Abstract C122: Efficacy of in-language mailers on receipt of colorectal cancer screening among Chinese Americans: A randomized controlled trial
Authors: Nguyen Tung T , Tsoh Janice , Sun Angela , Woo Kent , Cheng Joyce , Wong Ching , Zhang Jian , Bernet Janet , Pan Stella , Gildengorin Ginny 
Published: September 2020

Abstract
Background: Colorectal cancer (CRC) is the second most common cancer among Chinese Americans, the largest group of Asian Americans. Asian Americans and Chinese Americans are less likely than non-Hispanic whites to be screened for CRC. There are few randomized controlled trials (RCT) of interventions to increase CRC screening among Chinese Americans. Methods: A community-academic research team consisting of academic researchers and community organization leaders collaborated with 3 health care systems to develop an intervention called Small Media Interventions for Limited English Speakers (SMILES) project. The SMILES intervention consisted of a mailed letter and brochure about CRC screening in English and Chinese sent twice over the course of 1 month. The mailer also included a link to a website which provided additional in-language written and video information about CRC screening. Chinese American patients aged 50 to 75 who were due for CRC screening in 3 healthcare systems (an academic medical center, a community hospital network, and a federally-qualified health center) in San Francisco were eligible for the RCT. Eligible patients were randomized to the intervention arm versus a usual care comparison arm. Intervention participants were also given the opportunity to return a postcard indicating that they had read the mailer. CRC screening status were assessed using electronic health record 9 months after the first mailing. Results: There were 1,707 enrolled patients with 929 in the intervention arm and 778 in the comparison arm. The average age was 59.6 years (SD 6.0), with 45.6% female, 12.4% English speakers, 63.2% Cantonese speakers, and 10.8% Mandarin speakers. At 9-month post-intervention initiation, the CRC screening rate was 51.9% in the intervention group and 49.5% in the comparison group (p=0.331). For the age group 50 to 60, the screening rate was 47.4% vs. 42.2% (p&lt;0.0001). Multivariable analyses showed that the adjusted odds ratio for the intervention was 1.10 (95% CI: 1.001, 1.21). Other significant factors associated with CRC screening at post-intervention were female sex (OR: 1.37, 95% CI: 1.10, 1.71), age 61-75 (OR: 1.64, 95% CI: 1.57, 1.71, ref. age 50-60), and speaking a Chinese language (OR: 2.42, 95% CI: 1.22, 4.76). In multivariable analyses of the intervention group only, those who had documented engagement with the intervention (returning a postcard or going to the website) had an OR of 2.96 (95% CI: 2.08, 4.21) for CRC screening receipt compared to those who did not. Conclusions: A linguistically appropriate intervention to promote CRC screening among Chinese Americans using a mailed reminder, brochure, and access to a website led to a modest but significant increase in CRC screening compared to usual care among overdue patients in 3 healthcare systems. Mailed in-language materials should be considered as a low-resource intervention to increase CRC screening among Chinese Americans.
Citation Format: Tung T Nguyen, Janice Tsoh, Angela Sun, Kent Woo, Joyce Cheng, Ching Wong, Jian Zhang, Janet Bernet, Stella Pan, Ginny Gildengorin. Efficacy of in-language mailers on receipt of colorectal cancer screening among Chinese Americans: A randomized controlled trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C122.