Dr. Kesheng Wang, associate professor in the department of biostatistics and epidemiology at East Tennessee State University College of Public Health, is lead author of a paper in the Asian Pacific Journal of Cancer Prevention. The paper, Generalized linear mixed model analysis of urban-rural differences in social and behavioral factors for colorectal cancer screening, investigated social and behavioral factors across urban-rural groups on the usage of colorectal cancer screening.
Co-authors includes Dr. Ying Liu, an assistant professor in the department of biostatistics and epidemiology, and individuals from University of Cincinnati, University of Michigan, University of Southern Mississippi, and University of Texas Rio Grande Valley.
Screening for colorectal cancer can reduce disease incidence, morbidity, and mortality. However, few studies have investigated the urban-rural differences in social and behavioral factors influencing colorectal screening.
This study selected 38,505 adults (aged ≥40 years) from the 2009 California Health Interview Survey data – the latest data on colorectal screening from this survey. The weighted generalized linear mixed-model was used to deal with this hierarchical structure data.
The overall prevalence of colorectal cancer screening was 48.1 percent while the prevalence in four residence groups – urban, second city, suburban, and town/rural, were 45.8 percent, 46.9 percent, 53.7 percent and 50.1 percent, respectively. The weighted generalized linear mixed-model analysis showed residence effect and residence groups had significant interactions with gender, age group, education level, and employment status. Multiple logistic regression analysis revealed age, race, marital status, education level, employment stats, binge drinking, and smoking status were associated with colorectal screening. Stratified by residence regions, age and poverty level showed associations with colorectal screening in all four residence groups. Infrequent binge drinking was associated with colorectal screening in urban and suburban; while current smoking was a protective factor in urban and town/rural groups.
The researchers concluded that mixed models are useful to deal with the clustered survey data. Social factors and behavioral factors (binge drinking and smoking) were associated with colorectal cancer screening and the associations were affected by living areas such as urban and rural regions.
The Asian Pacific Journal of Cancer Prevention was launched in 2000 as the official publication of the Asia Pacific Organization for Cancer Prevention. This journal also acts as the official journal of the International Association of Cancer Registries and the Union for International Cancer Control Asian Regional Office.