This study sought to describe the colorectal cancer (CRC)-screening behavior of a population of two lower income communities near Pittsburgh, Pennsylvania. The transtheoretical model was used to characterize individuals according to their stage of readiness to engage in one of two recommended CRC screening tests—the Fecal Occult Blood Test (FOBT) or Flexible Sigmoidoscopy (FSG) test. A telephone survey was conducted of 50- to 79-year-old men and women in Aliquippa and Clairton in the spring of 1999. Analyses based on 414 survey respondents showed associations between FOBT or FSG behavioral stage and factors including gender, age, recent doctor checkup, chronic need for prescription medications, history of cervical Pap smear testing, history of prostate-specific antigen blood testing, and prior doctor recommendation in favor of FOBT or FSG testing. This study appears to be one of the first applications of this theory to understanding CRC screening behavior in a community intervention.
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References
1.
1. American Cancer Society: Cancer Facts and Figures, 1999. Atlanta, GA, American Cancer Society, 1999. (Pub. No. 5008.99.)
2.
2. Schrag D, Weeks J: Costs and cost-effectiveness of colorectal cancer prevention and therapy. Semin Oncol26:561-568, 1999.
3.
N Engl J Med328:1365-1371, 1993.
4.
4. Mandel JS, Church TR, Ederer F, Bond JH: Colorectal cancer mortality: Effectiveness of biennial screening for fecal occult blood. J Nat Cancer Inst91:434-437, 1999.
5.
5. Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondegaard O: Randomised study of screening for colorectal cancer with fecal-occult-blood test. Lancet348:1467-1471, 1996.
6.
6. Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al: Randomised controlled trial of fecal-occult-blood screening for colorectal cancer. Lancet348:1472-1477, 1996.
7.
7. Selby JV, Friedman GD, Quesenberry CP, Weiss NS: A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med326:653-657, 1992.
8.
8. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM: Screening sigmoidoscopy and colorectal cancer mortality. J Nat Cancer Inst84:1572-1575, 1992.
9.
9. Winawer SJ, Flehinger BJ, Schottenfeld D, Miller DG: Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy. J Nat Cancer Inst85:1311-1318, 1993.
10.
10. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF: Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med329(27):1977-1981, 1993.
11.
11. Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, et al: Colorectal cancer screening: Clinical guidelines and rationale. Gastroenterology112:594-642, 1997.
12.
12. Report of the U.S. Preventive Services Task Force: Guide to Clinical Preventive Services. Baltimore, MD, Williams and Wilkins, 1996.
13.
13. Department of Health and Human Services. Office of Disease Prevention and Health Promotion: Healthy People 2010 (2nd ed.). Washington, DC, Government Printing Office, 2000.
14.
14. Brown ML, Potosky AL, Thompson GB, Kessler LG: The knowledge and use of screening tests for colorectal and prostate cancer: Data from the 1987 National Health Interview Survey. Prev Med19:562-574, 1990.
15.
15. Centers for Disease Control and Prevention: Screening for colorectal cancer—United States, 1997. MMWR48:116-121, 1999.
16.
16. Gallup Organization: Adults' Knowledge and Experience With Testing for Colorectal Cancer—A Study of Adults Age 50 and Over. Atlanta, GA, American Cancer Society, 1998.
17.
17. Centers for Disease Control and Prevention: Trends in screening for colorectal cancer—United States, 1997 and 1999. MMWR50:162-166, 2001.
18.
18. Glanz K, Lewis FM, Rimer BK: Health Behavior and Health Education: Theory, Research, and Practice (2nd ed.). San Francisco, Jossey-Bass, 1997.
19.
19. Rakowski W, Dube CE, Marcus BH, Prochaska JO, Velicer WF, Abrams DB: Assessing elements of women's decisions about mammography. Health Psychol11(2):111-118, 1992.
20.
