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CHAPEL HILL, N.C. – A new study at UNC Chapel Hill will examine what complex and conjoined behavioral factors influence low income people to pursue colorectal cancer screening and what strategies could increase screening rates in disadvantaged communities.

Michael Pignone, MD, MPH, Professor of Medicine at the UNC School of Medicine and Stephanie Wheeler, PhD, MPH, Assistant Professor of Health Policy and Management in the UNC Gillings School of Global Public Health will lead the Colorectal Cancer Screening in Disadvantaged Communities: A Behavioral Economics Perspective study. The study will identify specific geographic areas in North Carolina with low colorectal cancer screening rates and high colorectal cancer mortality rates, as well as predictors of low screening rates, using Medicaid and Medicare claims data linked to NC Central Cancer Registry data. Focusing on communities identified through this process, researchers will then use conjoint analysis techniques to characterize consumers’ decision making processes around colorectal cancer screening. Researchers will then use this information to develop a simulation model to understand, rank, and prioritize potential policy decisions aimed at improving colorectal cancer screening in low income communities.

Pignone and Wheeler are both members of UNC Lineberger Comprehensive Cancer Center.

“Our goal with this study is to understand more fully the numerous conjoined factors that influence decision making around screening for colorectal cancer in underserved populations,” said Wheeler. “People living in financially constrained circumstances have many competing demands for their time and money. The risks and rewards of colorectal cancer screening may be weighed differently in underserved populations, given that these folks are weighing not just the benefits of screening, but also (and perhaps more importantly) the cost of a colonoscopy, distance required to travel for the appointment, time lost from work, preparations involved, and many other financial and non-financial tradeoffs.”

Colorectal cancer is the third most common cancer diagnosis and second leading cause of cancer-related deaths in the United States. Although overall rates of colorectal cancer screening have increased overall in recent years, screening rates for low-income, uninsured, less educated, minority, and rural-dwelling individuals and communities are lower than the rest of the population. Results from the study will be used to implement effective and efficient programs to reduce differences in screening rates between low income patients and those with higher incomes. Because many low income North Carolinians belong to racial/ethnic minority groups, this study also has the potential to characterize patterns of and uncover reasons for racial/ethnic disparities in screening and cancer outcomes. The study will include male and female North Carolina residents from all racial and ethnic groups ages 50 to 75 and either publicly insured (i.e., Medicare and/or Medicaid) or uninsured. Research will span a period of three years with findings expected to influence intervention strategies at the state level.

The study is based at the UNC Center for Health Promotion and Disease Prevention in Chapel Hill and funded by the Prevention Research Center Program at the Centers for Disease Control and Prevention. For more information please visit the UNC Center for Health Promotion and Disease Prevention’s website at

About the UNC Center for Health Promotion and Disease Prevention:

Founded in 1985, the UNC Center for Health Promotion and Disease Prevention hopes to bring research findings to the daily lives of North Carolina communities and populations vulnerable to disease. HPDP works with the UNC Schools of Dentistry, Medicine, Nursing, Pharmacy and Public Health supplementing research and promoting good health. HPDP receives funding from the Centers for Disease Control and Prevention and was one of the first three Prevention Research Centers.