demographic. In bivariate analyses, some socio-demographic factors were signif icantly associated with screening intention, but the significance disappeared after adjustment for other factors. Therefore, it suggests that the relationships between these variables and screening intention are largely mediated by other independent variables. For example, in bivariate analyses, people who were employed or engaged in home duties were more likely to screen Table 2: Adjusted associations between screening intention and socio-demographic variables. Variable Odds ratio Sex Female Male Age category 70-80 60-69 50-59 40-49 Marital status Married/de facto Single/never married Separated/divorced Widowed Education University/college degree Trade/tech. cert./dip. Senior Junior Primary or less Employment status Full-time Part-time/casual Home duties Unemployed Retired Household income < $10,000 $10,001-$20,000 $20,001-$40,000 $40,001-$60,000 $60,001-$80,000 > $80,000 Don’t know No response Personal history of CRC No/not sure Yes – 1.1 – 2.3 5.5 6.1 – 0.5 0.7 0.6 – 2.2 3.5 3.5 2.2 – 2.4 4.2 2.0 3.7 – 2.8 3.7 10.8 4.4 5.3 2.0 3.1 – 0.3 Yes vs. No 95% CI – 0.6-2.0 – 1.1-4.9 2.0-15.4 2.1-17.8 – 0.2-1.5 0.3-1.5 0.2-1.3 – 1.0-4.8 1.3-9.0 1.5-8.2 1.0-5.2 – 0.9-6.6 1.2-14.2 0.5-7.7 1.3-10.3 – 1.1-6.8 1.3-10.6 2.8-41.3 1.1-17.8 1.3-21.4 0.7-5.7 1.0-9.4 – 0.1-1.1 – 0.2-0.8 0.3-4.7 p value – 0.645 – 0.029 0.001 0.001 – 0.211 0.300 0.191 – 0.058 0.011 0.004 0.064 – 0.081 0.022 0.301 0.013 – 0.025 0.015 0.000 0.037 0.018 0.209 0.045 – 0.075 – 0.007 0.746 Odds ratio – 1.9 – 2.3 3.0 4.7 – 0.9 0.5 1.3 – 3.8 2.1 5.4 2.8 – 1.8 4.2 1.4 2.8 – 1.8 2.5 3.2 1.6 2.8 1.6 1.9 – 0.1 – 1.1 4.0 Not sure vs. No 95% CI – 0.9-3.9 – 0.9-5.8 0.9-10.3 1.3-16.7 – 0.2-3.4 0.2-1.4 0.4-3.7 – 1.4-10.7 0.6-7.8 1.9-15.7 0.9-8.5 – 0.5-6.0 1.0-17.2 0.3-7.3 0.8-9.3 – 0.6-5.3 0.7-8.8 0.7-15.8 0.3-9.4 0.5-15.0 0.4-5.8 0.5-7.2 – 0.0-1.3 – 0.5-2.4 0.9-17.2 p value – 0.074 – 0.067 0.081 0.018 – 0.874 0.191 0.675 – 0.010 0.251 0.002 0.063 – 0.348 0.046 0.727 0.102 – 0.315 0.161 0.153 0.576 0.219 0.497 0.350 – 0.088 – 0.748 0.062 Perceived symptom status Strongly agree/agree – Disagree/strongly disagree 0.4 Unsure/don’t know 1.2 2000 VOL. 24 NO. 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Tong et al. Brief Report than others. However, in multivariate analyses, persons employed on a full-time basis were less likely to screen than others (Odds ratios: 2.4 [95% CI 0.9-6.6] for part-time/casual; 4.2 [1.2-14.2] for home duties; 2.0 [0.5-7.7] for unemployed; and 3.7 [1.3-10.3] for retired). After removing age and income from the model, persons employed on a full-time basis were more likely to screen than those participants who were retired or unemployed (Odds ratios: 1.4 [95% CI 0.6-3.5] for part-time/casual; 1.3 [0.5-3.6] for home duties; 0.7 [0.2-2.4] for unemployed; and 0.6 [0.3-1.2] for retired). Therefore, a screening program may need to consider these complex relationships to maximise the compliance. These findings may provide important information for the development of population-based CRC screening programs. A screening program that takes into account the differential requirements of various demographic groups will likely improve compliance outcomes. Acknowledgements This study was supported by Queensland Health. We thank Gayle Pollard and David Firman for contributing to the development of the questionnaire and organising telephone interviews; Beth Newman for thoughtful comments; Diana Battistutta and Paul Lunney for statistical advice; and the residents of Queensland who participated in this study. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Socio‐demographic correlates of screening intention for colorectal cancer

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Publisher
Wiley
Copyright
Copyright © 2000 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2000.tb00526.x
Publisher site
See Article on Publisher Site

Abstract

