Project Grant F31CA294928

IMPLEMENTATION OF A COMMUNITY-BASED CANCER PREVENTION INTERVENTION WITH A MARGINALIZED POPULATION EXPERIENCING FOOD INSECURITY - PROJECT SUMMARY/ABSTRACT FOOD INSECURITY IS A STRONG MEDIATOR IN THE RELATIONSHIP BETWEEN POVERTY AND BREAST CANCER MORTALITY IN THE UNITED STATES. NATIONAL DATA HAS IDENTIFIED ADULT WOMEN EXPERIENCING FOOD INSECURITY HAVE 54% LOWER ODDS OF REPORTING BREAST CANCER SCREENING IN THE PAST TWO YEARS WHEN COMPARED WITH FOOD SECURE WOMEN. COUNTIES WITH VERY HIGH LEVELS OF FOOD INSECURITY ARE SIGNIFICANTLY ASSOCIATED WITH LATER-STAGE BREAST CANCER AMONG WOMEN AGES 65 AND OLDER. EARLY DETECTION REDUCES BREAST CANCER MORTALITY RATES AND INCREASES THE LIKELIHOOD OF BETTER TREATMENT OPTIONS. HOWEVER, HIGHER FOOD INSECURITY HAS BEEN ASSOCIATED WITH DELAYED UTILIZATION OF, AND REDUCED ADHERENCE TO, RECOMMENDED MEDICAL CARE AMONG INDIVIDUALS AND COMMUNITIES. PARTNERING WITH EXISTING COMMUNITY PROGRAMS THAT OFFER SUPPLEMENTAL FOOD ASSISTANCE MAY PROVIDE AN OPPORTUNITY TO ENCOURAGE BREAST CANCER SCREENING IN THIS HARDER-TO-REACH POPULATION. THE PROPOSED STUDY WILL APPLY COMMUNITY-ENGAGED RESEARCH METHODS TO IMPROVE ACCESS TO BREAST CANCER SCREENING AMONG A MARGINALIZED POPULATION THAT IS EXPERIENCING FOOD INSECURITY. THE CENTRAL HYPOTHESIS IS THAT ADDRESSING BARRIERS TO BREAST CANCER SCREENING PROMOTION FOR DIVERSE COMMUNITIES OF WOMEN WITH FOOD INSECURITY CAN INCREASE SCREENING UPTAKE, ULTIMATELY IMPROVING CANCER HEALTH EQUITY. WE WILL TEST OUR HYPOTHESIS VIA THE FOLLOWING SPECIFIC AIMS: (1) IDENTIFY BARRIERS AND FACILITATORS TO IMPLEMENTING A CANCER PREVENTION INTERVENTION IN A FOOD DISTRIBUTION SETTING; (2) DEVELOP A TAILORED COMMUNITY-BASED CANCER PREVENTION INTERVENTION TO PROMOTE BREAST CANCER SCREENING AMONG WOMEN WITH FOOD INSECURITY; AND (3) EVALUATE THE ACCEPTABILITY, APPROPRIATENESS, AND FEASIBILITY OF THE COMMUNITY-BASED INTERVENTION PROMOTING BREAST CANCER SCREENING AMONG WOMEN WITH FOOD INSECURITY. TO ACHIEVE AIM 1, I WILL COLLECT QUALITATIVE DATA ABOUT FOOD BANK DISTRIBUTION EVENTS AND THE CLIENTS SERVED USING PARTICIPANT OBSERVATION WITH SEMI-STRUCTURED FIELDNOTES AND INTERVIEWS (N=20) AND DIRECTED CONTENT ANALYSIS GUIDED BY THE CONSOLIDATED FRAMEWORK FOR IMPLEMENTATION RESEARCH TO GAIN AN IN-DEPTH UNDERSTANDING OF FACTORS AND ELUCIDATE MECHANISMS THAT IMPACT IMPLEMENTATION. FOR AIM 2, I WILL USE INTERVENTION MAPPING AS A SYSTEMATIC PROCESS FOR PLANNING A COMMUNITY-BASED INTERVENTION TO PROMOTE BREAST CANCER SCREENING AMONG DIVERSE WOMEN WHO ARE SERVED BY THE FOOD BANK. FOR AIM 3, I WILL CONDUCT A PILOT STUDY OF THE INTERVENTION WITH THE FOOD BANK, THEN SURVEY WOMEN AGES 40-74 YEARS (N=50) TO EVALUATE SELECT IMPLEMENTATION OUTCOMES. THIS RESEARCH STANDS TO SIGNIFICANTLY IMPROVE THE UNDERSTANDING OF FOOD INSECURITY AS A SOCIAL DETERMINANT OF CANCER HEALTH AND PROVIDE AN IMPLEMENTATION MODEL TO PROMOTE CANCER PREVENTION WITH THIS AT-RISK POPULATION. THE TRAINING PLAN WILL BE FACILITATED BY THE MENTORSHIP OF MY SPONSOR AND THE EXCEPTIONAL FACILITIES AT UC DAVIS. THIS PROPOSAL DESCRIBES AN INTEGRATIVE AND COMPREHENSIVE TRAINING PLAN TO SUPPORT SCIENTIFIC AND PROFESSIONAL DEVELOPMENT AND PROPEL ME TOWARD MY LONG-TERM GOAL OF BECOMING AN INDEPENDENT PUBLIC HEALTH RESEARCHER.