NYC Cancer Outreach Network in Neighborhoods for Equity and Community Translation

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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.