PROJECT SUMMARY / ABSTRACT Cervical cancer is the fourth most common cancer affecting people with a cervix worldwide, after breast, colorectal, and lung cancers, with 569,847 new cases every year. In the United States, cervical cancer incidence and mortality are 7.7 and 2.3 per 100,000 women, respectively, with substantial disparities in both cervical cancer incidence and mortality across racial and ethnic groups. Latinas, in particular, are disproportionately burdened with cervical cancer compared to non-Hispanic Whites (NHW), with incidence and mortality rates 50% higher than NHWs. Among women diagnosed with invasive cervical cancer, Latinas are more likely than NHWs to be diagnosed at an advanced stage, when there are fewer treatment options. Despite the average age of diagnosis of all cervical cancers occurring around age 50, the majority of screening interventions focus on younger and/or reproductive aged people with a cervix. Thus, there is growing urgency for improving cervical cancer prevention among middle to older age women nationally and internationally. In the U.S., middle to older age immigrant Latinas are disproportionately likely to be served at settings like Community Health Centers (CHCs). In 2017, 56% of poor and foreign-born Latina/os lived within two miles of a CHC. CHCs provide critical infrastructure and offer healthcare to historically underserved populations (e.g., those without insurance). Evidence also suggests that there are fewer racial/ethnic healthcare disparities among patients served by CHCs, underscoring the importance of studying and understanding the care delivered in these settings. Therefore, the goals of the proposed research, as part of a career development award, are to (1) describe cervical cancer screening rates in a 23-state network of CHCs from 2012 to 2023 among middle to older age Mexican immigrants; (2) examine individual, organizational, and structural level facilitators and barriers to cervical cancer screening among middle to older age Mexican immigrants in three CHCs located in the Pacific northwest; and (3) co-develop a multi-level intervention to improve cervical cancer screening among middle to older age Mexican immigrants in CHCs. This career development award will establish Dr. Vasquez Guzman as a multi-disciplinary investigator focused on implementing and disseminating novel primary care multi-level interventions that target complex, underserved patient populations to reduce disparities in ongoing and regular timely and high-quality cervical cancer prevention and screening services in safety-net settings. The K01 award provides mentored training for Dr. Vasquez Guzman to develop expertise in 4 areas: (1) team science and the integration of social science and clinical research approaches; (2) skills and knowledge in both intervention and implementation science (3) cervical cancer screening and cancer communication skills; and (4) expand community engaged expertise. To achieve these goals, Dr. Vasquez Guzman has assembled a well-funded and established mentoring team with expertise in health services research, primary care, intervention design and implementation science, team science, and CBPR, all of whom have success in mentoring faculty to research independence.

PROJECT NARRATIVE Middle to older age Latina immigrants have a higher incidence of cervical cancer than non-Hispanic Whites. The goal of the proposed project is to partner with community research team members to develop a multi-level intervention that builds on the strengths of community health centers, where many underserved and marginalized individuals receive a wide range of preventive services. The results of this project will help community healthcare systems develop scalable interventions for marginalized patients with a particular emphasis on community-clinic partnerships to increase cervical cancer screenings, which do not involve a one-time behavior but rather require ongoing follow-up and monitoring to improve health outcomes.