Objective: To assess the relationship between socio-demographic factors and screening intention for colorectal cancer (CRC). Methods: A cross-sectional survey of a random sample of 884 Queenslanders aged 40-80 years was conducted using a computer-assisted telephone interviewing system. The factors measured included socio-demographic characteristics, personal history of CRC, knowledge of others with CRC and perceived symptom status. Chi-squared and Monte Carlo estimates of Fisher Exact Tests were performed to determine the associations between socio-demographic factors and screening intention. In multivariate analyses, multinomial logistic regression (MNLR) was utilised to examine potential determinants of screening intention. Results: 77.5% (95% CI 74.0%-80.7%) of the respondents indicated their intention to participate in CRC screening if it were recommended by their doctor or health authorities. The likelihood ratio chi-squared tests in the MNLR analyses show that age (χ(df=6)2= 15.0; p=0.02), education (χ(df=8)2= 19.4; p=0.01), perceived symptom status (χ(df=4)2= 22.9; p=0.00), sex (χ(df=2)2= 4.5; p=0.11), income (χ(df=14)2= 19.6; p=0.14) and personal history of CRC (χ(df=2)2= 4.3; p=0.12) were potential determinants of screening intention. Other sociodemographic factors, including country of birth, private health insurance status, Socio-economic Index for Areas, and Rural and Remote Areas Classification codes, were not associated with screening intention. Conclusions and implications: The results indicate that a variety of socio-demographic factors are associated with screening intention and need to be considered in the future development of a population-based screening program for CRC. (Aust N Z J Public Health 2000; 24: 610-4) Shilu Tong, Karen Hughes, Brian Oldenburg Centre for Public Health Research, Queensland University of Technology Christopher Del Mar Department of Social and Preventive Medicine, University of Queensland Bryan Kennedy Health Information Centre, Queensland Health olorectal cancer (CRC) is the most common internal malignancy affecting both men and women, and the second leading cause of cancer-related death in Australia.1-3 Reducing mortality from CRC has therefore become a national priority.2,4 Secondary prevention strategies, namely CRC screening, have been advocated as an effective method for the early identification of CRC.2,5,6 Randomised controlled trials have reported that the faecal occult blood test (FOBT) screening can reduce mortality rates by 15-33% in average-risk populations.7-11 An examination of Australian data and screening outcomes for FOBT indicate that screening for CRC is comparable in cost to breast cancer screening.12 Based on such evidence, the Australian Health Technology Advisory Committee (AHTAC) report has called for urgent research into the feasibility of FOBT for a population-based CRC screening program.2 Screening participation rates of approximately 70% would be required to achieve sufficient benefits in terms of health and economic costs.13,14 However, the median adherence rate in programs offering FOBT screening is between 40% and 50%.15 Three Australian population-based surveys found that 10-28% of respondents intended to screen for CRC.16-18 Two Australian surveys reported associations between screening intention for CRC and a number of socio-demographic and CRC experience factors.17,18 However, these studies are limited because they were not designed to address the socio-demographic correlates of screening intention in a systematic and extensive manner. The aims of this study were two-fold: to examine current acceptance of populationbased CRC screening using FOBT; and to conduct a systematic and extensive assessment of the associations between screening intention and socio-demographic and CRC experience factors. Methods According to previous research,16-18 approximately 1,130 eligible participants were required to be contacted, with the estimated screening intention rate of 0.28 (95% CI to be 0.015 on either side) and response rate of 0.75. A random sample of Queensland residents aged 40-80 years was stratified to include equal numbers of men and women and a rural-urban distribution proportional to the population. Of the 3,918 telephone numbers attempted, 2,782 were discarded (2,322 ineligible [not in the age range, etc] and 460 uncontactable). Some 884 interviews were completed from a total of 1,136 eligible participants, resulting in a response Submitted: April 2000 