Research Project 1

研究项目1

• 批准号: 10660383
• 负责人: Lori Brand Bateman
• 金额: $ 41.4万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10660383
• 关键词: Academy; African American; Alabama; Area; Behavior; Biological Markers; Black American; Businesses; Cancer Center; Cancer Control; Caring; Censuses; Chronic stress; Cities; Communities; Community Health Aides; Data; Disadvantaged; Disparity; Electronic Health Record; Emergency department visit; Environment; Evaluation; Event; Excision; Focus Groups; Goals; Grant; Green space; Health behavior; Health care facility; Health system; Hospitalization; Intervention; Knowledge; Leadership; Lighting; Local Government; Malignant Neoplasms; Measures; Methods; Modification; Needs Assessment; Neighborhoods; Not Hispanic or Latino; Outcome; Patient Self-Report; Perception; Physical activity; Population; Poverty; Poverty Areas; Prevention; Preventive care; Race; Research; Research Project Grants; Risk Factors; Safety; Sampling; Screening for cancer; Social Environment; Socialization; Stress; Surveys; Testing; allostatic load; biological adaptation to stress; built environment; cancer health disparity; cancer prevention; cancer risk; community engagement; community intervention; comparison control; design; group intervention; health care service utilization; improved; indexing; member; perceived stress; poor communities; post intervention; prevention service; social; social cohesion; social health determinants; social vulnerability; urban area; virtual; walkability

ABSTRACT- PROJECT 1. Disparities in cancer prevention and outcomes by poverty status are rooted in structural and intermediate social determinants of health (SDH), including neighborhood built and social environments. Features of the built environment (e.g., walkability, safety, healthcare facilities) and the social environment (e.g., collective efficacy) have major implications for cancer risk through behaviors such as physical activity and access to preventive care. Adverse neighborhood conditions also exacerbate the stress response, in the form of high allostatic load, which is a risk factor for many cancers. This is a problem in persistent poverty (PP) areas where adverse neighborhood conditions are highly prevalent. However, despite compelling evidence that the living (built and social) environment impacts health-related behaviors and outcomes, including cancer, there are virtually no interventions that determine to what extent modifications of the neighborhood built and social environments reduce cancer risk. The proposed study aims to fill this knowledge gap. We propose a 5-year research project to implement Cancer Prevention through Enhanced EnvironMent (Cancer PREEMpT), to test whether a comprehensive community intervention that improves the neighborhood built and social environments can reduce cancer risk in PP areas. The specific aims of Cancer PREEMpT include: 1) Implementing Cancer PREEMpT and assessing whether the enhancement of living (built and social) environments leads to increased public safety, use of parks and community spaces, community events, and prevention services; 2) Determining the effect of improved living environments on community-level perceptions and behaviors related to cancer risk, such as walkability and safety, self-reported physical activity, social cohesion and collective efficacy, and use of preventive care and cancer screening; and 3) Evaluating the impact of improved living environments on self-reported and objective chronic stress (including allostatic load} and healthcare utilization (including cancer screening). Using a multisectoral approach to bring together citizens, organizations, businesses, and local governments to improve their living environment, the theorybased Cancer PREEMpT intervention will engage community members in five adjacent, urban PP census tracts in Bessemer, Alabama. After a community-engaged needs assessment, modifications will be made in the built and social environments, followed by an evaluation in Year 5. We will apply sequential explanatory mixed methods assessments using a two-group design with independent samples of 300 residents at pre( Year 1) and post-intervention (Year 5), and focus groups with residents. Finally, to ascertain impact on health care utilization, we will compare Electronic Health Records of all residents of the target area receiving care through the UAB Health System with residents of control urban PP communities similar in racial make-up. Cancer PREEMpT will fill a research gap by providing evidence for reduced cancer risk in PP areas through a community-engaged, stakeholder-supported intervention that improves the living environment.

摘要-项目 1. 贫困状况在癌症预防和结果方面的差异根源于 健康的结构性和中间社会决定因素（SDH），包括社区建设和社会 环境。建筑环境的特征（例如步行性、安全性、医疗设施）和社会功能 环境（例如集体效能）通过以下行为对癌症风险产生重大影响： 体力活动和获得预防性护理。不利的邻里条件也加剧了压力 以高别稳态负荷形式出现的反应，这是许多癌症的危险因素。这是一个问题 持续贫困（PP）地区的不良邻里条件非常普遍。然而，尽管 令人信服的证据表明生活（建筑和社会）环境影响健康相关行为 包括癌症在内的结果，实际上没有任何干预措施可以确定在多大程度上改变 社区建设和社会环境可降低癌症风险。拟议的研究旨在填补这一空白 知识差距。我们提出了一个为期 5 年的研究项目，通过加强癌症预防措施来实施癌症预防 环境（癌症 PREEMpT），测试综合社区干预是否可以改善癌症 社区建设和社会环境可以降低 PP 地区的癌症风险。癌症的具体目标 PREEMpT 包括： 1) 实施癌症 PREEMpT 并评估是否改善生活（建立 和社会）环境导致公共安全、公园和社区空间的使用、社区 事件和预防服务； 2) 确定改善居住环境对社区层面的影响 与癌症风险相关的认知和行为，例如步行性和安全性、自我报告的身体活动、 社会凝聚力和集体效能，以及预防性护理和癌症筛查的使用； 3) 评估 生活环境改善对自我报告和客观慢性压力（包括非稳态负荷）的影响} 和医疗保健利用（包括癌症筛查）。使用多部门方法将 公民、组织、企业和地方政府改善他们的居住环境，以理论为基础 癌症 PREEMpT 干预将让社区成员参与五个相邻的城市 PP 人口普查 阿拉巴马州贝塞默的大片地区。经过社区参与的需求评估后，将进行修改 建筑和社会环境，然后在第 5 年进行评估。我们将应用顺序解释 使用两组设计的混合方法评估，在预（ 第一年）和干预后（第五年），以及与居民的焦点小组。最后，确定对健康的影响 护理利用率，我们将比较目标区域接受护理的所有居民的电子健康记录 通过 UAB 卫生系统与种族构成相似的控制城市 PP 社区的居民进行调查。 癌症 PREEMpT 将通过以下方法提供 PP 区域癌症风险降低的证据，从而填补研究空白​​： 社区参与、利益相关者支持的改善生活环境的干预措施。