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Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020.

Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic. From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening. Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9). The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

Abstract 3469: Exploring the impact of a giant inflatable colon on the level of awareness, knowledge, and intent for colorectal cancer screening among men attending two state fairs in the Midwest

Abstract Purpose: This study aimed to evaluate the influence of an interactive inflatable colon as an effective educational tool to increase colorectal cancer (CRC) awareness, knowledge, and screening intention among men attending the Wisconsin (WI) and Minnesota (MN) state fairs. Methods: Eligible study participants were self-identified men aged 18-75 who spoke English, were residents of WI or MN, and able to read in English. The study was employed during the final operating weekend of both the 2023 WI State Fair (August 11-13) and the MN State Fair (September 1-3). Eligible participants completed: (1) a pre-survey, (2) an unguided tour of the inflatable “Super Colon”, and then (3) a post-survey. The primary outcomes of interest were change in awareness (two items), knowledge (four items), and behavioral intent to obtain CRC screening (one item) from pre- to post-survey. Chi-square tests were used to examine study site differences and to explore the association between demographics and behaviors (awareness, knowledge, intentions) before entry to the Super Colon. McNemar’s test were employed to test if there were significant differences in the distributions from pre- to post-survey. Results: A total of 940 eligible participants were included in the study sample. The men self-identified their race/ethnicity as Non-Hispanic (NH) White (72%), followed by NH other (12%), NH Black (9%), and Hispanic (8%). Race and ethnicity significantly varied by study site (<.0001) with participants from WI more likely being members of racial/ethnic groups that are often medically underserved (33% vs. 24% in MN). Only 13% of participants had walked through an inflatable colon before. Of those who were screening-age appropriate (age 45 or older), 89% had been screened for CRC previously. With the exception of one question, baseline CRC knowledge was relatively high among our study sample. Interestingly, having higher confidence of their awareness level was inversely associated with higher knowledge. As a result of touring the Super Colon, a significant improvement in confidence in individuals’ knowledge of CRC (<.0001), knowledge regarding a colon polyp (<.0001), and intentions to be screened in the future (<.0001) were observed. Most participants (95%) agreed that the Super Colon is an effective educational tool to teach people about CRC. Conclusion: Since both encouraging CRC screening uptake and increasing research study participation among men can be a difficult task, these findings emphasize the crucial role of community-based educational initiatives in achieving these goals. Our findings affirm how the three-dimensional interior of the Super Colon is as an effective educational tool for promoting CRC early detection screening behaviors among men and increasing their awareness. Citation Format: Ami E. Sedani, Kelly K. Rifelj, Malcolm S. Bevel, Cordero L. McCall, Mckenzi Rogalla, Lisa Laliberte, Kiara Ellis, Rebekah J. Pratt, Charles R. Rogers. Exploring the impact of a giant inflatable colon on the level of awareness, knowledge, and intent for colorectal cancer screening among men attending two state fairs in the Midwest [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3469.

Exploring Sociocultural Influences On Colorectal Cancer Screening Among Latino Men: Results From a Multi-State Survey

Background: The incidence of and mortality from early-onset colorectal cancer (CRC), which occurs in individuals under age 50 years, have been increasing among Latinos. In 2018, the American Cancer Society endorsed a reduction from 50 to 45 years in the recommended age at which average-risk adults should initiate screening. Methods: We partnered with Qualtrics to recruit a multi-state convenience sample of self-identified Latino men from sources such as targeted email lists and social media. Eligibility criteria include men who: self-identified as Hispanic or Latino, resided in New York, Florida, or Texas, and understood English or Spanish. Survey was fielded from February to March 2022; 1,371 responses collected. Primary exposure was masculinity barriers, measured using validated Masculinity Barriers to Medical Care (MBMC) scale. Additional exposures were two subscales from the Male Role Norms, Attitudes, and Perceptions associated with CRC Screening instrument, as well as Hispanic or Latino ethnicity: (1) Mexican or Mexican American; (2) Cuban; (3) Puerto Rican; (4) Other Hispanic or Latino. Our main outcomes were self-report of CRC screening and fecal immunochemical test. Intention to obtain CRC screening secondary outcome. Preliminary analyses restricted to participants in the 45–59, 60–75 age categories (N = 611). Results: Among participants, 26% were of Mexican descent, 31% were Puerto Rican, 14% Cuban, 29% other Latino background. Eighty-one percent planned to obtain CRC screening in the future, although only 40% have used a fecal immunochemical test, and 51% have ever had a sigmoidoscopy or colonoscopy. Latino men of other Hispanic ethnicity were more likely to report taking risks with their own health if it benefits their family (P = 0.018). Mexican men were least likely to report trust in healthcare professionals (P = 0.002), and Cuban men were most likely to report receiving quality medical care (P = 0.001). Conclusions: Masculinity barriers to medical care may play an important role in screening attitudes, intentions, and behaviors. It is important to understand the roles of intersecting social identities including race, ethnicity, gender identity and norms in reducing colorectal cancer disparities.

