Examining Racial/Ethnic Differences and Determinants of Self-Sample HPV Testing and Usual Care Cervical Cancer Screening Uptake in a Safety Net Health System

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SUMMARY The overarching goal of this Diversity Supplement is to prepare and launch Dr. Trisha Amboree into an academic career as an independent scientist. Dr. Trisha Amboree is a newly-graduated behavioral epidemiologist with research expertise in sexual risk behaviors among marginalized populations. Through the training supported by this Diversity Supplement, she will gain crucial training and experience in health disparities and health services research, as well as spatial epidemiology and multi-level analyses. The overarching goal of her postdoctoral research is to elucidate screening participation patterns in the parent Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) trial and inform future interventions that expand the reach and enhance the effectiveness of self-sample human papillomavirus (HPV) testing for cervical cancer screening among marginalized and vulnerable populations. The parent trial is a pragmatic randomized controlled trial of mailed self-sample HPV testing in a large, urban safety net health system to circumvent barriers to cervical cancer screening among medically underserved, racial/ethnic minority women. Using data from the PRESTIS Trial, Dr. Amboree will examine screening uptake, acceptability, and experiences across racial/ethnic and language use groups, by patient healthcare utilization characteristics, and by neighborhood-level economic deprivation and racial segregation. The central hypotheses that guide Dr. Amboree’s research are that screening uptake, acceptability, and experiences vary 1) across racial/ethnic and language use groups and by healthcare utilization characteristics; and 2) by area-level characteristics of the neighborhoods in which women live, specifically 2a) neighborhood-level economic disadvantage (measured using the census tract-level area deprivation index--ADI) and 2b) residential racial segregation (measured using the census tract-level local exposure/isolation metric-- LEx/Is). The findings of Dr. Amboree’s mentored research will inform the extent to which self-sample HPV testing may circumvent certain structural, neighborhood-level barriers to screening uptake among safety net health system patients and elucidate how future self-sample HPV testing programs can be refined and expanded to more effectively increase screening coverage. Along with the invaluable training and career development opportunities afforded through this Supplement, the findings of Dr. Amboree’s research will provide crucial preliminary data that will allow her to develop a competitive R99/00 proposal that will launch her career as an independent scientist.