Citations

Introduction: Systemic racism continues to shape maternal health care in the United States, contributing to higher rates of adverse outcomes for Black women and other women of color. Doulas have emerged as important advocates, yet little is known about how doulas’ own racial identities influence their work in challenging inequities. Methods: This qualitative study used a phenomenological approach to explore doulas’ perspectives on racism in maternal health care. Ten doulas in Northeast Florida participated in in-depth interviews and focus groups between 2021 and 2022. Data were transcribed verbatim and analyzed thematically using established qualitative methods. Results: Four major themes were identified: (1) challenging differential racial treatment, (2) leveraging privilege, (3) anti-racist doula training, and (4) advocating for Black doula recruitment and engagement. White doulas described using their privilege to support clients of color, while Black doulas described navigating heightened scrutiny and exclusion. Across participants, there was consensus that current training inadequately prepares doulas to address racism and that greater racial diversity within the profession is essential. Discussion: Findings highlight how doulas both confront and adapt to systemic racism in maternal health care. Their accounts point to gaps in training and structural barriers to equitable practice, while also illustrating how advocacy can both protect clients and, at times, reproduce inequities through unequal access to power and privilege. Health Equity Implications: Addressing how race and privilege shape advocacy pathways, reforming training to include racial justice, expanding recruitment and support for Black doulas, and integrating doulas into perinatal care models are important strategies for advancing maternal health equity and advocating for Black racial justice in health.

Abstract Background: Digital access, health literacy, and confidence in obtaining cancer information are well-known factors that influence cancer beliefs and behaviors. However, less is understood about whether these information-related factors vary across regions within a cancer center's catchment area and how they collectively relate to cancer beliefs in large community samples. This study investigated regional differences in digital access, health literacy, and confidence in seeking information, and examined the connections between these factors and cancer risk perceptions, fatalistic beliefs, prevention confusion, and willingness to participate in cancer clinical trials. Methods: Data (N=2,334) from the 2023 Mayo Clinic Comprehensive Cancer Center’s Cancer-Focused Needs Assessment, conducted across catchment areas in Arizona, Florida, and the Midwest (Minnesota, Wisconsin, Iowa). Regional differences in digital access (Internet use and device ownership), health literacy, and confidence in obtaining cancer information were analyzed using multivariable ANCOVAs and logistic regressions, adjusting for sociodemographic covariates. Follow-up models examined whether these information precursors are associated with perceived cancer risk, fatalistic beliefs, confusion about recommendations, and willingness to participate in cancer clinical trials, adjusting for the same covariates. Results: Regions showed minimal differences in digital access and health literacy. Health literacy was instead associated with ethnicity, age, gender, and education (all p<.001). Confidence in obtaining cancer information followed similar trends, with significant influences of ethnicity and gender (p<.01). Internet use was strongly associated with sociodemographic factors (all p<.01). Additionally, the information precursors consistently correlated with cancer beliefs across the full sample: Higher health literacy and greater confidence in obtaining cancer information were associated with increased perceived cancer risk, reduced cancer fatalism, and less confusion regarding prevention guidelines (ps < .001). Internet use and device access were significantly related to a greater willingness to participate in clinical trials (ps < .01). These relationships persisted even after controlling for sociodemographic covariates. Conclusions: Regional differences in digital access and health literacy were minimal, indicating a consistent information environment. Within this context, individual sociodemographic and information-related factors played a larger role, strongly shaping cancer beliefs. These findings underscore technology access and information empowerment as key targets for enhancing cancer prevention knowledge and research engagement, and indicate that the effects of information empowerment are primarily driven at the individual rather than the geographic level. Citation Format: Tingyu Zou, Monica L. Albertie, Emelina Asto-Flores, Manisha Salinas, Farhia Omar, Adeline Abbenyi, Noreen Stephenson, Nuwanthi Heendeniya, James R. Cerhan, Kathleen J. Yost, Folakemi T. Odedina. Digital access, health literacy, and cancer beliefs: Findings from a multi-region community survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 7553.

