Implications of a socio-cultural model of colorectal cancer screening among African Americans.

B35

Colorectal cancer is the third leading cause of cancer death for African Americans, and African Americans are as much as 40% more likely to die from the disease than Whites. However, screening consistent with American Cancer Society guidelines remains underutilized. Many of the theoretical models currently used to explain preventive health behavior do not include social and cultural factors relevant to this population, such as adoption of mainstream cultural norms (acculturation), mistrust of health care systems, group-level perceptions of susceptibility, and social support. The purpose of this study is to test a sociocultural model of intention to be screened for colorectal cancer among African Americans. The model proposes that sociodemographic variables, social support, socio-cultural factors, and perceived susceptibility are all predictors of the intention to undergo colorectal cancer screening for African Americans. The relationship between this set of variables and intentions is mediated by the perceived barriers and perceived benefits of screening. Data are presented on a community sample of 198 African Americans (65% female; age range 45-93, M = 59.7, SD = 9.9; 44% ≥ $50K). Structural equation modeling (LISREL) was used to test the model, which exhibited good fit (RMSEA = .061). Socio-cultural variables added significantly to the prediction of intention to screen for colorectal cancer with perceived benefits and barriers as mediators. Specifically, individuals with more traditional acculturative strategies, less medical mistrust, and more perceived group susceptibility reported more intention to be screened as a function of greater perception of benefits of screening. Younger individuals and those with greater access to health care also reported more intention as a function of less perceived barriers to screening. However, socioeconomic status, social support, and individual susceptibility did not have significant indirect effects through benefits and barriers. Post-hoc analyses revealed several significant interactions with perceptions of group-level susceptibility, traditional acculturative strategies, mistrust, and having an African American physician as predictors in regression models. These results are discussed with reference to their implications for future research and interventions addressing African American colorectal cancer screening.