Mental health concerns have been on the rise in recent years, especially in the context of the COVID-19 pandemic. Minoritized racial and ethnic groups are especially at risk for untreated mental health concerns. Mental health promotion via culturally relevant approaches in community settings serving minoritized groups can help to address mental health concerns among these populations. However, mental health promotion activities require resources reflective of organizational capacity. The current study investigates the role of organizational capacity and characteristics in barriers to mental health promotion among community organizations. We surveyed 21 leaders of distinct community organizations (e.g., mosques, housing communities, and public libraries) in Maryland to assess their organizational capacity, characteristics, and barriers to mental health promotion. Data were analyzed using configurational analysis to identify characteristics that distinguished organizations with low, medium, and high levels of barriers to mental health promotion. While no single variable explained the level of barriers to mental health promotion, characteristics differentiating the level of barriers experienced by organizations in the current sample included county in which the organization was located, leader interest in health promotion, number of members in the organization, organization type (e.g., mosque or housing community), presence of a health team, and budget for health promotion. Organizations reporting the fewest barriers to mental health promotion were located in an urban city and had an increase in leader interest in health promotion following the start of the COVID-19 pandemic or were medium-sized (100–399 active members) mosques. Organizations reporting the greatest number of barriers to mental health promotion were located in an urban city and had no increase in leader interest in health promotion following the start of the COVID-19 pandemic or were large organizations (400 + active members) with sufficient financial resources but no established health team. Building community organization capacity for, and interest in, mental health promotion may be one way to encourage the availability and utilization of mental health supporting services among populations that may not otherwise receive such care.

Importance:Growing literature recognizes the importance of contextual influences on outcomes across the cancer continuum, beyond those of individual biological and lifestyle factors. These contextual influences represent a neighborhood exposome consisting of socioeconomic, demographic, and built environmental factors. Objective:To identify which neighborhood-level factors are most relevant for cancer outcomes and determine the geographic scale of their operation. Design, Setting, and Participants:This cohort study of women with a primary diagnosis of breast cancer developed a geographically sensitive neighborhood exposome-wide association study (gs-NWAS) framework to determine specific neighborhood-level factors that may be associated with outcomes beyond individual-level factors. The study was performed at the University of Virginia Comprehensive Cancer Center from January 2014 to December 2024. Exposures:An analysis framework that assigned many neighborhood exposome components at 3 geographic scales: census tract and 1- and 5-km area-weighted buffer. Individual-level confounders (race and ethnicity, alcohol use, tobacco use, and body mass index) were also considered. Main Outcomes and Measures:Survival among women diagnosed with breast cancer. The gs-NWAS chose each component's most relevant scale of operation, determined factors adjusted for multiple comparisons associated with survival in adjusted Cox proportional hazards regression models, and used machine learning methods (elastic net regression) to validate and condense these components. Hazard ratios (HRs), 95% CIs, and P values were reported. Results:Participants included 2727 women diagnosed with breast cancer (median age, 66 [IQR, 57-75] years) followed up for a median of 1697 (IQR, 945-2536) days (330 Black [12%], 2227 White [82%], and 170 other or unknown race [6%]); known cancer stage at diagnosis included I in 1668 (61%), II in 741 (27%), and III in 301 (11%). Four neighborhood exposome factors were associated with shorter breast cancer survival: high housing cost among low-income households (HR, 1.02; 95% CI, 1.00-1.03; P = .02 [tract]), people who recently moved to their current residence (HR, 1.06; 95% CI, 1.02-1.10; P = .001 [5-km buffer]), people renting in crowded households (HR, 1.03; 95% CI, 1.02-1.05; P < .001 [tract]), and the number of public preschoolers (HR, 1.06; 95% CI, 1.02-1.10; P = .001 [1-km buffer]). Conclusions and Relevance:In this cohort study of women diagnosed with breast cancer, a gs-NWAS was developed and applied to determine key components of the neighborhood exposome and their geographic scales of operation, identifying neighborhood-level factors in housing, economic, and demographic domains associated with breast cancer survival. Future studies should validate these findings in different populations and tailor this framework to their respective populations.

