NYC Cancer Outreach Network in Neighborhoods for Equity and Community Translation

项目总结/摘要 健康的社会决定因素（SDH）在癌症筛查中存在差异方面发挥了重要作用， 风险因素和结果。种族主义、粮食不安全、住房不稳定、语言障碍、缺乏交通 儿童保育、居住隔离、邻里贫困和医疗保险的获得与 乳腺癌、宫颈癌和结直肠癌在癌症筛查、诊断检测和护理方面的差异和延迟。 系统性种族主义是癌症差异的根本原因，反映在高度隔离，贫困， 以及高人口密度的社区，其建筑和食物环境抑制了健康行为。这些 同样的社区往往是联邦指定的医疗服务不足的地区， 文化和语言上适当的医疗保健服务，地理上远离高质量 癌症中心纽约市社区平等癌症外展网络， 社区翻译）是一个多部门和多机构的建议，建立在一个长期的历史， 在纽约市开展以社区为基础的SDH干预和社区-临床联系战略， 健康公平。合作伙伴包括CDC资助的纽约市癌症预防和控制研究 网络中心，两个NCI指定的癌症中心，纽约市食品银行，以及他们的多部门网络 社区、临床和政府合作伙伴。我们将以纽约大学现有的社区为基础- 临床链接程序，其中：1）涉及具有相似特征和生活条件的患者导航器 作为他们所服务的社区的经验，并嵌入社区环境中，与值得信赖的 社区组织; 2）采用全人方法预防和控制癌症， 未得到满足的SDH，并将参与者与适当的SDH服务联系起来;以及3）促进获得健康保险， 为无保险和低收入个人提供的其他资源，以及从癌症筛查到治疗的导航 服务我们将与联合国人权事务高级专员办事处合作， 纽约市食品银行，值得信赖的基层社区合作伙伴，联邦合格的健康中心网络， 社区医疗诊所通过与社区利益相关者的共同创造过程，我们将应用 对社区建设和发展采取参与性和了解创伤的办法，以确定种族平等 批判性种族理论的策略。为了评估不同的因果机制， 干预措施的要素，导致提高癌症筛查率，我们将利用赋权理论 社区一级的社会资本和卫生系统一级的改革管理框架。使用 作为RE-AIM增强可持续发展模型的扩展，我们将评估实施因素以进行优化 旨在减少系统性种族主义的社区和临床战略的覆盖面、吸收率和可扩展性， SDH，减少癌症差异。

Project Summary/Abstract Social determinants of health (SDH) play a substantial role in the existence of disparities in cancer screening, risk factors, and outcomes. Racism, food insecurity, housing instability, language barriers, lack of transportation and childcare, residential segregation, neighborhood poverty, and health insurance access are associated with breast, cervical, and colorectal cancer disparities and delays in cancer screening, diagnostic testing, and care. Systemic racism is a fundamental cause of cancer disparities and is reflected in highly segregated, impoverished, and high population density neighborhoods with built and food environments that inhibit healthy behaviors. These same neighborhoods often are federally designated medically underserved areas with limited access to culturally- and linguistically-appropriate healthcare services and are geographically remote from high quality cancer centers. NYC CONNECT (New York City Cancer Outreach Network in Neighborhoods for Equity and Community Translation) is a multi-sector and multi-institutional proposal that builds on a long history of conducting community-based SDH interventions and community-clinical linkage strategies in NYC to advance health equity. Collaborating partners include a CDC-funded NYC Cancer Prevention and Control Research Network Center, two NCI-designated Cancer Centers, the Food Bank for NYC, and their network of multi-sector community, clinical and government partners. We will build on NYU’s existing community-based community- clinical linkage program which: 1) involves patient navigators who share similar characteristics and lived experiences as the communities they serve and are imbedded in community settings in partnership with trusted community organizations; 2) utilizes a whole-person approach to cancer prevention and control that screens for unmet SDH and links participants to appropriate SDH services; and 3) facilitates access to health insurance and other resources for uninsured and low-income individuals and navigation from cancer screening to treatment services. We will deepen this intervention’s effect by addressing systemic racism working in partnership with the Food Bank for NYC, trusted grassroots community partners, a network of federally qualified health centers and community medicine clinics. Through a co-creation process with community stakeholders, we will apply a participatory and trauma-informed approach to community-building and development to identify racial equity strategies that are informed by critical race theory. To assess causal mechanisms that underlie the different elements of the intervention that lead to improved cancer screening rates, we will utilize theories of empowerment and social capital at the community level and change management framework at the health systems level. Using an Extension of RE-AIM to Enhance Sustainability model, we will assess implementation factors to optimize reach, uptake, and scalability of community and clinical strategies aimed to reduce systemic racism, address SDH, and reduce cancer disparities.