In this retrospective study, we examined factors that associated with colonoscopy test use among adults who did not have colorectal cancer (CRC) in the USA. A total of 2,150 non-CRC adults >or=55 were selected from the Health Information National Trends Survey, a random-digit telephone survey that collected data in 2003-2004. Participants were classified based on receiving CRC tests within the recommended time interval. Socio-demographic and cognitive factors that are associated with colonoscopy test use were examined. The results show that adults 55-64 years old were less likely to have a colonoscopy compared with those 65 years and older. Participants with higher levels of knowledge, greater access to care, greater perceived risk, and lower psychological barriers were more likely to report receiving a colonoscopy. The findings indicate a continuous effort to increase awareness and risk perception, and reduce psychological barriers through health education.