Screening is an effective tool for reducing both colorectal cancer (CRC) incidence and mortality, but many adults are not screened at recommended intervals. Persons of low socioeconomic status or who are uninsured have disproportionately lower rates of screening and higher rates of CRC incidence and mortality. Novel strategies are needed for this population to increase awareness of CRC and facilitate screening attempts. The long-term objectives of this project are to develop effective, sustainable, and disseminable interventions that will increase CRC screening, decrease incidence, and improve survival in underserved populations. Such efforts are critical to decreasing the current health disparities in CRC and reducing overall CRC burden in the population. The Primary Aim in this application is to assess the promise of a peer-delivered outreach intervention for increasing decisions favoring, and completion of, CRC screening among patients from urban safety-net clinics. This randomized trial will test the effectiveness of a peer-delivered intervention compared to a traditional print-based intervention for promoting CRC screening. This study will be conducted with 200 patients who are between the ages of 50 and 75 and at average-risk for CRC. Patients will complete a baseline survey on-site at the safety-net clinic at the time of recruitment and will be randomized to either a "peer coach" or a comparison print intervention. Our theory-based intervention incorporates constructs from the Theory of Planned Behavior and Implementation Intentions Theory. Peer Coaches are community members who are employed by the clinic and trained to help patients access healthcare. The intervention will consist of three outreach counseling calls to promote and facilitate CRC screening. The comparison print intervention will consist of three mailings with targeted information about CRC screening. We will conduct a follow-up telephone survey of participants at 6-months post baseline. The primary outcome of this study is completion of any acceptable CRC screen (FOBT, sigmoidoscopy, colonoscopy) at six-months after baseline, measured by chart review. A secondary aim is to conduct process evaluation and demonstrate feasibility for intervening in safety-net settings. Successful completion of this R21 will inform the development of a planned full-scale R01 intervention trial to reduce disparities in CRC screening, incidence, and survival. PUBLIC HEALTH RELEVANCE: Early detection of colorectal cancer (CRC) is associated with better survival, but population screening rates are relatively low, especially so in low income and uninsured persons. Our study will examine the effect of an intervention using peer coaches to increase CRC screening rates in safety-net clinics. Increases in screening can have a significant impact on CRC burden in the United States.