***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine whether racial/ethnic differences in colon cancer screening are independent of socioeconomic and personal risk factors . DESIGN Baseline cross-section for a prospect i ve cohort . METHOD We recruited adults between 2000 and 2002 to undergo a question naire and venipuncture to study cancer risks . RESULTS Among 5595 adults over 50 years old , 40.3 % reported  sigmoidoscopy or colonoscopy  within the prior five years ; rates were 48.0 % for Whites , 32.8 % for Blacks , 27.9 % for Hispanics , 30.3 % for Asians , and 33.3 % for others . Adjusting for age , gender , access to care ( as income and insurance ) , and risk profile ( as cancer in family , smoking , and obesity ) , Blacks and Hispanics were less likely to have been screened than Whites . CONCLUSIONS Screening for colon cancer is low , especially among racial/ethnic minorities . Sociocultural factors merit closer attention CONTEXT A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who received a  5-fluorouracil-based regimen .  OBJECTIVE To determine whether adjuvant chemotherapy is used in the community as a st and ard of practice that improves outcome and whether it failed to benefit any specific sets of patients . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve data from 85 934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base between 1990 and 2002 and included st and ard clinical , pathological , and first course of treatment variables . MAIN OUTCOME MEASURES Prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in US hospitals . RESULTS  Adjuvant chemotherapy use increased from 39 % in 1991 to 64 % in 2002 but was lower in black , female , and elderly patients . It improved 5-year survival from almost 8 % in 1991 to more than 16 % in 1997 compared with surgery alone . Adjuvant chemotherapy  increases survival in elderly patients  as much as it does in younger patients . However , the benefit of adjuvant chemotherapy in blacks and those with high- grade cancers is not as great . CONCLUSIONS  Adjuvant chemotherapy  use has increased from 1990 to 2002 for patients with stage III colon cancer with an associated increase in 5-year survival of 16 % . The benefit of adjuvant chemotherapy seems to be lower in black patients and high- grade cancers . Women have the same benefit but are less often treated . Elderly patients have the same benefit as younger patients but are less frequently treated . New options for adjuvant therapy in 2004 - 2005 may further improve the outcome of patients with stage III colon cancer Background : Evidence about the accuracy of self-reports of colorectal cancer ( CRC ) screening is lacking . We conducted a validation protocol in a r and omized trial to increase CRC screening among high-risk individuals . Methods : First-degree relatives ( n = 1,280 ) of CRC cases who were due for CRC screening were included in the parent trial . All subjects who completed the follow-up interview ( n = 948 ) were asked to participate in validation activities . Self-reports of receipt of CRC screening during the 12-month study period were verified via physicians . Results : Although 60 % ( n = 567 ) verbally agreed , only 171 subjects ( 18 % of original sample ) returned the signed validation form with the physician name and contact information and a medical information release statement . The signed forms were mailed to physicians with a $ 10 incentive and the request to list the date s of recent CRC screening tests . One hundred twenty-three physicians ( 72 % of physicians contacted , 13 % of original sample ) returned completed validation forms . Rates of agreement were low across all three screening types with physicians verifying self-reported screening for 29 % of fecal occult blood testing , 56 % of sigmoidoscopy , 55 % of colonoscopy , and 57 % of any screening test . Conclusion : Validation of self-report using the type of protocol we used for subjects receiving medical care in many community setting s may be unfeasible and cost inefficient . Given the overall low participation rate in validation activities and considerable challenges in collecting high quality data , conclusions about the accuracy of self-reported CRC screening are difficult to make based on the results of this study . ( Cancer Epidemiol Biomarkers Prev 2008;17(4):791–8 Colorectal cancer is the second leading cause of cancer death in the United States.1 Appropriate screening can reduce incidence of and mortality from colorectal cancer.2–5 The US Preventive Services Task Force recommends that all average-risk individuals aged 50 years and older receive colorectal cancer screening.6 The American Cancer Society recommends several acceptable approaches to screening , including an annual 3-card home fecal occult blood test.7 The Healthy People 2010 objective is to increase the proportion of people aged 50 and older who have received a fecal occult blood test  within the preceding 2 years to at least 50%.8 Lack of knowledge , confidence , and skills ; negative attitudes toward the tests themselves ; fear of the consequences of screening ; and inadequate social support all have been suggested as possible barriers to colorectal cancer screening,9 whereas positive attitudes toward colorectal cancer screening and physician encouragement have been associated with receipt of a fecal occult blood test with a home stool kit.10 Despite these studies , gaps remain in what is known about barriers to successful interventions to increase  colorectal cancer screening  , particularly in minority population s.11,12 This study is based on the assumption that identification and definition of barriers to colorectal cancer screening in low-income , underserved minority population s can help guide the development of effective interventions Abstract The present study was design ed to assess ethnic disparities in CRC screening rates in a low-income population and to examine factors that could account for those differences . Participants were r and omly selected and asked to complete a question naire about CRC screening . After controlling for gender , age , education , income , health insurance , and family history of CRC , differences in screening rates as a function of ethnicity remained . Physicians ' recommendations and perceived efficacy of screening were also strong predictors of CRC screening .  