Screening for colortectal cancer in an Asian Community Center

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DESCRIPTION (provided by applicant): Colorectal cancer is a leading cause of cancer death among Asian Americans. Screening rates in this ethnic minority are lower than the Caucasian population. The reasons for low screening rates are uncertain, but could include language and cultural barriers. Interventions that target Asian Americans may not be effective if they are not language and culture specific. Specific targeted interventions are complicated because the national origin of Asian Americans is diverse. Colon cancer screening interventions which might occur in the primary care provider office, may not be successful if there are language or cultural barriers, lack of trust, or if individuals do not regularly visit their provider. We propose to study a colorectal cancer educational intervention in a unique setting: an Asian Health and Service Center, which serves more than 13,000 individuals in Portland, Oregon. This is a new paradigm for screening, which takes advantage of the trust and cultural awareness that exists at the community center and does not rely on the primary care provider. 800 Asian Americans, age 50 to 75 years, who have not had any colon screening for at least 5 years, will be randomly assigned to a control arm or an educational intervention which will take place at the community center. The educational intervention will be provided by bilingual staff in the primary language of the subject, and will address cultural barriers to colon cancer screening. All subjects will be offered FOBT cards at the community center. The primary aim will be to determine if rates of completed FOBT testing are higher in the intervention group within 12 months, compared to controls. Secondary analyses will evaluate the impact on knowledge and beliefs of colon cancer screening, explore differences among four Asian subgroups (Chinese, Korean, Vietnamese and Cambodian/Laotian immigrants), and evaluate the appropriate follow-up of the positive and negative FOBT. The proposed study provides an innovative approach to improving screening rates in an underserved community with historically low screening rates. Moreover, the proposal employs a community center model, which could be generalized to other community centers in the United States. We propose to study a colorectal cancer educational intervention in a unique setting: an Asian Health and Service Center, which serves more than 13,000 individuals in Portland, Oregon. This is a new paradigm for screening, which takes advantage of the trust and cultural awareness that exists at the community center and does not rely on the primary care provider.