• Melissa R Partin, Siamak Noorbaloochi, Joseph Grill, Diana J Burgess, Michelle van Ryn, Deborah A Fisher, Joan M Griffin, Adam A Powell, Krysten Halek, Ann Bangerter, and Sally W Vernon.
• Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA. melissa.partin@va.gov
• Cancer Causes Control. 2010 Sep 1; 21 (9): 1357-68.

ObjectivesWe examined the interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer (CRC) screening adherence.MethodsIn this study, 2,416 average risk patients aged 50-75 from 24 Veterans Affairs medical facilities responded to a mailed survey with phone follow-up (response rate 81%). Survey data (attitudes, behaviors, demographics) were linked to facility (organizational complexity) and medical records data (diagnoses, screening history). Patients with a fecal occult blood test within 15 months, sigmoidoscopy or barium enema within 5.5 years, or colonoscopy within 11 years of the survey were considered adherent. Logistic regressions estimated the association between adherence and background, cognitive, and environmental factors. Deviance ratios examined interrelationships between factors. Population attributable risks (PAR) were used to identify intervention targets.ResultsThe association of background factors with adherence was partially explained by cognitive and environmental factors. The association of environmental factors with adherence was partially explained by cognitive factors. Cognitive and environmental factors contributed equally to adherence. Factors with the highest PARs for non-adherence were age 50-64, less than two comorbidities, and lack of physician recommendation.ConclusionsEfforts to increase physician screening recommendations for younger, healthy patients at facilities with the lowest screening rates may improve CRC adherence in this setting.

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