PSYCHOSOCIAL VARIABLES ASSOCIATED WITH COLORECTAL CANCER SCREENING IN MAS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. OBJECTIVE: The overall aim of this research is to examine barriers to colorectal cancer screening participation in a convenience sample of Mexican Americans in a VA Hospital, the South Texas Veterans Health Care System-Audie L. Murphy Division (STVHCS-AMD) in San Antonio, Texas. RESEARCH PLAN: The specific aims are: 1. To estimate the magnitude of the associations between psychosocial variables, including socioeconomic disadvantaged status and participation in colorectal cancer screening. 2. To determine if a synergistic and/or independent relationship exists between specific psychosocial variables, the socioeconomic disadvantage variables and participation in colorectal cancer screening. This study will investigate the strength of the association between various psychosocial variables, specific SES variables and participation in colorectal cancer screening by Mexican American veterans enrolled in an outpatient Veterans Administration (VA) clinic in San Antonio, TX. These variables will also be examined by regression analysis to determine if interactive and/or independent associations exist. This study will utilize a cross-sectional survey design. Convenience sampling will be used to accrue Mexican American participants, ages 50 to 80. METHODS: After obtaining written informed consent from each participant, the trained investigator for this project (Dr. Pasko) will administer structured validated surveys to subjects. Subjects are recruited from patients seen in the outpatient clinic at the STVHCS-AMD Hospital in San Antonio, TX. Subjects will be drawn from the patient panels of primary care providers in this clinic. The criteria for inclusion into this study are Hispanic (Mexican American or other specified Hispanic/Latino origin) by self-report, ages 50 to 80. The criteria for exclusion are non-Hispanic ethnicity (self-report), age less than 50, and a history of colorectal cancer and/or current diagnosis of any cancer. Subjects will be identified by gender and birth date from the computerized outpatient clinic patient panel files on the days designated in the clinic setting. Convenience sampling will be used since it may not be feasible to approach each patient consecutively. Spearman's coefficient correlation will be used to analyze the data collected for a time period of three months. An estimated modest correlation (r) of a negative 0.20 is anticipated. The effect size (r) is equal to [-0.20] = 0.20. The alpha is two-sided and equal to 0.05. The beta is 0.10. The sample size for this descriptive study was calculated to be 259. A preliminary multivariate logistic regression model will be used to determine the potential interaction effects between the variables. The confidence interval level is set at 95%. CLINICAL RELEVANCE: Single or simple reasons probably do not explain the disparities in the cancer burden with respect to socioeconomic disadvantage and ethnicity. Research suggests that a variety of barriers impede prevention. Early screening and early detection have been shown to increase survival and reduce mortality rates for many cancers, including colorectal cancer. Differentially lower rates of screening among minorities, therefore, is a likely candidate for investigation as a significant contributor to health disparities with respect to colorectal cancer outcomes among minorities. There is a lack of data on specific aspects of access to care and other psychosocial factors that may contribute to underutilization in the Hispanic population. The results of the proposed investigation could suggest which specific factors to further examine as impediments to colorectal screening among Hispanics of Mexican American extraction.