Medical mistrust, culturally targeted message framing, and colorectal cancer screening among African Americans.

Mistrust in the information and treatment provided by medical professionals and organizations hinders cancer screening among African Americans. However, its impact on responses to health messaging aimed at bolstering screening uptake is unknown. The present study examined the effects of medical mistrust on message framing and culturally targeted health messaging about colorectal cancer (CRC) screening. Screening eligible African Americans (N = 457) completed the Group-Based Medical Mistrust scale and then viewed an informational video about CRC risks, prevention, and screening, during which all participants received either a gain or loss-framed message about screening. Half of participants received an additional culturally targeted screening message. After messaging, all participants completed Theory of Planned Behavior measures of CRC screening receptivity, as well as items assessing expectations about experiencing racism when obtaining CRC screening (i.e., anticipatory racism). Hierarchical multiple regressions showed that medical mistrust predicted lower screening receptivity and greater anticipatory racism. Additionally, effects of health messaging were moderated by medical mistrust. Among participants high in mistrust, targeted messaging-regardless of message frame-bolstered normative beliefs about CRC. Additionally, only targeted loss-framed messaging bolstered attitudes toward CRC screening. Although targeted messaging reduced anticipatory racism among participants with high mistrust, anticipatory racism did not mediate messaging effects. Findings indicate medical mistrust may be an important culturally-relevant individual difference to attend to in addressing CRC screening disparities, including its potential to impact responses to cancer screening messaging.

Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans.

Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5-81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02-2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28-2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01-1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03-1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86-0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16-2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.

Justice beliefs buffer against perceived barriers to colorectal cancer screening among African Americans

Objectives African Americans develop and die from colorectal cancer (CRC) more than any other racial group in the United States. Perceived barriers to screening (e.g. embarrassment and financial costs) likely exacerbate these disparities. Identifying psychological factors that can reduce the impact of perceived barriers and encourage CRC screening is therefore critical. This study explored whether believing the world is fairer for oneself than in general (personal justice ascendancy) would moderate the impact that perceived barriers have on receptivity to CRC screening. Method Four-hundred fifty-seven screening eligible African Americans completed measures of beliefs about justice for self and others, as well as perceived barriers to CRC screening. Participants also completed theory of planned behaviour (TPB) measures of screening receptivity (attitudes, norms, perceived behavioural control and intentions). Results Perceived barriers and justice beliefs interacted to predict perceived behavioural control over screening. Perceived barriers were associated with less perceived behavioural control only when personal justice beliefs were low. In turn, perceived behavioural control predicted stronger intentions to obtain CRC screening. Conclusions Interactive effects with perceived barriers highlight that strong personal justice beliefs play an important role in CRC screening and could aid in addressing CRC screening disparities among African Americans.

Abstract PO-035: Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches

Abstract Background: Colorectal cancer (CRC) mortality is 47% higher in African American men and 34% higher in African American women compared to non-Hispanic white men and women. Methods: Nine African American churches in Los Angeles (LA) participated in a one-group pre/post-test pilot study to promote cancer screening (2015-2018). Each church identified 5 Community Health Advisors (CHAs) who received training to recruit study participants ages 50 to 75; assess participants’ adherence to cancer screening guidelines of the U.S. Preventive Services Task Force; and provide one-on-one counseling for participants who were not adherent. Participants completed telephone surveys 3 months after the intervention. The goal of this analysis was to understand CRC screening outcomes among 163 African American participants who were baseline non-adherent to CRC screening guidelines. We fit bivariate and multivariate mixed effects logistic regression models to assess correlates of (1) discussion of CRC screening with provider and (2) receipt of CRC screening during follow-up. Results: 49% of respondents reported that they discussed CRC screening with a provider during the follow-up period and 28% of respondents reported receipt of CRC screening. Respondents who reported that they were counseled by a CHA were more than twice as likely to discuss CRC screening with their provider as those who reported that they did not receive the intervention (54% versus 24%, p<0.005). Those who had a regular doctor, who had more than 3 health care visits in the past 3 months and who had a routine check-up in the past 12 months were also significantly more likely to discuss CRC screening with a provider (all p<.001). Females were almost twice as likely as males to receive CRC screening during the follow-up period than males (35% versus 18%, p<.02) and South LA residents were significantly less likely to receive CRC screening than participants outside of South LA (22% versus 38%, p<.02). Those who had a routine check-up in the past 12 months were also significantly more likely to report receipt of CRC testing during the follow-up period (all p<0.01). Those who had discussed CRC screening with a provider were significantly more likely to obtain CRC screening (p<.001). Knowledge of CRC screening guidelines was low overall but significantly higher among those who received CRC screening than among their counterparts who did not receive screening (p<.02). In multivariable analyses, receipt of CHA counseling (OR 3.77) was significantly associated with discussing CRC screening with a provider during follow-up but not with CRC screening. Residence in South LA (OR 0.38) was significantly associated with lack of CRC screening. Conclusions: Findings confirm the important role of health care providers and suggest that residence in South LA constitutes an additional barrier to CRC screening. Further research and additional resources are needed to address disparities in the uptake of CRC screening among African Americans, especially in South LA. Citation Format: Annette E. Maxwell, Aziza Lucas-Wright, Cindy Chang, Rhonda Santifer, Catherine M. Crespi. Factors associated with colorectal cancer screening in a peer-counseling intervention study in partnership with African American churches [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-035.

