In response to RFA ES-02-009, a multi-disciplinary group of investigators from the Ohio State University and the University of Michigan have collaborated to propose a Center for Population Health and Health Disparities focusing on an important health issue in underserved populations,cancer. The Center will initially focus on the goal of understanding why high rates of cervical cancer incidence and mortality are observed in Appalachia Ohio, a mainly rural area in Southern and Eastern Ohio. This goal will be accomplished using community-based participatory research within the framework of the Social Determinants of Health model in three inter-related projects and four supporting cores. All studies will be conducted in 16 clinics which represent the general population of women aged 18 and older in the region. We will utilize the Center's internal and external advisory committees and community partners organized into a community advisory board and Consortium of communityorganizations to facilitate the accomplishment of project goals. Project 1 will recruit 1600 women to an observational study to investigate multi-level (social, environmental, behavioral, and biological) correlates of "risk-appropriate" Pap smear utilization, in Phase I. From this cohort of women, those who smoke (30%) will be eligible to participate in Project 2, which tests the effectiveness of a lay health educator (social) intervention to promote smoking cessation (behavioral) and validate cessation endpoints with saliva cotinine measurements (biological) in a quasi-experimental trial design;those women who are in need of &Pap test (48% of 1600) will be eligible to participate in Phase II of Project 1 which will test the effectiveness of a lay health educator (social) intervention to promote "risk-appropriate" Pap smear utilization (behavioral) and follow-up for abnormalities (biological) detected in a quasi-experimental trial design. Project 3 will examine the contribution of HPV (biological) to cervical abnormalities in Appalachia in relation to individual-level behaviors (e.g. smoking, sexual activity) within the social and environmental region of Appalachia in a case-control observational study among women who have Pap smears in these 16 clinics.The research will be supported by four cores: A) Administration - fiscal and Center oversight; B) Biostatistics and Data Resources - sample selection, data management, data analysis, and population data resources;C) Clinical Correlative Sciences - collect, obtain and process biomarker specimens;and D) Behavioral Assessment and Intervention - train interviewers and lay health educators, conduct interviews, design intervention material, and facilitate communication amongst sites. The Center includes a mechanism for pilot project solicitation, review and funding. This Center has institutional commitment in terms of personnel, funds and space, as well as, a commitment to focus on the problem of health disparities in the region. Finally, members of the team have worked together in the past in various settings that focus on the goals of the proposed Center and have an established relationship in Appalachian Ohio for the purpose of improving the health of the population. Future work of this Center will focus on moving this type of multi-level observational and interventional community-based research, into other areas where health disparities exist in relation to cancer withinour region.
Cervical cancer disparities exist among women in Appalachia. Our previous work has found that the prevalence of factors known to cause cervical cancer e.g. tobacco use, genetic predisposition, HPV infection, and stress due to economic conditions, are disproportionately higher in this population. This Center, CARE II, proposes to use a transdisciplinary research team in conjunction with community partners, to address and reduce this health disparity.
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