Revision requested: September 2000 Accepted: October 2000 Correspondence to: Shilu Tong, Centre for Public Health Research, Queensland University of Technology, Kelvin Grove, Queensland 4059. Fax: (07) 3864 5941 or 3864 3369; e-mail: s.tong@qut.edu.au AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2000 VOL. 24 NO. 6 Brief Report Socio-demographic correlates of screening intention for colorectal cancer rate of 77.8%. The sample was representative of the Queensland population aged 40-80 years in terms of sex, age and education.19 A computer-assisted telephone interviewing (CATI) survey was conducted in April 1999, utilising a random digit dialling system. A household resident, aged 40 to 80 years of age, and of a particular sex (depending on stratification procedures), was requested. If there was more than one eligible resident in the household, the individual with the most recent birthday was requested for the interview. Brief definitions of ‘bowel cancer’ and ‘FOBT’ were included in the protocol to ensure respondents were clear on and/or aware of these terms. Piloting of the instrument was conducted over a five-hour period and subsequent modifications were made on the questionnaire to assist clarity. Each interview took approximately 10-15 minutes to complete. A series of chi-squared tests were conducted to assess the associations between socio-demographic factors and screening intention. If the assumptions of the chi-squared test were not met (i.e. more than 20% of the cells had expected values less than five, or the minimum expected frequency was less than one), the Monte Carlo estimate of the Fisher Exact Test (FET) was utilised. Multinomial logistic regression (MNLR) was performed to examine potential determinants of screening intention. Finally, increasing household income appeared to be associated with a greater likelihood of a positive screening intention (p=0.00). However, other socio-demographic factors, including country of birth, private health insurance status, Socio-economic Index for Areas, and Rural and Remote Areas Classification codes, were not significantly associated with screening intention. CRC experience Approximately one-tenth of respondents had a first-degree relative (i.e. parent, sibling or child) with CRC (10.6%; 95% CI 8.413.4%). An additional 1.1% (95% CI 0.5-2.4%) had two or more first-degree relatives with CRC. Respondents reporting a personal history of bowel cancer were more likely to say no to screening than those without a CRC history (p=0.04) (see Table 1). In a gauge of personal symptom status, those respondents whom strongly agreed or agreed with the statement: “Sometimes I have had symptoms that I thought might be bowel cancer”, seemed more likely to say yes to screening than the remainder of the sample (p=0.00). The percentage of respondents reporting past participation in CRC testing (other than FOBT) increased as the number of first-degree relatives with CRC increased (p=0.00). However, no significant association was observed between screening intention and knowledge of a friend/relative with bowel cancer or number of first-degree relatives with CRC (p≥0.31). Multivariate analyses Results Screening intention Of the 884 respondents in this sample, 77.5% (95% CI 74.0%80.7%) thought they would participate in screening if recommended by doctors or health authorities. Of the remaining sample, 12.9% (10.4%-15.8%) of respondents were ‘unsure’ and 9.6% (7.5%-12.3%) indicated they would not participate. Bivariate analyses Demographics Analyses indicated that several socio-demographic variables were significantly associated with screening intention (see Table 1). Persons aged 40-49 and 50-59 years appeared to be more likely to express a positive screening intention than persons aged 60-69 and 70-80 (p=0.00). A positive screening intention was more common among respondents who were in a married or de facto relationship, or divorced or separated, when compared to their widowed and single counterparts (p=0.00). Persons completing senior education seemed more likely to say yes to screening than persons with other educational backgrounds (p=0.01). The percentage of persons reporting a positive screening intention was higher for persons employed on either a full-time or parttime/casual basis, and for those reporting home duties as primary occupation, in comparison to the remainder of the sample (p=0.03). 