A Promotor-Led Pilot Study to Increase Colorectal Cancer Screening in Latinos: The Juntos Contra El Cáncer Program.

Background. Latinos have lower colorectal cancer (CRC) screening rates compared to other racial/ethnic groups in the United States, despite an overall increase in CRC screening over the past 10 years. To address this disparity, we implemented a promotor-led intervention to increase CRC screening test adherence in community-based settings, connecting community members with a partnering federally qualified health center. Purpose. To evaluate the Juntos Contra el Cáncer/Together Against Cancer (JUNTOS) intervention, by assessing pre-post changes in (1) CRC screening test adherence and (2) CRC knowledge and perceived barriers to CRC screening. We also assessed the feasibility and acceptability of program activities. Method. JUNTOS was a group-based intervention, delivered by promotores (community health workers), to promote CRC screening test adherence among Latino adults. The intervention consisted of a culturally tailored 2½-hour interactive workshop followed by an appointment scheduling assistance from a promotor. Workshop participants were Latino adults (males and females) aged 50 to 75 years who were not up-to-date with CRC screening guidelines. We conducted interviews before and 6 to 9 months after the workshop to assess program outcomes. Results. Of the 177 participants included, 118 reported completing the CRC screening test (66.7%) by 6 to 9 months postintervention. We observed baseline to 6- to 9-month increase in CRC knowledge and lower perceived barriers to obtaining CRC screening. Furthermore, the intervention was found to be feasible and acceptable. Conclusion. Results suggest that JUNTOS can be feasibly implemented in partnership with a federally qualified health center. The current study supports group-based CRC interventions in community and clinic settings.

Repeated Cross-Sectional Survey of Knowledge and Attitudes to Colorectal Cancer Screening in Lebanon

The continuous awareness campaigns about Colorectal Cancer (CRC) directed towards the Lebanese population in order to foster preventive medicine are on the rise. The impact has been positive and reported in previous research, although the number of victims is still high. This paper aims to perform a recent cross-sectional study of Lebanese residents’ CRC awareness by comparing the findings of two studies carried out in the years 2016 and 2018. The samples of the current study include 1140 (2016) and 993 (2018) participants who completed a simple structured questionnaire directed to assess their knowledge of colon cancer and the behavioral intentions of obtaining CRC screening. Upon comparing results, the percentage of those who know about CRC has increased significantly from 40.4% in 2016 to 78.7% in 2018, the proportion of respondents who believed that family history is the major risk factor for CRC did increase significantly from 47.7% in 2016 to 90.8% in 2018. Likewise, the proportions of respondents who believed that overweight, age, and stress are among the major risk factors for CRC increased from 26.9%, 26.7% and 11.3% in 2016 to 86.2%, 52.1% and 21.51% in 2018, respectively. On the other hand, the proportions for the risk factors related to alcohol and smoking have dropped from 37.7% and 37.3% to 27.4% and 24.2%, respectively. Moreover, the most important source of information for CRC was friends (18.4% in 2016 versus 73.8% in 2018), followed by family (18.7% in 2016 versus 56.7% in 2018), and then physicians (18.9% in 2016 and 40.2% in 2018). In fact, the efforts of the non-governmental organization (NGO) SAID (118 different major activities in the span of 3 years) did make a significant difference in what relates to CRC awareness among the Lebanese population. These findings are used to encourage and support other NGOs to adopt targeted new awareness campaigns which have proven successful, and to present evidence based on facts to government officials in the Ministry of Health to support and possibly sponsor national awareness campaigns and preventive efforts to mitigate CRC levels.

Factors Influencing Colorectal Cancer Screening Among Thais in the U.S.

