Bastani Roshan, Glenn Beth A, Maxwell Annette E, Ganz Patricia A, Mojica Cynthia M, Alber Susan, Crespi Catherine M, Chang L Cindy
Fielding School of Public Health, Jonsson Comprehensive Cancer Center, UCLA Kaiser Permanente Center for Health Equity, University of California at Los Angeles, Los Angeles, California.
Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Cancer. 2015 Sep 1;121(17):2951-9. doi: 10.1002/cncr.29403. Epub 2015 May 6.
Ethnic minorities, especially African Americans and Latinos, bear a disproportionate burden of colorectal cancer (CRC), as reflected in incidence, cancer stage, and mortality statistics. In all ethnic groups, first-degree relatives (FDRs) of CRC cases are at an elevated disease risk. However, underuse of CRC screening persists and is particularly evident among minority groups. The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of CRC cases.
A statewide cancer registry was used to recruit CRC cases and through them their FDRs. Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms. The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at 6 months.
The study sample of 1280 individuals consisted of 403 Latino, 284 African American, 242 Asian, and 351 white FDRs. Statistically significant effects were observed for the cumulative print plus telephone intervention at 12 months (26% in the intervention vs 18% in the control group) and the print intervention alone at 6 months (15% in the intervention vs 10% in the control group). The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different. Stratified analyses indicated that the intervention was effective among white, Latino, and Asian individuals, but not among African-Americans.
Overall, the intervention was effective in increasing screening rates. Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups, revealing no effect among African American individuals. This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses.
少数族裔，尤其是非裔美国人和拉丁裔，在结直肠癌（CRC）的发病率、癌症分期和死亡率统计数据中承担着不成比例的负担。在所有种族群体中，结直肠癌患者的一级亲属（FDRs）患癌风险更高。然而，结直肠癌筛查的使用率仍然较低，在少数族裔群体中尤为明显。本研究测试了一种逐步干预措施，以提高结直肠癌患者不同种族样本的一级亲属的结直肠癌筛查率。
利用全州癌症登记处招募结直肠癌患者，并通过他们招募其一级亲属。未进行结直肠癌筛查的亲属被随机分为干预组或常规护理对照组。逐步干预包括针对不同种族的个性化印刷材料，随后对6个月时未进行筛查的患者进行电话咨询。
1280名个体的研究样本包括403名拉丁裔、284名非裔美国人、242名亚洲人和351名白人一级亲属。在12个月时，累积印刷加电话干预（干预组为26%，对照组为18%）和仅印刷干预在6个月时（干预组为15%，对照组为10%）观察到统计学上的显著效果。仅印刷干预与累积干预的效果在统计学上无显著差异。分层分析表明，干预在白人、拉丁裔和亚洲个体中有效，但在非裔美国人中无效。
总体而言，该干预措施在提高筛查率方面是有效的。对种族/族裔少数群体进行过度抽样，以便在亚组中检查效果，结果显示在非裔美国人个体中没有效果。这一发现说明了在干预研究中纳入足够数量来自不同种族亚组的参与者以进行此类分层分析的重要性。
