Stephenson-Hubert, Noreen

Abstract Introduction. Understanding the unique social and environmental contexts of communities is essential for designing effective, locally tailored cancer intervention strategies. This study aimed to identify key findings from a comprehensive, multifaceted, cancer-focused needs assessment conducted across three U.S. regions, offering insights into the social, behavioral, and structural barriers that hinder cancer prevention and control, and informing regionally tailored interventions. Methods. This study focused on adult residents within the Mayo Clinic Comprehensive Cancer Center catchment areas, covering 75 counties across Arizona, Florida, and the Midwest (Minnesota, Wisconsin, and Iowa). Data was collected through collaborations with the University of Florida and Mayo Clinic Survey Research Centers, and the “Boots on the Ground" approach involving community health workers. Methods included phone calls, online submissions, and community outreach for an anonymous survey. Validated measures assessed healthcare access, lifestyle, social networks, neighborhood conditions, and discrimination. Descriptive analyses were conducted using valid responses. Non-responses and selections of “Prefer not to answer” were excluded from percentage calculations to ensure interpretive accuracy. Results. Involving 2,681 respondents, the data reveal consistent yet regionally nuanced barriers to cancer prevention. Health insurance coverage was relatively high across all regions—77.6% in Arizona, 85.5% in Florida, and 89.2% in the Midwest. Despite this, access to care remained limited. In Arizona, 22% of respondents could not afford to see a regular doctor, and 41.3% reported delays due to work or transportation. In Florida, 26.6% reported financial barriers to primary care, and nearly half (49.7%) experienced delays in receiving care. The Midwest showed fewer neighborhood safety concerns but still faced high rates of care delays (46.7%) and housing-related issues (42.6%). Neighborhood-level challenges were common. Housing-related problems were reported by 42.9% of respondents in Arizona, 54% in Florida, and 42.6% in the Midwest. Concerns about drug use were highest in Arizona (40%) but present across all regions. Health behavior risks were also widespread: 72–79% of respondents reported sleep difficulties, and many reported low physical activity, suboptimal sun protection, and routine alcohol use. Psychosocial stressors were prominent, with 51–65% of respondents reporting experiences of disrespect and 42–66% feeling unheard by healthcare providers. Conclusions. Despite relatively high rates of insurance coverage, communities across all regions face persistent challenges in accessing timely, affordable, and respectful healthcare. Coupled with neighborhood instability, adverse health behaviors, and psychosocial stressors, these barriers highlight the urgent need for regionally tailored strategies that strengthen both cancer prevention and care. Addressing these interconnected challenges at the community level is essential for promoting more equitable cancer outcomes. Citation Format: Tingyu Zou, Monica L. Albertie, Emelina Asto-Flores, Manisha Salinas, Farhia Omar, Adeline Abbenyi, Noreen Stephenson-Hubert, Nuwanthi Heendeniya, Kathleen Yost, Folakemi T. Odedina. Place, people, and prevention: Contextual drivers of cancer health equity in three US Regions [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 B031.

Abstract Introduction: Understanding how communities access and engage with health information is essential for effective health communication. Health literacy—the ability to read, understand, and use healthcare information—plays a crucial role in making informed health decisions. With the rise of digital technologies, internet access and online engagement have become key tools for obtaining health information. However, variations in health literacy and digital engagement can limit some populations' ability to fully access these resources. This study examined health literacy, cancer information-seeking behaviors, internet access, and digital engagement among adults in the Mayo Clinic Comprehensive Cancer Center catchment areas to inform more effective and region-specific health communication strategies. Methods: This study focused on adult residents within the Mayo Clinic Comprehensive Cancer Center catchment areas, covering 75 counties across Arizona, Florida, and the Midwest (Minnesota, Wisconsin, and Iowa). Data were collected through partnerships with the University of Florida and Mayo Clinic Survey Research Centers, and the "Boots on the Ground" approach involving community health workers. Methods included phone calls, online submissions, and community outreach for an anonymous survey. Validated measures assessed health literacy, information access, and digital engagement. Descriptive analyses were performed using valid responses, excluding non-responses and "Prefer not to answer" options to ensure interpretive accuracy. Results: Data from 2,681 respondents highlighted consistent barriers to cancer prevention with regional differences. In Arizona, 42.6% of respondents need help reading medical materials, but only 3.1% reported lacking confidence in obtaining cancer-related information. In contrast, 63.1% felt very or completely confident in accessing cancer advice. The primary sources of health information were doctors (17.6%), internet searches (11.4%), and family (9.8%). In Florida, 38.4% need assistance, but only 2.7% lack confidence, and 68.2% feel very or completely confident. Doctors (18%) and internet searches (13.1%) were top sources. In the Midwest, 38.5% struggle with medical documents, and 3.1% reported lacking confidence, while 66.4% felt very or completely confident. Internet access is widespread across all regions, with smartphones being the dominant device. Daily internet use for communication, browsing, and engagement with health apps and social networks remains high. Conclusion: Although many respondents face challenges with reading health-related materials, most report high confidence in obtaining cancer information, suggesting a gap between functional health literacy and perceived ability to access information. The widespread use of mobile devices and near-universal internet access offers a valuable opportunity to enhance health communication through digital tools. These findings emphasize the importance of tailored digital outreach to bridge literacy gaps and ensure underserved populations can access reliable health information. Citation Format: Tingyu Zou, Monica L. Albertie, Emelina Asto-Flores, Manisha Salinas, Farhia Omar, Adeline Abbenyi, Noreen Stephenson-Hubert, Nuwanthi Heendeniya, Kathleen Yost, Folakemi T. Odedina. Health literacy and digital engagement across US Regions: Insights from the mayo clinic catchment areas [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 B030.