This study examined factors related to colorectal cancer (CRC) screening uptake among Thais in the United States. A total of 121 Thais between 50 and 75years of age, who were married and living in southern California participated in the survey (mean age = 61years). Out of all the participants, only 21% of the participants had fecal occult blood tests, 21% had sigmoidoscopy, and 45% had colonoscopy that were within the recommended period. Overall, 55% of participants met CRC screening adherence criteria. Participants who had had regular checkups in the previous 2years without having any symptoms were 16 times more likely to have obtained CRC screening than their counterparts (OR 16.01, CI 3.75-68.75) in the multivariable logistic regression model. Other significant predictors of screening adherence included older age (OR 1.08, 95% CI 1.00-1.17), having lived in the U.S. 15years or longer (OR 6.65, 95% CI 1.55-28.59), having had at least some college education (OR 3.74, 95% CI 1.23-11.37), and higher levels of perceived self-efficacy (OR 1.88, 95% CI 1.01-3.50) to obtain CRC screening. Targeted interventions for Thais who are less likely receive CRC screening could be effective in improving CRC screening. Interventions to improve the populations' awareness of the importance of preventive measures when they are not sick could be also effective.

Abstract C71: Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members

Abstract Background: With colorectal cancer (CRC) persisting as the second leading cause of cancer deaths in the US, it is imperative that screening perceptions and behaviors among underserved populations be investigated and better understood. Latinos have exhibited lower rates of maintaining consistent and timely screening measures for CRC: while nearly 61% of non-Hispanic whites are screening regularly for CRC, Latinos fall behind at just below 45%. Federally Qualified Health Centers (FQHCs) attempt to address this disparity by providing outreach and screening services to medically underserved patients. In 2014, approximately 13% of FQHC patients nationwide self-identified as Latino; this underscores this population's need for affordable and tailored care. As the passing of the Affordable Care Act has gradually increased access to health care among Americans who had previously been uninsured, FQHCs have a unique opportunity to implement interventions that target populations and individuals who now have access to regular care. Objective: The purpose of the present study was to identify discrepancies in perceptions of CRC screening and willingness to screen among FQHCs staff and Latino community members living in San Diego, California. In-depth interviews (n=17) were held with health care providers and staff at local FQHCs (mean age: 38.8 years; 64.7% female; 88.2% Latino) and five focus groups (n=39) were conducted with community members who reside in neighborhoods served by FQHCs (mean age: 59.4 years; 79.5% female; 97.4% Latino). Method: Using standardized interview and focus group guides based on Social Ecological Model (SEM), FQHCs staff and community members were asked to describe their experience with CRC screening. Beliefs, attitudes, and perceptions regarding CRC screening and related referrals were also discussed. Interviews and focus groups were audio recorded and transcribed, and content analysis was used to create a codebook based on SEM. Two coders independently reviewed transcripts and applied codes, meeting to resolve inconsistent coding via consensus. Data were summarized according to two themes: 1) patient-level facilitators and barriers to CRC screening and 2) organizational barriers to CRC screening. Results: While patients often reported feeling that they had access to medical information and had a grasp of the basic tenets of preventive health care, FQHCs staff consistently reported a lack of CRC-specific knowledge among patients in their clinics. Community members' reported willingness to screen for CRC was higher than FQHCs staffs' perception of it. FQHCs patients were viewed by staff as being afraid or embarrassed to screen, while community members generally reported feeling comfortable with CRC screening methods. FQHCs staff identified organizational barriers, such as the fragmentation of the referral process and a lack of knowledge of appropriate screening procedures. Organizational facilitators at FQHCs were also identified, including the option of mailing completed fecal immunochemical tests (FIT) to labs as well as the overall cohesion and organizational capacities of the FQHCs' Electronic Health Record systems. Additionally, FQHCs staff reported having implemented a pilot program that sought to aid patients in understanding the importance and processes of using the FIT kit as well as facilitating the completion and return of FIT tests. Discussion: The present study's findings suggest FQHCs staff may lack confidence in their patients' abilities and knowledge in obtaining CRC screening. Several discrepancies were noted with regard to patients' willingness and ability to obtain CRC screening. Interventions that work to improve communication between FQHC staff and patients would be beneficial to the Latino populations living in this region. Citation Format: Elizabeth N. Alpert, Sumayah Nuhaily, Carolina López De la Torre, Jessica Haughton, Samir Gupta, Jesse Nodora, Balambal Bharti, Christian Ramers, Felipe Garcia, Tatianna Clark, Claudia Carrizosa, Elva M. Arredondo, Kristen J. Wells. Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C71.

Targeting and tailoring message-framing: the moderating effect of racial identity on receptivity to colorectal cancer screening among African-Americans.

