Community Outreach Program

水牛城、尼亚加拉瀑布、它们的郊区和周边农村县的历史经验和文化环境对WNYC(2)中心的使命和拟议的社区外联计划的背景很重要。在1850年S和南北战争时期，威斯康星州是废奴主义运动的主要旅程点，作为美国地下铁路的最后一站，帮助以前的奴隶逃往加拿大。然后，随着航运和工业革命的发展，布法罗在20世纪初成为人均百万富翁最多的地方。第二次世界大战和战后 繁荣时期，更多来自南部各州的非洲裔美国人搬到布法罗从事工业工作，然后成为东区占主导地位的亚群体，导致之前的欧洲种族群体从布法罗城市转移到伊利的其他地区和周围的县。这些历史上的移民浪潮导致了所谓的“肤色界线”，指的是在世纪之交将爱尔兰、意大利和东欧的移民列为“非白人”的种族/种族特征或起源的阶级和资源的等级划分。 到了20世纪80年代的S，布法罗市已经失去了23%的人口，成千上万的工作岗位和像伯利恒钢铁这样的主要工业雇主，导致其税基损失了70%。这些被解雇的工人(白人和黑人)中的许多人仍然生活在布法罗、尼亚加拉瀑布、伊利和周围的县，他们既体现了过去暴露在风险中的职业风险，也体现了失业的经济压力。由此产生的社会文化动态对种族和经济环境产生了重要影响。这种经济衰退导致了与担心阶层和工作被取代有关的社会和政治影响，如延迟 公立学校的一体化(1981)；波兰、德国和爱尔兰家庭白人种族逃亡的模式；为白人和黑人居民开发住房“项目”，以及继续实行事实上的社区隔离。(2，3)媒体最近的一篇报道称，布法罗市“是纽约州最空荡荡的社区”，指的是有最多废弃房屋的社区。(4) 南方，包括肖陶瓦县，主要是在17世纪末由欧洲移民S定居，借给其主要是白人的人口基础。然而，在1800年的S时代，詹姆斯敦拥有遍布全县的多个地下铁路车站，是最早的自由有色人种定居点之一。(5)肖陶夸县的第一个非裔美国人锡安教堂于1882年在詹姆斯敦开设。(6)纽约州也是旁克尔克地区大量人均拉美裔/拉美裔人口的家园，他们是从纽约市迁徙过来的，主要是波多黎各后裔。在纽约有大量的移民 该地区的农业劳动力来自墨西哥。 在全国范围内，卫生和医疗保健领域存在的种族不平等现象已经得到了很好的记录。(7)几个因素被认为是造成这些不平等和由此产生的差异的可能原因，包括但不限于卫生保健提供者的偏见、刻板印象和临床不确定性。(7)同样，社区动态包括隔离、士绅化、建成的环境和贫困影响行为和疾病。(8)历史过程及其对社区和环境水平变量的影响的组合 在布法罗、尼亚加拉瀑布和肖陶夸造成了显著的癌症差距，这些社区及其资源将提供解决方案。 简而言之，我们的社区外展计划的理论基础是建立在遵循社会生态学模型的多个层面上解决差异的基础上。(9)例如，在烟草方面，RPCI将继续在政策层面(例如，税收和禁烟政策)(参见设施和资源)进行工作，我们将通过与街区俱乐部协会的新干预措施来加强社区层面的参与，同时在机构/提供者层面努力促进我们拟议的研究中的戒烟。(见N4.R01)干预措施 我们中心建议的减少差距的重点是在西尼苏达州医疗服务不足的居民中建立社会资本，以优化他们使用现有癌症资源和程序的能力和兴趣‘；同时扩大RPCI工作人员的经验，以提高对脆弱社区的社会和文化背景的了解。(10)我们中心使用的社会资本的概念被定义为“参与社会网络和团体所产生的好处和挑战(11)，包括积极的 公民参与的属性以及互惠和信任的规范(在公共卫生文献中经常使用)。

The historical experiences and cultural environment of the cities of Buffalo, Niagara Falls, their suburbs and the surrounding rural counties is important to the context of the mission of the WNYC(2) Center and proposed Community Outreach Program. Puring the 1850's and Civil War era, WNY was a major journey point in the abolitionist movement serving as final American stops on the Underground Railroad for assisting former slaves to escape into Canada. Then with the growth of shipping and the industrial revolution, Buffalo became the home of the most millionaires per capita at the turn of the 20th century. Puring World War II and post-war boom, more African Americans from southern states moved into Buffalo for industrial jobs and then became the predominate subgroup on the Eastside creating a movement of the previous European ethnic groups from urban Buffalo into other parts of Erie and surrounding counties. These historical waves of migration resulted in what has been characterized as the "color line," referring to the hierarchical categorization of class and resources by ethnic/racial characteristics or origins that included Irish, Italian and Eastern European immigrants as "nonwhite" at the turn ofthe century.(1) By the 1980's, the City of Buffalo had lost 23% of its population, thousands of jobs and major industrial employers like Bethlehem Steel, resulting in a loss of 70% of its tax base.^ Many of these displaced workers¿White and Black- still live in Buffalo, Niagara Falls, Erie and the surrounding counties and embody both the occupational risks from past exposures as well as the economic pressures of unemployment. The resulting sociocultural dynamics are important influences on racial and economic circumstances. This economic decline resulted in social and political repercussions related to fears of class and job displacement such as delayed integration of public schools (1981); patterns for white ethnic flight of Polish, German, and Irish families; development of housing "projects" for both White and Black residents, and continued de facto segregation of neighborhoods.(2,3) A recent story in the media reported that the City of Buffalo "is the home to the emptiest neighborhood in New York State" referring to a neighborhood with the most abandoned homes. (4) The Southern Tier, including the county of Chautauqua, was primarily settled in the late 1700's by European immigrants, lending to its primarily white demographic base. In the 1800's however, with multiple stations of the Underground Railroad throughout the county, Jamestown was host to one of the first settlements of 'free colored people.(5) The first African American Episcopal Zion Church in Chautauqua County opened in Jamestown in 1882.(6) WNY is also home to a large per capita population of Hispanic/Latinos in the Punkirk area, migrating from New York City, primarily of Puerto Rican descent. There is a strong migrant presence in the area's agricultural workforce originating from Mexico. The presence of racial inequities in health and healthcare has been well documented nationally. (7) Several factors are suggested as possible causes of these inequities and resulting disparities, including, but not limited to, health care provider bias, stereotyping, and clinical uncertainty.(7 )Likewise, neighborhood dynamics including segregation, gentrification, built environment and poverty impact behavior and disease.(8) The combination of historical processes and their impact on community and environmental level variables have created significant cancer disparities in Buffalo, Niagara Falls and Chautauqua and these communities and their resources will provide the solutions. Briefly, the theoretical foundation for our Community Outreach Program plans is built upon addressing disparities at multiple levels following a Socioecological Model.(9) For example, in tobacco, RPCI will continue work at a policy level (e.g., taxes and no-smoking policies), (see Facilities and Resources) and we will enhance the community level involvement with new interventions with Block Club Associations, while working at the institutional/provider level to enhance cessation in our proposed research. (See N4.R01) The interventions to reduce disparities proposed in our Center are focused on building social capital among medically underserved residents of WNY to optimize their ability and interest in using available cancer resources and procedures'"; while expanding the experiences of the RPCI staff to improve understanding of the social and cultural context of vulnerable communities.(10) The concept of social capital as used in our Center is defined as the "benefits and challenges that accrue from participation in social networks and groups(11) and includes the positive attributes of civic engagement and norms of reciprocity and trust (as is often used in public health literature).(12)