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Health Educ Behav. 2017 Dec;44(6):928-936. doi: 10.1177/1090198117734284. Epub 2017 Oct 4.

Colorectal Cancer Screening Uptake's Association With Psychosocial and Sociodemographic Factors Among Homeless Blacks and Whites.

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1 University of Minnesota Medical School, Minneapolis, MN, USA.
2 National Cancer Institute, Bethesda, MD, USA.
3 Barnes-Jewish Hospital, St. Louis, MO, USA.
4 University of Minnesota-Twin Cities, Minneapolis, MN, USA.
5 Uganda National Expanded Programme on Immunisation, Kampala, Uganda, Africa.
6 University of Utah, Salt Lake City, UT, USA.


The homeless represent an extremely disadvantaged population that fare worse than minority groups in access to preventive services and health, and minority groups fare worse than Whites. Early detection screening for colorectal cancer (CRC) saves lives, but empirical data about CRC screening practices among homeless Blacks and Whites are limited. Psychosocial risk factors may serve as a barrier to CRC screening completion among homeless Black individuals. A secondary data analysis of a randomized clinical trial for smoking cessation among homeless smokers was conducted to determine whether psychosocial factors and sociodemographic factors were more highly associated with CRC screening uptake among homeless Blacks than among their White counterparts. Study participants ( N = 124) were surveyed on their CRC screening status, sociodemographic variables, and psychosocial correlate measures including anxiety, depression, hopelessness, depression severity, and perceived stress. Associations between these factors were examined with logistic regression. White participants who were currently disabled/unable to work were 6.2 times more likely to ever receive CRC screening than those who were employed. Black participants with public health insurance coverage were 90% less likely to ever obtain CRC screening than participants without health insurance. Black and White participants had similar levels of anxiety symptoms, depression, and hopelessness, yet depression was the only psychosocial variable negatively associated with CRC screening status. Black and White participants with symptoms of depression were 58% less likely to complete screening than those without depression. Mental health risk and sociodemographic factors may serve as barriers to CRC screening among homeless Blacks and Whites.


cancer early detection; colon cancer; homelessness; mental hygiene; psychosocial deprivations

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