BACKGROUND: The New Hampshire Comprehensive Cancer Collaboration aims to increase the colorectal cancer screening rate per the US Preventive Services Task Force (USPSTF) guidelines among those experiencing disparities in income, education and access to health insurance and workers employed in seasonal, part-time or low-paying jobs. The BRFSS industry and occupational (I/O) data can provide a snapshot of industrial and occupational groups with low screening rates.
METHODS: The study used 4 years of NH BRFSS data, combined and re-weighted. The sample comprised of about 6,800 respondents aged 50-75 who were employed, self-employed or out of work for less than 1 year and had participated in the colorectal cancer screening module. The USPSTF defines colorectal cancer screening as “Not Up To Date” if any of the following conditions were not met: Having a fecal occult blood test (FOBT) within the past year; or flexible sigmoidoscopy within the past 5 years and FOBT within the past 3 years; or colonoscopy within the past 10 years. Statistical Analysis System (SAS) was used to produce statistics to identify industry and occupation with low screening rates and to study the relationships between screening rates and disparities in income, education and access to health insurance.
RESULTS: Respondents with lower income, education and lack of a health plan have lower colorectal screening rates. Those with incomes of less than $15,000 when compared to those earning over $50,000 were 2.6 times “Not Up To Date” with their screening. Those with less than a high school education when compared to college or technical school graduates were 2.5 times “Not Up To Date” with their screening and those without a health plan were 5.2 times “Not Up To Date” with their screening. The BRFSS data shows that those employed in industries such as Agriculture/Forestry/Fishing, Arts/Entertainment/Recreation, Accommodation/Food and Wood Manufacturing, Construction have a higher percent of its workers not “Not Up To Date” with their screening compared to the overall state screening rate.
CONCLUSIONS: Workers with disparities in income, education, access to health insurance have a lower rate of colorectal screening that meets the USPSTF guidelines. The BRFSS data can identify low screening rates by industrial and occupational groups and is useful for initiating cancer screening outreach and education efforts through employers as active partners for work-site health promotion.