Abstract C021: A conceptual framework for investigating measures of neighborhood-level structural racism and cancer health inequities developed through academic and community collaboration

Background: Recent commentaries have called for more detailed conceptual frameworks that guide new data collection, study design, and analytic strategies for research of neighborhood structural racism and its impact on health inequities. We are developing a robust framework that applies nuance and precision to existing models to inform causal inference studies. Methods: A draft conceptual framework has gone through multiple rounds of discussion among our academic/community collaboration comprising project investigators and community scientists residing in California, Hawai‘i, and Tennessee. The framework is currently being used in three cancer epidemiology studies of structural racism; studies of (1) neighborhood structural racism on lung cancer outcomes, (2) the impact of new racial- and ethnic-specific indices of structural racism on life expectancy, and (3) the mediating effect of neighborhood socioeconomic status on the association between neighborhood structural racism and prostate cancer mortality. Results: Our framework includes factors that characterize domains of the process of structural racism (e.g., mortgage lending, policing, voting) and neighborhood-level consequences of structural racism (e.g., employment, food environment, air pollution), which guided selection of variables to consider for structural racism indices. As much as possible, we strove to include only measures of the process of structural racism in latent class analyses to specify race and ethnicity-specific composite measures of structural racism to reflect hypothesized pathways. Incorporating insights from community scientists, the model integrates neighborhood strengths, including social cohesion, shared norms, and culturally and linguistically relevant resources, that may protect against the harmful consequences of structural racism. Our framework builds upon existing models to hypothesize causal relationships between these risk and resiliency factors in addition to illustrating their downstream effects on health, which is informing interpretation of mediation analyses in the study of the impact of structural racism on prostate cancer mortality. For example, our model indicated that contemporary neighborhood redlining may confound associations between racial bias in mortgage lending and prostate cancer mortality, guiding appropriate model adjustments. Conclusions: Our academic/community collaboration has resulted in productive discussions focused on (1) further specifying the mechanisms of causal relationships among and across domains of neighborhood factors and with individual-level factors and (2) adapting the overarching model to specific racial and ethnic populations. Our conceptual model makes it possible to communicate our current understanding and make our assumptions and research hypotheses explicit. Doing so makes our analyses more robust and meaningful, maximizing the potential of translating our research results to neighborhood-level population health interventions to improve cancer health inequities. Citation Format: Mindy C. DeRouen, Meera Sangaramoorthy, Deidre Johns, Palama Lee, Ila McDermott, Scarlett L. Gomez, Loic Le. Marchand, Melinda C. Aldrich, Lani Park, Iona Cheng, Salma Shariff-Marco. A conceptual framework for investigating measures of neighborhood-level structural racism and cancer health inequities developed through academic and community collaboration [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C021.