This study demonstrates the potential of racial identity to moderate how gain and loss-framed messaging, as well as culturally-targeted messaging, can affect receptivity to preventive health screening. African-Americans (N = 132) who were noncompliant with recommended colorectal cancer (CRC) screening completed a measure of racial identity centrality-encompassing the extent to which racial identity is a core component of self-concept-and then participated in an online education module about CRC screening, during which either gain or loss-framed messaging was introduced. Half of African-Americans were also exposed to a culturally-targeted self-help message about preventing CRC. Theory of Planned Behavior measures of attitudes, normative beliefs, perceived behavioral control, and intentions to obtain a CRC screen served as outcomes. Results confirmed that effects of messaging on receptivity to CRC screening depended on racial identity. Among low racial identity African Americans, gain-framed messaging most effectively increased normative beliefs about obtaining CRC screening, whereas among high racial identity African Americans loss-framed messaging was most compelling. However, these effects most strongly emerged when culturally-targeted self-help messaging was included. We discuss implications for health disparities theory and research, including a potential to simultaneously deploy culturally-targeted and tailored messaging based on racial identity.

Colorectal Cancer Screening Uptake's Association With Psychosocial and Sociodemographic Factors Among Homeless Blacks and Whites.

The homeless represent an extremely disadvantaged population that fare worse than minority groups in access to preventive services and health, and minority groups fare worse than Whites. Early detection screening for colorectal cancer (CRC) saves lives, but empirical data about CRC screening practices among homeless Blacks and Whites are limited. Psychosocial risk factors may serve as a barrier to CRC screening completion among homeless Black individuals. A secondary data analysis of a randomized clinical trial for smoking cessation among homeless smokers was conducted to determine whether psychosocial factors and sociodemographic factors were more highly associated with CRC screening uptake among homeless Blacks than among their White counterparts. Study participants ( N = 124) were surveyed on their CRC screening status, sociodemographic variables, and psychosocial correlate measures including anxiety, depression, hopelessness, depression severity, and perceived stress. Associations between these factors were examined with logistic regression. White participants who were currently disabled/unable to work were 6.2 times more likely to ever receive CRC screening than those who were employed. Black participants with public health insurance coverage were 90% less likely to ever obtain CRC screening than participants without health insurance. Black and White participants had similar levels of anxiety symptoms, depression, and hopelessness, yet depression was the only psychosocial variable negatively associated with CRC screening status. Black and White participants with symptoms of depression were 58% less likely to complete screening than those without depression. Mental health risk and sociodemographic factors may serve as barriers to CRC screening among homeless Blacks and Whites.

Clinical utility of a blood-based protein assay to increase screening of elevated-risk patients for colorectal cancer in the primary care setting.

Colorectal cancer (CRC) screeningis effective in finding early stage CRC and dramatically improves survival rates. Despite this, the number of eligible patients who do not obtain CRC screening is unacceptably high. We conducted a longitudinal, randomized controlled trial investigating the utility of a blood-based protein assay on the quality of care delivered by practicing PCPs in the United States. We used standardized simulated patients (CPVs), presenting with symptoms suggestive of a higher likelihood of CRC, to measure how frequently these PCPs ordered diagnostic colonoscopy. 190 PCPs cared for three patients at baseline and three patients post-intervention. The PCPs were randomized into one of two study arms: control and intervention. The intervention arm consisted of educational materials about the blood-based protein assay and positive test results. Each simulated patient in the intervention arm had a positive test result that was given to the doctor. The controls were given neither intervention materials nor blood-based protein assay results. Physician responses in both groups were scored against evidence-based criteria. Data were collected at baseline and post-intervention. At baseline, we found that 71% of physicians ordered diagnostic colonoscopy. In round 2, 23% of physicians in the intervention arm adopted the new blood-based protein assay. Ordering physicians were 3.88 (95% CI 1.67-9.03) times more likely to order a diagnostic colonoscopy. In percentage terms, those who ordered the assay were more likely to order colonoscopy (92%) than either intervention physicians who did not order the assay (77%) or control physicians (66%) (p<0.001). A marginal effects estimation showed that use of the assay would increase ordering colonoscopy to nearly 95%. Over one-third of adults in the United States do not follow the recommended screening guidelines for CRC. The introduction of a blood-based protein assay significantly increased the likelihood that physicians would order diagnostic colonoscopies in elevated-risk patients compared to those without access to the assay results. The overall change in clinical utility observed here has the potential to significantly improve clinical care.

