Need Priority Population Hispanics are the second largest racial/ethnic group in the United States and will soon be the largest racial/ethnic group in Texas, comprising 40.2% of the state's population. Cancer is the leading cause of death amongst Hispanics. Breast, colorectal and liver cancer, linked to behaviors such as physical inactivity, poor diet, and use of alcohol, are among the most diagnosed cancers for Hispanics. Rates of Incidence, Mortality, and Screening. The Hispanic population in the four-county service area (Cameron, Duval, Hidalgo, and Willacy) generally experiences a higher rate of cancer incidence and mortality when compared to the entire Hispanic population of Texas. ...

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Need Priority Population Hispanics are the second largest racial/ethnic group in the United States and will soon be the largest racial/ethnic group in Texas, comprising 40.2% of the state's population. Cancer is the leading cause of death amongst Hispanics. Breast, colorectal and liver cancer, linked to behaviors such as physical inactivity, poor diet, and use of alcohol, are among the most diagnosed cancers for Hispanics. Rates of Incidence, Mortality, and Screening. The Hispanic population in the four-county service area (Cameron, Duval, Hidalgo, and Willacy) generally experiences a higher rate of cancer incidence and mortality when compared to the entire Hispanic population of Texas. Incidence rates for breast, colorectal, and liver cancer in Hispanics are higher than the rate for Texas in three out of four service area counties. Cancer disparities are especially large in rural Duval County, where the mortality rate for all cancers in the Hispanic population is 57% higher than the rate for Texas. Barriers in the rural counties of Duval and Willacy include a general lack of access to infrastructure, policies that support healthy lifestyles, and a workforce trained in cancer prevention. Cameron and Hidalgo Counties contain significant for-profit healthcare options, but these options seldom provide prevention services. Populations living in all four counties face barriers to primary cancer prevention related to social determinants of health (SDOH), especially in the areas of economic stability and healthcare access. Overall Project Strategy For 19 years, the multilevel intervention Tu Salud ¡Si Cuenta! (TSSC) has successfully increased physical activity and fruit and vegetable consumption for over 50,000 individuals living in the underserved border counties of Cameron and Hidalgo. The proposed project would improve services to these two counties while building capacity for expansion of the TSSC program to the high-need rural counties of Duval and Willacy. The University of Texas Health Science Center at Houston (UTHealth) School of Public Health (SPH), Brownsville Regional Campus (UTHealth SPH-Brownsville) will employ evidence-based strategies to build the capacity needed in the two rural counties to implement the TSSC model. Through partnerships with local organizations and municipalities, UTHealth SPH-Brownsville will train stakeholders on policy and environmental change related to physical activity and food choice, train community health workers (CHWs) on delivering the evidence-based TSSC Outreach Modules, assist stakeholders with conducting an assessment/action planning process, and support local CHWs as they deliver the TSSC outreach modules to individuals in these two counties. UTHealth SPH-Brownsville will also enhance the TSSC multilevel intervention that is currently being delivered in Cameron and Hidalgo counties to meet the complex needs of urban and suburban participants. CHWs will receive additional training on alcohol reduction strategies. TSSC will also incorporate a screening process for social determinants of health (SDOH) needs and utilize the services of a social worker to address individual barriers to care. Specific Goals This proposed project will have two overall goals: Goal 1: By the end of the project period, Tu Salud ¡Si Cuenta! (TSSC) will build capacity in two rural counties (Duval and Willacy) for the implementation of an evidence-based, multilevel intervention focused on healthy lifestyles to prevent cancer (TSSC Community-wide Campaign). Goal 2: By the end of the project period, implement and evaluate the original TSSC intervention and the enhanced TSSC intervention with components related to reduced alcohol intake and social determinants of health (SDOH) needs in two underserved South Texas border counties (Cameron and Hidalgo) to promote cancer prevention through healthy lifestyles. The strategies implemented through these two goals will provide an estimated 3,709 services to 965 people. Significance and Impact The proposed TSSC program offers a unique opportunity to build on current primary cancer prevention efforts in underserved urban areas while expanding to high-need rural areas. We believe the program will show that directly addressing alcohol intake and SDOH needs in low-income urban populations will improve the outcomes of the current cancer prevention program. Through this expansion to rural areas, we believe we will build sufficient capacity to support a long-term transformation in the approach to primary cancer prevention in these communities. Because we have extensive experience with the dissemination of this multilevel intervention, we know that an initial phase of building capacity and community support in the prioritized rural counties for the intervention is necessary. Therefore, we are applying for a New Project grant first with plans to follow with an Initial Expansion grant.

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