20. Rakowski W, Fulton JP, Feldman JP: Women's decision making about mammography: A replication of the relationship between stages of adoption and decisional balance. Health Psychol12(3):209-214, 1993.
21.
21. Pearlman DN, Rakowski W, Ehrich B: The information environment of women and mammography screening: Assessing reciprocity in social relationships. J Womens Health4(5):541-553, 1995.
22.
22. Rakowski W, Dube CE, Goldstein MG: Considerations for extending the transtheoretical model of behavior change to screening mammography. Health Educ Res Theory Practice11(1) 77-96, 1996.
23.
23. Rakowski W, Ehrich B, Dube CE, Pearlman DN, Goldstein MG, Peterson KK, Rimer BK, Woolverton H: Screening mammography and constructs from the transtheoretical model: Associations using two definitions of the stages-of-adoption. Ann Behav Med18(2):91-100, 1996.
24.
24. Rakowski W: The transtheoretical model of behavior change: Application to clinical practice. Mind/Body Med1(4):207-223, 1996.
25.
25. Pearlman DN, Rakowski W, Clark MA, Ehrich B, Rimer BK, Goldstein MG, Woolverton H, Dube CE: Why do women's attitudes toward mammography change over time? Implications for physician-patient communication. Cancer Epidemiol Biomarkers Prev6:451-457, 1997.
26.
26. Rakowski W, Clark MA, Pearlman DN, Ehrich B, Rimer BK, Goldstein MG, Dube CE, Woolverton H: Integrating pros & cons for mammography and Pap testing: Extending the construct of decisional balance to two behaviors. Prev Med26:664-673, 1997.
27.
27. Sugg Skinner C, Arfken CL, Sykes RK: Knowledge, perceptions, and mammography stage of adoption among older urban women. Am J Prev Med14(1):54-63, 1998.
28.
28. Rakowski W, Ehrich B, Goldstein MG, Rimer BK, Pearlman DN, Clark MA, Velicer WF, Woolverton H: Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention. Prev Med27:748-756, 1998.
29.
29. Abrams DB, Herzog TA, Emmons KM, Linnan L: Stages of change versus addiction: A replication and extension. Nicotine Tob Res2(3):223-229, 2000.
30.
30. O'Neill HK, Gillispie MA, Slobin K: Stages of change and smoking cessation: A computer-administered intervention program for young adults. Am J Health Prom15(2):93-96, 2000.
31.
31. Dunbar CR: Application of the transtheoretical model of change to exercise behavior among Type 2 diabetics. Dissertation Abstracts International: Section B: The Sciences & Engineering61(3-B):1631, 2000.
32.
32. Rodgers WM, Courneya KS, Bayduza AL: Examination of the transtheoretical model and exercise in 3 populations. Am J Health Behav25(1):33-41, 2001.
33.
33. Harlow LL, Prochaska JO, Redding CA, Rossi JS, Velicer WF, Snow MG, Schnell D, Galavotti C, O'Reilly K, Rhodes F: Stages of condom use in a high HIV-risk sample. Psychol Health14(1):143-157, 1999.
34.
34. Vernon SW: Participation in colorectal cancer screening; A review. J Nat Cancer Instit89:1406-1422, 1997.
35.
35. Schoen RE, Weissfeld JL, Kuller LH: Sigmoidoscopy use among primary care physicians. Prev Med24(3):249-254, 1995.
36.
36. Gordon NP, Rundall TG, Parker L: Type of health care coverage and the likelihood of being screened for cancer. Med Care36(5):636-645, 1998.
37.
37. Burke W, Beeker C, Kraft JM, Pinsky L: Engaging women's interest in colorectal cancer screening: A public health strategy. J Womens Health Gend Based Med9(4):363-371, 2000.
38.
38. Friedman LC, Webb JA, Richards CS, Plon SE: Psychological and behavioral factors associated with colorectal cancer screening among Ashkenazim. Prev Med29(2):119-125, 1999.
