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Kentucky: Fatalistic Culture Discourages Cancer Screening in Appalachia

Do fatalistic cultural attitudes toward health contribute to low rates of cancer screening in Appalachian? Investigators from the University of Kentucky College of Public Health set out to find answers to this under-researched question. Their findings are reported in the Journal of Rural Health.

The purpose of the study was to identify correlates of ever having endoscopy screenings for CRC and to determine whether fatalism plays a unique role. Because evidence suggests that cancer-associated fatalistic beliefs may be particularly common among rural Americans, the study was conducted in a medically underserved area of rural Appalachia. 

In this investigation, rural residents (N = 260) between 51 and 75 years of age, from a medically underserved Appalachian area in Kentucky, were recruited for a cross-sectional study. The outcome measure was assessed by a single item asking whether participants ever had a colonoscopy or flexible sigmoidoscopy. Demographic and health-related correlates of this outcome were selected based on past studies of rural populations. A single item assessed perceptions of fatalism regarding CRC. Age-adjusted analyses of correlates testing significant at the bivariate level were conducted. 

The analytic sample was limited to 135 rural residents indicating they had ever had CRC endoscopy and 107 indicating never having endoscopy. In age-adjusted analyses, only the measure of fatalism had a significant association with having endoscopy. Those endorsing the statement pertaining to fatalism were 2.3 times more likely (95% CI = 1.24-4.27, P = .008) than the remainder to indicate never having endoscopy. 

A community-based approach to the promotion of endoscopy for CRC screening could focus on overcoming CRC-associated fatalism, thereby potentially bringing more unscreened people to endoscopy clinics.

The lead author of the paper is Dr. Richard Crosby, professor of Health, Behavior & Society and principal investigator of the Rural Cancer Prevention Center. Tom Collins, RCPC associate director, is co-author.