Exploring Sociodemographic and Behavioral Factors Underlying Racial/Ethnic Dispar

描述（由申请人提供）：通过我的博士和博士后培训，我在癌症流行病学方面有广泛的背景，在营养方面有专门的培训和专业知识。作为耶鲁大学的一名博士生，我分析了一项关于食管癌和胃癌的大型多中心病例对照研究的数据。作为这项研究的一部分，我检查了饮食和生活方式的风险因素，包括使用新的统计方法，如主成分分析和分类以及回归树分析。在阿尔伯特·爱因斯坦医学院（AECOM）工作期间，我分析了国家乳腺癌筛查研究（NBSS）的数据，在该研究中，我检查了各种生活方式和医疗风险因素对许多癌症结果的作用。由于这些经验，我意识到通过项目成员之间的频繁沟通来发展和保持成功合作的重要性，以及构建一个现实的研究计划和时间轴的重要性。我过去的培训为我提供了进行流行病学研究的初始工具，并导致我对癌症结果中的种族/民族差异产生了浓厚的兴趣。然而，我缺乏在三个领域（社会流行病学，癌症预防和控制，空间分析）进行和领导癌症预防行为和癌症差异的多学科研究所需的知识广度。此外，由于我目前的机构缺乏研究指导的机会，我沉重的教学负担，我在这方面作为一个独立的研究人员的发展受到了限制。 为了实现我的职业目标，成为一名独立的调查员，并在癌症结果的差异公认的专家，我提出了一个职业发展计划，其中我将通过社会流行病学，健康差异和空间分析课程，以及通过指导阅读，定期会议与导师和顾问，中心访问，并参加选定的研讨会和会议，扩大我的培训。我将与一个优秀的指导团队合作，包括Demissie和Bandera博士（都在UMDNJ）和Jones博士（耶鲁大学），他们都是癌症预防和控制以及健康差异领域的专家，并且在指导硕士和博士生以及初级教师方面拥有丰富的经验。UMDNJ的流行病学系参与了许多流行病学活动，课程和研讨会，（www.umdnj.edu）包括公共卫生学院，消除健康差异研究所（IEHD）和新泽西癌症研究所的活动。Demissie博士作为IEHD的主任，以及Bandera博士在CINJ的工作，也将为与这两个研究所的智力互动和未来合作提供很好的机会。此外，我们已经确定了一些顾问，包括余博士，他在我的家乡机构，谁将提供GIS的培训和援助，帕尔默博士将提供援助，招募参与者从SNAP-Ed和EFNEP，杜宾博士谁将提供专业知识和统计方法的援助和博士。在整个颁奖期间，我的系主任和学院院长同意提供实质性的支持，投入至少9个人月（75%的全职专业工作），以发展我的研究计划，其中包括限制我的教学负荷，支持我的工资，超过10万美元的上限K奖，减少我在学院和大学委员会中代表系的责任，并为我提供必要的资源，包括办公空间，秘书支持，研究生支持，以及获得计算机支持和图书馆服务。 拟议的K 01职业发展奖还将允许在新泽西的癌症差异的流行病学研究计划的发展。乳腺癌和宫颈癌分别是美国女性癌症的主要原因，文献中充分注意到了诊断和死亡率的种族/民族差异。这些差异的部分原因是社会经济和种族群体之间获得癌症筛查的机会不平等，但人们对获得癌症筛查的看法对癌症筛查行为的影响知之甚少。本研究将评估种族/民族、对筛查的感知、个人层面的社会经济（SES）和人口统计学因素以及地区层面的特征（包括SES、低成本或无成本宫颈癌筛查和乳腺X线检查的可用性）之间的关联。对参加新泽西补充营养援助计划-教育（SNAP-Ed）的低收入妇女进行横断面研究，扩大食品和营养教育计划（EFNEP）。多变量模型将检查个人和联合的影响，地理和感知访问遵守乳腺癌和宫颈癌筛查指南，调整后的个人和地区水平的特点。这些发现将有助于研究社会经济地位和健康行为之间的复杂相互作用，以及新泽西的非西班牙裔黑人，非西班牙裔白色和西班牙裔之间的差异。该项目还将有助于编制初步数据 支持R 01申请，建议进行更大规模的研究，并可能进行干预，以解决该社区的这些问题。

DESCRIPTION (provided by applicant): Through my doctoral and post-doctoral training, I have a broad background in cancer epidemiology, with specific training and expertise in nutrition. As a doctoral student at Yale University, I analyzed data from a large multicenter case-control study of esophageal and gastric cancers. As part of this study, I examined dietary and lifestyle risk factors, including the use of novel statistical approaches such as principle components analysis and classification and regression tree analysis. During my time at Albert Einstein College of Medicine (AECOM), I analyzed data from the National Breast Screening Study (NBSS) where I examined the roles of various lifestyle and medical risk factors for numerous cancer outcomes. As a result of these experiences, I am aware of the importance of developing and maintaining successful collaborations through frequent communication among project members and of constructing a realistic research plan and timeline. My past training has provided me with the initial tools to conduct epidemiologic studies and led to my deep interest in racial/ethnic disparities in cancer outcomes. However, I lack the breadth of knowledge in three areas (Social Epidemiology, Cancer Prevention and Control, and Spatial Analyses) necessary to conduct and lead multidisciplinary studies of cancer prevention behaviors and cancer disparities. Further, due to lack of research mentoring opportunities at my current institution, an my heavy teaching load, my development as an independent researcher in this area has been limited. To accomplish my career goal of becoming an independent investigator, and a recognized expert in the disparities in cancer outcomes, I am proposing a career development plan in which I will expand my training through coursework in social epidemiology, health disparities, and spatial analysis as well as through guided readings, regular meetings with mentors and consultants, center visits, and attendance at