The proposed research will study the effectiveness of an intervention designed to promote the provision of appropriate cancer screening services to blue-collar order adults by primary care physicians. Although at high risk for cancer, this group displays low adherence to cancer screening recommendations. A review shows that poor communication between older adults and their physicians is a key barrier. We will test the hypothesis that an intervention for older adults, implemented through senior citizens clubs, will be more effective when reinforced by a low- cost, easily replicable intervention for primary care physicians. Our intervention for older adults is designed to: (1) increase awareness that cancer risk increases with age; (2) alter negative attitudes towards cancer testing and treatment; (3) promote positive attitudes towards communicating with physicians about cancer testing. The presentation to senior citizens groups involves a slide/tape presentation, a guided discussion, distribution of printed materials, and completion of the Health Risk Questionnaire. Several weeks later, participants receive an individualized letter on cancer risk generated through the Health Risk Questionnaire process. Further reinforcement will be provided through primary care physicians who serve the older adults study subjects. A random sample of these physicians will receive educational materials on cancer designed to prompt and facilitate physician efforts to discuss cancer testing with their older patients, and to perform test as appropriate. This study will be implemented in three blue-collar communities. We will assess the effectiveness of the seniors group program through comparison to members of seniors groups who view a control program. We will assess the effects of the intervention for older adults with and without physician-based reinforcement. Through comparisons between the study communities, we will assess the effect of a prior cancer control campaign conducted in one study community on acceptance of our educational messages; and the effectiveness of our intervention among Black blue-collar older adults.
