title: Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials.
abstract: BACKGROUND
  Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans.
  
  
  METHODS
  Cluster randomized comparative trial.
  
  
  METHODS
  From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin.
  
  
  METHODS
  Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls.
  
  
  METHODS
  Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015.
  
  
  RESULTS
  This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date.
  
  
  CONCLUSIONS
  Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.gov NCT00947206.
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California. Electronic address: tung.nguyen@ucsf.edu.
authors.forename: Tung T
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California.
authors.forename: Janice Y
authors.initials: JY
authors.lastname: Tsoh
authors.affiliation: Asian American Research Center on Health, San Francisco, California; NICOS Chinese Health Coalition, San Francisco, California.
authors.forename: Kent
authors.initials: K
authors.lastname: Woo
authors.affiliation: Department of Public Health Sciences, University of California, Davis, Davis, California.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stewart
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Gem M
authors.initials: GM
authors.lastname: Le
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Department of Health Education, San Francisco State University, San Francisco, California.
authors.forename: Adam
authors.initials: A
authors.lastname: Burke
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Ginny
authors.initials: G
authors.lastname: Gildengorin
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Rena J
authors.initials: RJ
authors.lastname: Pasick
authors.affiliation: Asian American Research Center on Health, San Francisco, California; The American College of Traditional Chinese Medicine, San Francisco, California.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, California; NICOS Chinese Health Coalition, San Francisco, California.
authors.forename: Elaine
authors.initials: E
authors.lastname: Chan
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Chinatown Public Health Center, Department of Public Health, San Francisco, California.
authors.forename: Lei-Chun
authors.initials: LC
authors.lastname: Fung
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Jane
authors.initials: J
authors.lastname: Jih
authors.affiliation: Asian American Research Center on Health, San Francisco, California; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: McPhee
mesh_terms: D000368:Aged; D001213:Asian; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D010174:Pamphlets; D012495:San Francisco