2000 VOL. 24 NO. 6 The likelihood ratio chi-squared tests in the MNLR analyses showed that age (χ(df=6)2= 15.0; p=0.02), education (χ(df=8)2= 19.4; p=0.01) and perceived symptom status (χ(df=4)2= 22.9; p=0.00) were significantly associated with screening intention. Sex (χ(df=2)2= 4.5; p=0.11), income (χ(df=14)2= 19.6; p=0.14) and personal history of CRC (χ(df=2)2= 4.3; p=0.12) were marginally associated with screening intention. Significant associations for marital status and employment situation observed in bivariate analyses were not evident in the multivariate model (p≥0.21). There was a clear pattern for some variables. For example, respondents aged 40-49 years (odds ratio: 6.1; 95% CI 2.1-17.8), 50-59 years (5.5; 2.0-15.4) and 60-69 years (2.3; 1.1-4.9) exhibited more positive responses to screening compared to those aged 70-80 years (see Table 2). Discussion This is the first study since the AHTAC recommendations were made to systematically evaluate current community acceptance of CRC screening by FOBT and socio-demographic correlates of screening intention. The high proportion of respondents reporting a screening intention (77.5%) observed in this study is inconsistent with the findings of previous Australian surveys, in which only 10-28% of respondents reported a positive screening intention.16-18 There are three possible explanations for this inconsistency. First, the characteristics of the samples among these studies are quite different. For example, only 37% of the sample in the earlier Queensland survey were aged 50 years or more.18 It is reasonable to AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Tong et al. Brief Report assume that the proportion of respondents willing to screen was low among younger people (e.g. <40 years) because they correctly viewed screening as unnecessary at this point in their lives. Second, the question measuring screening intention in this study was different to questions utilised in other research. The present survey queried intention within the context of a recommendation Table 1: Screening intention and socio-demographic factors. Variable Study sample Yes na Demographics Sex Male Female Age category 70-80 60-69 50-59 40-49 Marital status Married/de facto Single/never married Separated/divorced Widowed Education University/college degree Trade/ tech. cert./dip. Seniorb Junior Primary Some primary or less Employment statusc Full-time Part-time/casual Home duties Unemployed Student Retired Household income < $10,000 $10,001-$20,000 $20,001-$40,000 $40,001-$60,000 $60,001-$80,000 > $80 000 Don’t know/ No response CRC experience Personal history of CRCc No/not sure Yes Perceived symptom status Strongly agree/agree Disagree/strongly disagree Unsure/don’t know by health authorities or doctors, while previous surveys have asked about screening intention without relating it to a possible health recommendation.16,17 Third, people may be becoming more aware over time of the impact of CRC and the importance of cancer screening in general. Therefore, the community is likely to be more positive towards CRC screening. Intention to screen No n % Significance Not sure n % Note: (a) Total numbers varied due to the missing values. (b) Senior high school (ie, completed 12 years’ education). (c) Monte Carlo estimate of Fisher’s exact statistic. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2000 VOL. 24 NO. 6 Brief Report Socio-demographic correlates of screening intention for colorectal cancer In this study, a person’s age, income, education, personal history of CRC and perceived symptom status were found to be potential determinants of screening intention. The analyses showed that older persons seemed less likely to express a positive screening intention when compared to younger participants, which was consistent with the South Australia survey.17 This is of particular concern given CRC incidence increases with age and populations in many countries (including Australia) are ageing. Multivariate analyses found that there was a curvilinear trend