# Project 1

> **NIH NIH U54** · STANFORD UNIVERSITY · 2024 · $251,119

## Abstract

Research Project 1: Project Summary
The fundamental cause framework treats socioeconomic status as a master cause that lies behind the many
intermediary causes of cancer (e.g., behaviors and attitudes, access to preventative services, access to and
quality of care). This framework, although immensely influential, has mainly served as a scholarly school of
thought rather than a programmatic approach around which concrete cancer-prevention work has been built.
We aim to carry out the research needed to determine whether an upstream “fundamental cause” program
could be a cost-effective component of our country’s cancer-prevention policy. We focus on income not just
because it’s readily manipulated but also because it’s likely to be a consequential manipulation. The best
available evidence suggests that the key intermediary determinants of cancer (e.g., diet, tobacco use, excess
body weight, stress, health care quality) are likely to be quite responsive to increases in income. This novel
project proposed is a unique opportunity to build out this evidence base by collaborating with the California
Department of Social Services (CDSS) on the state’s $35 million guaranteed income pilots. These pilots will be
used to deliver a randomized field experiment on the effects of income on presumed intermediary determinants
of cancer. The overall objective of this project is to examine the effects of income on these intermediary
factors, and to assess whether guaranteed income could be a cost-effective intervention. This project will
address this through these Specific Aims: Aim 1: Estimate the causal effects of guaranteed income on
modifiable cancer risk factors using California’s Guaranteed Income Pilots (GIPs), Aim 2: Estimate the effects
of guaranteed income on key types of cancer by combining short-term outcomes into a surrogate index that
equals the predicted value of long-term cancer rates, and Aim 3: Develop a comprehensive fundamental cause
approach to reducing cancer that combines income supplementation with conventional services. We will
conduct follow-up interviews and preliminary tests to begin developing new approaches to combining income
supplementation with conventional services. This project focuses on a novel approach to evaluate income as a
fundamental cause, whereas our second proposed project of the UPSTREAM Research Center broadens the
assessment to include income and employment (by evaluating the EITC). Because the two projects will share
measures and methods (with coordination via the Research & Methods Core), it will be possible to compare
across our two formulations of a fundamental cause approach. These two projects, taken together, will also
allow us to train a new cadre of scholars on upstream community-informed interventions in persistent poverty
census tracts.

## Key facts

- **NIH application ID:** 10875542
- **Project number:** 5U54CA280811-02
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** DAVID B GRUSKY
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $251,119
- **Award type:** 5
- **Project period:** 2023-06-26 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10875542

## Citation

> US National Institutes of Health, RePORTER application 10875542, Project 1 (5U54CA280811-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10875542. Licensed CC0.

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