Substantial racial disparities exist in the health-related quality of life (HRQOL) and mortality of African American (AfAm) relative to Non-Hispanic White (NHW) cancer survivors. The premise of this study is that community, interpersonal, and individual influences combine to negatively affect the HRQOL of AfAm cancer survivors and are, thus, responsible for health disparities between AfAms and NHWs. We propose that the best way to understand these disparities is to move beyond simple documentation of them to an examination of domains that cause variation in HRQOL among AfAm survivors. This effort, however, should be implemented with a collaboration between academic researchers and community stakeholders. To understand the root causes of variability in HRQOL among AfAm breast and prostate cancer survivors, this study proposes to (1) identify significant domains of causal influence on HRQOL among AfAm survivors; (2) specify the paths from these domains to survivors? HRQOL; (3) identify modifiable factors affecting the strength of these paths; and (4) specify targets of change for future interventions. Our theoretical model draws heavily on a social-ecological model of health and assumes that the domains of influence include significant stressors linked to racial group membership that result from interpersonal, institutionalized, and structural racism and socioeconomic adversity in the U.S. We will test this model in a four-wave longitudinal study, recruiting 600 participants from a National Cancer Institute-funded infrastructure grant of 5500 AfAm cancer survivors living in metropolitan Detroit. The study will address the following Specific Aims:
Aim 1. 1a. To use an academic-community collaboration to create a theoretically and community-grounded model of variability in HRQOL among AfAm cancer survivors. 1b. To evaluate the success of the collaboration with a systematic evaluation of community stakeholders? perceptions of, and attitudes toward, the collaboration experience.
Aim 2. To conduct a four-wave longitudinal study of 600 AfAm cancer survivors that empirically tests the relationships proposed in our social-ecological model.
Aim 3. To collaborate with the community stakeholders in the dissemination of study findings to scientific and lay audiences and to translate study findings and inform future interventions. The paths through which race-related community, interpersonal, and individual domains of influence may affect the HRQOL of AfAm cancer survivors have not been comprehensively investigated with a longitudinal design. Nor has academic research on AfAm cancer survivors combined a theoretically-driven approach with strong community engagement to develop and test a social-ecological model and disseminate study findings. We expect findings from this study will help to identify modifiable targets of change and risk profiles and inform the development of interventions to address causes of poor HRQOL experienced by AfAm survivors.
Community, interpersonal, and individual influences combine to negatively affect the health-related quality of life (HRQOL) of African American (AfAm) cancer survivors and create racial health disparities between AfAm and Non-Hispanic White survivors. Using a social-ecological model that emphasizes the impact of social inequities on health, this study will examine community, interpersonal, and individual domains of influence that may lead to variability in AfAm survivors? HRQOL over time. We expect findings from this study will help to identify modifiable targets of change and inform the development of interventions to address causes of poorer HRQOL experienced by AfAm survivors.