between intention to screening and education or income. Further analyses showed that a higher proportion of respondents with university/college degrees (or incomes above $80,000), compared to the remainder of the sample, stated that they were too busy or lacked the time to participate in screening. Utilisation of test kits requiring one rather than three samples, and a promotional campaign emphasising the time efficiency of FOBT, may serve to increase testing compliance in this demographic. In bivariate analyses, some socio-demographic factors were signif icantly associated with screening intention, but the significance disappeared after adjustment for other factors. Therefore, it suggests that the relationships between these variables and screening intention are largely mediated by other independent variables. For example, in bivariate analyses, people who were employed or engaged in home duties were more likely to screen Table 2: Adjusted associations between screening intention and socio-demographic variables. Variable Odds ratio Sex Female Male Age category 70-80 60-69 50-59 40-49 Marital status Married/de facto Single/never married Separated/divorced Widowed Education University/college degree Trade/tech. cert./dip. Senior Junior Primary or less Employment status Full-time Part-time/casual Home duties Unemployed Retired Household income < $10,000 $10,001-$20,000 $20,001-$40,000 $40,001-$60,000 $60,001-$80,000 > $80,000 Don’t know No response Personal history of CRC No/not sure Yes – 1.1 – 2.3 5.5 6.1 – 0.5 0.7 0.6 – 2.2 3.5 3.5 2.2 – 2.4 4.2 2.0 3.7 – 2.8 3.7 10.8 4.4 5.3 2.0 3.1 – 0.3 Yes vs. No 95% CI – 0.6-2.0 – 1.1-4.9 2.0-15.4 2.1-17.8 – 0.2-1.5 0.3-1.5 0.2-1.3 – 1.0-4.8 1.3-9.0 1.5-8.2 1.0-5.2 – 0.9-6.6 1.2-14.2 0.5-7.7 1.3-10.3 – 1.1-6.8 1.3-10.6 2.8-41.3 1.1-17.8 1.3-21.4 0.7-5.7 1.0-9.4 – 0.1-1.1 – 0.2-0.8 0.3-4.7 p value – 0.645 – 0.029 0.001 0.001 – 0.211 0.300 0.191 – 0.058 0.011 0.004 0.064 – 0.081 0.022 0.301 0.013 – 0.025 0.015 0.000 0.037 0.018 0.209 0.045 – 0.075 – 0.007 0.746 Odds ratio – 1.9 – 2.3 3.0 4.7 – 0.9 0.5 1.3 – 3.8 2.1 5.4 2.8 – 1.8 4.2 1.4 2.8 – 1.8 2.5 3.2 1.6 2.8 1.6 1.9 – 0.1 – 1.1 4.0 Not sure vs. No 95% CI – 0.9-3.9 – 0.9-5.8 0.9-10.3 1.3-16.7 – 0.2-3.4 0.2-1.4 0.4-3.7 – 1.4-10.7 0.6-7.8 1.9-15.7 0.9-8.5 – 0.5-6.0 1.0-17.2 0.3-7.3 0.8-9.3 – 0.6-5.3 0.7-8.8 0.7-15.8 0.3-9.4 0.5-15.0 0.4-5.8 0.5-7.2 – 0.0-1.3 – 0.5-2.4 0.9-17.2 p value – 0.074 – 0.067 0.081 0.018 – 0.874 0.191 0.675 – 0.010 0.251 0.002 0.063 – 0.348 0.046 0.727 0.102 – 0.315 0.161 0.153 0.576 0.219 0.497 0.350 – 0.088 – 0.748 0.062 Perceived symptom status Strongly agree/agree – Disagree/strongly disagree 0.4 Unsure/don’t know 1.2 2000 VOL. 24 NO. 6 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Tong et al. Brief Report than others. However, in multivariate analyses, persons employed on a full-time basis were less likely to screen than others (Odds ratios: 2.4 [95% CI 0.9-6.6] for part-time/casual; 4.2 [1.2-14.2] for home duties; 2.0 [0.5-7.7] for unemployed; and 3.7 [1.3-10.3] for retired). After removing age and income from the model, persons employed on a full-time basis were more likely to screen than those participants who were retired or unemployed (Odds ratios: 1.4 [95% CI 0.6-3.5] for part-time/casual; 1.3 [0.5-3.6] for home duties; 0.7 [0.2-2.4] for unemployed; and 0.6 [0.3-1.2] for retired). Therefore, a screening program may need to consider these complex relationships to maximise the compliance. These findings may provide important information for the development of population-based CRC screening programs. A screening program that takes into account the differential requirements of various demographic groups will likely improve compliance outcomes. Acknowledgements This study was supported by Queensland Health. We thank Gayle Pollard and David Firman for contributing to the development of the questionnaire and organising telephone interviews; Beth Newman for thoughtful comments; Diana Battistutta and Paul Lunney for statistical advice; and the residents of Queensland who participated in this study.

Journal

Australian and New Zealand Journal of Public HealthWiley

Published: Dec 1, 2000

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