PROJECT SUMMARY While approximately 85% of Black women report being screened for Cervical Cancer (CC) compared with about 83% of White women, Black women have a higher incidence of cervical cancer, are more likely to present with progressed stage CC, and have a higher rate of mortality from CC, in fact, Black women are 80% more likely to die from CC than White women. Yet, only two evidence-based interventions in the Evidence- Based Cancer Program Registry have been designed specifically for Black women. These interventions were developed in the 1990s, and they do not address the diversity in ethnicity and culture among Black women, including African American women (AAW) and Black African Immigrant women (BAIW). These populations have differences in knowledge, awareness, and behaviors related to cervical cancer screening that are important to consider in creating effecting interventions for these women. To create interventions that respond to cultural diversity among Black women, and meet the specific needs of AAW and BAIW, we need to understand the unique differences in multilevel determinants (beyond knowledge and behaviors) of cervical cancer screening among BAIW and AAW. Our long-term goal is to develop a publicly available, evidence- based CC intervention for BW with components targeted specifically for BAIW and AAW. In our previous work with BW and CC screening, we focused on disaggregating differences in behavioral determinants, such as the knowledge and attitudes of BAIW versus AAW. In this proposed study, we will expand this focus to examine entrenched structural barriers and socioeconomic factors that influence routine CC screening and follow-up, and perpetuate CC health disparities for both BAIW and AAW. Our specific aims include to (1) identify multilevel determinants of routine CC screening and follow-up adherence (Colposcopy) among BAIW and AAW, (2) Aim 2: Co-design components of a multi-level intervention to promote CC screening and follow-up adherence (Colposcopy) among BAIW and AAW., and (3) evaluate intervention component preferences among BAIW and AAW to refine the intervention. To accomplish these aims, we will use an innovative, community-engaged, student- intensive approach through focus groups and survey. This proposed project will uncover the multilevel factors that influence CC screening and follow-up among BAIW and AAW and help to fill a significant gap in knowledge and clinical practice regarding various determinants of CC screening and follow-up in these populations. This project will support the development of a multilevel intervention plan that contains a core educational component that is relevant to BW and 2 subcomponents that are specifically relevant to AAW and BAIW. This project will also inform a report that summarizes our intervention design and describes best practices for public health professionals, which could be used by the National Cancer Institute.

NARRATIVE Cervical Cancer prevention programs treat Black Women as a cultural and ethnic monolith. The proposed project uses a cross-sectional, mixed-methods design to: 1) identify the distinct determinants of routine cervical cancer screening and follow-up among Black African Immigrant Women and African American Women and 2) determine the intervention components that can be tailored to address the relevant multi-level factors influencing cervical cancer screening and follow-up among both populations.