Grant Number:	5U54CA280811-04 Interpret this number
Primary Investigator:	Rehkopf, David
Organization:	Stanford University
Project Title:	The Upstream Center: Income Interventions to Address the Fundamental Causes of Cancer
Fiscal Year:	2026

Persistent poverty areas, a formal geographic classification developed by the United States Department of Agriculture and codified by Congress, are defined as areas with a poverty rate of 20% or higher across four consecutive ten-year time periods, spanning 30 years. Cancer rates are higher in these areas, and improving cancer outcomes in these areas requires transformational, multisector solutions that are co-created with the impacted communities. To address this challenge, we will form the Upstream Research Center, an innovative approach to study problems inherent in persistent poverty areas. To best understand what type of clinical interventions and for whom they will be most effective in these, we take multiple causal identification approaches in this project. We will analyze data from a randomized income experiment and from quasiexperimental assignment to levels of support from the Earned Income Tax Credit (EITC) to understand etiologic pathways to cancer, thus increasing our understanding of where clinical interventions can reduce cancer incidence. Our team science approach to this problem is supported by the unparalleled resources at Stanford University, the University of California, San Francisco and the University of California, Davis. Our work advances multiple conceptual and methodological innovations through two main research projects: 1) a quasi-experimental study design to evaluate the $35M, pre-existing, California state funded Guaranteed Basic Income program in persistent poverty areas with a focus on modifiable cancer risk factors and intermediate outcomes that are amenable to clinical intervention; 2) a quasi-experimental analysis of the stated-funded EITC, which in California has a unique focus on lower income wage earners. Our Specific Aims are to: Aim 1. Build a collaborative community of residents in persistent poverty areas, trainees, cancer and social science researchers and data scientists to understand how best to intervene to prevent cancer, Aim 2. Evaluate the impact of income-based interventions in persistent poverty areas in Northern CA, Aim 3. Develop a mathematical model, with community input, that can assist in predicting long-term impacts of interventions on cancer incidence, providing guidance on how best to eliminate the increased burden of cancer in persistent poverty areas, Aim 4. Develop and implement a career enhancement program that will facilitate the training and career development of interdisciplinary early-career scholars who are committed to advancing cancer research in persistent poverty areas and Aim 5. Implement innovative and collaborative cancer prevention and control programs and innovations in clinical care identified through the Upstream Research Center research projects and our community partners to develop long-term sustainable strategies for prevention. Results from this novel groundbreaking work will lay the foundation for transformative approaches to address cancer prevention and control programs through capacity building and sustainable partnerships, including how clinical care providers can better meet the needs of their patients living in persistent poverty areas.




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