Monitoring Community Efforts to Increase Colorectal Cancer Screening in African Americans

Document text

Principal Investigator: John S. Luque
Organization: FLORIDA AGRICULTURAL AND MECHANICAL UNIV
Fiscal Year: 2024
Award: $150,316
Funding agency: National Institute of General Medical Sciences

Project Summary
African Americans continue to experience disparities for colorectal cancer (CRC) incidence and deaths
compared to other racial/ethnic groups in the US and adherence with evidence-based CRC screening
recommendations can reduce these disparities. Advantages of stool-based CRC screening tests compared to
other screening methods include convenience and lower cost. However, stool-based CRC screening generally
must be done annually and individuals who screen abnormally must be able to access and complete a screening
colonoscopy following a positive result on a stool-based test. Patients who are uninsured or have inadequate
health insurance or face financial or structural obstacles may require additional support from their community
health center (CHC) to complete a screening colonoscopy, and CHCs may experience challenges securing
access to colonoscopy for such patients. The Test Up Now Education Program (TUNE-UP) is a 5-year behavioral
clinical trial for African Americans ages 45-64 who are patients at one of two partnering north Florida CHCs and
tests whether an innovative 6-week community health advisor (CHA) intervention can increase stool-based CRC
screening compared to a usual care approach. Participants are surveyed at baseline, 3-months and 9-12 months
to measure the primary study outcome, completion of stool-based screening. In this follow-up monitoring study
now being proposed, we will reestablish contact with TUNE-UP participants and obtain informed consent to
examine if there was a sustained effect of the CHA intervention for two ensuing annual screenings and whether
outcomes vary longitudinally. Thus, we present a time-sensitive proposal to assess repeat annual screening in
this CHC patient cohort. Aim 1 will test the hypothesis that CHC patients who participated in the TUNE-UP trial
and received the CHA intervention will show a higher likelihood of adherence with subsequent stool-based CRC
screening than TUNE-UP participants who had been assigned to the usual care study group. Aim 2 of the
proposed study will utilize a community-partnered participatory research (CPPR) framework to explore the CHC
context for implementing CRC screening educational interventions among African American patients in north
Florida. The proposed TUNE-UP Monitoring Study is significant, innovative and timely in addressing persistent
disparities in CRC incidence and mortality among African Americans through convenient and accessible stool-
based screening in the context of recently updated USPSTF recommendations to begin CRC screening at age
45. Additionally, this research will enable monitoring of CRC preventive screening programs amid the challenges
of the Covid-19 pandemic and will increase understanding of the relationships between decision-making factors
and CRC screening among African Americans. This research program will also improve the research capacity
of Florida A&M University to conduct research in partnership with health centers and involve graduate students.

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outcome><programs><racial minority group><racial minority individual><racial minority people><racial minority population><racial population><racial subgroup><recommended screening><recruit><reduce disparity><reduction in disparity><routine screening><screening><screening guidelines><screening program><screening recommendations><screenings><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><smart phone><smartphone><socio-demographic factors><sociodemographic factors><stool><treatment as usual><usual care>