INCREASING COLORECTAL CANCER SCREENING AMONG AFRICAN AME

结直肠癌(CRC)是美国癌症死亡的第二大原因。临床研究结果表明，通过适当的筛查可以预防相当数量的结直肠癌死亡。尽管包括卫生保健政策研究机构在内的许多医疗机构都建议定期进行结直肠癌筛查，但结直肠癌筛查的参与率仍然很低，特别是与许多其他癌症的筛查相比。结直肠癌筛查远低于《2000年健康人》中提出的2000年目标。的确，结直肠癌筛查是最可预防但又最难预防的疾病之一。这个问题对于非洲裔美国人来说尤其重要，他们不太可能被筛查为CRC，而且这种疾病的预后更差。因此，有必要系统地努力了解对非裔美国人进行CRC筛查的障碍是什么，并采取干预措施增加筛查。以前通过预测健康信息来增加结直肠癌筛查参与率的努力基本上是无效的。之前的尝试存在一个问题，那就是基本上没有效果。以往尝试的一个问题是，无论个人的社会人口背景如何，都只提供一套教育材料。知识水平和关注点。其他与健康相关的行为改变的干预措施(例如，戒烟参与乳腺癌筛查)表明，将这些改变视为分阶段进展的结果(例如，预想、冥想、准备、行动、维持健康行为的改变)并针对每个阶段设计个性化的干预措施是有价值的。旨在改善饮食、增加乳房X光检查和鼓励戒烟的阶段性匹配干预措施已被发现比非阶段匹配干预措施更有效。这项拟议研究的目标有两个：1)评估STGE模型的适用性，以了解非裔美国人结直肠癌筛查的障碍和促进者；2)开发阶段匹配干预措施，以增加非裔美国人的结直肠癌筛查。我们建议从一家大型城市教学医院的门诊医疗机构评估大约150名健康的非洲裔美国人男性和女性，年龄在51岁或以上。研究参与者将接受采访，以评估他们接受CRC筛查的准备程度。其他因素包括有关结直肠癌筛查的知识以及相关的心理和人口统计变量(例如，医生的影响、感知的易感性、性别)。这次访谈的数据分析将导致在非裔美国人中开发一种促进和阻碍儿童结直肠癌筛查的模式，将根据该模式设计增加儿童结直肠癌筛查的干预材料。干预材料随后将在最初的150人中由10人组成的焦点小组进行评估。在焦点小组评估的基础上，干预材料将在第二个焦点小组中修订和重新评估。所有参与研究的人都将接受筛查检查，并将评估他们参加CRC筛查测试(研究过程中的FOBT)的情况。为增加非裔美国人结直肠癌筛查而开发的干预措施将在随后的随机临床试验中进行评估。

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Results from clinical research indicate that a substantial number of CRC deaths could be prevented by appropriate screening. Although regular CRC screening has been recommended by a number of medical agencies including the Agency for Healthcare Policy Research, participation in CRC screening remains low, especially in comparison to screening for many other cancers. CRC screening is well below the year 2000 goals set forth in Health people 2000. Indeed, CRC screening is one of the most preventable, yet least prevented disease. This issue is particularly important for African-Americans who are less likely to be screened for CRC and suffer a worse prognosis from this disease. Thus, systematic efforts to understand what are the Barriers to CRC screening for African-Americans and intervention to increase screening are warranted. Prior efforts to increase CRC screening participation through prevision of health information have been largely ineffective. One problem with previous attempts have been the largely ineffective. One problem with previous attempts have been the provision of a single set of educational materials regardless of the individuals socio-demographic background. Level of knowledge and concerns. Interventions with other health related changes in behavior (e.g., quitting smoking participation in Breast cancer screening) suggest the value of viewing such changes as the result of progression through stages (e.g., pre-contemplation, contemplation, preparation, action, maintenance of changes in health behaviors) and designing interventions individualized to each stages. Staged matched interventions designed to improve diet, increase mammography and encourage smoking cessation have been found to be more effective than non-stage-matched interventions. The goals of the proposed study are twofold: 1) To assess the applicability of a stge-model to understand the barriers and facilitators of CRC screening in African-Americans; and 2) To develop a stage-matched intervention to increase CRC screening in African Americans. We propose to assess approximately 150 healthy African-American men and women, 51 years or older, from an outpatient medical facility of a large urban teaching hospital. Study participants will be interviewed to assess their stage of readiness to undergo CRC screening. Additional factors include knowledge regarding CRC screening as well as relevant psychological and demographic variables (e.g., physician influence, perceived susceptibility, gender). Data analyses from this interview will lead to the development of a model of facilitators and barriers to CRC screening in African-Americans from which intervention material to increase CRC screening will be designed. The intervention materials will then be evaluated in a focus groups with ten participants form the initial 150. Based on the focus group evaluation, the intervention materials will be revised and re-evaluated in a second focus group. All individuals in the study will be offered screening examination and their participation with the CRC screening test (FOBT over the course of the study) will be assessed. The intervention developed to increase CRC screening in African Americans will then be evaluated in a subsequent randomized clinical trial.