Abstract B82: Predictors of intention to obtain colorectal cancer screening among African American men in a state fair setting

Abstract Racial disparities in health among African American men in the United States are appalling: African American men have the highest mortality and incidence rates from colorectal cancer (CRC) compared to all other ethnic, racial, and gender groups. Juxtaposed to their white counterparts, African American men have CRC incidence and mortality rates 25% and 50% higher, respectively. CRC is a treatable and preventable condition when detected early, yet the intricate factors influencing African American men's intention to screen remain understudied. Employing a non-experimental, on-line survey research design at the Minnesota State Fair, the purpose of this study was to explore whether male role norms affect knowledge, attitudes, and intention to screen for CRC directly, or mediated by perceived barriers, among 297 African American men. As hypothesized, these Minnesota men (ages 18-65) lacked appropriate CRC knowledge: only 33% of the sample received a “passing” knowledge score (85% or better). In a logistic regression model, the three factors significantly associated with a higher probability of obtaining CRC screening were age, perceived barriers, and perceived subjective norms. Findings from this study provide a solid basis for informing health policy and designing health promotion and early-intervention CRC prevention programs that are responsive to the needs of African American men in Minnesota and beyond. Citation Format: Charles R. Rogers, Patricia Goodson, Lindsey R. Dietz, Kola S. Okuyemi. Predictors of intention to obtain colorectal cancer screening among African American men in a state fair setting. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B82.

Abstract B74: Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients

Abstract Asian Americans have much lower colorectal cancer (CRC) screening rates than other ethnic groups, even after controlling for access and language factors. According to a national report, Chinese Americans (the largest Asian subgroup) had the lowest screening rates. Their low screening rates were largely attributed to the lack of physicians' recommendations, in addition to lacking screening knowledge and stressing self-care over medical checkups. Thus, we conducted a cluster randomized controlled trial to examine whether an intervention group of Chinese-speaking primary care physicians would motivate their Chinese-speaking patients to obtain higher rates of CRC screening versus usual care practice (control group). The physician-based intervention was culturally targeted and guided by social cognitive theory. It consisted of two components: a communication guide describing and responding to Chinese patients' screening barriers and two in-office training sessions mimicking real life medical encounters to practice the guide. Twenty-five Chinese primary care physician practices from Washington DC, Philadelphia, and New York City were enrolled and randomized (13 to intervention and 12 to control). Patients aged 50 -75 years, non-adherent to CRC screening guidelines, and were active patients of the 25 physicians were eligible. In total, 371 out of 458 consented patients who completed both of the baseline assessment and 12-month post-baseline follow-up via telephone were included in the outcome analysis. Physicians were blinded about their patients' participation until the follow-up assessment was completed. The end outcome was patients' self-reported receipt of CRC screening. Medical verification of the self-reported screening was conducted among 20% of the screened patients. Validated measures were used to assess physicians' knowledge of screening guidelines, self-efficacy in communication, and outcome expectancies, as well as patients' knowledge, self-care views, and perceived quality communication with physicians about CRC screening. We examined the screening outcome by two-sample t-tests, due to a balanced randomization of physician practices, and ran hierarchical logistic regression models to examine the impact of physician and patient factors in the screening outcome. The weighted (by sample size) CRC screening rates after one year of follow-up were .31 for the intervention group and .23 for the control group. The 8 percentage point difference was not statistically significant (P=.17), even after adjusting for group differences in patient characteristics. Self-reported screening was 100% consistent with medical records among those who were verifiable. Patients who had better knowledge, lower self-care views, and perceived better communication with physicians were more likely to obtain CRC screening after controlling for group assignment and patient demographics. Overall, the physician-based intervention led to a modest increase in Chinese patients' CRC screening rates, although patients in the intervention group had a greater increase in knowledge and perceived quality communication (both p&amp;lt;.01). Many of our physicians reported a time constraint in reading through the communication guide and attending the intervention. This might have limited their capacity to maximize the intervention effects. Educating Chinese patients about CRC screening and how to communicate with physicians may be an efficient alternative to promote their overall screening rates. Citation Format: Judy Huei-yu Wang, Grace X. Ma, Wenchi Liang, Edmund Gehan, Yin Tan, Kepher MaKambi, Yiru Wang, Sally W. Vernon, Shin-Ping Tu, Jeanne Mandelblatt. Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B74.

