title: Against colorectal cancer in our neighborhoods (ACCION): A comprehensive community-wide colorectal cancer screening intervention for the uninsured in a predominantly Hispanic community.
abstract: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Screening is widely recommended but underutilized, particularly among the low income, the uninsured, recent immigrants and Hispanics. The study objective was to determine the effectiveness of a comprehensive community-wide, bilingual, CRC screening intervention among uninsured predominantly Hispanic individuals. This prospective study was embedded in a CRC screening program and utilized a quasi-experimental design. Recruitment occurred from Community and clinic sites. Inclusion criteria were aged 50-75years, uninsured, due for CRC screening, Texas address and exclusions were a history of CRC, or recent rectal bleeding. Eligible subjects were randomized to either promotora (P), video (V), or combined promotora and video (PV) education, and also received no-cost screening with fecal immunochemical testing or colonoscopy and navigation. The non-randomly allocated controls recruited from a similar county, received no intervention. The main outcome was 6month self-reported CRC screening. Per protocol and worst case scenario analyses, and logistic regression with covariate adjustment were performed. 784 subjects (467 in intervention group, 317 controls) were recruited; mean age was 56.8years; 78.4% were female, 98.7% were Hispanic and 90.0% were born in Mexico. In the worst case scenario analysis (n=784) screening uptake was 80.5% in the intervention group and 17.0% in the control group [relative risk 4.73, 95% CI: 3.69-6.05, P<0.001]. No educational group differences were observed. Covariate adjustment did not significantly alter the effect. A multicomponent community-wide, bilingual, CRC screening intervention significantly increased CRC screening in an uninsured predominantly Hispanic population.
authors: Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States. Electronic address: navkiran.shokar@ttuhsc.edu.
authors: Navkiran K
authors: NK
authors: Shokar
authors: Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9430, Lubbock, TX 79430-9430, United States. Electronic address: Theresa.byrd@ttuhsc.edu.
authors: Theresa
authors: T
authors: Byrd
authors: Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States. Electronic address: Rebekah.salaiz@ttuhsc.edu.
authors: Rebekah
authors: R
authors: Salaiz
authors: Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States. Electronic address: Silvia.flores@ttuhsc.edu.
authors: Silvia
authors: S
authors: Flores
authors: Department of Family and Community Medicine and Biomedical Sciences, Texas Tech University Health Sciences Center-El Paso, 9849 Kenworthy Street, El Paso, TX 79924, United States. Electronic address: maria.chaparro@ttuhsc.edu.
authors: Maria
authors: M
authors: Chaparro
authors: Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Office of Diversity Affairs, 5001 El Paso Drive, El Paso, TX 79905, United States.
authors: Jessica
authors: J
authors: Calderon-Mora
authors: Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Regional Brownsville Campus, 80 Fort Brown, Brownsville, TX 78520, United States. Electronic address: Belinda.M.Reininger@uth.tmc.edu.
authors: Belinda
authors: B
authors: Reininger
authors: Department of Biomedical Sciences, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, United States.
authors: Alok
authors: A
authors: Dwivedi
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D017057:Medically Uninsured; D008875:Middle Aged; D009780:Occult Blood; D011203:Poverty; D011446:Prospective Studies; D013781:Texas
keywords: Colorectal neoplasms; Community health education; Community health workers; Early detection of cancer; Hispanic Americans; Intervention studies; Medically uninsured; Occult blood; Patient navigation