Context-specific adaptation of implementation strategies is an important component of promoting evidence-based intervention use. But guidance on systematic approaches is limited. Here we described our mixed method approach to adapting (Study 1) and monitoring (Study 2) a champion implementation strategy to improve implementation of anal cancer prevention procedures at an HIV clinic in Abuja, Nigeria. Building from existing literature, in Study 1, an implementation team of eight Nigerian stakeholders adapted a champion implementation strategy model. Team members ranked different attributes in terms of their importance for defining the strategy. The responses were aggregated and presented to the team who then discussed until consensus was reached on the operationalization of the strategy. In Study 2 we monitored the implementation of the strategy by one champion over six weeks by collecting daily checklists and weekly reflections from the champion. Study 1 team members described the champion as needing to be reliable and confident in using anal cancer prevention procedures, with responsibilities that included providing mentorship and raising awareness. In Study 2 the champion reported engaging in strategy-related activities 75

Community outreach and engagement (COE) is an integral component of NCI-Designated Cancer Centers' efforts to affect the cancer burden in their catchment areas. We describe examples of community-informed research and bidirectional engagement strategies undertaken by cancer center COE teams across the Big Ten Cancer Research Consortium. Guided by the Continuum of Community Engagement Framework, examples of community engagement were described by COE teams from 11 centers. Four examples were selected to illustrate varying levels of bidirectional community engagement across cancer center programs. The most common strategies included disseminating information about research studies to community partners and the public, assisting community research partners in developing surveys, conducting community needs surveys to inform scientific focus, and facilitating scientists' communication with the community to assess the relevance of their research. Key challenges include garnering financial resources, motivating scientists to develop community partnerships, and creating ways to reimburse community members for their time. Although shared leadership is the highest level of engagement, it is not always practical or appropriate. Researchers should strive for bidirectional community engagement to inform research questions, foster research relevant to the community, and facilitate the translation of findings to reduce the cancer burden.

Religiosity is central in the lives of many African Americans, with notable geographic variation in religious involvement throughout the United States (US). Using cluster analyses, we examined associations of religious clusters and geographic region with mental health in a sample of African American men. Participants from a national survey of religion and health completed six measures of religiosity and measures of depressive symptoms, daily hassles, and uplifts. Participants (N = 902) were from the South, Northeast, and Midwest regions of the US. The cluster analysis revealed three religious clusters: Positive Religious, Negative Religious, and Low Religious. The Positive Religious tended to have better mental health outcomes. There was also evidence that the Low Religious group had better mental health than the Negative Religious group. Further, we found more religious cluster differences on mental health in the South than the Northeast and Midwest. Implications for theory and interventions to support mental health in African American men are discussed.

Coding textual data is a vital but time-consuming part of qualitative data analysis. This article evaluates the integration of artificial intelligence (AI) tools with manual coding of participant interviews in a study examining how individual, interpersonal, and neighborhood factors affect overall health and cancer risk in the African American community. We conducted eighty-one semistructured, virtual, one-on-one interviews with stakeholders. The study team manually coded seventeen interviews (21 percent) to develop a coding framework of primary and secondary codes, which were then used to train the AI-assisted autocoding tool in NVivo. The tool autocoded the remaining sixty-four interviews (79 percent). The AI-assisted tool successfully extracted and matched secondary codes to their corresponding primary codes (e.g., barriers, facilitators, health care access, health outcomes). Notably, the AI-assisted tool achieved 100 percent accuracy in identifying participants' neighborhoods and place names mentioned in the interviews, supporting spatial analysis of risk factors of cancer by location. The AI-assisted tool struggled, however, to distinguish nuanced secondary codes, such as interpreting safety contextually as a barrier or facilitator, requiring manual review and correction. Despite this limitation, the integration of AI with modest human intervention proved effective for efficient and scalable coding in large qualitative data sets. This integrated approach offers a promising strategy for accelerating coding while maintaining rigor in qualitative research.

