A Cross-sectional Partnership to Improve Prevention and Health Equity Among African Americans

Using a Cross-sectional Partnership to Improve Prevention and Health Equity Among African Americans

African Americans face racial disparities in colorectal cancer (CRC), with lower screening rates and higher incidence and mortality rates. To address this gap and improve CRC screening rates, investigators aims to recruit a total of 1,200 African American participants aged 45-75 during their visits to the DMV, 4606 N 56th St Ste100, Omaha, for CRC screening. All participants will receive a free Fecal Immunochemical Test (FIT) kit with a prepaid return envelope, a culturally tailored educational brochure, reminder text messages and calls, and post-FIT navigation support for participants with positive results or without family doctor/insurance. Kits are returned to a designated Nebraska Medicine lab for testing, and test results will be mailed to participants within 14-21 days. Participants will be assigned to one of two groups: the on-site distribution group or the on-site distribution group with social media advertising group. The social media advertising group will additionally be exposed to targeted ads on platforms like Facebook, Instagram, and YouTube to increase awareness and potentially improve participation rates. The study will compare FIT kit return rates, positive screening rates, and completion rates of follow-up colonoscopies after positive FIT results between the two groups.

Study Overview

• Status: Recruiting
• Conditions: Colorectal Cancer; Prevention
• Intervention / Treatment: Other: On-site Fecal Immunochemical Test (FIT) Kit Distribution; Other: On-site With Social Media Advertising Fecal Immunochemical Test (FIT) Kit Distribution

Detailed Description

African Americans face racial disparities in colorectal cancer (CRC), with lower screening rates and higher incidence and mortality rates. The American Cancer Society reported that African Americans are about 20% more likely to have CRC and 40% more likely to die from it compared to other racial groups. The main reasons for high CRC incidence and mortality for African Americans are structural barriers in access to quality healthcare and timely screening that can be attributed in large part to historical and persistent structural racism in the U.S. To address this gap and improve CRC screening rates among African Americans, this study will partner with the Department of Motor Vehicles (DMV) to recruit African Americans eligible for CRC screening during their regular visits to the DMV. Investigators will recruit 1,200 participants aged 45-75 for CRC screening.

Upon consent, participants' demographic and screening-related information will be collected via a paper-based registration survey (e.g., name, age, gender, race/ethnicity, address, healthcare access, recent CRC screening history, smoking status, and personal/family history of CRC). All participants will receive a free Fecal Immunochemical Test (FIT) kit with a prepaid return envelope, a culturally tailored educational brochure, reminder text messages and calls. Participants will be assigned to one of two groups: the on-site distribution group or the on-site distribution group with social media advertising group. The social media advertising group will additionally be exposed to targeted ads on platforms like Facebook, Instagram, and YouTube from August 19, 2024, to October 29, 2024, to increase awareness and potentially improve participation rates.

Kits are returned to a designated Nebraska Medicine lab, and test results will be mailed to participants within 14-21 days. Follow-up services, including assistance with scheduling colonoscopies and applying for financial support programs, will be provided by a health navigator at Charles Drew Health Center for participants with positive results or those without health insurance or a primary care provider. Outcomes (screening completion rate and positive results) will be compared between the onsite and onsite with social media advertising groups, controlling for other covariates (age, gender, income, previous screening, smoking status, healthcare access, and health beliefs). The study will also assess the cost-effectiveness of each strategy and the completion rate of follow-up colonoscopies after receiving positive FIT results. Participants' perceptions and beliefs about screening will be collected via an online survey.

• Study Type: Interventional
• Enrollment (Estimated): 1200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jungyoon Kim, PhD; Phone Number: (402) 552-7235; Email: jungyoon.kim@unmc.edu

Study Locations

• United States
  • Nebraska
    • Omaha, Nebraska, United States, 68104
      • Recruiting
      • Department of Motor Vehicles (DMV)
      • Contact: Jungyoon Kim, PhD; Phone Number: 402-552-7235; Email: beatcancer@unmc.edu
    • Omaha, Nebraska, United States, 68104
      • Recruiting
      • Douglas County Treasurer's Office
      • Contact: Jungyoon Kim, PhD; Phone Number: 402-552-7235; Email: beatcancer@unmc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Self-identification as Black or African American
• Between 45 and 75 years old
• Not up-to-date with colorectal cancer (CRC) screening per guidelines
• Willingness to provide contact information for follow-up
• Ability to speak, read, and write English
• Current residency in Douglas County, NE.

Exclusion Criteria:

