PROJECT SUMMARY/ABSTRACT Cancer screening is an essential cancer control strategy for several cancer types, including colorectal, cervical, and lung cancer screening. However, cancer screening utilization rates are suboptimal and disparities by race and ethnicity persist. Observed disparities in cervical, colorectal, and lung cancer screening by race and ethnicity likely contribute to the persistent and historic disparities in survival for these cancers. Prior research and theoretical models indicate that multilevel (e.g., patient-, provider-, healthcare system-level) cancer screening initiatives are the most effective for improving outcomes and understanding modifiable drivers of disparities. However, such initiatives have been difficult to implement given the paucity of research on healthcare system- level factors, including how factors at the healthcare system-level intersect with those at the other levels. Improving utilization of cancer screening is critical to achieve population-level mortality reduction, but care must be taken to tailor interventions to underserved populations in order to ensure that existing disparities are narrowed, rather than widened. The objective of the proposed research is to improve understanding of the synergistic effects of patient-, provider-, and healthcare system-level factors on cancer screening rates, and how these multilevel factors modify racial and ethnic disparities. My specific aims are: 1) Assess cervical, colorectal, and lung cancer screening rates by healthcare system-level factors (e.g., screening policies and programs), and compare the magnitude of any observed disparities by race and ethnicity across different healthcare system- level factors (K99), 2) Characterize patient and provider perspectives on multilevel factors throughout the lung screening process using qualitative interviewing and thematic analysis (K99), and 3) Elucidate provider-level drivers of cervical, colorectal, and lung cancer screening and employ a multilevel approach to examine associations with cancer screening rates, including interactions with race and ethnicity (R00). To achieve these aims, data from the National Cancer Institute’s Population-based Research to Optimize the Screening Process (PROSPR II) consortium will be leveraged, which is unique, rich data comprised of a racially and ethnically diverse population receiving care at community healthcare systems across the US. The results of this analysis will provide evidence for the identification of potential targets for a multilevel intervention to improve screening utilization and narrow disparities. In addition to this research, Dr. Del Vecchio’s comprehensive career development plan includes structured mentorship from leaders in cancer screening research and additional training in qualitative and mixed methods research, healthcare delivery research, health disparities research, implementation science, and multilevel analysis. Throughout this award, Dr. Del Vecchio will acquire the knowledge, skills, and experience necessary to achieve her long-term goal of becoming an independent investigator studying factors contributing to suboptimal care throughout the cancer control continuum and developing multilevel interventions to improve healthcare delivery and cancer outcomes.

PROJECT NARRATIVE Despite the success of cancer screening as an impactful cancer control strategy, utilization is suboptimal and disparities in screening rates by race and ethnicity persist, contributing to the disparities in cancer-specific survival. Improving utilization of cancer screening is critical to achieve population-level mortality reduction, but care must be taken to tailor interventions to underserved populations to ensure that existing disparities are narrowed, rather than widened. This research will address a critical gap in our understanding of multilevel drivers of cancer screening rates by incorporating healthcare system-level factors and advancing understanding of patient- and provider-level factors while focusing on racial and ethnic disparities.