Comparing colorectal cancer screening and immunization status in older americans

Am J Prev Med. 2007 Jul;33(1):1-8. doi: 10.1016/j.amepre.2007.02.043.


Background: This study examined patterns of use of three adult preventive services-influenza vaccination, pneumococcal polysaccharide vaccination, and colorectal cancer (CRC) screening; factors associated with different use patterns; and reasons for non-use.

Methods: Data from 3675 individuals aged 65 and older responding to the 2004 National Adult Immunization Survey, which included a CRC screening module, were analyzed in 2005-2006. Descriptive statistics were used to characterize patterns of use of preventive services, and to assess reasons for non-use. Polytomous logistic regression modeling was used to identify predictors of specific use patterns.

Results: Thirty-seven percent of respondents were current with all three preventive services; 10% were not current with any. Preventive services use varied by demographic and healthcare utilization characteristics. Having a recent visit to a doctor or other health provider was the most consistent predictor of use. Concern about side effects was the most frequently cited reason for not having an influenza vaccination (25%), while not knowing that the preventive service was needed was the most common reason for non-use of pneumonia vaccination (47%) and CRC tests (44% FOBT, 51% sigmoidoscopy, 47% colonoscopy).

Conclusions: Rates of influenza and pneumonia vaccination and CRC screening are suboptimal. This is especially apparent when examining the combined use of these services. Patient and provider activation and the new "Welcome to Medicare" benefit are among the strategies that may improve use of these services among older Americans. Ongoing monitoring and further research are required to determine the most effective approaches.

Publication types

  • Comparative Study

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Colonoscopy / psychology
  • Colonoscopy / statistics & numerical data*
  • Colorectal Neoplasms / diagnosis
  • Ethnicity / statistics & numerical data
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Status
  • Health Surveys
  • Humans
  • Influenza Vaccines / therapeutic use*
  • Logistic Models
  • Male
  • Pneumococcal Vaccines / therapeutic use*
  • Preventive Health Services / statistics & numerical data*
  • United States


  • Influenza Vaccines
  • Pneumococcal Vaccines