Research Project-002

摘要-项目2。生活在持续贫困（PP）地区的癌症幸存者遭受更大的癌症差异，这种差异在非西班牙裔黑人（以下简称黑人）人群中被放大。在PP地区，健康的社会决定因素（SDH），包括恶劣的生活环境，会产生不良的行为后果，如不良饮食、缺乏体育活动和肥胖。实施应对这些健康行为后果的方案需要情境适应和针对导致差异的上游因素（恶劣的物理和社会环境等）的多层次实施策略。然而，据我们所知，目前还没有针对癌症幸存者及其共同幸存者（朋友和家人）的有效饮食和身体活动干预措施在特定的PP环境中采用多层次实施策略进行调整和实施。因此，本应用程序的总体目标是通过改善健康行为来减少主要生活在黑色PP地区的癌症幸存者及其共同幸存者所经历的健康差异。为了实现这一目标，我们将利用现有的实施科学框架和多个地方利益相关者的大量投入，将两项有效的干预措施纳入新的社区提供的LEAP计划，并实施和评估该计划。我们的具体目标是：目标1 -适应为癌症幸存者（及其共同幸存者）设计的有效饮食和体育活动干预，以适应PP背景和SDH。为癌症幸存者（及其共同幸存者）建立了两种有效的饮食和体育活动干预措施，BEAT cancer和RENEW，我们将把它们纳入LEAP计划。适应过程将侧重于PP领域的可接受性、可行性、可持续性和SDH。目标2 -使用多层次实施策略在PP领域实施LEAP计划。我们将确定实施策略，开发LEAP实施工具包，并实施LEAP计划。目标3 -评估LEAP计划在生产区的实施情况。使用混合方法方法，我们将检查3种类型的结果：实施（准备程度、覆盖范围、可接受性、保真度、可持续性）、服务（安全性、成本）和客户（饮食质量、身体活动、体重指数、生活质量）。我们将使用两组前瞻性设计，其中我们的工作将从4个PP人口普查区（第1组）开始，并在剩余的5个PP人口普查区（第2组）进行复制，其中另一个持续贫困地区癌症控制中心（C3P2）项目将介入以改善生活环境（建筑和社会）。这将使我们能够检查PP生活环境的改善是否增强了LEAP计划的适应和实施。通过利用C3P2基础设施和有效的干预措施，该项目将提高在PP地区实施健康促进的能力。

ABSTRACT - PROJECT 2. Cancer survivors living in persistent poverty (PP) areas suffer greater cancer disparities which are magnified in non-Hispanic Black (hereafter Black) populations. In PP areas, Social Determinants of Health (SDH), including poor living environments have negative behavioral consequences such as poor diet, physical inactivity, and obesity. Implementing programs that counter these health behavior consequences require contextual adaptation and multilevel implementation strategies that target upstream factors (poor physical and social environment, etc.) contributing to disparities. Yet, we know of no prior efficacious diet and physical activity intervention for cancer survivors and their co-survivors (friends and family) that has been adapted and implemented in the specific PP context using multilevel implementation strategies. Thus, the overall goal of this application is to reduce health disparities experienced by cancer survivors and their co-survivors living in primarily Black PP areas by improving health behaviors. To achieve this goal, we will use established Implementation Science frameworks and significant input from multiple local stakeholders to adapt two efficacious interventions into a new community-delivered LEAP Program, and implement and evaluate this program. Our specific aims are: Aim 1 -Adapt efficacious diet and physical activity interventions designed for cancer survivors (and their co-survivors) to the PP context and SDH. Building off two efficacious diet and physical activity interventions for cancer survivors (and their co-survivors), BEAT Cancer and RENEW, we will adapt them into the LEAP Program. The adaptation process will focus on acceptability, feasibility, sustainability, and SDH in PP areas. Aim 2 - Implement the LEAP program in PP areas using multilevel implementation strategies. We will identify implementation strategies, develop a LEAP Implementation Toolkit, and implement the LEAP program. Aim 3 - Evaluate LEAP program implementation in PP areas. Using a mixed methods approach, we will examine 3 types of outcomes: implementation (readiness, reach, acceptability, fidelity, sustainability), service (safety, cost), and client (diet quality, physical activity, body mass index, quality of life). We will use a 2-cluster prospective design in which our work will start in 4 PP census tracts (Cluster 1) and be replicated in the remaining 5 PP census tracts (Cluster 2) where the other Center for Cancer Control in Persistent Poverty Areas (C3P2) project will intervene to improve the living environment (built and social). This will allow us to examine whether PP living environment improvements enhance the adaptation and implementation of the LEAP program. By leveraging the C3P2 infrastructure and efficacious interventions, this project will advance capacity for implementation of health promotion in PP areas.