Illinois Multi-Sectoral Preventive Intervention (I-MSPI) - Food insecurity is defined as the limited or uncertain access to adequate food and is a critical driver of variation in cancer incidence and survival. Food insecurity is an actionable target to reduce variation in cancer incidence and mortality for the 13 dietary-related cancers (DRC). Mechanisms underlying the impact of food insecurity on DRC outcomes include poor diet quality; high body mass index (BMI); and altered immune, metabolic, and microbial metabolite profiles. DRC survivors and people with a family history may suffer a greater adverse impact of food insecurity, due to dietary-influenced cancer etiology and other vulnerabilities (e.g., harmful genomic variants). Our team and others have tested effective strategies to reduce food insecurity and related DRC risks. However, gaps exist, such as: limited bundling of multilevel strategies across service sectors; limited integration of “high touch” (e.g., navigation, coalition building) and “high tech” strategies (e.g., virtual platforms); and a limited focus on DRC survivors and people with familial DRC risks. Building on our team’s expertise, we propose the Illinois Multi-Sectoral Preventive Intervention (I-MSPI) that integrates efficacious strategies at multiple levels and sectors, including: (1) coalition building activities for multi-sectoral neighborhood hubs (e.g., federally qualified health center (FQHC) clinics, food assistance programs); (2) a virtual platform to facilitate referrals for food insecurity and associated needs between FQHC and food assistance programs; (3) shared food delivery systems; (4) FQHC health informatics tools and navigation for food insecurity and dietary lifestyle programs; and (5) tailored, digitally delivered, dietary lifestyle modules to increase diet quality. Within neighborhoods in Chicago, I-MSPI will be deployed across a FQHC network with system-wide familial risk cancer assessment, cancer prevention / risk services, and cancer survivorship services; and a network of 800+ food assistance programs. In the UG3, we will produce a comprehensive, integrated I-MSPI protocol (Aim 1) and demonstrate the acceptability, feasibility, and capacity to deploy I-MSPI (Aim 2). Using hybrid implementation-effectiveness and randomized stepped wedge designs in the UH3, we will test the neighborhood-level reach of I-MSPI (Aim 1), test clinic-level adoption and uptake of I-MSPI for food insecurity screening and referrals / enrollments in food assistance and dietary lifestyle programs (Aim 2), test the effectiveness of I-MSPI to reduce food insecurity, dietary cancer risks, and DRC risk biomarkers among DRC survivors and patients with familial DRC risks (Aim 3). We will also examine and plan for sustainability of I-MSPI for multi-sectoral neighborhood hubs, FQHC, and food assistance programs (Aim 4).
