For Americans living in poverty, cancer prevention and screening is a lower priority than meeting basic needs. When basic needs are addressed, the likelihood of engaging in these prevention behaviors increases. Strategies to eliminate cancer disparities in disadvantaged populations must recognize and address this fundamental challenge. We propose the first-ever cancer communication research partnership with United Way 2-1-1 (hereafter, 211) - a telephone information and referral system reaching millions of low-income and minority Americans every year and connecting them to locally available resources that can meet their basic needs. This study will: (1) estimate the prevalence of eligibility for cancer control referral in a population of 211 callers;(2) determine whether cancer communication interventions delivered through 211 can increase use of breast, cervical and colon cancer screening, HPV vaccination, smoking cessation and adoption of smoke free home policies;(3) determine how intensive an intervention is needed to bring about these changes;and (4) determine whether the effectiveness of these interventions is enhanced when callers'basic needs have been addressed. A10% random sample of callers to 211 in Missouri will complete a cancer risk assessment during a follow-up call after receiving usual 211 service. Those found to need at least one cancer control service will be eligible to participate in a randomized intervention trial. All trial participants (n=2,880) will receive a telephone referral from 211 to needed cancer control services that are locally available and free. By random assignment in a 2 x 2 factorial design, they will then receive either: (1) Tailored Cancer Communication mailed to their home that provides a clear and simple summary of all information they would need to act on the cancer control referral they received;(2) A Cancer Control Navigator to help them act on the cancer control referral they received;(3) Tailored Cancer Communication + A Cancer Control Navigator: or, (4) No additional intervention (i.e., 211 cancer control referral only, or control). Follow-up at 1 and 4 months post referral will assess whether participants obtained a needed cancer screening, vaccination or prevention service. The study aims are to: (1) Estimate the prevalence of need for cancer screening and prevention in a population of 211 callers and compare these rates to population data from Missouri and U.S., (2) Evaluate effects of Tailored Cancer Communication (TCC) and Cancer Control Navigation fNAV) on use of cancer control services in a randomized trial among 211 callers, and;(3) (Dissemination Research Aim) Determine costs to 211 and effects on quality of service by offering cancer control referrals.
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