Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US and throughout Texas. Our target population resides in El Paso County (EPC) and Hudspeth County (HC): two US/Mexico border Counties with a combined population of 824,266. One is an urban and rural county and the other a frontier county, both are predominantly Hispanic (81% EPC; 79.6% HC), have a high poverty rate (26.6% EPC; 46% HC), a high proportion of uninsured (36% EPC; 54.3% HC), have low educational attainment and are medically underserved.

Between 2002 and 2006 there were 1270 new CRC cases diagnosed and 460 CRC deaths in El Paso County. CRC incidence and mortality among Hispanics in El Paso County is...

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Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US and throughout Texas. Our target population resides in El Paso County (EPC) and Hudspeth County (HC): two US/Mexico border counties with a combined population of 824,266. One is an urban and rural county and the other a frontier county, both are predominantly Hispanic (81% EPC; 79.6% HC), have a high poverty rate (26.6% EPC; 46% HC), a high proportion of uninsured (36% EPC; 54.3% HC), have low educational attainment and are medically underserved. Between 2002 and 2006 there were 1270 new CRC cases diagnosed and 460 CRC deaths in El Paso County.

CRC incidence and mortality among Hispanics in El Paso County is higher than for Hispanics in the rest of Texas. CRC screening can prevent CRC and reduce CRC deaths, yet only 51.5% of El Paso County residents aged 50 and above have ever had a flexible sigmoidoscopy or colonoscopy compared to 61.6% of Texans and 65.2% of the US population, and current CRC screening rates among 50-64 year olds in El Paso County are one of the lowest in Texas at 37.7% compared to 53.3% in Texas. Despite enrolling 6,545 participants over 22 months, our enrollment rate has not waned, indicating the continuing need for the program in this community.

Against Colorectal Cancer in Our Neighborhoods(ACCION) is a comprehensive, evidence-based program that we developed with previous CPRIT funding to reduce the burden of CRC throughout El Paso County. This program is being comprehensively evaluated and has resulted in high rates of uptake of screening services (76%). ACCION is led by Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, El Paso and is partnered by an extensive network of 137 community organizations (churches, community centers, food banks, the Housing Authority, Department of Public Health, federally qualified health centers, University Medical Center safety net clinics, non-profits, etc.), giving the program considerable reach into the community. The program utilizes the strengths, experiences and resources of each collaborating organization.

For this competing continuation, we build on the pre-existing strengths of the program and expand and enhance it further, based on our prior experiences. Program components are: 1)Outreach through a community network covering El Paso and Hudspeth County, through health fairs, and earned media; 2)Education by bilingual,certified promotoras using one of three educational delivery formats that can be tailored to the setting, a video-only version, a promotora-only version delivered with the aid of a flip chart and a combined version; 3)Provision of no-cost fecal immunochemical tests (FIT), colonoscopy, and a fast track referral system; 4)Patient navigation to facilitate testing uptake, address barriers, and facilitate health coverage, diagnosis and treatment, and new expanded navigation to facilitate screening among participants with health coverage; 5)Facilitation of sustainability through maintenance of a newly founded cancer focused non-profit organization and facilitating system changes in our clinical delivery network; 6) Dissemination of the ACCION program locally, regionally and nationally through a combination of strategies; 7) Addition of enhancements to participant pathways to facilitate screening among new populations (Hudspeth County residents, those with health insurance).

The long term goal of the ACCION is to reduce avoidable deaths from CRC in El Paso county, across Texas, and nationally. The specific goals of this enhanced ACCION 2 Program are: 1)Increase community CRC awareness and knowledge and reduce cultural barriers to CRC screening; 2) Increase CRC screening uptake in participants of El Paso and Hudspeth counties; 3) Increase uptake of diagnosis & treatment services to reduce the number of advanced cases; 4 ) Facilitate sustainability of the ACCION program; 5). Facilitate dissemination of the ACCION program across the state.

Eligible individuals are 50-75 years old underinsured and uninsured, predominantly Hispanic residents of El Paso or Hudspeth County that are due for CRC screening. We expect to directly serve 6,617 participants; 5,767 participants will qualify for comprehensive services and another 850 participants will receive education or partial navigation services. We anticipate a total of 508 screening and diagnostic colonoscopies.We will reach many more individuals through our outreach, earned media and educational video dissemination strategies.

ACCION is meeting the goals of the Texas Cancer Plan which are to reduce the impact of cancer in Texas through the implementation of sustainable and effective programs that target the underserved and reduce disparities in cancer throughout the State. With our dissemination efforts we hope to impact underserved, low income, and Hispanic communities in Texas and the rest of the US.

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