Abstract Background: The incidence of cancers diagnosed before age 50 has risen steadily over the past several decades. Survivorship research has not advanced at the same pace as these trends. Existing models of care were developed primarily for older adults and emphasize medical surveillance and risk reduction. Psychosocial dimensions, including anxiety, fear of recurrence, uncertainty about long-term health, and difficulty returning to social or professional roles, remain less consistently addressed. These needs are increasingly relevant as more individuals face the long-term impact of early-onset cancers. Methods: We are developing a digital survivorship model designed to extend support beyond the clinic and focus on psychosocial recovery in the early post-treatment period. The intervention integrates evidence-based behavioral strategies with participatory input from survivors, providers, and community partners. Features under development include educational modules, guided reflection, and interactive prompts to strengthen coping, resilience, and self-management. Evaluation will examine feasibility, acceptability, and early signals of impact using surveys, usage metrics, and qualitative interviews. Preliminary Results: Stakeholder engagement to date has demonstrated strong demand for resources that are both accessible and relevant to the life stage of early-onset survivors. Survivors report that many existing programs feel generic or better suited to older adults. Key priorities identified include managing fear of recurrence, navigating uncertainty about long-term effects, and balancing recovery with the responsibilities of family, career, and caregiving. These themes are informing design decisions and shaping evaluation measures. Conclusion: The rise in early-onset cancers creates an opportunity to expand the scope of cancer control to include survivorship as a central focus. Addressing psychosocial outcomes such as coping, resilience, and quality of life is essential for long-term health. Digital health strategies provide a scalable way to meet these needs by delivering tailored support that complements advances in prevention, detection, and treatment. Integrating survivorship into the broader response to early-onset cancers ensures progress is measured not only by survival but also by the ability of survivors to live well after treatment. Citation Format: Manisha Salinas. Psychosocial Survivorship Gaps in Early-Onset Cancers: Opportunities for Digital Health Research [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: The Rise in Early-Onset Cancers—Knowledge Gaps and Research Opportunities; 2025 Dec 10-13; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(23_Suppl):Abstract nr A008.

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 Background: Black women continue to face disproportionate mortality and long-term challenges after breast cancer treatment, including gaps in follow-up care, culturally relevant support, and access to survivorship resources. Digital tools designed with Black survivors in mind remain limited, despite their potential to reduce disparities in post-treatment engagement. Objective: To address these gaps, we developed HERCaRE (Health Equity Resources for Breast Cancer Responsive Education), a progressive web application (PWA) designed to deliver culturally responsive survivorship education and engagement tools to Black breast cancer survivors. HERCaRE was designed to meet the need for a culturally responsive, easily accessible resource that empowers survivors to engage more confidently in their post-treatment care. Methods: The concept for HERCaRE was informed by a previous pilot study on virtual breast health education, in which participants expressed the need for more sustained and accessible support for survivors. Building on that insight, the platform was developed with advisory input from Black breast cancer survivors and community advocates through informal, discussion-based feedback. While not a formal co-design process, this input helped ensure cultural relevance in tone, structure, and visual language. HERCaRE includes three core features: educational modules on key survivorship topics, interactive behavior-prompting activities, and a notes section for self-reflection and goal tracking. The platform is grounded in the Health Promotion Model and RE-AIM framework, providing a foundation for future implementation and evaluation. The platform is currently being prepared for pilot testing, which will assess usability, perceived relevance, and engagement frequency among Black breast cancer survivors. Mixed-method surveys and platform analytics will guide refinement ahead of broader implementation. Preliminary Insights: Early input emphasized the importance of affirming, plain-language content and simple navigation. Activities were designed to promote exploration of the educational material and personal health behaviors through simple, self-guided prompts. Current efforts are focused on content finalization, participant recruitment, and platform readiness for testing. Conclusion: HERCaRE offers a responsive, theory-informed approach to digital survivorship support for Black women. While still in the pre-implementation phase, its development reflects a commitment to accessible design, cultural alignment, and future scalability. The platform lays important groundwork for reducing disparities in survivorship care and expanding digital health tools that center the needs of historically underserved populations. HERCaRE’s modular design and emphasis on user experience position it for adaptation across diverse clinical and community settings, including integration into survivorship programs serving other medically underserved populations. Citation Format: Manisha Salinas, Timethia Bonner, Laura Pacheco-Spann, Oluwadamilola Oladeru, Dianne Townsend, Che Ngufor. A culturally tailored digital health platform to improve breast cancer survivorship for Black women: HERCaRE [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 B048.

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.

Endotoxemia is closely related to many diseases. As the largest endotoxin reservoir in the human body, the gut microbiota should be a key target for alleviating endotoxemia. The intestinal microbiota is believed to cause endotoxemia directly or indirectly by modifying the intestinal barrier function through dysbiosis, changing intestinal mucosal permeability and bacterial translocation. Diet is known to be the main environmental factor affecting the intestinal microbiota, and different diets and food components have a large impact on the gut microbiota. The Mediterranean diet, which received much attention in recent years, is believed to be able to regulate the gut microbiota, thereby maintaining the function of the intestinal barrier and alleviating endotoxemia. In this review, we focus on the relationship between the gut microbiota and endotoxemia, and how the Mediterranean dietary (MD) pattern can interfere with endotoxemia through the gut microbiota.

Abstract The Cancer Advocacy Training Program aimed to enhance participants' knowledge, skills, and confidence in cancer advocacy, particularly addressing disparities in cancer health outcomes. This evaluation assesses the program's impact through pre- and post-training survey comparisons. The program included 25 participants from various states and focused on comprehensive training. Surveys measured changes in knowledge, attitudes, self-perceived skills, and confidence. Results showed that accurate identification of cancer's main categories increased from 83% to 96%, and awareness of the NCI's mammogram recommendations rose from 70% to 96%. Recognition of the root causes of health disparities remained at 100%, and belief in the inclusivity of cancer advocacy roles was consistently high. Understanding of trust dynamics in advocacy increased by 50%, and recognition of essential political advocacy components improved by 14%. Specific learning outcomes indicated consistent identification of research advocates, a 23% increase in knowledge of strategic funding sources, a 31% improvement in understanding health communication audiences, a 19% rise in awareness of patient advocacy benefits, and a 13% increase in comprehension of informed consent. Confidence in advocacy skills also saw significant improvements. "Extremely confident" participants increased to 33% in problem-solving, adaptability, and communication with stakeholders. Confidence in fundraising and partnership building rose to 19%, evaluation of advocacy outcomes to 24%, identifying key issues to 29%, presentation skills to 33%, and using digital tools to 29%. Self-efficacy results demonstrated notable gains: confidence in solving difficult problems related to cancer advocacy increased with participants reporting "extremely confident" rising from 11% to 33%. Confidence in adaptability under stress improved significantly, with "extremely confident" participants rising from 11% to 33%. Effective communication with stakeholders saw a significant increase, with "extremely confident" participants rising from 17% to 33%. Fundraising and partnership-building confidence increased from 6% to 19%, and confidence in evaluating advocacy outcomes improved, with "extremely confident" participants rising from 6% to 24%. The program effectively enhanced participants' knowledge, attitudes, and advocacy skills, integrating theoretical and practical learning. Gains in confidence across problem-solving, adaptability, and communication skills underline the program's success in preparing participants for real-world advocacy. Participant feedback confirmed the program's relevance and efficacy, suggesting future iterations should emphasize diversity in advocacy and deepen content on key topics. This program serves as a valuable model for empowering cancer advocates and addresses the critical need for targeted training to reduce cancer health disparities. Citation Format: Manisha Salinas, Monica Albertie. Empowering cancer advocates: Evaluating the impact of a comprehensive training program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B112.

Background Breast cancer remains a leading cause of cancer morbidity and mortality worldwide. In the United States, Black women face significant disparities in screening mammograms, experience higher rates of breast cancer at advanced stages, and are more likely to die from the disease. Aims This study aimed to develop and beta-test a virtual health navigation program to enhance breast cancer care within the Black community. We identified barriers to utilizing virtual patient navigators and factors impacting the adoption of virtual navigation for breast cancer information among Black women. Methods The vCONET (Virtual Community Oncology Navigation and Engagement) intervention was delivered through the Second Life virtual platform. The informational content was collaboratively developed with community members. Participants engaged in an informational session on risk factors, mammography information, and preventive behaviors. Surveys (n = 18) and focus groups (n = 9) assessed knowledge and insights into perceptions. Results Findings revealed a positive impact of the intervention, with participants expressing increased knowledge and willingness to seek further information about breast cancer prevention, and highlighted the engaging nature of the virtual environment, while acknowledging potential technological challenges. Conclusion Virtual health navigation shows promise in addressing breast cancer disparities by promoting awareness among Black women. Future efforts should optimize virtual navigation approaches through collaborative engagement for lasting impact, enhancing breast cancer care and equity in communities of color.