Research Project 1

摘要--项目1.癌症预防方面的差异和因贫困状况而导致的结果的差异根源于 健康的结构性和中间社会决定因素(SDH)，包括社区建设和社会 环境。建筑环境的特点(例如，可步行、安全、医疗设施)和社会环境 环境(例如，集体疗效)通过以下行为对癌症风险有重大影响 体力活动和获得预防性护理的机会。不利的社区条件也加剧了压力。 反应，以高不平衡负荷的形式，这是许多癌症的危险因素。这是一个问题， 持续贫困(PP)地区，那里不利的邻里条件非常普遍。然而，尽管 令人信服的证据表明，生活(建筑和社会)环境影响与健康相关的行为和 结果，包括癌症，几乎没有任何干预措施来确定在多大程度上修改 社区建设和社会环境降低了患癌症的风险。拟议的研究旨在填补这一点 知识鸿沟。我们提出了一项为期5年的研究计划，通过增强 环境(癌症先发制人)，以测试全面的社区干预是否可以改善 社区建设和社会环境可以降低PP地区的癌症风险。癌症的特定目标 先发制人包括：1)实施癌症先发制人，评估是否提高了生活(建造 和社会)环境导致公共安全增加，公园和社区空间的使用，社区 事件和预防服务；2)确定生活环境改善对社区的影响 与癌症风险有关的看法和行为，如步行和安全，自我报告的体力活动， 社会凝聚力和集体效力，以及预防性护理和癌症筛查的使用；以及3)评估 生活环境改善对自述和客观慢性应激(包括稳态负荷)的影响 和医疗保健利用(包括癌症筛查)。使用多部门方法将 公民、组织、企业和地方政府改善他们的生活环境，以理论为基础 癌症先发制人干预将使社区成员参与五次相邻的城市PP普查 阿拉巴马州贝塞默的大片土地。在社区参与的需求评估之后，将在 建筑和社会环境，然后在第五年进行评估。我们将采用顺序解释 混合方法评估采用两组设计，独立样本为300名居民( 第一年)和干预后(第五年)，以及与居民的重点小组。最后，确定对健康的影响 护理利用情况，我们将比较目标地区所有接受护理的居民的电子健康记录 通过UAB卫生系统与控制城市PP社区的居民在种族构成上相似。 癌症先发制人将填补研究空白，通过提供证据表明PP地区的癌症风险通过 社区参与、利益相关者支持的干预措施，改善生活环境。

ABSTRACT- PROJECT 1. Disparities in cancer prevention and outcomes by poverty status are rooted in structural and intermediate social determinants of health (SDH), including neighborhood built and social environments. Features of the built environment (e.g., walkability, safety, healthcare facilities) and the social environment (e.g., collective efficacy) have major implications for cancer risk through behaviors such as physical activity and access to preventive care. Adverse neighborhood conditions also exacerbate the stress response, in the form of high allostatic load, which is a risk factor for many cancers. This is a problem in persistent poverty (PP) areas where adverse neighborhood conditions are highly prevalent. However, despite compelling evidence that the living (built and social) environment impacts health-related behaviors and outcomes, including cancer, there are virtually no interventions that determine to what extent modifications of the neighborhood built and social environments reduce cancer risk. The proposed study aims to fill this knowledge gap. We propose a 5-year research project to implement Cancer Prevention through Enhanced EnvironMent (Cancer PREEMpT), to test whether a comprehensive community intervention that improves the neighborhood built and social environments can reduce cancer risk in PP areas. The specific aims of Cancer PREEMpT include: 1) Implementing Cancer PREEMpT and assessing whether the enhancement of living (built and social) environments leads to increased public safety, use of parks and community spaces, community events, and prevention services; 2) Determining the effect of improved living environments on community-level perceptions and behaviors related to cancer risk, such as walkability and safety, self-reported physical activity, social cohesion and collective efficacy, and use of preventive care and cancer screening; and 3) Evaluating the impact of improved living environments on self-reported and objective chronic stress (including allostatic load} and healthcare utilization (including cancer screening). Using a multisectoral approach to bring together citizens, organizations, businesses, and local governments to improve their living environment, the theorybased Cancer PREEMpT intervention will engage community members in five adjacent, urban PP census tracts in Bessemer, Alabama. After a community-engaged needs assessment, modifications will be made in the built and social environments, followed by an evaluation in Year 5. We will apply sequential explanatory mixed methods assessments using a two-group design with independent samples of 300 residents at pre( Year 1) and post-intervention (Year 5), and focus groups with residents. Finally, to ascertain impact on health care utilization, we will compare Electronic Health Records of all residents of the target area receiving care through the UAB Health System with residents of control urban PP communities similar in racial make-up. Cancer PREEMpT will fill a research gap by providing evidence for reduced cancer risk in PP areas through a community-engaged, stakeholder-supported intervention that improves the living environment.