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1.  Trends in Colorectal Cancer Test Use among Vulnerable Populations in the U.S. 
Background
Evaluating trends in colorectal cancer (CRC) screening use is critical for understanding screening implementation, and whether population groups targeted for screening are receiving it, consistent with guidelines. This study examines recent national trends in CRC test use, including among vulnerable populations.
Methods
We used the 2000, 2003, 2005, and 2008 National Health Interview Survey to examine national trends in CRC screening use overall and for FOBT, sigmoidoscopy, and colonoscopy. We also assessed trends by race/ethnicity, educational attainment, income, time in the U.S., and access to health care.
Results
During 2000–2008, significant declines in FOBT and sigmoidoscopy use and significant increases in colonoscopy use and in the percentages of adults up-to-date with CRC screening occurred overall and for most population subgroups. Subgroups with consistently lower rates of colonoscopy use and being up-to-date included Hispanics; people with minimal education, low income, or no health insurance; recent immigrants; and those with no usual source of care or physician visits in the past year. Among up-to-date adults, there were few subgroup differences in the type of test by which they were up-to-date (i.e., FOBT, sigmoidoscopy, or colonoscopy).
Conclusions
Although use of CRC screening and of colonoscopy increased among U.S. adults, including those from vulnerable populations, 45% of adults aged 50–75—or nearly 35 million people—were not up-to-date with screening in 2008.
Impact
Continued monitoring of CRC screening rates among population subgroups with consistently low utilization is imperative. Improvement in CRC screening rates among all population groups in the U.S. is still needed.
doi:10.1158/1055-9965.EPI-11-0220
PMCID: PMC3153583  PMID: 21653643
colorectal cancer; screening; trends; health disparities; National Health Interview Survey
2.  Correlates of Unrealistic Risk Beliefs in a Nationally Representative Sample 
Journal of behavioral medicine  2010;34(3):225-235.
Unrealistically optimistic or pessimistic risk perceptions may be associated with maladaptive health behaviors. This study characterized factors associated with unrealistic optimism (UO) and unrealistic pessimism (UP) about breast cancer. Data from the 2005 National Health Interview Survey were analyzed (N=14,426 women). After accounting for objective risk status, many (43.8%) women displayed UO, 12.3% displayed UP, 34.5% had accurate risk perceptions (their perceived risk matched their calculated risk), and 9.5% indicated “don’t know/no response.” Multivariate multinomial logistic regression indicated that UO was associated with higher education and never smoking. UP was associated with lower education, lower income, being non-Hispanic Black, having ≥3 comorbidities, current smoking, and being overweight. UO was more likely to emerge in younger and older than in middle-aged individuals. UO and UP are associated with different demographic, health, and behavioral characteristics. Population segments that are already vulnerable to negative health outcomes displayed more UP than less vulnerable populations.
doi:10.1007/s10865-010-9303-7
PMCID: PMC3088765  PMID: 21110077
Unrealistic optimism; unrealistic pessimism; breast cancer; health behavior
3.  Adherence to Cervical Cancer Screening Guidelines for U.S. Women Aged 25–64: Data from the 2005 Health Information National Trends Survey (HINTS) 
Journal of Women's Health  2009;18(11):1759-1768.
Abstract
Background
Although it is widely accepted that Papanicolaou (Pap) screening can reduce cervical cancer mortality, many women still do not maintain regular cervical cancer screenings.
Objective
To describe the prevalence of cervical cancer screening and the demographic, behavioral, psychological, and cancer-related knowledge factors associated with adherence to U.S. Preventive Services Task Force (USPSTF) cervical cancer screening guidelines among women in the United States.
Methods
Data for women aged 25–64 were obtained from the National Cancer Institute's (NCI) 2005 Health Information National Trends Survey (HINTS). Women were considered adherent to screening guidelines if they had two consecutive, on-schedule screenings and planned to have another within the next 3 years. The sample comprised 2070 women.
Results
Ninety-eight percent of women reported ever having a Pap smear, 90% reported having had a recent Pap smear (within 3 years), and 84% were adherent to USPSTF screening guidelines. Maintaining regular cervical cancer screening was significantly associated with having health insurance, normal body mass index (BMI), smoking status (nonsmoker), mood (absence of a mood disturbance), and being knowledgeable about cervical cancer screening and human papillomavirus (HPV) infection.
Conclusions
Based on the observation that women who were current smokers, obese, or experiencing a substantial degree of psychological distress were significantly less likely to adhere to recommended screening guidelines, we suggest that healthcare providers pay particular attention to the screening needs of these more vulnerable women.
doi:10.1089/jwh.2009.1430
PMCID: PMC2864462  PMID: 19951209

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