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。癌症预防和贫困状况结果的差异根源于 健康的结构性和中间社会决定因素，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、医疗保健设施）和社会 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， 体育活动和获得预防保健。不利的邻里条件也加剧了压力 高非稳态负荷是许多癌症的危险因素。这是一个问题， 持续贫困（PP）地区，那里的邻里条件非常普遍。但尽管 令人信服的证据表明生活（建筑和社会）环境影响与健康相关的行为， 结果，包括癌症，几乎没有干预措施，以确定在何种程度上的修改， 社区建设和社会环境降低了癌症风险。这项研究旨在填补这一空白。 知识差距。我们建议进行一项为期五年的研究计划，透过加强 环境（癌症PREEMpT），以测试是否有一个全面的社区干预，改善 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，评估是否提高生活（建立） 和社会）环境导致公共安全的增加，公园和社区空间的使用，社区 活动和预防服务; 2）确定改善生活环境对社区一级的影响 与癌症风险相关的认知和行为，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，以及预防保健和癌症筛查的使用;以及3）评估 改善生活环境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）。采用多部门办法， 公民，组织，企业和地方政府改善他们的生活环境，理论基础 癌症PREEMpT干预将使社区成员参与五个相邻的城市PP普查 位于亚拉巴马的贝塞默。在进行社区参与的需求评估后， 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 采用两组设计的混合方法评估，独立样本为300名居民， 第1年）和干预后（第5年），以及与居民的焦点小组。最后，确定对健康的影响 医疗利用率，我们将比较目标地区接受医疗的所有居民的电子健康记录 通过UAB卫生系统与控制城市PP社区的居民在种族构成上相似。 癌症PREEMpT将填补研究空白，通过一项研究提供证据，降低PP地区的癌症风险， 社区参与、业主支持的干预措施，改善生活环境。