UB works to increase colorectal cancer screening among African Americans

BUFFALO, N.Y. – More African Americans get colorectal cancer (CRC) and die from it than any other ethnic or racial group.

While screening for the disease, by colonoscopy in particular, is the most effective way to detect colorectal cancer early and thereby improve treatment outcomes, studies show that there are substantial disparities for screening when comparing African Americans to other groups.

Compared to white Americans, African Americans are 20 percent more likely to get CRC and 18 percent more likely to die from it.

The University at Buffalo, Roswell Park Cancer Institute and Icahn School of Medicine at Mount Sinai are collaborators on a $2,658,940 grant from the National Cancer Institute to study what influences African Americans to get screened for CRC and to develop interventions based on those influences.

“There is a critical need to understand why so many African Americans aren’t getting screened for CRC,” says Marc Kiviniemi, PhD, assistant professor in the UB Department of Community Health and Health Behaviors and one of several principal investigators on the grant.

Kiviniemi says that while most behavioral research has linked cognitive decision-making (perceived benefits and barriers) and affective decision-making (fear and worry) to predicting whether individuals will get CRC screening, little work has been done on examining these dynamics among African Americans.

“This creates significant gaps in knowledge about the role of feelings in predicting and potentially increasing CRC screening for minorities,” he says.

Kiviniemi says most educational material about CRC involves fact-based strategies for informing the public about the importance of CRC screening, but this does not seem to be an effective strategy for encouraging screening for African Americans.

The goal of this study, he says, is to use our understanding of how and why African Americans are influenced to participate in CRC screening and to develop narrative-based educational strategies to encourage CRC screening in African American communities.

The study will examine the impact of two randomized community interventions on cognitive and affective factors and their resulting influence on health care seeking and CRC screening behaviors for African Americans.

Kiviniemi is an expert on how individuals’ health decision making is influenced by feelings. He began his research in 2004.

“At first I was just observing and listening to people talk about their health behaviors and noticing that there were situations where people knew that they ‘should’ do something but didn’t really want to – like exercising or getting a colonoscopy – or other situations where they knew that they shouldn’t do something but liked doing it – like eating junk food,” he says.

Most of the theories that existed to explain people's health behaviors, Kiviniemi says, could explain the "should do" or "shouldn't do" judgments people were making but couldn't account for the more visceral, emotional reactions that lead people to do things like eat junk food or to not get a screening test.

“For several years now, my lab’s work has focused on understanding how individuals’ emotions affect their choices about health,” says Kiviniemi.

“From a practical, health promotion perspective, we address the question of how we can shift the emotional associations people have with health behaviors to encourage them to make healthier behavioral choices.”

Kiviniemi’s lab will figure prominently into the study. It is set up for the work on study design and data analysis.

His fellow principal investigators on the grant are Deborah Erwin, PhD, Roswell Park Cancer Institute, and Lina Jandorf, MA, of Icahn School of Medicine at Mount Sinai.  Gary Winkel, PhD, also of Icahn School of Medicine at Mount Sinai, is a co-investigator.