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Research ArticleOriginal Research

Testing to Prevent Colon Cancer: Results From a Rural Community Intervention

John M. Westfall, Linda Zittleman, Christin Sutter, Caroline B. Emsermann, Elizabeth W. Staton, Rebecca Van Vorst and L. Miriam Dickinson
The Annals of Family Medicine November 2013, 11 (6) 500-507; DOI: https://doi.org/10.1370/afm.1582
John M. Westfall
1Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
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  • For correspondence: jack.westfall@cohealthop.org
Linda Zittleman
1Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
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Christin Sutter
1Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
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Caroline B. Emsermann
1Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
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Elizabeth W. Staton
1Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
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Rebecca Van Vorst
2IPRO, Lake Success, New York
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L. Miriam Dickinson
1Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
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  • Figure 1
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    Figure 1

    Change in colorectal cancer screening (ever had test) in intervention vs control regions.

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    Figure 2

    Impact of exposure on colorectal cancer screening (n = 1,048).

    Note: endoscopy refers to colonoscopy and/or sigmoidoscopy.

    aP <.05

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    Figure 3

    Temporal changes in hospital endoscopy for intervention and control regions.

    Note: Annual number of sigmoidoscopies and colonoscopies performed as reported by hospitals in the intervention region vs control region. Vertical line denotes beginning of intervention in 2004–2005.

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    Table 1

    Demographics of Respondents at Baseline and Follow-up

    Baseline (n=1,005)Follow-up (n=1,000)
    CharacteristicNo (%)No. (%)P Value
    Age, y.66
     50–64524 (52.2)511 (51.1)
     65–70289 (28.7)273 (27.3)
     75–84164 (16.3)179 (17.9)
     ≥8527 (2.7)36 (3.5)
     Declined1 (0.1)1 (0.1)
    Sex.94
     Male333 (33.2)330 (33.0)
     Female672 (66.8)670 (67.0)
    Race.43
     White886 (88.1)896 (89.6)
     African American2 (0.2)1 (0.1)
     Asian3 (0.3)1 (0.1)
     Native Hawaiian/other Pacific Islander5 (0.5)1 (0.1)
     American Indian/Alaska Native15 (1.5)10 (1.0)
     Other72 (7.2)69 (6.9)
     Don’t know/declined22 (2.2)23 (2.3).
    Ethnicity.06
     White non-Hispanic839 (83.5)874 (87.4)
     Hispanic101 (10.0)73 (7.3)
     Other non-Hispanic53 (5.3)40 (3.9)
     Don’t know/declined12 (1.2)14 (1.4)
    Education level.09
     High school or less412 (41.0)397 (39.7)
     13–16 years443 (44.1)485 (48.5)
     ≥17 years147 (14.6)114 (11.4)
     Don’t know/declined4 (0.3)4 (0.4)
    Income.01
     <$20,000282 (28.1)240 (24.0)
     $20,000–$49,000372 (37.0)345 (34.5)
     $50,000–$74,999126 (12.6)125 (12.5)
     ≥$75,00078 (7.8)103 (10.3)
     Don’t know/declined146 (14.5)187 (18.7)
    Employment.22
     Employed/self-employed438 (43.6)394 (39.4)
     Unemployed/unable to work76 (7.5)75 (7.4)
     Homemaker49 (4.9)66 (6.6)
     Retired435 (43.3)458 (45.8)
     Other8 (0.8)7 (0.7)
    • Note: Weighted sample.

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    Table 2

    Changes in Colon Cancer Screening Behavior From Baseline to Follow-up: Intervention vs Control

    Weighted VariableIntervention Region, % (n=1,018)Control Region, % (n=988)Difference in Change,aP Value
    Baseline (n=518)Follow-up (n=500)Baseline (n=487)Follow-up (n=501)
    Any test
     Ever had76817777.22
     Up to date60695765.82
     Plans to have16281517.18
    Fecal occult blood test
     Ever had61636460.11
     Up to date29293429.29
     Plans to haveNANANANANA
    Sigmoidoscopy
     Ever had35353231.72
     Up to date30302525.70
     Plans to have5757.73
    Colonoscopy
     Ever had43554252.70
     Up to date38523749.78
     Plans to have915817.63
    Endoscopyb
     Ever had53625058.83
     Up to date47584353.86
     Plans to have818919.54
    Barium enema
     Ever had27253023.31
     Up to date1311128.38
     Plans to haveNANANANANA
    Virtual colonoscopy
     Ever had15151111.83
     Up to date101198.91
     Plans to haveNANANANANA
    • NA=not applicable.

    • Note: Models for “ever had” and “up to date” were adjusted for intervention group; time; time-by–intervention group interaction; and respondent’s age, sex, race, and income; these analyses included all respondents. Models for “plans to have” were adjusted for intervention group, time, and time-by–intervention group interaction; these analyses included only respondents who never had the test performed.

    • ↵a Intervention vs control, change from baseline to follow-up.

    • ↵b Sigmoidoscopy and/or colonoscopy.

Additional Files

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    Testing to Prevent Colon Cancer: Results From a Rural Community Intervention

    John M. Westfall , and colleagues

    Background Colon cancer is the second leading cause of cancer death in the United States, but rates of colon cancer screening are low. This study examined a community-based participatory approach to increase colon cancer screening in rural northeast Colorado.

    What This Study Found The program, which included educational and motivational materials disseminated through local newspapers and other targeted outlets (eg, auction flyers and community organizations), successfully engaged community members and resulted in a modest, though not statistically significant, increase in overall colon cancer screening. Researchers with the High Plains Research Network found a 5 percent increase in the proportion of respondents who reported ever having had any test in the intervention communities compared with no increase among control counties in southeast Colorado. They also found the extent of exposure to intervention materials was associated with a significant and cumulative increase in screening. Community members who reported seeing five or more products were significantly more likely to report having ever been tested or being up to date for colon cancer screening than those who had seen only one component.

    Implications

    • The authors conclude that the findings provide preliminary evidence for the effectiveness of a multicomponent community approach to improve colon cancer screening.
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The Annals of Family Medicine: 11 (6)
The Annals of Family Medicine
Vol. 11, Issue 6
November/December 2013
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Testing to Prevent Colon Cancer: Results From a Rural Community Intervention
John M. Westfall, Linda Zittleman, Christin Sutter, Caroline B. Emsermann, Elizabeth W. Staton, Rebecca Van Vorst, L. Miriam Dickinson
The Annals of Family Medicine Nov 2013, 11 (6) 500-507; DOI: 10.1370/afm.1582

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Testing to Prevent Colon Cancer: Results From a Rural Community Intervention
John M. Westfall, Linda Zittleman, Christin Sutter, Caroline B. Emsermann, Elizabeth W. Staton, Rebecca Van Vorst, L. Miriam Dickinson
The Annals of Family Medicine Nov 2013, 11 (6) 500-507; DOI: 10.1370/afm.1582
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Subjects

  • Domains of illness & health:
    • Prevention
  • Person groups:
    • Vulnerable populations
    • Community / population health
  • Methods:
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    • Mixed methods
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Keywords

  • Colon cancer prevention
  • rural
  • underserved
  • community-based participatory research
  • practice-based research

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