The Virginia Advancing Cancer Control Equity Research Through Transformative Solutions (ACCERT) Center

SOCIAL DRIVERS OF HEALTH (SDOH) RESEARCH PROJECT: PROJECT SUMMARY In the US, individuals and families living in poverty are placed at increased risk for cancer. Living in an under- resourced environment and having limited access to affordable and healthy food and opportunities for physical activity play a central role in cancer risk. Suboptimal diet quality and physical inactivity are both higher among

economically disadvantaged households compared with more resourced households—and these disparities are even more pronounced among individuals living in income-based housing. Thus, translating evidence-based lifestyle interventions to income-based housing communities offers potentially high public health impact—

however, to enhance effectiveness and mitigate cancer disparities, such efforts must be conducted in partnership with residents and target multiple levels of the social-ecological model. To that end and in close partnership with the Virginia Advancing Cancer Control Equity Research Through Transformative Solutions (VA-ACCERT) Center

Housing Collaborative Community Advisory Board (HCCAB), the overarching goal of this project is to implement a multi-level lifestyle intervention to mitigate cancer risk for residents of income-based housing communities across Virginia. The HCCAB identified a critical need to promote community-level social cohesion and collective

efficacy, and a multi-level lifestyle intervention targeting diet quality and physical activity is aligned with their priorities. Grounded in evidence and from previous work, this intervention spans the individual, community, and built neighborhood environment levels—and posits collective efficacy as a mechanism of action. Using a cluster

randomized, hybrid type 2 trial design, this intervention will assess both the clinical effectiveness and implementation effectiveness, which will be implemented over 6-months, followed by a 6-month maintenance phase. Income-based housing communities (n=12) will be randomized to intervention or delayed intervention

control, and 480 participants (~40 per housing community, ≥18-years) will be enrolled and assessed at 0, 6, and 12 months. Primary dual effectiveness outcomes are diet quality and moderate-to-vigorous physical activity (ASA-24 and accelerometry). Co-primary implementation effectiveness will be evaluated using the RE-AIM

Framework and its contextual enhancement, PRISM. Finally, investigators will examine mechanisms of action associated with greater clinical benefit and maintenance of behavior change. Specific aims include: Aim 1: Test the clinical effectiveness of the multi-level intervention to promote changes in diet quality (ASA-24) and physical

activity (accelerometry) compared to delayed intervention control among residents of income-based housing communities in Virginia; Aim 2a: Evaluate implementation effectiveness of the multi-level intervention; Aim 2b: Systematically evaluate facilitators and barriers to sustainability of each level of the intervention via a

combination of process data, surveys, and in-depth interviews with residents as well as Public Housing Authority staff; and Aim 3: Examine putative intervention mechanisms associated with greater clinical benefit and maintenance of behavior change.