Grant Number:	1R01CA303699-01 Interpret this number
Primary Investigator:	Cheng, Iona
Organization:	University Of California, San Francisco
Project Title:	Persistent Poverty and Colorectal Cancer Risk: Elucidating Biological, Behavioral, and Place-Based Pathways
Fiscal Year:	2025

Poverty is a major public health challenge, with over 28 million people living in areas of persistent poverty in the United States (U.S.). Reflecting years of disinvestment, residing in an area of persistent poverty limits access to healthy foods, places to engage in physical activity, and health care – all which impact health. In this proposal, we focus on colorectal cancer (CRC), the third most common cause of cancer in the U.S., which has well-established behavioral risk factors; marked population differences in incidence; and emerging data suggest may be linked to persistent poverty. Our overarching hypothesis is that persistent poverty impacts CRC risk through place-based factors and health behaviors, which have physiological effects that can be measured biologically by epigenetic changes in blood leukocytes. To address important research gaps in the multi-level drivers of CRC risk, we will leverage existing data from the Multiethnic Cohort Study (MEC) and the Southern Community Cohort Study (SCCS), including data from 272,933 adults in geographically distinct areas with extensive residential histories; long-term follow-up; health behavior, -omics, and cancer incidence data. The use of two population-based U.S. cohorts, statistically powered to study five population groups - African American, Japanese American, Latino, Native Hawaiian, and White - from urban and rural settings across the U.S. with a wide range of social and economic standing ensures representation of high-risk populations. Our preliminary data show 20% of participants live in areas experiencing persistent poverty. We propose the following Specific Aims to assess associations of residing in persistent and intermittent poverty areas in relation to: (1) the social and built environment (e.g., food environment, walkability, geographic access to health care) and health behaviors (e.g., diet, physical activity, smoking, CRC screening), including adherence to the American Institute for Cancer Research (AICR) Cancer Prevention Recommendations; (2) blood DNA methylation in an epigenome-wide association study (discovery n=1,200; replication n=5,494); and (3) incidence of CRC, overall and by subtypes (e.g., stage, tumor subsite). In Aim 3, we will also assess whether place-based attributes, adherence to nutrition and physical activity guidelines for cancer prevention, or CRC screening mediate associations between persistent poverty and CRC risk. Across aims, we will adjust for individual-level confounding factors and test whether associations vary by demographics, education, or rurality. Our team is uniquely able to accomplish this work - no other cohort studies have the sample size; range in health behaviors and geographic areas, and -omic data needed to achieve these aims. Our study is also strengthened by a Community and Policy Stakeholder Board to guide our analyses, disseminate research results, and build community capacity to implement policy changes. The data from this proposal will shed light on the complex effects of persistent poverty on health and inform strategies to reduce the burden of CRC.




HBV Remodels PP2A Complexes to Rewire Kinase Signaling in Hepatocellular Carcinoma.
Authors: Turnham R.E. , Pitea A. , Jang G.M. , Xu Z. , Lim H.C. , Choi A.L. , Von Dollen J. , Levin R.S. , Webber J.T. , McCarthy E. , et al. .
Source: Cancer Research, 2025-02-17 00:00:00.0; 85(4), p. 660-674.
PMID: 39652575
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