Project 3-Community Health workers United to Reduce Colorectal cancer and CVD among people at Higher risk (CHURCH)

项目摘要/总结 非裔美国人（AA）成年人更有可能合同和死于结直肠癌（CRC）比任何其他 在美国的种族群体中，AA是最不可能接受CRC筛查的， 切除息肉，并在足够早的阶段检测到CRC以进行根治性切除。降低筛查率 与结构性种族主义和其他社会生态因素的下游影响有关。虽然降低 CRC的死亡率最好通过筛查来确定，有令人信服的证据表明炎症性饮食和 其他心血管疾病（CVD）风险因素增加CRC风险。黑人教堂是中心 在AA社区的机构，可以帮助增加获得CRC筛查和解决心血管疾病的风险因素。 社区卫生工作者（CHW）是来自目标社区的受信任的辅助专业人员， 能够通过基于教会的干预，在CRC筛查和CVD风险因素之间建立联系 交付.因此，本研究的总体目标是建立一个全面的、适合文化的社区- 基于CRC的预防模式，双重强调降低CRC风险沿着其CVD风险因素。的 研究干预有两个组成部分：筛查、短暂干预和转诊治疗（SBIRT）， 解决CRC筛查和基于网络的生活方式计划称为“活着！”以解决与以下因素相关的CVD风险因素： 《儿童权利公约》。C.H.U.R.C. H试验（社区卫生工作者联合减少结直肠癌和 高风险人群中的心血管疾病）有四个具体目标：（1）比较 CHW领导的SBIRT（干预）转介为患者（RAU）（患者护理）治疗指南一致性CRC 筛选摄取;（2）评估文化适应CHW连锁的活！（CACA）计划 纳入干预组的饮食炎症评分（DIS）;（3）评价CACA的效果 生活简单7（LS 7）得分的变化;（4）检查多层次的上下文机制， 影响CHW有效性、覆盖范围和实施CRC筛查和CACA的因素 通过混合方法的过程评估活动。鉴于布莱克的广泛影响力 教会，这项研究的结果可以用来告知未来扩大这种多管齐下的干预措施。

PROJECT ABSTRACT/SUMMARY African American (AA) adults are more likely to contract and die from Colorectal Cancer (CRC) than any other racial group in the U.S. AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. Lower screening rates are linked to the downstream effects of structural racism and other socio-ecological factors. Although reducing the mortality from CRC is best accomplished by screening, compelling evidence links inflammatory diets and other cardiovascular disease (CVD) risk factors to increased risk of CRC. Black churches are central institutions in AA communities that can help increase access to CRC screening and address CVD risk factors. Community Health Workers (CHWs), who are trusted paraprofessionals from the target community, may be able to bridge the connection between CRC screening and CVD risk factors through church-based intervention delivery. Thus, the overall goal of this study is to develop a comprehensive, culturally tailored community- based CRC prevention model with a dual emphasis on reducing CRC risk along with its CVD risk factors. The study intervention has two components: Screening, Brief Intervention, and Referral to Treatment (SBIRT) to address CRC screening and a web-based lifestyle program called “Alive!” to address CVD risk factors linked to CRC. The C.H.U.R.C.H. Trial (Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk) has four specific aims: (1) to compare the effect of a CHW-Led SBIRT (Intervention) to Referral As Usual (RAU) (Usual Care) on guideline-concordant CRC screening uptake; (2) to evaluate the effect of a Culturally Adapted CHW-linked Alive! (CACA) program incorporated into the intervention arm on dietary inflammatory score (DIS); (3) to evaluate the effect of CACA on changes in Life Simple-7 (LS7) scores; and (4) to examine the multi-level contextual mechanisms and factors influencing CHW effectiveness, reach, and implementation of CRC screening uptake and CACA activities through a mixed-methods process evaluation. Given the broad reach and influence of Black churches, results from this study can be used to inform future scale up of this multi-pronged intervention.