Background Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence. Methods We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening. Results A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P< .001) or given a choice between FOBT or colonoscopy (69%) (P< .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, non-white participants adhered more often to FOBT, while white participants adhered more often to colonoscopy. Conclusions The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations. Trial Registration clinicals.gov Identifier: NCT00705731

Drawing from two samples of Asian American emerging adults, one in an ethnicallyconcentrated context (n = 108) and the other in an ethnically-dispersed, mainly White context (n = 153), we examined (a) how ethnic identity and other-group attitudes were related to psychosocial functioning (i.e., depression, self-esteem, and connectedness to parents) and (b) how these relations were moderated by context. Results (direct effects) indicated that ethnic identity predicted more positive functioning in terms of self-esteem and connectedness to parents, whereas other-group attitudes predicted more positive functioning in terms of self-esteem and depression. Furthermore, moderated effects indicated that the links with other-group attitudes did not vary with context but that the links with ethnic identity did. Ethnic identity was linked to more positive functioning in terms of depression and connectedness to parents only for those in the ethnically-concentrated context. These findings demonstrate how different types of functioning are differentially influenced by ethnic identity and other-group attitudes and by the contexts in which these identities and attitudes are embedded.

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