Project 2

研究项目2：项目总结 尽管个人层面的方案和干预措施取得了一些成功，以促进预防 结直肠癌--持续贫困地区的负担仍然特别高。许多癌症专家 预防和控制最近提出，为了真正解决这种不公平的负担，我们必须采取多种措施-- 这一方法包括解决癌症的根本原因。我们提出了一种准实验 美国最大的反贫困政策项目--劳动所得税的影响研究 信贷(EITC)，特别关注加利福尼亚州两个县的当地持续贫困地区：1)Yolo，a 以农业为主的县，加州大学戴维斯分校(UCD)的所在地，以及拥有 加州贫困率最高；2)圣克拉拉，斯坦福大学的所在地，有 严重的收入不平等。自2015年以来，对于年收入超过3万美元的家庭，加州EITC (CalEITC)和联邦信贷每年提供高达10,000美元。这笔收入，通过帮助支付 日常开支、食物和住房、交通和医疗保健，因此也通过减少 贫穷，可能会影响结直肠癌的几个危险因素。同样值得注意的是，申请资格的变化 2020年发生在加利福尼亚州的CalEITC-不再需要社保号，开放 具有个人纳税人识别码(ITIN)的非美国公民的资格。我们将与我们的 社区合作伙伴区域联盟，以实现以下具体目标：目标1.审查影响 关于加州2015年关于结直肠癌风险因素和预防性筛查的EITC扩展(CalEITC)， 目的2.评估CalEITC对结直肠癌危险因素的短期影响，并在 生活在持续贫困地区的加州人，目标3.定性检查加州经济贸易中心获奖者的经历 了解CalEITC对与预防结直肠癌相关的行为和暴露的影响，以及 3.2)有资格了解不申请CalEITC福利的原因的非EITC受助人， 特别是在尤洛和圣诞老人的拉丁裔和越南社区的新符合条件的ITIN接受者中 克拉拉县和目标4.与我们的区域联盟合作，建设能力，支持多层次和 通过评估EITC扩容对降低结直肠癌发病率的影响进行结构性干预 在持续贫困地区的比率。该项目将建立在多机构和多学科的基础上 上游研究中心合作解决最紧迫的癌症预防需求 在约洛县和圣克拉拉县持续贫困地区，重点关注拉丁裔和越南人的需求 通过我们正在进行的区域联盟社区合作，这些社区的人民。通过 在CalEITC的情况下，配合项目1中保证的基本收入的评价，我们预计 我们的计划将增加证据来支持解决结构性和社会性问题的倡导和行动 促进结直肠癌预防和筛查的健康决定因素。

Research Project 2: Project Summary Despite some successes of individual-level programs and interventions to promote behaviors that prevent colorectal cancer – the burden in persistent poverty areas remains particularly high. Many experts in cancer prevention and control have recently argued that to truly address this inequitable burden we must take a multi- level approach that includes addressing the fundamental causes of cancer. We propose a quasi-experimental study of the impacts of the largest anti-poverty policy program for families in the U.S. -- the Earned Income Tax Credit (EITC), with a particular focus on local persistent poverty areas in two counties in California: 1) Yolo, a largely agricultural county which is home to University of California, Davis (UCD), and the county with the highest poverty rate in California; and 2) Santa Clara, an urban area home to Stanford University, with dramatic income inequality. Since 2015, for households earning up to $30,000 per year, the California EITC (CalEITC) and Federal Credits provide up to $10,000 a year. This amount of income, through helping pay for daily expenses, food and housing, transportation, and healthcare, and therefore also by reducing the stress of poverty, may influence several risk factors for colorectal cancer. Also notable is the change in eligibility for CalEITC that occurred in California in 2020 – having a social security number is no longer required, opening eligibility to non-U.S. citizens with an Individual Taxpayer Identification Number (ITIN). We will work with our Regional Coalition of community partners to accomplish the following specific aims: Aim 1. Examine the impact of the California 2015 EITC expansion (CalEITC) on colorectal cancer risk factors and preventative screening, Aim 2. Estimate the short-term effects of CalEITC on colorectal cancer risk factors and screening among Californians living in persistent-poverty areas, Aim 3. Qualitatively examine 3.1) CalEITC recipients’ experience to understand the impacts of CalEITC on behaviors and exposures related to colorectal cancer prevention, and 3.2) non-EITC recipients who qualify to understand the reasons for not applying for CalEITC benefits, especially among newly eligible ITIN recipients in the Latino and Vietnamese communities in Yolo and Santa Clara Counties, and Aim 4. Work with our Regional Coalition to build capacity in support of multilevel and structural interventions by estimating the effects of EITC expansion on reducing colorectal cancer incidence rates in persistent poverty areas. The project will build on the multiple institution and multi-disciplinary collaborations of the UPSTREAM Research Center to address the most pressing needs for cancer prevention in persistent poverty areas in Yolo and Santa Clara Counties, focusing on the needs of Latino and Vietnamese people in these communities through our ongoing Regional Coalition community collaborations. Through the case of the CalEITC, in coordination with the evaluation of Guaranteed Basic Income in Project 1, we expect that our program will add evidence to support advocacy and actions to address the structural and social determinants of health to promote colorectal cancer prevention and screening.