BACKGROUND: Screening can reduce colorectal cancer mortality, yet screening rates remain low. Data from the Centers for Disease Control and Prevention (CDC) for 1999 suggest that only 33.7% of US adults over 40 have ever received a sigmoidoscopy (SIG) or colonoscopy (COL), and 31.1% have ever received a fecal occult blood test (FOBT). OBJECTIVE: To inform policy that may improve screening rates, we sought to characterize the barriers associated with low screening compliance. METHODS: A national random sample of US adults 50 years and older was conducted via random digit dial methods. A computer assisted telephone survey was administered to 502 subjects. Data including utilization of FOBT, SIG, COL and x-ray with barium enema (XBE), as well as demographics, awareness, concerns, attitudes and beliefs about those tests were collected. RESULTS: Screening rates were low, with awareness and screening rates lower for Blacks/Hispanics than for Whites. For example, Blacks and Hispanics were less aware of screening tests (aware of FOBT=73.3%; SIG=51.7%; COL=70%; XBE=68.3%) than Whites (88.1%, 81.8%, 87.6% and 80.1%, respectively) (p<.05). Significantly lower screening compliance is apparent with FOBT screening rates of 21.7% (Blacks/Hispanics) compared with 34.8% (Whites). Other significant barriers to screening found were: discomfort with exam; low health care seeking behavior; low belief in value of prevention; and low perceived personal health threat (all p<.05).