title: Text message reminders increased colorectal cancer screening in a randomized trial with Alaska Native and American Indian people.
abstract: Alaska Native and American Indian people (AN/AIs) have a high incidence of colorectal cancer (CRC) and CRC-related mortality. Screening can prevent death from CRC, but screening rates are low in racially and ethnically diverse populations. The authors conducted a randomized controlled trial using text messaging to increase CRC screening among unscreened AN/AIs in a tribal health care system in Anchorage, Alaska.
  
  
  
  The intervention entailed up to 3 text messages sent 1 month apart. The authors randomized 2386 AN/AIs aged 40 to 75 years who were eligible for CRC screening to the intervention or usual-care control conditions. Screening status was ascertained from electronic health records 3 months and 6 months after the last text message. Hazard ratios (HRs) were estimated to evaluate the effectiveness of the intervention, stratified by age and sex.
  
  
  
  The intervention increased CRC screening for AN/AIs aged 50 to 75 years (HR, 1.42; 95% confidence interval [95% CI], 0.97-2.09) and aged 40 to 49 years (HR, 1.24; 95% CI, 0.95-1.62). Within both age groups, the HRs were higher for women (HR, 1.69 [95% CI, 1.02-2.80] and HR, 1.37 [95% CI, 1.01-1.88]) compared with men (HR, 1.09 [95% CI, 0.59-1.99] and HR, 0.90 [95% CI, 0.54-1.53]). Interaction analysis yielded P values of .55 and .09, respectively, for age and sex.
  
  
  
  A simple text messaging intervention was found to increase CRC screening rates in AN/AIs, a group with high CRC morbidity and mortality. Text messaging may be a cost-effective means of reducing CRC screening disparities in AN/AIs and other populations. Cancer 2017;123:1382-1389. © 2016 American Cancer Society.
authors.affiliation: Partnerships for Native Health, Washington State University, Seattle, Washington.
authors.forename: Clemma J
authors.initials: CJ
authors.lastname: Muller
authors.affiliation: Southcentral Foundation, Anchorage, Alaska.|United States Public Health Service, Indian Health Service, Region X, Southcentral Foundation.
authors.forename: Renee F
authors.initials: RF
authors.lastname: Robinson
authors.affiliation: Southcentral Foundation, Anchorage, Alaska.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Smith
authors.affiliation: Partnerships for Native Health, Washington State University, Seattle, Washington.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Jernigan
authors.affiliation: Southcentral Foundation, Anchorage, Alaska.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hiratsuka
authors.affiliation: Southcentral Foundation, Anchorage, Alaska.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Dillard
authors.affiliation: Partnerships for Native Health, Washington State University, Seattle, Washington.
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D000072957:Alaska Natives; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D060145:Text Messaging
keywords: Alaska Natives; American Indians; Native Americans; cancer screening; colorectal cancer; randomized controlled trial; text messaging