NYC Cancer Outreach Network in Neighborhoods for Equity and Community Translation

项目摘要/摘要 健康的社会决定因素(SDH)在癌症筛查方面存在差异方面发挥着重要作用， 风险因素和结果。种族主义、粮食不安全、住房不稳定、语言障碍、交通不便 而儿童保育、居住隔离、社区贫困和获得医疗保险与 乳腺癌、子宫颈癌和结直肠癌在癌症筛查、诊断测试和护理方面的差异和延误。 系统性种族主义是癌症差异的根本原因，反映在高度隔离、贫困和 以及人口密度高的社区，其建筑和食物环境抑制了健康行为。这些 同样的社区通常被联邦政府指定为医疗服务不足的地区，进入 文化和语言上合适的医疗服务，与高质量的地理位置相去甚远 癌症中心。NYC CONNECT(纽约市平权社区癌症外展网络 社区翻译)是一项多部门和多机构的提案，它建立在 在纽约市开展基于社区的SDH干预和社区-临床联动战略，以促进 健康公平。合作伙伴包括疾控中心资助的纽约市癌症预防和控制研究 网络中心、两个NCI指定的癌症中心、纽约市食品银行及其多部门网络 社区、临床和政府合作伙伴。我们将在纽约大学现有的基于社区的社区的基础上- 临床联系计划：1)涉及有相似特征的患者导航员 作为他们服务的社区的体验，并与Trusted合作嵌入社区环境中 社区组织；2)利用全人方法预防和控制癌症，筛选 未满足的SDH并将参与者链接到适当的SDH服务；以及3)促进获得医疗保险和 为未参保和低收入个人提供的其他资源以及从癌症筛查到治疗的导航 服务。我们将通过与世界银行合作解决系统性种族主义来深化这种干预的效果 纽约市食品银行，值得信赖的基层社区合作伙伴，联邦合格健康中心网络，以及 社区医疗诊所。通过与社区利益相关者共同创建过程，我们将应用 以参与性和了解创伤的方式开展社区建设和发展，以确定种族平等 以批判种族理论为指导的战略。来评估不同的原因 提高癌症筛查率的干预要素，我们将利用赋权理论 在社区一级和社会资本，并在卫生系统一级改变管理框架。vbl.使用 扩展RE-AIM以增强可持续发展模型，我们将评估实施因素以优化 旨在减少系统性种族主义的社区和临床战略的覆盖面、接受度和可扩展性，解决 SDH，并减少癌症差异。

Project Summary/Abstract Social determinants of health (SDH) play a substantial role in the existence of disparities in cancer screening, risk factors, and outcomes. Racism, food insecurity, housing instability, language barriers, lack of transportation and childcare, residential segregation, neighborhood poverty, and health insurance access are associated with breast, cervical, and colorectal cancer disparities and delays in cancer screening, diagnostic testing, and care. Systemic racism is a fundamental cause of cancer disparities and is reflected in highly segregated, impoverished, and high population density neighborhoods with built and food environments that inhibit healthy behaviors. These same neighborhoods often are federally designated medically underserved areas with limited access to culturally- and linguistically-appropriate healthcare services and are geographically remote from high quality cancer centers. NYC CONNECT (New York City Cancer Outreach Network in Neighborhoods for Equity and Community Translation) is a multi-sector and multi-institutional proposal that builds on a long history of conducting community-based SDH interventions and community-clinical linkage strategies in NYC to advance health equity. Collaborating partners include a CDC-funded NYC Cancer Prevention and Control Research Network Center, two NCI-designated Cancer Centers, the Food Bank for NYC, and their network of multi-sector community, clinical and government partners. We will build on NYU’s existing community-based community- clinical linkage program which: 1) involves patient navigators who share similar characteristics and lived experiences as the communities they serve and are imbedded in community settings in partnership with trusted community organizations; 2) utilizes a whole-person approach to cancer prevention and control that screens for unmet SDH and links participants to appropriate SDH services; and 3) facilitates access to health insurance and other resources for uninsured and low-income individuals and navigation from cancer screening to treatment services. We will deepen this intervention’s effect by addressing systemic racism working in partnership with the Food Bank for NYC, trusted grassroots community partners, a network of federally qualified health centers and community medicine clinics. Through a co-creation process with community stakeholders, we will apply a participatory and trauma-informed approach to community-building and development to identify racial equity strategies that are informed by critical race theory. To assess causal mechanisms that underlie the different elements of the intervention that lead to improved cancer screening rates, we will utilize theories of empowerment and social capital at the community level and change management framework at the health systems level. Using an Extension of RE-AIM to Enhance Sustainability model, we will assess implementation factors to optimize reach, uptake, and scalability of community and clinical strategies aimed to reduce systemic racism, address SDH, and reduce cancer disparities.