Abstract Introduction. Growing literature demonstrates a role of neighborhood disadvantage (ND), which disproportionately affects African American (AA) men, in prostate cancer (PC) disparities by race. One component of ND is historical redlining, which involved the systematic denial of mortgages in certain urban neighborhoods, often based on race. Redlining led to disinvestment and subsequent ND over time, and has been linked with poorer health outcomes in the present day. Epigenetic perturbations related to chronic stress may play a role in these associations. We hypothesized that residing in a formerly redlined neighborhood would be associated with prostate tumor DNA methylation (DNAm) alterations. Methods. This cross-sectional study leveraged prostate tumor DNAm data for AA men with PC who received radical prostatectomy at the University of Maryland Medical Center between 1992-2021. Historical redlining status was determined by intersecting participants' address at diagnosis with the 1930s Home Owners’ Loan Corporation redlining map of the Baltimore metropolitan area. DNAm was measured using Illumina’s EPIC v2 array. After quality control steps, there were 683,765 CpG sites for analysis. Linear regression models were used to estimate associations between historical redlining and DNAm levels (beta values, ranging from 0-1), adjusting for age at surgery and year of surgery. Differentially methylated regions (DMRs) were identified using the bumphunter R package. Results. We included 92 AA men with a median (interquartile range, IQR) age of 60 (54-63) years at surgery. Eight men (9%) lived in a historically redlined neighborhood. Residence in a redlined neighborhood was significantly associated with DNAm at 12 CpG sites after adjustment for multiple comparisons [False Discovery Rate (FDR)-adjusted p<0.05], 10 of which exhibited hypomethylation [IQR for difference: (-0.14, -0.07)]. These sites annotated to nine genes: PLEKHG5, KDR, ZDHHC19, ZNF316, ZFYVE21, CDH26, HPCA, FAM228B, PTPRN2. The most significant CpG site (cg11384525) was in ZDHHC19, which plays a role in tumor progression via S-palmitoylation activity (mean DNAm for men in redlined vs. non-redlined neighborhoods: 0.76 vs. 0.92; p=6.4x10-9; FDR-adjusted p=2.2x10-3). We identified one significant DMR involving hypomethylation of TNXB, which encodes an extracellular matrix glycoprotein that is associated with tumor progression for several cancers, including PC. Discussion. In this study of AA men with PC, tumor DNAm levels at 12 CpG sites were significantly different among men who resided in historically redlined neighborhoods. This study is one of the first to suggest associations of historical redlining with prostate tumor DNAm. Additional research is needed to replicate these findings and further investigate the relationships between the neighborhood environment, epigenetic tumor modifications, and PC disparities to elucidate mechanisms and inform interventions. Citation Format: Joseph Boyle, Camryn Cohen, Derrick Butts, Jimmie L. Slade, Yuji Zhang, Teklu B. Legesse, Ashley Johnson, Kimberly Clark, Jessica Wimbush, Nicholas Ambulos, Jing Yin, Jong Y. Park, Eberechukwu Onukwugha, Arif Hussain, Cheryl L. Knott, Kathryn H. Barry. Historical redlining and DNA methylation in prostate tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(8_Suppl):Abstract nr LB376.

Cigarette smoking and alcohol consumption remain leading causes of preventable cancers and mortality in the United States, and there is growing evidence that their effect could be additive. African Americans experience a disproportionate burden of psychosocial stress, driven in part by interpersonal inequities and structural racism. However, limited research has explored how everyday stressors may influence concurrent smoking and alcohol consumption behaviors within this population. This study examines the role of various personal, interpersonal, and occupational everyday stressors on smoking status and alcohol use among African Americans. This study analyzed data from a national probability survey of African Americans (AA) conducted in 2008. The analytic sample included 1,956 AA aged 21 and older with complete survey responses to smoking status, alcohol use, psychosocial stressors, and covariates. The dependent variable categorized participants into four groups: neither use (reference), smoking only, alcohol only, and both smoking and drinking (‘dual use’). Smoking was defined as smoking ≥100 cigarettes in one’s lifetime, and alcohol use was defined as consumption within the past 30 days (yes/no). Adapted from the Hassles and Uplifts Scale (Kanner et al., 1981), the independent binary variables for everyday psychosocial stressors included interpersonal conflict, daily hassles, loneliness, dissatisfaction with physical abilities, and work-related challenges. Covariates included age, gender, educational attainment, and median household income. A multinomial logistic regression model was used to examine associations between stressors and the categorical outcome, adjusting for covariates. Of the participants, 35.4% reported neither smoking nor drinking, 21.3% reported smoking only, 21.1% reported alcohol use only, and 22.2% reported dual use. The adjusted logistic regression model revealed that several interpersonal stressors were significantly associated with increased odds of dual use. Feeling let down by friends (Adjusted odds ratio [AOR] = 1.60, 95% confidence interval [CI]: 1.21–2.13, p = .001), experiencing separation from loved ones (AOR=1.40, 95% CI: 1.06–1.84, p = .017), and having conflict with a romantic partner (AOR = 1.38, 95% CI: 1.03–1.84, p = .029) were all significantly associated with dual use compared to neither use. In contrast, stressors tied to occupational dissatisfaction, daily hassles, sleep deprivation, physical health concerns, and loneliness did not show significant associations with concurrent substance use behaviors. Additional models examined smoking-only and alcohol-only groups. These findings indicate that interpersonal stressors may play a more central role than those at individual or occupational levels in influencing concurrent smoking and alcohol consumption behaviors within the AA population. Future studies should explore how interpersonal stressors may interact with structural factors (e.g., housing instability, racism) to shape smoking and alcohol use behaviors. Tiffany F. Saavedra, Cheryl L. Knott. Examining the role of psychosocial stressors in concurrent smoking and alcohol consumption among African American adults [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 B015.

