Low-income, underserved African- Americans have disproportionate colorectal cancer morbidity and mortality. This is partly due to late-stage diagnosis and low receipt of timely screening. Having a usual source of care is a major predictor of screening; however, little is known about specific features of those usual sources of care as they relate to colorectal cancer screening. This proposal assesses specific characteristics of primary care systems associated with receipt of timely screening. Informed by national data and focus groups, a culturally appropriate community clinic-based intervention will be conducted to promote colorectal cancer screening. In striving to help decrease the gap in screening for African-Americans, this project is consistent with NCI's Strategic Plan to Reduce Health Disparities.
The research aims of this proposal are to: Phase I, 1) Characterize the population least likely to receive colorectal cancer screening using nationally representative data (Medical Expenditure Panel Survey linked with the National Health Interview Survey--MEPS/NHIS). 2) Examine MEPS/NHIS to identify barriers and facilitators of colorectal screening in low income and minority groups in community clinics. This includes assessment of features of primary care associated with screening. In, Phase II, the candidate will use these findings to develop and pilot test the feasibility and preliminary effectiveness of a simple low-cost community-clinic based intervention. This intervention will be a randomized controlled trial of a personalized targeted letter to promote colorectal cancer screening, it will be conducted in 360 non-adherent women and men, age 55 and over, from a clinic serving low-income, predominantly African-American persons in Washington, D.C. The findings from phase I (on barriers and facilitators of screening and primary care use) will inform the content of the targeted letter, and the surveys used to assess this intervention. (Yrs 2-5) This award will provide the time and resources for structured and applied educational experiences to ensure the short-term goal of successfully completing this project, and ultimately of becoming an independent investigator. Major endpoints will be: 1.) Published papers on features of primary care associated with adherent colorectal screening for low-income adults; and, on the feasibility of the clinic intervention. 2.) Submission of an R01; and, 3.) Disseminating findings to those who impact services for low- income persons. A physician-researcher trained in preventive medicine and public health, the candidate has potential to fulfill the goals of the Cancer Prevention, Control and Population Sciences K07 Award and to become a fully independent investigator.
