Abstract
Lung cancer is the leading cause of cancer morbidity and mortality in the U.S. and racial/ethnic minorities carry the greatest burden of lung cancer disparities with African Americans (AAs) impacted disproportionately. Inequities in lung cancer health disparities are often associated with multiple bio-behavioral and socio-cultural factors among racial/ethnic minorities. Epigenetic research has advanced the understanding of the intersectionality between biological and socio-cultural factors in lung cancer disparities among AAs. However, gaps exist in the engagement of diverse populations in epigenetic lung cancer research, which poses a challenge in ensuring the generalizability and implementation of epigenetic research in populations that carry an unequal cancer burden. Grounding epigenetic lung cancer research within a socio-ecological framework may prove promising in implementing a multi-level approach to community engagement, screening, navigation, and research participation among AAs. The University of Illinois Cancer Center (UI Cancer Center) is employing an evidence–based (EB) model of community/patient engagement utilizing the socio-ecological model (SEM) to develop a culturally sensitive epigenetic lung cancer research program that addresses multiple factors that impact lung cancer outcomes in AAs. By implementing epigenetic research within a group of Federally Qualified Health Centers (FQHCs) guided by the SEM, the UI Cancer Center is proposing a new pathway in mitigating lung cancer disparities in underserved communities. At the individual level, the framework examines tobacco use among patients at FQHCs (the organizational level) and also tailors epigenetic research to explore innovative biomarkers in high risk populations. Interpersonal interventions use Patient Navigators to support navigation to EB tobacco cessation resources and lung cancer screening. Community level support within the SEM is developed by ongoing partnerships with local and national partners such as the American Lung Association (ALA) and the American Cancer Society (ACS). Lastly, at the policy level, the UI Cancer Center acknowledges the role of policy implications in lung cancer screening and advocates for policies and screening recommendations that examine the current guidelines from the United States Preventive Services Task Force (USPTF).
Highlights
Lung cancer remains the leading cause of cancer mortality in the United States (U.S.) with a projected estimate of 234,030 new cases and 154,050 deaths from lung cancer in 2018 [1, 2]
Include engagement of more than 500 patients from the Mile Square Health Center (MSHC) Federally Qualified Health Centers (FQHCs) who were navigated to EB tobacco cessation and lung cancer screening using the revised socio-ecological model (SEM)
This indicates the utility of the multilevel approach to address lung cancer disparities
Summary
Lung cancer remains the leading cause of cancer mortality in the United States (U.S.) with a projected estimate of 234,030 new cases and 154,050 deaths from lung cancer in 2018 [1, 2]. While tobacco is a known risk factor for lung cancer, a disproportionate number of AA women die from lung cancer, despite having lower rates of smoking This indicates that other biological, genetic, or environmental factors may contribute to lung cancer outcomes, which interact with gender and race/ethnicity [2, 9]. Conceptual models that examine associations between gene expression and multi-level social, environmental, and structural risk factors are needed to understand how health inequalities are produced and reproduced among those underserved, such as those seen and treated at FQHCs including AAs. In response to addressing risk factors that impact cancer outcomes in its catchment area, the University of Illinois Cancer Center (UI Cancer Center) has developed a multi-level approach to cancer screening, prevention and education embedded within a socio-ecological theoretical framework. The UI Cancer Center asserts that we can successfully respond to the intersection of biological and socio-cultural factors that contribute to cancer outcomes by addressing barriers and facilitators that affect cancer outcomes in underserved populations through a multilevel approach that aligns prevention, screening, navigation and epigenetic research
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