Structurally Racist Policies and Cancer Mortality Disparities in Northern California Persistent Poverty Communities

Grantee: Tracy Lam Hine, DrPH, MBA
Postdoctoral Scholar, Department of Epidemiology and Population Health
Stanford University School of Medicine

PI: Salma Shariff-Marco, PhD, MPH
Associate Professor of Epidemiology and Biostatistics
University of California San Francisco School of Medicine

Communities experiencing persistent poverty suffer from high rates of cancer mortality, and 80% of residents in these communities in Northern California are people of color. Structural racism is the fundamental driver of racial and ethnic health disparities and operates through specific state and local policies that maintain and reinforce systemic racial inequity. This proposal aims to create a structural racism policy exposure database for Northern California and estimate county-level racial differences in all-site cancer mortality associated with the interaction between these policies and poverty rates. Findings from this pilot study will inform local and state-level health and social policy to reduce racial inequities in cancer outcomes in persistent poverty areas.

Quantifying and Categorizing Social and Built Environment Heterogeneity in Persistently Impoverished Census Tracts in California

Grantees: Nita Mukand, PharmD, MBA, MPH
Postdoctoral Scholar, Department of Epidemiology and Biostatistics
University of California San Francisco

Mentor: Scarlett Lin Gomez, PhD, MPH
Professor, Department of Epidemiology and Biostatistics
University of California San Francisco (UCSF)
Helen Diller Family Comprehensive Cancer Center (HDFCCC)
Greater Bay Area Cancer Registry (GBACR)

The extent to which persistent poverty areas are characterized by multiple axes of adversity including inadequate resources, lack of education and employment opportunities, poor housing and transportation infrastructure, and unhealthy built environments is not well understood. This pilot will describe variations in the social and built environment among persistently impoverished census tracts using data from the UCSF Health Atlas and create archetypes that distill complex intersecting disadvantage into categories. We will conduct in-depth interviews with individuals who reside in each archetype category, to gain a thorough, qualitative understanding of the experience of residing in a persistently impoverished area. A deeper understanding of the co-occurring types of disadvantage in persistently impoverished areas will enable meaningful, contextually mediated interventions to reduce upstream drivers of cancer disparities.

Central California – Communities addressing Upstream cancer Risks and Equity (CC-CURE)

Grantee: Manali I. Patel, MD, MSPH, MS
Associate Professor, Department of Medicine
Stanford University School of Medicine

Arleana Waller, PhD
Founder and Executive Director
MLK CommUNITY Initiative

Carmen Lee, PhD
Post-doctoral Scholar, Department of Pediatrics
Stanford University School of Medicine

Kathryn Conlon, PhD
Assistant Professor, Department of Public Health
UC Davis

Amber Shavers, MA
Data Scientist
Central California Public Health Consortium

Gary Darmstadt, MD
Professor, Department of Pediatrics
Stanford University School of Medicine

Central California – Communities addressing Upstream cancer Risks and Equity (CC-CURE) proposes to co-design intervention strategies with community members to achieve lung cancer equity in persistent poverty areas in Fresno County. Our research strategy involves the integration of the views and knowledge of community members with lived experiences in persistent poverty areas within Fresno census tracts 25, 5, 9, 6, and 14, otherwise known as “The Place,” and experts from Stanford University, including health services, cancer health equity and system science researchers, UC Davis public health, and community partners in Fresno regarding the influence of upstream factors of lung cancer mortality. Through group model building, a method used in other contexts to create consensus regarding complex problems and identify targets for intervention, the group will jointly understand the unique, complex upstream contributors to lung cancer treatment and mortality in the community, codesign context-specific intervention strategies for implementation and evaluation, and pilot test the intervention strategies. The group will evaluate the organizational context for intervention implementation, inputs for intervention, and potential barriers and facilitators in preparation for future work together to address lung cancer mortality in “The Place.”