selected seminars, and conferences. I will be working with an outstanding mentoring team, including Drs. Demissie and Bandera (both at UMDNJ) and Dr. Jones (Yale University), all of whom are experts in the field of cancer prevention and control and health disparities and who have extensive experience mentoring masters and doctoral level students and junior faculty. The Department of Epidemiology at UMDNJ engages in a number of epidemiology activities, courses, and seminars, (www.umdnj.edu) including activities at the School of Public Health, the Institute for the Elimination of Health Disparities (IEHD), and the Cancer Institute of New Jersey. Dr. Demissie, as Director of IEHD, and Dr. Bandera's work with CINJ, will also provide great opportunities for intellectual interactions and future collaborations with both of these institutes. In addition, we have identified a number of consultants, including Dr. Yu, who is at my home institution, who will provide training and assistance in GIS, Dr. Palmer who will provide assistance in recruiting participants from SNAP-Ed and EFNEP, Dr. Dubin who will provide expertise and assistance in statistical methodology and Drs. Natale-Periera and Echeverria who will provide expertise in health disparities and social epidemiology. During the entire period of the award, my department chair and college Dean, have agreed to provide substantial support to devote at least 9 person months (75% full-time professional effort) to develop my research program, which includes limiting my teaching load, supporting my salary that goes above and beyond the $100,000 cap for K awards, reducing my responsibility to represent the Department in College and University committees, and providing me with necessary resources including, office space, secretarial support, graduate student support, and access to computer support and library services. The proposed K01 Career Development Award will also allow the development of an epidemiologic research program in Cancer Disparities in New Jersey. Breast and cervical cancer are leading causes of cancer for women in the United States, respectively and racial/ethnic disparities in diagnosis and mortality are well noted in the literature. These disparities are explained, in part, by unequal access to cancer screening across socioeconomic and racial groups, however little is known about the impact of perception of access to cancer screening on cancer screening behaviors. This study will assess the association between race/ethnicity, perceived access to screening, and individual-level socioeconomic (SES) and demographic factors and area-level characteristics, including SES, availability of low- or no-cost cervical cancer screening and mammography, on screening behavior using a cross-sectional study of low-income women enrolled in the New Jersey Supplemental Nutrition Assistance Program - Education (SNAP-Ed) or Expanded Food and Nutrition Education Programs (EFNEP). Multivariate models will examine the individual and joint effects of geographic and perceived access on adherence to breast and cervical cancer screening guidelines, after adjusting for individual- and area-level characteristics. These findings will serve to examine the complex interaction between socioeconomic status and health behaviors, how they differ between non-Hispanic Black, non-Hispanic White and Hispanics, in New Jersey, which has one of the highest cancer rates in the nation. This project will also serve to develop preliminary data to support an R01 application proposing to conduct a larger scale study, and possibly, an intervention to address these issues in this community.