Through my doctoral and post-doctoral training, I have a broad background in cancer epidemiology, with specific training and expertise in nutrition. As a doctoral student at Yale University, I analyzed data from a large multicenter case-control study of esophageal and gastric cancers. As part of this study, I examined dietary and lifestyle risk factors, including the use of novel statistical approaches such as principle components analysis and classification and regression tree analysis. During my time at Albert Einstein College of Medicine (AECOM), I analyzed data from the National Breast Screening Study (NBSS) where I examined the roles of various lifestyle and medical risk factors for numerous cancer outcomes. As a result of these experiences, I am aware of the importance of developing and maintaining successful collaborations through frequent communication among project members and of constructing a realistic research plan and timeline. My past training has provided me with the initial tools to conduct epidemiologic studies and led to my deep interest in racial/ethnic disparities in cancer outcomes. However, I lack the breadth of knowledge in three areas (Social Epidemiology, Cancer Prevention and Control, and Spatial Analyses) necessary to conduct and lead multidisciplinary studies of cancer prevention behaviors and cancer disparities. Further, due to lack of research mentoring opportunities at my current institution, an my heavy teaching load, my development as an independent researcher in this area has been limited. To accomplish my career goal of becoming an independent investigator, and a recognized expert in the disparities in cancer outcomes, I am proposing a career development plan in which I will expand my training through coursework in social epidemiology, health disparities, and spatial analysis as well as through guided readings, regular meetings with mentors and consultants, center visits, and attendance at selected seminars, and conferences. I will be working with an outstanding mentoring team, including Drs. Demissie and Bandera (both at UMDNJ) and Dr. Jones (Yale University), all of whom are experts in the field of cancer prevention and control and health disparities and who have extensive experience mentoring masters and doctoral level students and junior faculty. The Department of Epidemiology at UMDNJ engages in a number of epidemiology activities, courses, and seminars, (www.umdnj.edu) including activities at the School of Public Health, the Institute for the Elimination of Health Disparities (IEHD), and the Cancer Institute of New Jersey. Dr. Demissie, as Director of IEHD, and Dr. Bandera's work with CINJ, will also provide great opportunities for intellectual interactions and future collaborations with both of these institutes. In addition, we have identified a number of consultants, including Dr. Yu, who is at my home institution, who will provide training and assistance in GIS, Dr. Palmer who will provide assistance in recruiting participants from SNAP-Ed and EFNEP, Dr. Dubin who will provide expertise and assistance in statistical methodology and Drs. Natale-Periera and Echeverria who will provide expertise in health disparities and social epidemiology. During the entire period of the award, my department chair and college Dean, have agreed to provide substantial support to devote at least 9 person months (75% full-time professional effort) to develop my research program, which includes limiting my teaching load, supporting my salary that goes above and beyond the $100,000 cap for K awards, reducing my responsibility to represent the Department in College and University committees, and providing me with necessary resources including, office space, secretarial support, graduate student support, and access to computer support and library services. The proposed K01 Career Development Award will also allow the development of an epidemiologic research program in Cancer Disparities in New Jersey. Breast and cervical cancer are leading causes of cancer for women in the United States, respectively and racial/ethnic disparities in diagnosis and mortality are well noted in the literature. These disparities are explained, in part, by unequal access to cancer screening across socioeconomic and racial groups, however little is known about the impact of perception of access to cancer screening on cancer screening behaviors. This study will assess the association between race/ethnicity, perceived access to screening, and individual-level socioeconomic (SES) and demographic factors and area-level characteristics, including SES, availability of low- or no-cost cervical cancer screening and mammography, on screening behavior using a cross-sectional study of low-income women enrolled in the New Jersey Supplemental Nutrition Assistance Program - Education (SNAP-Ed) or Expanded Food and Nutrition Education Programs (EFNEP). Multivariate models will examine the individual and joint effects of geographic and perceived access on adherence to breast and cervical cancer screening guidelines, after adjusting for individual- and area-level characteristics. These findings will serve to examine the complex interaction between socioeconomic status and health behaviors, how they differ between non-Hispanic Black, non-Hispanic White and Hispanics, in New Jersey, which has one of the highest cancer rates in the nation. This project will also serve to develop preliminary data to support an R01 application proposing to conduct a larger scale study, and possibly, an intervention to address these issues in this community.
These findings will add to literature exploring the complex interaction between individual- and area-level measures of access to cancer screening and screening behaviors among low-income women, and how they differ between non-Hispanic Black, non-Hispanic White, and Hispanic populations in New Jersey.
