Project Summary African Americans continue to experience disparities for colorectal cancer (CRC) incidence and deaths compared to other racial/ethnic groups in the US and adherence with evidence-based CRC screening recommendations can reduce these disparities. Advantages of stool-based CRC screening tests compared to other screening methods include convenience and lower cost. However, stool-based CRC screening generally must be done annually and individuals who screen abnormally must be able to access and complete a screening colonoscopy following a positive result on a stool-based test. Patients who are uninsured or have inadequate health insurance or face financial or structural obstacles may require additional support from their community health center (CHC) to complete a screening colonoscopy, and CHCs may experience challenges securing access to colonoscopy for such patients. The Test Up Now Education Program (TUNE-UP) is a 5-year behavioral clinical trial for African Americans ages 45-64 who are patients at one of two partnering north Florida CHCs and tests whether an innovative 6-week community health advisor (CHA) intervention can increase stool-based CRC screening compared to a usual care approach. Participants are surveyed at baseline, 3-months and 9-12 months to measure the primary study outcome, completion of stool-based screening. In this follow-up monitoring study now being proposed, we will reestablish contact with TUNE-UP participants and obtain informed consent to examine if there was a sustained effect of the CHA intervention for two ensuing annual screenings and whether outcomes vary longitudinally. Thus, we present a time-sensitive proposal to assess repeat annual screening in this CHC patient cohort. Aim 1 will test the hypothesis that CHC patients who participated in the TUNE-UP trial and received the CHA intervention will show a higher likelihood of adherence with subsequent stool-based CRC screening than TUNE-UP participants who had been assigned to the usual care study group. Aim 2 of the proposed study will utilize a community-partnered participatory research (CPPR) framework to explore the CHC context for implementing CRC screening educational interventions among African American patients in north Florida. The proposed TUNE-UP Monitoring Study is significant, innovative and timely in addressing persistent disparities in CRC incidence and mortality among African Americans through convenient and accessible stool- based screening in the context of recently updated USPSTF recommendations to begin CRC screening at age 45. Additionally, this research will enable monitoring of CRC preventive screening programs amid the challenges of the Covid-19 pandemic and will increase understanding of the relationships between decision-making factors and CRC screening among African Americans. This research program will also improve the research capacity of Florida A&M University to conduct research in partnership with health centers and in...