The proposed study is a 5-year randomized controlled community trial to test two interventions designed to promote increased use of colorectal cancer (CRC) screening. The interventions will be tested in 74 churches in Los Angeles County and Honolulu with men and women church members ages 50-75. The interventions comprise a church-level one, Church Leadership Training (CLT) and a member-level one, Targeted Print (TP). CLT targets pastors and other key church leaders through training workshops to increase public health awareness throughout the organization with a focus on promoting CRC screening. This proposal is a competing continuation application that builds on a previous trial in Los Angeles churches that successfully tested a targeted print intervention to increase mammography screening. In this study, TP will target older church members through mailings that address barriers to CRC screening. Low to moderate income Asians, blacks, Hispanics and whites will be the focus population. We propose a 2-site study in Los Angeles and Honolulu using a randomized longitudinal cohort design within each site. 54 churches from Los Angeles and 20 from Honolulu will be randomized into 3 study conditions (2 interventions and a minimal contact control). 2,700 church members from Los Angeles and 1,000 from Honolulu will be followed over 3 years to study the effectiveness and cost-effectiveness of the 2 interventions on regular CRC screening. A church-wide evaluation, consisting of extended interviews with pastors and other key church leaders, will be conducted to develop case studies. This qualitative assessment will contribute to an appreciation of the impact of research studies on church organizations. Several strengths of this study include testing a church-level vs. a member-level intervention to promote CRC screening, the use of extensive church pilot data to establish the feasibility of this study, a design that allows generalizations about the efficacy of church-based health promotion programs, and a quantitative and qualitative approach that broadens our understanding of using urban churches to reach underserved groups.
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