Abstract A40: Promoting colorectal cancer education: A partnership facilitated program evaluation examining generalizability across diverse populations

Abstract Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths among men and women with over 96,000 new cases and 50,000 individuals expected to die from the disease in 2014. Cancer mortality rates, however, are higher among certain ethnic populations including Hispanics and American Indians/Alaska Natives (AI/AN). Through education and screening, CRC can be successfully detected early and treated before it progresses to advanced stages. The purpose of this study was to evaluate the effectiveness of a partnership-facilitated colorectal cancer education program across different ethnic populations in two U.S. regions. Pre/post design was used to measure changes in CRC knowledge as well as behavioral intentions to obtain screening and share CRC information obtained with others. Methods: The National Cancer Institute's National Outreach Network (NON) Community Health Educators (CHE) at New Mexico State University (NMSU) and at the Fred Hutchinson Cancer Research Center (FHCRC), a Comprehensive Partnership to Advance Health Equity (CPACHE) program, collaborated to develop an assessment tool that would evaluate the Inflatable Colon (IC) as a CRC educational tool across diverse ethnic populations. Instrument: NON CHE developed a pre/post-test assessment questionnaire based on literature reviews; questions asked about CRC knowledge, intention to obtain screening, and intention to disseminate CRC information. Procedure: In New Mexico, individuals at an educational institution were recruited to participate in this study, whereas participants in Eastern Washington were recruited at community health events. All study participants received the pre-test prior to touring the IC and the post-test after completing the IC tour. Results: A total of 1,286 individuals from Southern New Mexico and Eastern Washington participated in this study, 60% were males. We conducted a repeated measures analysis of covariance, including study site, age, education, insurance, regular doctor, and history of CRC as covariates. Analyses found a significant interaction by race/ethnicity and time, F (2, 1181) = 3.29, p = .04. After adjusting for covariates, there were significant differences in CRC knowledge across race/ethnicity, F (2, 1188) = 2.94, p = .05. Hispanic participants had a significantly greater change in knowledge relative to non-Hispanic whites (NHW). There was also a non-significant trend concerning AI/AN participants and NHW. Hispanic and AI/AN participants had greater change in intentions to obtain a CRC screening in the future relative to NHW. Subsequent post-hoc comparisons revealed that, relative to NHWs, Hispanics reported being more likely to intend to discuss CRC with their parents, p = .02, and grandparents, p = 0.003. AI/AN participants were also less likely to report to intend to discuss CRC with their parents, p = .04. Conclusion: This study examined the generalizability of a partnership-facilitated CRC educational program and assessment tool across different US populations and its effectiveness in increasing CRC knowledge as well as behavioral intention to obtain CRC screening and disseminate CRC information. This study suggests that the IC is an effective educational tool for increasing cancer knowledge and behavioral intentions among diverse ethnic populations. Complementing the IC intervention with access to free CRC screening, such as the FOBT kits, has the potential to address the CRC mortality disparities through the promotion of screening among certain ethnic populations and among those at a higher risk for CRC. Citation Format: Janeth I. Sanchez, Katherine Briant, Yamile Molina, Noah Espinoza, Nathan Marchello, Rebecca Palacios, Beti Thompson, Mary O'Connell. Promoting colorectal cancer education: A partnership facilitated program evaluation examining generalizability across diverse populations. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A40.

Abstract A59: The inflatable colon is a unique tool for educating people about colorectal cancer in New Mexico and Washington states

Abstract Background: As the second leading cause of cancer-related deaths in the United States (US), colorectal cancer (CRC) may be prevented through screening along with early education to promote screening. In the past decade, an NCI-funded Partnership comprised of New Mexico State University (NMSU), a minority serving institution, and the Fred Hutchinson Cancer Research Center (FHCRC), a comprehensive cancer center, have increased the cancer outreach programs in their respective communities by targeting underserved populations. Purpose: In both sites, education about CRC has taken place during a tour through an Inflatable Colon (IC). In this study, we focus on the similarities and differences among the two sites. Methods: Each site, NMSU and FHCRC, measured gains in CRC knowledge and intention to be screened, but engaged distinct populations and measured site specific outcomes. In New Mexico (NM), study participants included 485 college faculty, staff, and students, 67% female, between 20 and 69 years of age. Ethnic comparisons were limited to non-Hispanic Whites (NHW) (31%) and Hispanics (51%) due to the low sample size for other race/ethnicities in this group. Overall, the NM participants demonstrated significant increases in CRC knowledge and awareness after touring the inflatable colon (p-values &amp;lt; .001). Interestingly, both NHW men and Hispanics started off with lower CRC awareness at pre-test, but exhibited maximum awareness gains equal to that of women and NHWs after touring the colon. Behavioral intentions to obtain CRC screening in the future and to promote CRC awareness also significantly increased (p-value &amp;lt; .001). Gender differences in behavioral intentions to act as advocates for CRC education were found (p &amp;lt; .05), with women being more likely to educate others about CRC than men. In the Yakima Valley of Washington State, pre- and post-surveys were collected from 947 participants (76.4% Hispanic, 12.3% NHW, and 7.8% Native American) who toured the inflatable colon. Of the respondents, 76% were female. Knowledge about CRC increased significantly from pre-test to post-test (p &amp;lt;0.001). A comparison of those under 50 years of age with those 50 and older showed no differences in knowledge at post-test; they were uniformly high. There was also a significant increase in those who stated they were likely to be screened, from 64.3 at pre-test to 79.3 at post-test (p&amp;lt;0.01). There were no significant differences by gender or ethnicity. Conclusions: The results from both of these areas showed that using a novel educational tool, such as the walk through colon, can increase CRC knowledge and intention to be screened. Use of the inflatable colon educational tool with both young and age-eligible (&amp;gt; 50 years of age) adults may facilitate the dissemination of CRC information among social networks of both groups of adults. The partnership between the research studies permits comparisons of the results of both studies on a wide array of ethnic- and age-disparate populations. Citation Format: Janet Sanchez, Rebecca Palacios, Katherine Briant, Elizabeth Carosso, Mary O'Connell, Beti Thompson. The inflatable colon is a unique tool for educating people about colorectal cancer in New Mexico and Washington states. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A59. doi:10.1158/1538-7755.DISP13-A59