• History of colorectal cancer (CRC)
• History of adenomas (precancerous polyps) or inflammatory bowel disease
• Family history of colorectal cancer (CRC)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: On-site Group; The on-site distribution group will receive the Fecal Immunochemical Test (FIT) kits directly while visiting the Department of Motor Vehicles (DMV) location at 4606 N 56th St Suite 100, Omaha, NE 68104. Participants in the on-site group will be guided through the kit process by trained research staff present. They will be given instructions on collecting the stool sample and using the FIT kit properly. They will also be given a culturally tailored educational brochure, a prepaid return envelope, and receive reminder text messages and phone calls within 3 weeks of receipt of the FIT kit. Post-FIT navigation support will be provided for those with positive results or without a family doctor/insurance.	Other: On-site Fecal Immunochemical Test (FIT) Kit Distribution; Participants will receive home based Fecal Immunochemical Test (FIT) kit directly at the Department of Motor Vehicles (DMV) location at 4606 N 56th St Suite 100, Omaha, NE 68104, by research staff.; Other Names: Face-to-face distribution
Active Comparator: On-site Group With Social Media Advertising; The onsite group with social media advertising participants will receive FIT kits directly at the Department of Motor Vehicles (DMV) location at 4606 N 56th St Suite 100, Omaha, NE 68104. Additionally, they will be exposed to targeted social media advertisements on Facebook, Instagram, and YouTube. These participants will encounter ads featuring video content with community member testimonials, emphasizing the importance of colorectal cancer screening for African Americans aged 45-75. The campaign will run from August 19 to October 29, 2024. Participants in this group will receive the FIT kits at the DMV along with detailed instructions on how to collect the stool sample and use the kit. They will also receive a culturally tailored educational brochure, prepaid return envelope, reminder text messages, and phone calls within three weeks of receipt of the FIT kit. Post-FIT navigation support will be provided for those with positive results or without a family doctor/insurance.	Other: On-site With Social Media Advertising Fecal Immunochemical Test (FIT) Kit Distribution; Participants will receive home-based Fecal Immunochemical Test (FIT) kits directly at the Department of Motor Vehicles (DMV) location at 4606 N 56th St Suite 100, Omaha, NE 68104, by research staff supplemented by exposure to targeted social media advertisements.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fecal Immunochemical Test Kit Return Rate	The fecal immunochemical test kit (FIT) return rate is the proportion of participants who have completed the screening by returning the FIT kits.	6 months from date of FIT distribution

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fecal Immunochemical Test (FIT) Kit Positive Rate	The fecal immunochemical test (FIT) kit positive rate is the proportion of participants who have positive FIT kit results.	6 months from date of FIT distribution
Follow-up Colonoscopy Completion Rate	The follow-up colonoscopy completion rate is the proportion of participants with positive FIT results who complete a follow-up colonoscopy.	6 months from date of positive FIT result notification

Collaborators and Investigators

• Sponsor: University of Nebraska
• Collaborators: Robert Wood Johnson Foundation
• Investigators: Principal Investigator: Jungyoon Kim, PhD, University of Nebraska

Publications and helpful links

General Publications

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• American Cancer Society. Colorectal Cancer Facts and Figures 2020-2022. Atlanta, GA: 2022.
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• Fedewa SA, Flanders WD, Ward KC, Lin CC, Jemal A, Goding Sauer A, Doubeni CA, Goodman M. Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence: A Population-Based Cohort Study. Ann Intern Med. 2017 Jun 20;166(12):857-866. doi: 10.7326/M16-1154. Epub 2017 May 23.
• Laiyemo AO, Doubeni C, Pinsky PF, Doria-Rose VP, Bresalier R, Lamerato LE, Crawford ED, Kvale P, Fouad M, Hickey T, Riley T, Weissfeld J, Schoen RE, Marcus PM, Prorok PC, Berg CD. Race and colorectal cancer disparities: health-care utilization vs different cancer susceptibilities. J Natl Cancer Inst. 2010 Apr 21;102(8):538-46. doi: 10.1093/jnci/djq068. Epub 2010 Mar 31.
• Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Health Insurance Coverage and Access to Care Among Black Americans: Recent Trends and Key Challenges. (Issue Brief No. HP-2022-07). February 2022.
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• Christy SM, Davis SN, Williams KR, Zhao X, Govindaraju SK, Quinn GP, Vadaparampil ST, Lin HY, Sutton SK, Roethzeim RR, Shibata D, Meade CD, Gwede CK. A community-based trial of educational interventions with fecal immunochemical tests for colorectal cancer screening uptake among blacks in community settings. Cancer. 2016 Nov 15;122(21):3288-3296. doi: 10.1002/cncr.30207. Epub 2016 Jul 15.
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• Davis MM, Freeman M, Shannon J, Coronado GD, Stange KC, Guise JM, Wheeler SB, Buckley DI. A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States - How, what and when? BMC Cancer. 2018 Jan 6;18(1):40. doi: 10.1186/s12885-017-3813-4.
• Jager M, Demb J, Asghar A, Selby K, Mello EM, Heskett KM, Lieberman AJ, Geng Z, Bharti B, Singh S, Gupta S. Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA: A Systematic Review and Meta-analysis. Dig Dis Sci. 2019 Sep;64(9):2489-2496. doi: 10.1007/s10620-019-05587-6. Epub 2019 Mar 26.
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Study record dates

Study Major Dates

• Study Start (Actual): October 2, 2023
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): October 1, 2026

Study Registration Dates

• First Submitted: June 5, 2023
• First Submitted That Met QC Criteria: June 5, 2023
• First Posted (Actual): June 15, 2023

Study Record Updates

• Last Update Posted (Actual): February 10, 2026
• Last Update Submitted That Met QC Criteria: February 6, 2026
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Keywords: Screening; Prevention; African Americans; Department of motor vehicles; Cross-sectoral partnership
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Intestinal Diseases; Gastrointestinal Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colonic Diseases; Colorectal Neoplasms
• Other Study ID Numbers: 0115-23-EP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes