Psychosocial determinants of socioeconomic inequalities in cancer screening participation: a conceptual framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.     

Socioeconomic status and cancer screening in Japanese males: Large inequlaity in middle-aged and urban residents

Objectives Cancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males. Methods Using the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ≥65 years). Results The cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas. Conclusions There are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.     

Does reading keep you thin? Leisure activities,cultural tastes,and body weight in comparative perspective

While sedentary leisure-time activities such as reading, going to movies, attending cultural events, going to sporting events, watching TV, listening to music, and socialising with friends would seem to contribute to excess weight, a perspective focusing on socioeconomic status (SES) differences in cultural tastes suggests the opposite, that some sedentary activities are associated with lower rather than higher body weight. This study aims to test theories of cultural distinction by examining relationships between leisure-time activities and body weight. Using 2007 data on 17 nations from the International Social Survey Program (ISSP), the analysis estimates relationships between the body mass index and varied leisure-time activities while controlling for SES, physical activities, and sociodemographic variables. Net of controls for SES and physical activities, participation time in cultural activities is associated with lower rather than higher body weight, particularly in high-income nations. The results suggest that both cultural activities and body weight reflect forms of distinction that separate SES-based lifestyles.     

Fundamental Causes of Colorectal Cancer Mortality: The Implications of Informational Diffusion

Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths estimated in 2012. To explore further the social inequalities in colorectal cancer mortality, we used fundamental cause theory to consider the role of societal diffusion of information and socioeconomic status. Methods: We used the number of deaths from colorectal cancer in U.S. counties between 1968 and 2008. Through geographical mapping, we examined disparities in colorectal cancer mortality as a function of socioeconomic status and the rate of diffusion of information. In addition to providing year‐specific trends in colorectal cancer mortality rates, we analyzed these data using negative binomial regression. Findings: The impact of socioeconomic status (SES) on colorectal cancer mortality is substantial, and its protective impact increases over time. Equally important is the impact of informational diffusion on colorectal cancer mortality over time. However, while the impact of SES remains significant when concurrently considering the role of diffusion of information, the propensity for faster diffusion moderates its effect on colorectal cancer mortality. Conclusions: The faster diffusion of information reduces both colorectal cancer mortality and inequalities in colorectal cancer mortality, although it was not sufficient to eliminate SES inequalities. These findings have important long‐term implications for policymakers looking to reduce social inequalities in colorectal cancer mortality and other, related, preventable diseases.     

The role of socioeconomic factors in the survival of patients with colorectal cancer in Saarland/Germany

The role of socioeconomic factors in the survival of patients with colorectal cancer was assessed using data from the cancer registry of Saarland/Germany, and census information. Among 2627 patients with colorectal cancer diagnosed from 1974 to 1983, patients from communities in the lowest of three categories defined by socioeconomic factors showed significantly lower survival rates than patients from other communities. After adjustment for potential biological and other sociogeographic risk factors in multivariate analyses, relative hazard of death associated with low socioeconomic status (SES) compared with high SES was estimated to be 1.22 (95% CI: 1.01-1.47) for colon cancer and 1.32 (95% CI: 1.09-1.60) for rectum cancer. The results are in agreement with earlier studies from North America, Hawaii and Sweden and indicate that an attempt to improve health care services and acceptance and possibly other relevant general living conditions in socioeconomically less privileged communities may be a rewarding approach towards increasing survival of patients with colorectal cancer.     

The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors.

OBJECTIVES: This study described factors related to colorectal cancer stage at diagnosis. METHODS: Logistic regression analyses were used on data from the New York State Tumor Registry and US Census area-level social class indicators. RESULTS: After the effects of other predictors were controlled for, the odds of late-stage cancer increased as age decreased; women and African Americans were significantly more likely to have late stage than men and Whites; and individuals living in areas of low socioeconomic status (SES) were significantly more likely to be diagnosed at late stage than those living in higher SES areas. Stratified analyses showed that living in a low SES area was the most important determinant of stage for all age, race, gender and source-of-care groups. CONCLUSIONS: While all populations would benefit from the systematic use of screening socioeconomically disadvantaged groups may also benefit from targeted screening.     

The effect of socioeconomic status on survival from colorectal cancer in the Melbourne Collaborative Cohort Study

Previous research relating lower socioeconomic status (SES) with poorer survival from colorectal cancer has varied in adjustment for confounding factors and in the use of individual-level or aggregate-level indicators of SES. We investigated the effect of SES and country of birth on survival from colorectal cancers diagnosed in participants of the Melbourne Collaborative Cohort Study. A total of 526 colorectal cancer cases diagnosed since baseline were followed from diagnosis to 1 June 2006 or death. Information on tumour site and stage, and treatments given were obtained from systematic medical record review. SES at diagnosis was assigned using both an area-based measure of social disadvantage and individual level of educational attainment. Cox regression models were used to estimate hazard ratios associated with socioeconomic disadvantage, educational attainment, and country of birth. During an average follow-up of 5.6 years from diagnosis, 230 deaths occurred, 197 from colorectal cancer. After adjusting for age, sex, tumour stage, waist circumference and adjuvant chemotherapy and radiotherapy, the hazard ratios of dying from all causes and from colorectal cancer associated with living in the least disadvantaged areas compared with most disadvantaged areas were 0.73 (95% CI 0.53–1.00, p for trend = 0.06) and 0.80 (95% CI 0.57–1.12, p for trend = 0.22) respectively. Further adjustment for hospital case-load, tumour characteristics, and lifestyle factors did not change the estimates materially. Level of educational attainment and country of birth were not independent predictors of the risk of dying from colorectal cancer. Despite a universal health care system in Australia, socioeconomic inequalities in survival from colorectal cancer exist, and an enduring challenge is to ensure that improvements in colorectal cancer survival are shared equally across the population.     

Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour

Several studies have shown socioeconomic differences in leisure-time physical activity. One explanation may be socioeconomic differences in relevant psychosocial conditions. The Malm? Diet and Cancer Study is a prospective cohort study including inhabitants in Malm?, Sweden. The baseline questionnaire used in this cross-sectional study was completed by the 11,837 participants born 1926-1945 in 1992-1994. Leisure-time physical activity was measured by an item presenting a variety of activities. These activities were aggregated into a summary measure of leisure-time physical activity that takes both the intensity and duration of each specific activity into consideration. The effects of the psychosocial variables on the socioeconomic differences in leisure-time physical activity were calculated in a multivariate logistic regression analysis. The quartile with the lowest degree of leisure-time physical activity was not evenly distributed between the socioeconomic groups. Socioeconomic differences were seen as odds ratios 1.5 for skilled and 1.5 for unskilled male manual workers, compared to the high level non-manual employees. An OR 1.6 was observed for female unskilled manual workers. Self-employed men and female pensioners also had a significantly increased risk of low leisure-time physical activity. Adjustment for age, country of origin and previous/current diseases had no effect on these SES differences. Finally, adjusting for social participation almost completely erased the SES differences. Among the psychosocial variables, social participation was the strongest predictor of low physical activity, and a strong predictor for socioeconomic differences in low leisure-time physical activity. Social participation measures the individual's social activities in, for example political parties and organisations. It therefore seems possible that some of the socioeconomic differences in leisure-time physical activity are due to differing social capital between socioeconomic groups.     

Do patient characteristics,disease, or treatment explain social inequality in survival from colorectal cancer?

This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient.     

Can cancer risk information raise awareness without increasing anxiety? A randomized trial

OBJECTIVE: Promoting public awareness of cancer risk factors is an important public health goal, but there is concern that it could heighten anxiety. This study examined the impact of mailed information about colorectal cancer on awareness of risk factors, emotional well-being, and interest in attending screening in a population not previously exposed to screening. METHOD: Individuals (3,185) aged 45-66 years registered with general practitioners in South-West England in 2004 were randomized to (1) control group (no information), (2) information on colorectal cancer risk factors, or (3) information on risk factors and colorectal screening. All participants were sent a questionnaire assessing knowledge, anxiety, worry about colorectal cancer, and interest in screening. RESULTS: Questionnaires (1,945; 61%) were returned. As expected, participants receiving information had significantly greater knowledge than the control group. Anxiety scores were in the normal range and neither anxiety nor worry about cancer differed significantly between the groups. Ninety-three percent of respondents indicated they would be interested in screening, with equally high levels across groups. CONCLUSION: This study suggests that information leaflets can promote knowledge of cancer risk factors without increasing anxiety. Low-cost educational materials have the potential to contribute to public engagement with health promotion and disease prevention.     

Association of socioeconomic status with inflammation markers in black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study

Inflammatory processes are implicated in a number of diseases for which there are known socioeconomic status (SES) disparities, including heart disease and diabetes. Growing evidence also suggests SES gradients in levels of peripheral blood markers of inflammation. However, we know little about potential gender and racial/ethnic differences in associations between SES and inflammation, despite the fact that the burden of inflammation-related diseases varies by gender and race. The present study examines SES (education and income) gradients in levels of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6), in a biethnic (White and Black) sample of men and women (n = 3549, aged 37–55 years) in the USA from the CARDIA Study. Health status, behavioral and psychosocial variables that may underlie SES differences in inflammatory biomarker levels were also examined. Age-adjusted CRP and IL-6 levels were inversely associated with education level in each race/gender group except Black males. Income gradients were also observed in each race/gender group for IL-6 and in White females and males for CRP. In general, differences in CRP and IL-6 levels between low and high SES groups were reduced in magnitude and significance with the addition of health status, behavioral, and psychosocial variables, although the impact of the addition of model covariates varied across race/gender groups and different SES-inflammation models. Overall, findings indicate SES gradients in levels of inflammation burden in middle-aged White and Black males and females.     

Socioeconomic status as determinant for participation in mammography screening: assessing the difference between using women’s own versus their partner’s

Objectives  

Earlier research has shown that participation in mammography screening tends to vary across socioeconomic levels. We assessed the difference between using the woman’s own socioeconomic status (SES) and using that of her household or partner as determinant of participation in mammography screening.     