Colorectal cancer screening: what do women from diverse ethnic groups want?

Little is known about factors associated with willingness to undergo colorectal cancer (CRC) screening for personal or public health benefit among women from diverse race/ethnic groups. To evaluate factors associated with willingness to undergo CRC screening for personal and public health benefit among women from diverse race/ethnic groups. We interviewed women aged 50 to 80 from four racial/ethnic groups from primary care clinics in 2003-2005. We asked about demographics, CRC screening knowledge and history, perceived risk of colon cancer, and about the outcomes of intention to be screened for personal benefit and for public health benefit. Of the 492 women who completed the interview, 32 % were White, 16 % were African American, 21 % were Latina and 32 % were Asian. Up-to-date screening was reported by 77 % of women, with similar numbers obtaining fecal occult blood test (FOBT) within 2 years or colonoscopy within 10 years. The majority of women were "likely or very likely" to get FOBT or colonoscopy after learning the benefits and risks. Multivariate models showed that compared to Whites, fewer Asians would undergo colonoscopy (OR = 0.28; 95 % CI: 0.12, 0.63), while more Latinas would undergo colonoscopy (OR = 6.14; 95 % CI: 1.77, 21.34) and obtain regular CRC screening (OR = 4.47; 95 % CI: 1.66, 12.04). The majority would obtain CRC screening even if they would not personally benefit; those who perceived themselves to be at higher than average cancer risk were more likely to participate in CRC screening for public health benefit (OR = 2.32; 95 % CI: 1.32, 4.09). The majority of women are willing to undergo screening for personal benefit. Asians were less likely, and Latinas more likely, to accept colonoscopy. Most are also willing to undergo screening for public health benefit. Self-perceived risk of CRC was the most consistent predictor of willingness and intention to be screened for either personal or public health benefit.

Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: which groups are most vulnerable?

Background. Colorectal cancer (CRC) is a significant cause of mortality among Asian Americans and Pacific Islanders (AAPIs), yet studies have consistently reported lower CRC screening rates among AAPIs than among non-Latino Whites and African Americans. Moreover, existing research tends to aggregate AAPIs as one group when reporting CRC screening, masking the disproportionate burden in cancer screening that exists across AAPI groups. Methods. This study examines differences in CRC screening rates in both aggregated and disaggregated AAPI groups as compared with non-Latino Whites in order to identify the most vulnerable AAPI subgroups in terms of obtaining CRC screening. This study utilizes merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS), specifically the data pertaining to adults aged 50 and older (n=52,491) from seven AAPI groups (Chinese, Japanese, Korean, Filipino, South Asian, Vietnamese, and Pacific Islander) and non-Latino Whites. Andersen's Behavioral Model of Health Services Use was utilized to select potential confounders to racial/ethnic differences in CRC screening. Results. When AAPI groups were considered as an aggregate, their CRC screening rate (46.8%) was lower than that of non-Latino Whites (57.7%). When AAPI groups were disaggregated, further disparity was noted: Koreans (32.7%) showed the lowest CRC screening rate, whereas Japanese (59.8%) had the highest. When the influence of potential predisposing, enabling, and need confounders was adjusted, Koreans, Filipinos, and South Asians were found to have a lower likelihood than non-Latino Whites to undergo CRC screening. Comparisons among AAPI subgroups further revealed that Filipinos, Koreans, Pacific Islanders, and South Asians were less likely than Chinese, Japanese, and Vietnamese to receive CRC screening. Conclusion. These results highlight the importance of identifying differences in CRC screening behavior among disaggregated AAPI subgroups in order to help health professionals and policy-makers prioritize which AAPI subgroups need the most urgent interventions in terms of CRC screening promotion.