In 2018, 4,170 women will die from cervical cancer and 23,240 will die from colorectal cancer, yet many of these deaths avoidable through cancer screening. Cancer mortality rates and screening prevalence vary by geography, with women living in rural and racially-segregated areas more likely to die from, but less likely to screen for, these cancers compared to women in other areas. Women in rural and segregated areas face unique multilevel barriers to screening (e.g., low cancer risk perceptions, high travel burden). Home-based self- collection of human papillomavirus (HPV) tests for cervical cancer and fecal immunochemical tests (FIT) for colorectal cancer, paired with culturally-appropriate educational materials, could overcome these barriers. However, the successful implementation of such interventions in rural and segregated communities is understudied. The proposed study will use health behavior theory and intervention design and adaptation techniques to clarify person- and environment-level factors related to cancer screening among women in rural and segregated areas. In the proposed K22 project, the principal investigator (PI) and collaborators will conduct mixed methods formative research (including analysis of spatial data, in-depth interviews, surveys, and focus groups) to examine environment- and person-level correlates of cancer screening among women (ages 50-65 years) in rural, segregated areas (Aim 1). Using those findings, the team will adapt existing, evidence-based cancer screening educational materials, which will be delivered to eligible women in rural, segregated communities in conjunction with self-collected HPV tests and FIT (Aim 2). The team will examine feasibility and preliminary outcomes data for this pilot study to support an R01-level randomized hybrid effectiveness-implementation trial of the intervention materials to improve cancer screening in these underserved and understudied communities. In addition to these research activities, the proposed K22 project includes several training activities to support the career development of the PI, Dr. Jennifer L. Moss. Dr. Moss?s long-term career goal is to become a scientific leader in transdisciplinary research on geographic disparities in cancer prevention behaviors and outcomes. Her short-term career goals include obtaining additional training in mixed methods analysis, intervention design, and grant writing. With protected time for research and further training, Dr. Moss can use the proposed K22 project to launch a career as an independent behavioral scientist contributing to the National Cancer Institute?s mission to reduce the burden of cancer in the population.
Screening can reduce cancer mortality rates, including for cervical and colorectal cancers, but screening is lower and mortality is higher among people living in rural and segregated areas compared to people living elsewhere. The public health implications of the proposed project include the identification of novel, multilevel determinants of cancer screening among women in vulnerable areas using techniques from geospatial analysis, mixed methods, and intervention development and adaptation. Long-term, the findings from this project have the potential to reduce geographic disparities in cancer screening and burden and to lower overall rates of cancer in the population.
