Core 3: Improving Uptake of Cervical Cancer Prevention Services in Appalachia: Biostatistics and Evaluation Core

The Appalachian region is a 205,000 square mile, mainly rural, region of the U.S. that includes one of the most medically underserved, and economically disadvantaged areas in the U.S. The National Cancer Institute has designated Appalachia as a special population based upon its significant cancer health disparities: overall cancer incidence and mortality rates in Appalachia are higher than the national average, with particularly high rates of breast, colorectal, cervical, lung and other tobacco-related cancers. The goal of this Program Project is to address the burden of cervical cancer incidence and mortality in Appalachia, a large vulnerable population, through the delivery of a clinic-based integrated prevention program designed to target individual, social and community, health system and broader contextual-level barriers (such as area-level poverty) to reducing the burden of cervical cancer. Building upon our long history of collaborative research and community partnerships, the program will test the ability of an integrated prevention program focused on the three main risk factors for cervical cancer – tobacco use, Human Papillomavirus (HPV) vaccination, and cervical cancer screening (Pap test and/or self-testing with follow-up of positive tests) – to be effective as well as implemented by the clinic and acceptable to patients in four Appalachian states (OH, KY, WV, VA). Our research process is guided by a socio-ecological model based on the Social Determinants of Health the Proctor Model for Implementation Science and a Community-Based Participatory Research framework. Each project is based on prior preliminary work of the Program team and will test the interventions which will be bundled at the clinic level as a comprehensive prevention program using a theory-driven and communityengaged process with shared measures, an implementation science framework and an overall program evaluation. The aims of this Program Project are to: Aim 1. Conduct a multi-level needs assessment within the study region to refine and customize the interventions to be tested and formalize the approaches that will guide the implementation of the three interconnected practice-based interventions aimed at reducing cervical cancer in health systems/clinics in four Appalachian states. Aim 2. Test the effectiveness of three distinct practice-based interventions, packaged as a prevention program, designed to overcome key social determinants of cervical cancer health disparities in a region with one of the highest cervical cancer rates in the US; and Aim 3. Evaluate the Program Project impact including its community collaborations, synergy, cost, and uptake of new services, with attention to both short and long term impact and sustainability at the clinics.