Psychological factors accounted in part for differences in screening rates between European Americans and Mexican Americans Colorectal carcinoma ranks as the second most common cancer and the second leading cause of cancer death in the United States . Hispanics are less likely than their non‐Hispanic white counterparts to have ever received a  fecal occult blood test ( FOBT ) or sigmoidoscopy/colonoscopy . Little is known about the barriers to screening in the Hispanic population Background : Diabetics have been found to have a greater risk of colorectal cancer than non-diabetics . Methods : We examined whether this relationship differed by ethnic group , cancer site or tumour stage in a population -based prospect i ve cohort , including 3549 incident colorectal cancer cases identified over a 13-year period ( 1993–2006 ) among 199 143 European American , African American , Native Hawaiian , Japanese American and Latino men and women in the Multiethnic Cohort . Results : Diabetics overall had a significantly greater risk of colorectal cancer than did non-diabetics ( relative risk (RR)=1.19 , 95 % confidence interval (CI)=1.09–1.29 , P-value (P)<0.001 ) . Positive associations were observed for colon cancer , cancers of both the right and left colon , and cancers diagnosed at a localised and regional/distant stage . The association with colorectal cancer risk was significantly modified by smoking status ( PInteraction=0.0044 ) , with the RR being higher in never smokers ( RR=1.32 , 95 % CI=1.15–1.53 , P<0.001 ) than past ( RR=1.19 , 95 % CI=1.05–1.34 , P=0.007 ) and current smokers ( RR=0.90 , 95 % CI=0.70–1.15 , P=0.40 ) . Conclusion : These findings provide strong support for the hypothesis that diabetes is a risk factor for colorectal cancer Objective : There is evidence that non-English speakers in the United States receive lower quality health care and preventive services than English speakers . We tested the hypothesis that Spanish-speaking women would respond differently to an intervention to increase up-to- date status for cancer screening . Study Design and Setting : A multisite r and omized controlled trial showed that scripted telephone support , provided by a Prevention Care Manager ( PCM ) , increased up-to- date rates for breast , cervical , and colorectal cancer screening . This subgroup analysis investigated the relative efficacy of the PCM  among women who chose to communicate with the PCM in Spanish versus English . Results : Of 1,346 women in this analysis , 63 % were Spanish speakers . Whereas the PCM intervention increased cancer screening rates generally , Spanish-speaking women seemed to benefit disproportionately more than English-speaking women for cervical cancer screening ( unadjusted odds ratio , 1.77 ; 95 % confidence interval , 1.03 - 3.05 ) . In addition , in this exploratory analysis , there was a trend toward Spanish-speaking women receiving more benefit than English-speaking women from the intervention in increased breast and colorectal cancer screening rates . Conclusion : Spanish-speaking women seemed to benefit more than did English-speaking women from a bilingual telephone support intervention aim ed at increasing cancer screening rates . ( Cancer Epidemiol Biomarkers Prev 2007;16(10):2058–64 Background This paper presents the study design , intervention components , and baseline data from Open Doors to Health , a study design ed to address social context ual factors in colorectal cancer ( CRC ) prevention for low-income , racial/ethnic minority population s. Methods A cluster r and omized design with 12 housing sites as the primary sampling units was used : 6 sites were assigned to a " Peer-led plus Screening Access " ( PL ) condition , and 6 were assigned to " Screening Access only " ( SCR ) condition . Study -related outcomes were CRC screening , physical activity ( measured as mean steps/day ) , and multivitamin use . Results At baseline ( unweighted sample size = 1554 ) , two-thirds self-reported that they were current with screening recommendations for CRC ( corrected for medical records validation , prevalence was 52 % ) , with half having received a colonoscopy ( 54 % ) ; 96 % had health insurance .  Mean steps per day was 5648 ( se mean = 224 ) , and on average 28 % of the sample reported regular multivitamin use . Residents reported high levels of social support [ mean = 4.40 ( se = .03 ) ] and moderately extensive social networks [ mean = 2.66 ( se = .02 ) ] . Conclusion Few studies have conducted community-based studies in public housing communities ; these data suggest areas for improvement and future opportunities for intervention development and dissemination . Findings from the r and omized trial will determine the effectiveness of the intervention on our health-related outcomes as well as inform future avenues of research OBJECTIVE Health promotion efforts directed at Latinos may be more effective when culturally adapted methods are used . Our study was design ed to test a novel communication modality for promoting colorectal cancer ( CRC ) prevention and screening messages among Latinos . METHODS We compared a culturally aligned , brief storytelling educational intervention ( ST ) to a numeric risk tool intervention ( NR ) based on the Harvard Cancer Risk Index . Both interventions included risk factor information and recommendations for primary prevention and screening for CRC .  Sixty-four Latinos ( mean age 46.8 , 86 % female ) were r and omized and completed pre- and post-tests . RESULTS Participants in ST indicated intent to add significantly more servings of vegetables ( p=.030 ) and more minutes of exercise ( p=.018 ) to daily routines than those in NR . Most respondents ( ST and NR ) reported intentions to recommend CRC screening to friends and relatives . CONCLUSIONS These data provide support for storytelling 's potential to promote health behavior change with cultural relevance for Latinos . PRACTICE IMPLICATION S Storytelling shows promise as an effective method for reaching one of the historically underserved ethnic groups with cancer prevention and screening information Background Minority racial/ethnic groups have low colorectal cancer ( CRC ) screening rates . Objective To evaluate a culturally tailored intervention to increase CRC screening , primarily using colonoscopy , among low income and non-English speaking patients . Design R and omized controlled trial conducted from January to October of 2007 . Setting Single , urban community health center serving a low-income , ethnically diverse population . Patients A total of 1,223 patients 52 - 79 years of age overdue for CRC screening , r and omized to intervention ( n = 409 ) vs. usual care control ( n = 814 ) groups .  InterventionIntervention patients received an introductory letter with educational material followed by phone or in-person contact by a language -concordant “ navigator . ” Navigators ( n = 5 ) were community health workers trained to identify and address patient-reported barriers to CRC screening . Individually tailored interventions included patient education , procedure scheduling , translation and explanation of bowel preparation , and help with transportation and insurance coverage . Rates of colorectal cancer screening were assessed for intervention and usual 
    Output:
    
There is great inconsistency in reported characteristics of Hispanics in health research .