Demographic,social cognitive and social ecological predictors of intention and participation in screening for colorectal cancer

Background  

Previous research points to differences between predictors of intention to screen for colorectal cancer (CRC) and screening behavior, and suggests social ecological factors may influence screening behavior. The aim of this study was to compare the social cognitive and social ecological predictors of intention to screen with predictors of participation.     

Colorectal cancer screening in North Carolina: associations with diabetes mellitus and demographic and health characteristics

BACKGROUND. Diabetes mellitus (DM) may increase the risk of colorectal cancer, a leading cause of cancer death in the United States. This report examines factors associated with colorectal cancer screening, including DM status. METHODS. Data from the 1993/1995/1997 North Carolina (NC) Behavioral Risk Factor Surveillance System were analyzed to assess self-reported screening rates within guidelines for sigmoidoscopy/proctoscopy (sig/proct) and fecal occult blood test (FOBT). RESULTS. Overall, 28.6, 27.2, and 19.7% received a sig/proct, FOBT, or either test within guidelines, respectively. Screening rates varied according to some demographic variables, but not by DM status. However, DM status changed some relationships between screening and some demographic/health characteristics. CONCLUSIONS. Colorectal cancer screening in NC is similar to national rates, but certain subgroups are less likely to get screened. Persons with DM are as likely to get colorectal cancer screening, but some groups with DM (ethnic minorities, persons of low socioeconomic status) may be at high risk for not getting screened. Educational efforts to increase screening should target these groups.     

Is Neighbourhood Linking Social Capital Associated With Colorectal Cancer Incidence and Mortality? A National Cohort Study From Sweden

Journal of Prevention - Past research on the social determinants of colorectal cancer (CRC) has shown that lower socioeconomic status (SES) is associated with a higher risk of CRC. Similar to SES...     

Socioeconomic differences in cancer survival: The Norwegian Women and Cancer Study

Background  

Cancer survival has been observed to be poorer in low socioeconomic groups, but the knowledge about the underlying causal factors is limited. The purpose of this study was to examine how cancer survival varies by socioeconomic status (SES) among women in Norway, and to identify factors that explain this variation. SES was measured by years of education and gross household income, respectively.     

Psychosocial factors associated with the public's willingness to pay for genetic testing for cancer risk: a structural equations model

An adaptation of Andersen's behavioral model of health services utilization is used to examine the psychosocial and socio-demographic factors that directly and indirectly influence the likelihood of undergoing genetic susceptibility testing for cancer, and the amount of money that individuals would be willing to pay out-of-pocket for such a test. Apart from willingness and likelihood, the model also included perceived benefits and barriers, perceived susceptibility, dispositional optimism, information seeking, family history of cancer, socioeconomic status (SES), and age, and explained 30.3% of the variation in willingness. We found as hypothesized that likelihood of undergoing such tests was central to understanding willingness to pay. Being aware of genetic susceptibility testing for cancer, and talking and seeking information about it was directly associated with an increased chance of being willing to pay more, independent of other indirect associations (effects). Interventions targeting those with a family history of cancer and those with a higher SES should generate more awareness about the potential positive and negative consequences to one's family of testing, and the interface between family history of cancer and perceived susceptibility. Interventions should also motivate people to talk and seek more information about genetic testing for cancer risk to enable them take well-informed decisions.     

Using directed acyclic graphs to consider adjustment for socioeconomic status in occupational cancer studies

There is an ongoing debate on whether analyses of occupational studies should be adjusted for socioeconomic status (SES). In this paper directed acyclic graphs (DAGs) were used to evaluate common scenarios in occupational cancer studies with the aim of clarifying this issue. It was assumed that the occupational exposure of interest is associated with SES and different scenarios were evaluated in which (a) SES is not a cause of the cancer under study, (b) SES is not a cause of the cancer under study, but is associated with other occupational factors that are causes of the cancer, (c) SES causes the cancer under study and is associated with other causal occupational factors. These examples illustrate that a unique answer to the issue of adjustment for SES in occupational cancer studies is not possible, as in some circumstances the adjustment introduces bias, in some it is appropriate and in others both the adjusted and the crude estimates are biased. These examples also illustrate the benefits of using DAGs in discussions of whether or not to adjust for SES and other potential confounders.     

Pecuniary compensation increases participation in screening for colorectal cancer

The participation rate in medical screening programmes is typically below 100%, which means that not all potential health benefits are fully exploited. In this paper, the prospect of pecuniary compensation is tested as a method of increasing the participation rate. We propose a model explaining the individual's probability of participating in screening for colorectal cancer when he is offered pecuniary compensation, given that he did not participate when first invited. The participant's decision is based on both known and uncertain factors. The estimation is conducted in two steps, where a binary probit model is used in each. We find that pecuniary compensation increases the probability of participation, and that an individual's participation probability systematically varies with variables such as travel expenses, income, age, education level, expected benefit from the screening, use of health-care services, genetic predisposition and subjective health status. Using the results from the estimation, we predict changes in the participation rate for different levels of compensation and estimate the cost per additional individual screened. The cost per additional individual screened is 808, including 25 in compensation; this cost increases with the level of compensation.     

Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009–2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.