Research Project 2: Project Summary Despite some successes of individual-level programs and interventions to promote behaviors that prevent colorectal cancer – the burden in persistent poverty areas remains particularly high. Many experts in cancer prevention and control have recently argued that to truly address this inequitable burden we must take a multi- level approach that includes addressing the fundamental causes of cancer. We propose a quasi-experimental study of the impacts of the largest anti-poverty policy program for families in the U.S. -- the Earned Income Tax Credit (EITC), with a particular focus on local persistent poverty areas in two counties in California: 1) Yolo, a largely agricultural county which is home to University of California, Davis (UCD), and the county with the highest poverty rate in California; and 2) Santa Clara, an urban area home to Stanford University, with dramatic income inequality. Since 2015, for households earning up to $30,000 per year, the California EITC (CalEITC) and Federal Credits provide up to $10,000 a year. This amount of income, through helping pay for daily expenses, food and housing, transportation, and healthcare, and therefore also by reducing the stress of poverty, may influence several risk factors for colorectal cancer. Also notable is the change in eligibility for CalEITC that occurred in California in 2020 – having a social security number is no longer required, opening eligibility to non-U.S. citizens with an Individual Taxpayer Identification Number (ITIN). We will work with our Regional Coalition of community partners to accomplish the following specific aims: Aim 1. Examine the impact of the California 2015 EITC expansion (CalEITC) on colorectal cancer risk factors and preventative screening, Aim 2. Estimate the short-term effects of CalEITC on colorectal cancer risk factors and screening among Californians living in persistent-poverty areas, Aim 3. Qualitatively examine 3.1) CalEITC recipients’ experience to understand the impacts of CalEITC on behaviors and exposures related to colorectal cancer prevention, and 3.2) non-EITC recipients who qualify to understand the reasons for not applying for CalEITC benefits, especially among newly eligible ITIN recipients in the Latino and Vietnamese communities in Yolo and Santa Clara Counties, and Aim 4. Work with our Regional Coalition to build capacity in support of multilevel and structural interventions by estimating the effects of EITC expansion on reducing colorectal cancer incidence rates in persistent poverty areas. The project will build on the multiple institution and multi-disciplinary collaborations of the UPSTREAM Research Center to address the most pressing needs for cancer prevention in persistent poverty areas in Yolo and Santa Clara Counties, focusing on the needs of Latino and Vietnamese people in these communities through our ongoing Regional Coalition community collaborations. Through the case of the CalEITC, in coordinat...