Asian Americans, the fastest-growing U.S. racial/ethnic group, have a significantly higher uninsured rate than Whites. Cancer is the leading cause of death among the largest Asian American subgroup – Chinese Americans (more than 70% are immigrants and about 40% have limited English proficiency). Among all types of cancers, colorectal cancer (CRC) is the second leading cause of cancer death and the second most commonly diagnosed cancer for Chinese Americans. Yet, Chinese Americans have the lowest CRC screening rate among all Asian subgroups and other races/ethnicities. Westernized lifestyles also increase Chinese Americans’ CRC risk. A recent trend in the cancer prevention field – famil...

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Asian Americans, the fastest-growing U.S. racial/ethnic group, have a significantly higher uninsured rate than Whites. Cancer is the leading cause of death among the largest Asian American subgroup – Chinese Americans (more than 70% are immigrants and about 40% have limited English proficiency). Among all types of cancers, colorectal cancer (CRC) is the second leading cause of cancer death and the second most commonly diagnosed cancer for Chinese Americans. Yet, Chinese Americans have the lowest CRC screening rate among all Asian subgroups and other races/ethnicities.

Westernized lifestyles also increase Chinese Americans’ CRC risk. A recent trend in the cancer prevention field – family health history (FHH)-based cancer genomics services – holds tremendous potential for reducing cancer morbidity and mortality by providing FHH-based, individualized lifestyle and cancer screening recommendations. These services, however, are not effectively employed due to lay individuals’ lack of FHH collection.

Following national efforts to urge Americans to gather FHH information and further adopt FHH-based lifestyle and medical recommendations, researchers have conducted FHH interventions for Whites, Blacks, and Hispanics. Nevertheless, Chinese Americans are underserved in FHH-based services due to the lack of culturally/linguistically appropriate FHH educational programs, FHH collection and tailored prevention messages tools, and health insurance to access to health care. To bridge this gap, this resubmitted academic-community collaboration project seeks to develop, implement and evaluate the first theoretically-driven, culturally/linguistically appropriate FHH-based CRC prevention and navigation to clinical services program among uninsured Chinese Americans in Texas.

We will collaborate with three Asian American community organizations that provide health insurance enrollment assistance for uninsured Chinese Americans in Houston-the Woodlands-Ford Bend Metro Area, Dallas-Fort Worth-Arlington Metro Area, and Austin-Round Rock-San Macros Metro Area of Texas (about 83% of Texas Asian Americans lives in these areas).

Our program will include CRC prevention education, FHH instruction, an FHH collection and tailored prevention messages tool, health insurance enrollment, and assistance navigating clinical services. The impact of the FHH-based program upon participants’ behaviors (i.e., collecting FHH from family members, visiting doctors’ offices for discussing FHH, adopting healthier lifestyles in diet, physical activity, alcohol and tobacco use, and adhering to personalized CRC screening recommendations) and theoretical mediators shaping such behaviors (i.e., knowledge, attitudes, self-efficacy, barrier, and intention) will be evaluated by pre-test, 6-, and 12-months post-intervention surveys.

Specific Goals: Goal 1: Develop the first theoretically-driven, culturally/linguistically appropriate FHH-based CRC prevention and navigation to clinical services program. The initial program will be pilot tested with 50 uninsured Chinese Americans. Goal 2: Adopt the pilot test findings to implement the FHH-based program with 800 uninsured Chinese Americans. Goal 3: Evaluate the effectiveness of the FHH-based program on participants’ FHH collection, lifestyle changes, doctor visits, and CRC screening adherence at the 6- and 12-months post-intervention.

The proposed project will serve 850 uninsured Chinese Americans and reach about 20,850 Chinese Americans through program advertisements and dissemination from various community outreach activities (e.g., TV, radio, workshops, social media, newspapers/newsletters, and health fairs).

Cancer genomics (personalized FHH-based prevention) is a new research area. CRC is highly associated with FHH and preventable through CRC screening and lifestyle changes. This project is the first to propose a comprehensive development of a culturally/linguistically appropriate FHH-based program with two components – the FHH-based CRC prevention education and navigation to clinical services assistance. Moreover, previous cancer prevention programs often provided cancer screening at limited service sites and/or failed to sustain their programs after the end of the project.

Our program will help uninsured Chinese Americans enroll in health insurance plans and further teach them how to use health insurance and select/visit their family doctors. This will empower participants to continuously access and utilize healthcare after the end of the project.

This project will reduce disparities in FHH-based services by improving the collection of FHH, the communication of FHH with doctors, health behaviors, and CRC screening adherence among uninsured Chinese Americans in Texas. This project holds potential to be disseminated to Chinese Americans throughout the U.S. and be adapted for other Asian subgroups and races/ethnicities in the future.

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