U01 CRC Project for Vietnamese Americans

Colorectal cancer (CRC) is the second most commonly diagnosed cancer and the third highest
cause of mortality in Vietnamese and Asian Americans. CRC incidence is rising rapidly in
Vietnamese Americans, but they have among the lowest rates of CRC screening (14%) and are
more likely to be diagnosed with advanced stage disease, which is highly preventable. Over
85% of Vietnamese Americans in our region (PA, NJ, and NYC) are foreign-born with limited
English proficiency, have low SES, and live in economically disadvantaged neighborhoods. Many
lack knowledge about CRC risks and screening benefits and have limited access to culturally
appropriate preventive care. Thus, a multilevel intervention is needed to address the
multiple barriers to and determinants of CRC screening in this community. Vietnamese
community organizations (VCOs) serve dynamic social functions and represent an important
resource for addressing this critical health disparity priority by promoting CRC screening.
This project builds on established partnerships and successful work of Center for Asian
Health, Temple University with Vietnamese CBOs that address their overwhelming health
disparities. CBPR principles will be applied to engage 20 VCOs in all phases of planning,
implementing, evaluating, and disseminating a culturally appropriate, theory- and
evidence-based multilevel CRC intervention. The proposed intervention will be guided by
Social Ecological Model, which addresses sociocultural, behavioral and environmental
determinants and intervention strategies at the individual, interpersonal, and community
organizational levels. CDC's Clinical Preventive Services Guidelines for adults 50+ (CPS)
recommend that cancer screenings and other preventive services should be promoted. The
standard CPS will be provided to both intervention and control groups, and intervention group
will receive CPS + multilevel CRC intervention. Specific Aim 1 is to test the hypothesis that
CPS + multilevel CRC intervention will yield higher CRC screening rates compared to CPS
control at 12-month follow up; Aim 2 is to examine whether CPS + multilevel CRC intervention
(which includes CHW-led group education, automated and interactive text messaging and
phone-based peer support) is more effective in changing screening determinants (e.g. KAB,
self-efficacy, risk factors, lifestyles, social support, social norms, access barriers) than
CPS control condition; and Aim 3 is to assess costs and cost-effectiveness of CPS +
multilevel CRC intervention compared to CPS control condition in relation to CRC screening
rates in order to inform future dissemination efforts. In sum, this project represents the
first large-scale community-based randomized controlled trial of a multilevel,
culturally-appropriate CBPR intervention to increase CRC screening among underserved
Vietnamese. If effective, this innovative multilevel CRC intervention can be used as a model
program that has potential generalizability and sustainability in Asian American and other
underserved ethnic communities to impact preventive behaviors at the population level.

Inclusion Criteria:

1. self-identified Vietnamese ethnicity,

2. age 50 and above,

3. accessible by cell telephone,

4. presence in the same geographic study area for a period of one year (to minimize
participant attrition);

5. not enrolled in any CRC intervention (to prevent a potential program impact),

6. do not have the colorectal polyp, CRC cancer or a family history of CRC (first-degree
relative),

7. non-adherent to CRC screening guidelines (never had CRC screening or are overdue for
screening).

Exclusion Criteria:

1. enrolled in any CRC intervention (to prevent a potential program impact)

2. have the colorectal polyp, CRC cancer or a family history of CRC

3. had CRC screening or adherent to CRC screening guidelines