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着更大的癌症差异，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，具有负面的行为后果，如不良饮食，缺乏身体活动和肥胖。实施对抗这些健康行为后果的计划需要针对上游因素（不良的物理和社会环境等）的背景适应和多层次实施策略。造成差距。然而，我们知道没有事先有效的饮食和身体活动干预癌症幸存者和他们的共同幸存者（朋友和家人），已适应和实施的特定PP背景下，使用多层次的实施策略。因此，本申请的总体目标是通过改善健康行为来减少生活在主要是黑人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，我们将利用已建立的实施科学框架和多个当地利益相关者的重要投入，将两项有效的干预措施纳入新的社区交付LEAP计划，并实施和评估该计划。我们的具体目标是：目的1 -使为癌症幸存者（及其共同幸存者）设计的有效饮食和身体活动干预措施适应PP背景和SDH。建立了两个有效的饮食和身体活动干预癌症幸存者（及其共同幸存者），击败癌症和RENEW，我们将适应他们到飞跃计划。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 -使用多层次实施战略在PP领域实施LEAP计划。我们将确定实施战略，开发LEAP实施工具包，并实施LEAP计划。目标3 -评估在PP地区实施LEAP计划的情况。使用混合方法的方法，我们将检查3种类型的结果：实施（准备，覆盖，可接受性，忠诚度，可持续性），服务（安全，成本）和客户（饮食质量，身体活动，身体质量指数，生活质量）。我们将使用2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，并在其余5个PP人口普查区（第2组）中复制，其中另一个持续贫困地区癌症控制中心（C3 P2）项目将进行干预，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C3 P2基础设施和有效的干预措施，该项目将提高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.