John R. Ureda - US grants

DESCRIPTION (provided by applicant): Elimination of the glaring colorectal cancer-related disparities in African Americans (AA) IS POSSIBLE. In this community based participatory research project (CPBR), we address both the SUPPLY and DEMAND components of the solution. Employing the community consultants and physicians successfully trained in Phase I, we have an adequate provider base to satisfy the increased demand resulting from this faith oriented barrier-free colonoscopy screening initiative. Colorectal cancer (CRC) is predominately preventable through screening for and removal of precancerous polyps. Unfortunately every year over 50,000 Americans of all races die unnecessarily. Multiple barriers result in an unacceptable disparity in both incidence and mortality for the AA, with the result that the death rate for AA males with advanced CRC cancer is double that for white males. The discovery of the evolution of CRC from benign polyps gives physicians ample time to remove the offending tissue prior to the development of cancers. The importance for screening in the AA population is accentuated by the documented shorter interval from the appearance of a polyp until its malignant transformation. We also know that colonoscopy is the "gold standard." The current capacity for performing colonoscopy is far below what is needed to screen the at-risk population as recent data reveals that only one-third of the appropriate population is compliant. In addition to capacity issues, many barriers to screening are patient related characteristics such as knowledge, attitudes and beliefs, cultural and ethnic issues, acceptability of screening method(s), ability to pay, and other socioeconomic and environmental issues (i.e. transportation, stigma, social support, etc.). Although over 80% of colonoscopies are provided by gastroenterologists, less than 4% in training are AA, fostering a growing gap in culturally competent colonoscopy providers. Using a triangulated theoretical framework including the Health Belief Model, the Social Cognitive Theory and the RE-AIM Evaluation model, we will further demonstrate a successful solution to addressing both SUPPLY (capacity for colorectal screening) and DEMAND (targeted patient access to and utilization of colorectal screening). The Phase I study confirmed that compliance can be achieved comparable to that for breast cancer screening (75%). The astounding high-rate of neoplasia (4%) emphasizes the critical importance of this endeavor.