domingo, 12 de julio de 2015

Understanding Barriers to Colorectal Cancer Screening in Kentucky

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Understanding Barriers to Colorectal Cancer Screening in Kentucky

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Understanding Barriers to Colorectal Cancer Screening in Kentucky

Jennifer Redmond Knight, DrPH; Sarojini Kanotra, PhD, MPH; Seth Siameh; Jessica Jones, MSW; Becki Thompson, RN; Sue Thomas-Cox, RN

Suggested citation for this article: Redmond Knight J, Kanotra S, Siameh S, Jones J, Thompson B, Thomas-Cox S. Understanding Barriers to Colorectal Cancer Screening in Kentucky. Prev Chronic Dis 2015;12:140586. DOI:


Colorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers.
The state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening.
The most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system.
Barriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.


For more than 10 years, local and statewide public health efforts in Kentucky focused on reducing barriers to colorectal cancer screening. Since 2001, the state has seen a 22% decline in both colorectal cancer incidence and mortality (1). According to the Kentucky Behavioral Risk Factor Surveillance System (KyBRFSS), screening rates for colorectal cancer (CRC) using sigmoidoscopy or colonoscopy increased from 34.7% in 1999 to 63.7% in 2008 (2). Screening rates remained static at 63.7% in 2010 (2). Methodology changes in 2011 influenced the KyBRFSS, and in 2012 the screening rate for sigmoidoscopy or colonoscopy was 65.9% (2,3). Although significant progress has been made, to achieve the national and Kentucky CRC screening objective of 80% by 2018, it is necessary to understand and address the greatest barriers to screening (4,5).


Funding for the state-added question to KyBRFSS in 2012 was provided by a CDC Preventive Health and Health Services Block Grant.

Author Information

Corresponding Author: Jennifer Redmond Knight, 119 E. Markham St, Apartment D309, Little Rock, AK 72201. Telephone: 859-509-4123. Email:
Author Affiliations: Sarojini Kanotra, Seth Siameh, Becki Thompson, Sue Thomas-Cox, Kentucky Department for Public Health, Frankfort, Kentucky; Jessica Jones, University of Kentucky, Lexington, Kentucky.


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