Obesity and colorectal cancer and the knowledge, attitudes, beliefs and behaviors related to colorectal cancer prevention among non-Hispanic Black women in Rhode Island

Obesity is an established risk factor for colorectal cancer (CRC). Numerous studies have linked diets low in fruits and vegetables and decreased physical activity, risk factors for obesity, with increased cancer risk. The purpose of this study was to evaluate the effect of obesity on CRC mortality; the behavioral, socioeconomic and demographic predictors of obesity; and the knowledge attitudes, beliefs and behaviors of a Rhode Island population identified at high risk for both obesity and CRC. The first study tested a model hypothesis that a diet low in fruits and vegetables, decreased physical activity, and obesity as defined by a Body Mass Index (BMI) of greater than or equal to 30 kg/m2 play a mediating role in the effect of socioeconomic variables on CRC. Structural Equation Modeling using national data sets from 1996-2000 suggested a mediating role of diet, physical activity and obesity in CRC mortality. Using multi-year logistic regression analyses of Risk Factor Surveillance (BRFS) data, the second study evaluated the identified behavioral, socioeconomic and demographic predictors of obesity in Rhode Island. Among males and females, 45 years of age and older, no physical activity during the past month, less than 200% of the Federal Poverty Level (FPL), and non-Hispanic Black race were significant predictors of obesity. As non-Hispanic Black women have the greatest prevalence of obesity nationally, and a greater CRC mortality rate than non-Hispanic Black males in Rhode Island, a survey was developed and distributed to evaluate the knowledge, attitudes, beliefs and behaviors related to obesity and CRC among this population in Rhode Island. Key findings from this survey include (1) physician recommendations for CRC screening need to be increased; (2) other health care providers (e.g., nurse practitioners), family, friends, and community- and faith-based organizations are important channels for providing health care information; (3) the perceived cost of CRC screening among the un/underinsured, and access to colonoscopy are health care system barriers that need to be addressed; (4) gaps exist between knowledge and behavior related to CRC prevention; and (5) gaps exist between knowledge of overweight as a risk factor for CRC and self perception of body weight.