INCREASING CRC SCREENING AMONG AFRICAN AMERICANS

结直肠癌（CRC）是美国癌症死亡的第二大原因。临床研究的结果表明，通过适当的筛查可以预防大量的CRC死亡。尽管包括医疗保健政策研究机构在内的许多医疗机构都建议定期进行CRC筛查，但CRC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。CRC筛查远远低于《2000年健康人》中提出的2000年目标。事实上，CRC筛查是最可预防，但预防最少的疾病之一。这个问题对于非洲裔美国人尤其重要，他们不太可能接受CRC筛查，并且这种疾病的预后更差。因此，有必要系统地努力了解非洲裔美国人进行CRC筛查的障碍，并进行干预以增加筛查。先前通过预先提供健康信息来提高CRC筛查参与率的努力在很大程度上是无效的。以前尝试的一个问题是基本上无效。以往尝试的一个问题是提供单一的一套教材，而不管个人的社会人口背景如何。知识水平和关注点。对其他健康相关行为变化的干预（例如，戒烟参与乳腺癌筛查）表明将这些变化视为阶段进展的结果的价值（例如，预先考虑、考虑、准备、行动、保持健康行为的变化），并针对每个阶段设计个性化的干预措施。旨在改善饮食、增加乳房X光检查和鼓励戒烟的阶段匹配干预措施被发现比非阶段匹配干预措施更有效。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CRC筛查的障碍和促进因素; 2）制定阶段匹配的干预措施，以增加非裔美国人的CRC筛查。我们建议评估大约150名健康的非洲裔美国男性和女性，51岁或以上，从一个大型城市教学医院的门诊医疗设施。将对研究参与者进行访谈，以评估他们接受CRC筛查的准备程度。其他因素包括关于CRC筛查的知识以及相关的心理和人口统计学变量（例如，医生影响、感知易感性、性别）。从这次采访的数据分析将导致开发一个模型的促进者和障碍，以CRC筛选在非洲裔美国人的干预材料，以增加CRC筛选将被设计。然后，将在一个焦点小组中对干预材料进行评估，从最初的150名参与者中选出10名参与者。根据重点小组的评价，将在第二个重点小组中修订和重新评价干预材料。将为研究中的所有个体提供筛选检查，并评估其参与CRC筛选试验（研究过程中的FOBT）的情况。为增加非裔美国人的CRC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.