Examining the Determinants of Colorectal Cancer Screening Practices among Asian Americans

Abstract

Asian Americans (AA) are documented to have low colorectal cancer (CRC) screening rates. Recent studies have further revealed screening disparities among AA subgroups. Focused research on CRC screening among AA subgroups are needed to more effectively address the CRC burden experienced by this growing racial/ethnic population. The purpose of this dissertation was to examine the determinants of CRC screening among AA. Study 1 was a systematic review of the determinants to CRC screening among AA subgroups using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study 2 used the 2012 Hawai‘i Behavioral Risk Factor Surveillance System dataset and examined the associations between CRC screening and ethnicity, controlling for socio-demographic and healthcare variables using multiple logistic regression. Study 3 used the 2009 California Health Interview Survey dataset and examined the associations between physician’s recommendation and ethnicity, controlling for socio-demographic, cultural, and healthcare related variables using multiple logistic regression. All reported odds ratios were considered statistically significant at the p ≤ 0.05 level. Study 1 found different determinants to CRC screening between the AA subgroups. Study 2 revealed ethnic and gender variances in CRC screening among the AA subgroups. Chi-square analyses showed gender variances in CRC screening among the total women sample and Japanese compared to their respective counterparts. Multiple logistic regression results further revealed ethnic and gender variances in CRC screening even after controlling for other covariates. Study 3 revealed that having high limited English proficiency decreased the odds for physician’s recommendation for Chinese; being employed decreased the odds for Filipino; and having insurance decreased the odds for Korean. Wide array of determinants influence AA subgroups’ colorectal cancer screening practice (CCSP). Implications for policy, social work practice, and future research are evident from this dissertation. Researchers should remain cognizant of unique factors that play an influential role in subgroup’s decision to complete CRC screening; and further investigate potentially important but understudied and misunderstood determinants of CCSP presented in this dissertation. In turn, intervention efforts should be tailored to highlight the cultural strengths of each distinct subgroup and to address their unique needs and barriers to CRC screening.