Despite evidence that early detection of colorectal cancer (CRC) effectively prevents premature deaths, racial disparities in CRC persist and the gap is widening, especially among African Americans. Underutilization of cancer screening services often results in late stage diagnosis and higher mortality rates. Behavioral interventions to increase CRC screening have produced mixed results;therefore, a better understanding of factors that contribute to cancer health disparities is warranted. A review of the literature reveals four promising psychosocial/cultural factors: trust, social support, risk perception, and religiousness that have high potential to inform intervention research design. Additionally, as shown by empirical evidence, the behaviors of individuals and their social and physical environments are mutually influential. Since the study population resides in urban neighborhoods, characterized by poverty and racial residential segregation, a better understanding of neighborhood level factors contributing to cancer health disparities also is necessary. The literature shows interventions that take into account the environment of the individual are more likely to be successful. The proposed research will use a socio-ecologic framework to examine and understand both individual- and neighborhood-level factors associated with CRC screening. The proposed research has three specific aims:1) Investigate the associations among individual-level factors (e.g., psychosocial/cultural constructs, sociodemographics) and their relationship with CRC screening;2) Characterize the associations among neighborhood-level factors (e.g., socioeconomic index, residential poverty, education, income) and their relationship with CRC screening;and 3) Explore the associations of individual-level factors, including perceptions of neighborhoods, and neighborhood-level factors with CRC screening using multi-level modeling. My ultimate aim is to build a research career focused on understanding the combined effects of individual and neighborhood level factors that may contribute to the development of scientifically sound and culturally relevant community-based interventions to increase CRC screening among African Americans.
NIH encourages research that promotes an understanding of the factors contributing to cancer health disparities. My proposed research will provide a more comprehensive understanding of the relationships among individual and neighborhood level factors that may explain CRC health disparities;thus, improving community-based interventions designed to increase CRC screening among African Americans.
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