Colorectal cancer (CRC) is the fourth most common cancer among U.S. men and women and the second deadliest. Effective screening modalities can either prevent CRC or find it earlier, but fewer than two thirds of U.S. adults are adherent to CRC screening guidelines. We tested whether people who defensively avoid CRC information have lower adherence to CRC screening recommendations and weaker intentions for being screened and whether CRC information avoidance adds predictive ability beyond known determinants of screening. Participants, aged 45–75 years, completed a survey about known structural determinants of CRC screening (healthcare coverage, healthcare use, provider recommendation), CRC information avoidance tendencies, and screening behavior (n = 887) and intentions (n = 425). Models were tested with multivariable regression and structural equation modeling (SEM). To the extent that participants avoided CRC information, they had lower odds of being adherent to CRC screening guidelines (OR = 0.55) and if non-adherent, less likely to intend to be screened (b=-0.50). In the SEM model, avoidance was negatively associated with each known structural determinant of screening and with lower screening adherence (ps < 0.01). Fit was significantly worse for nested SEM models when avoidance was not included, (i.e., the paths to avoidance were fixed to zero). Information avoidance was associated with screening behavior and other known structural determinants of screening adherence, potentially compounding its influence. Novel strategies are needed to reach avoiders, including health communication messaging that disrupts avoidance and interventions external to the healthcare system, with which avoiders are less engaged.

结直肠癌 (CRC) 是美国男性和女性中第四大常见癌症，也是第二大致命癌症。有效的筛查方式可以预防结直肠癌或更早发现结直肠癌，但只有不到三分之二的美国成年人遵守结直肠癌筛查指南。我们测试了防御性回避 CRC 信息的人对 CRC 筛查建议的遵守程度是否较低，接受筛查的意愿是否较弱，以及回避 CRC 信息是否增加了超出已知筛查决定因素的预测能力。年龄 45-75 岁的参与者完成了一项关于 CRC 筛查的已知结构性决定因素（医疗保健覆盖范围、医疗保健使用、提供者推荐）、CRC 信息回避倾向以及筛查行为 ( n  = 887) 和意图 ( n  = 425) 的调查。使用多变量回归和结构方程模型 (SEM) 测试模型。就参与者回避 CRC 信息而言，他们遵守 CRC 筛查指南的可能性较低 (OR = 0.55)，如果不遵守，则不太可能打算接受筛查 (b=-0.50)。在 SEM 模型中，回避与每个已知的筛查结构决定因素以及较低的筛查依从性呈负相关（ps < 0.01）。当不包括回避时（即回避路径固定为零），嵌套 SEM 模型的拟合度明显较差。信息回避与筛查行为和其他已知的筛查依从性结构决定因素有关，可能会加剧其影响。需要新的策略来接触回避者，包括扰乱回避的健康沟通信息以及医疗系统外部的干预措施，而回避者则较少参与这些干预。