PROJECT SUMMARY Colorectal cancer (CRC) is the third leading cause of cancer death in Black men and women, with mortality rates that are 44% and 31% higher in Black men and women compared to White men and women respectively. Approximately 40% of the difference in incidence and 20% of the difference in mortality are due to disparities in screening. Community health centers (CHCs) in urban areas serve a large share of racial and ethnic minorities and have lower screening rates (41.9%) compared to the general population (69.7%). Low screening rates, and rising incidence and mortality from CRC in adults at younger ages also suggests that focusing on increasing screening uptake from 45 to 54 is a critical target. This career development award leverages an existing partnership with Codman Square Health Center, a predominantly Black CHC in inner- city Boston, to develop implementation strategies with a focus on equity to initiate CRC screening in previously unscreened individuals age 45 to 54 at CSHC. Dr. Adjoa Anyane- Yeboa’s long-term career goal is to use equity-driven implementation science methods to reduce CRC inequities among historically marginalized populations. The proposed project blends rigorous methodologic training with an innovative research agenda to facilitate Dr. Anyane-Yeboa’s development into an independent investigator through three training goals: (1) enhance quantitative and qualitative research skills, (2) design and conduct mixed methods research to inform implementation of evidence-based interventions, and (3) learn equity-driven implementation science methods. This proposal has three scientific aims: (1) identify system- level determinants of CRC screening in individuals 45 to 54 using mixed methods; (2) identify equity-driven implementation strategies to initiate CRC screening matched to systems-level determinants; and (3) determine the acceptability and feasibility of implementation strategies for CRC screening by conducting a pilot trial and using mixed methods. In addition to advanced training through formal coursework, this award is supported by an extraordinary mentorship team, including internationally-recognized experts in CRC prevention, implementation science, health equity, community-engaged research, and mixed methods. Upon completion of the proposed research and training, Dr. Anyane-Yeboa will expand her findings in an R01 to rigorously test her findings in a trial across CHCs in Massachusetts. The combination of formal training and mentored research outlined in this application is designed to ensure that Dr. Anyane-Yeboa will emerge from this award as a nationally recognized independent investigator with the skills and experience to reduce CRC inequities in marginalized patient populations.

PROJECT NARRATIVE Community health centers (CHCs) serve a large share of racial and ethnic minority patients and have disproportionately low colorectal cancer (CRC) screening rates compared to the general population. Even a delay of a few years for screening initiation can lead to increased CRC incidence and mortality. Using a rigorous mixed methods approach, the proposed research will identify equity-driven implementation strategies to initiate CRC screening in previously unscreened individuals 45 to 54 at a CHC with a predominantly Black patient population, and advance our understanding of strategies to increase CRC screening in the newly eligible population aged 45 to 49 at CHCs.