Asian Americans are the fastest growing racial/ethnic group in the United States, increasing 72% between 2000 and 2015, from 11.9 to 20.4 million. Texas has the third largest Asian American population in the nation, with a high increase of 76.1% from 2000 to 2012. Chinese Americans are the largest subgroup with a high immigrant proportion (70%), a high poverty rate (14.4% compared to 12.1% for all Asians and 10% for Whites in the United States), and a large percentage with low English competency (41%).

Family health history (FHH)-based, personalized cancer genomics services have tremendous potential for cancer morbidity and mortality reductions. Compared to Whites, Blacks, and Hispanic...

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Asian Americans are the fastest growing racial/ethnic group in the United States, increasing 72% between 2000 and 2015, from 11.9 to 20.4 million. Texas has the third largest Asian American population in the nation, with a high increase of 76.1% from 2000 to 2012. Chinese Americans are the largest subgroup with a high immigrant proportion (70%), a high poverty rate (14.4% compared to 12.1% for all Asians and 10% for Whites in the United States), and a large percentage with low English competency (41%).

Family health history (FHH)-based, personalized cancer genomics services have tremendous potential for cancer morbidity and mortality reductions. Compared to Whites, Blacks, and Hispanics, however, Chinese Americans are underserved in FHH-based cancer services and education. To bridge this gap, this dissemination project, based on the success and products of three previously CPRIT-funded awards (PP160032, PP100214, and PP140210), proposes to recruit and train Chinese CHWs from the ten Texas counties with the largest numbers of Chinese Americans as well as from four rural and underserved geographic priority areas defined by CPRIT (i.e., Taylor, Randall, Midland, and Jackson counties) to provide FHH-based education and navigation services to Chinese Americans, targeting six major cancers. Engaging community health workers (CHWs), culturally competent lay health educators, in cancer prevention is a promising evidence-based, nationally recognized dissemination approach.

This multidisciplinary project, led by experienced CPRIT-funded investigators and leaders at the Texas Department of State Health Services (TDSHS)-certified National Community Health Worker Training Center (NCHWTC), will consist of two phases. In Phase I, we will develop a bilingual (English and Chinese), first-of-its-kind, and state-approved CHW certification training program, focusing not only on the basic competencies for CHWs but also on the specific knowledge, skills, and cultural competencies in providing FHH-based cancer prevention and navigation services to Chinese Americans.

The training will target six major cancers: breast, colorectal, gastric, liver, lung, and prostate cancer. We will train fifty Chinese Americans to become certified CHWs. Courses with continuing education units (CEUs) in the FHH-based prevention and navigation for the six cancers will also be developed and offered to existing Chinese CHWs. Trained Chinese CHWs will provide FHH-based prevention and navigation services to various Chinese American communities in Texas. A total of 1,590 Chinese Americans will be served.

In Phase II, we will develop a bilingual (English and Chinese versions) dissemination website, hosted by the NCHWTC, to deliver online CHW certification and CEU training, share resources and news, and promote a dissemination toolkit for best practices in recruiting and training Chinese CHWs. The website will also provide a virtual community for engaging CHWs, CHW training centers, programs employing CHWs, and our research team to interact and discuss challenges and solutions. Adopting various active and passive dissemination techniques, the website will be further promoted to all CHW training centers and programs in Texas. In-person and online workshops, along with technical assistance, will be provided to facilitate successful implementation of Chinese CHW recruitment and training by the participating CHW training centers and programs.

Specific Goals: Goal 1: Develop a Chinese CHW workforce in FHH-based breast, colorectal, gastric, liver, lung, and prostate cancer prevention. Goal 2: Equip CHW training centers and programs employing CHWs with best practices in recruiting and training Chinese CHWs to implement FHH-based breast, colorectal, gastric, liver, lung, and prostate cancer prevention and navigation services to Chinese Americans.

This proposal leverages the innovations established in the previous CPRIT awards by adopting genomics (FHH) into traditional cancer prevention programs and including a navigation component. Developing and delivering the first English and Chinese CHW certification and CEU training program in FHH-based cancer prevention, recruiting and training Chinese CHWs, as well as adding active and passive dissemination components in this proposal enhances the innovative nature.

Among the 4,178 TDSHS-certified CHWs, only eight (0.19%) are Chinese Americans. Our project will contribute to a culturally competent CHW workforce by addressing the critical need for a greater representation of Chinese CHWs in the Texas CHW system. Moreover, because CHWs serve as the bridge between communities and healthcare services, developing a Chinese CHW workforce in cancer prevention will assist a large number of underserved Chinese Americans across Texas to engage in FHH-based, personalized primary and secondary cancer prevention activities.

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