Supplementary Figure S2 shows questions asked in the community forum

BACKGROUND:Although community engagement has had a substantial presence in public health research, community input to inform geospatial and health analyses remains underutilized and novel. This article reports on community engagement activities to solicit stakeholder perspectives on the role of neighborhood conditions in health and cancer. We discuss how this community input refined an a priori conceptual model to be tested in the larger Families, Friends, and Neighborhoods Study. METHODS:We conducted semistructured virtual interviews with 82 stakeholders (e.g., community and faith leaders, educators, and healthcare workers) across four states (Maryland, Connecticut, Alabama, and Missouri). Participants discussed the impact where a person lives can have on their health and cancer risk. We subsequently convened a virtual group discussion with 17 randomly selected interviewees. Our study team individually reviewed discussion notes, which were synthesized into a consensus document. RESULTS:In addition to constructs from the original conceptual model, participants identified neighborhood-level factors not present in the original model, including K-12 educational quality, local property investment, homelessness, public transportation infrastructure, proximity to healthcare facilities, environmental toxin exposures, access to healthy foods, and cost of living. These factors will be incorporated into the Families, Friends, and Neighborhoods Study analytic models. CONCLUSIONS:Although geospatial analyses in health research have not traditionally employed community engagement techniques, this study illustrates the value of informing multilevel analytic models with the lived experiences of those negatively affected by neighborhood conditions that underlie the risk, prevention, and screening behaviors driving cancer incidence and mortality. IMPACT:Future social epidemiology research can be enriched through community engagement.

Emerging literature notes the importance of neighborhood-level factors for cancer control behaviors beyond that of individual factors. Markers of neighborhood-level disadvantage have been linked to greater likelihood of nonsalutary cancer control behaviors. There has been less examination of many neighborhood factors simultaneously, which more accurately reflects individuals' daily experiences. We estimated associations of neighborhood deprivation indices with cancer control behaviors, identifying the relative importance of neighborhood-level deprivation index components for these outcomes. We used data from the Religion and Health in African Americans study, a national probability sample of African American adults. We separately considered 4 screening and 4 prevention behaviors as outcomes. We constructed neighborhood deprivation indices using census tract-level data and estimated their associations with outcomes using bayesian index models, adjusting for individual-level covariates. We reported odds ratios (ORs), credible intervals, and exceedance probabilities. Participants in our sample engaged in relatively high levels of screening behaviors and lower levels of prevention behaviors. Neighborhood deprivation indices were statistically significantly associated with a greater likelihood of binge drinking (OR = 1.13, exceedance probability = 98.5%), smoking (OR = 1.07, exceedance probability = 99.4%), and insufficient colonoscopy (exceedance probability = 99.9%), Papanicolaou (exceedance probability = 99.7%), and prostate-specific antigen (exceedance probability = 99.1%) screening. Within neighborhood deprivation indices, median household income, percentage of individuals without some college education, and percentage of individuals unemployed received large estimated importance weights. We identified statistically significant associations between neighborhood disadvantage and nonsalutary cancer control behaviors as well as important neighborhood-level deprivation index components for each outcome. These and similar findings from future studies should be used to target specific neighborhood factors for specific cancer control behaviors rather than using a one-size-fits-all approach.

The characteristics of where people live are increasingly recognized as influential in shaping health-related behaviors, including smoking. The adverse impact of poor neighborhood characteristics on health disproportionately plagues Black Americans, but also likely varies across subgroups within the Black community, leading to health disparities. This study examined the roles of residential segregation and housing cost burden in smoking behavior among a national probability sample of 2370 Black American adults. We further assessed whether individual demographics and social support moderated these associations. Survey data on health behaviors and psychosocial resources were merged with neighborhood characteristics. After adjusting for individual demographics and social support, we found that living in an economically segregated neighborhood where a higher number of low-income (i.e., with ≤$25,000 in annual income) households were separated from the high-income (i.e., ≥$100,000 in annual income) households more than doubled the odds of being a current daily smoker (OR = 2.40, p < 0.05). We also identified statistically significant moderation effects, where Black women living in neighborhoods with a high housing cost burden of 30 % or more of their household income were more likely to have smoked 100 or more cigarettes in their lifetime. These findings highlight the importance of neighborhood context in shaping smoking behavior, particularly in segregated areas and among Black women facing housing-related financial strain. Our study underscores the need for multilevel interventions that address both structural and individual factors, such as strengthening social support networks and reducing neighborhood stressors to mitigate smoking-related health disparities among Black Americans.

108 Background: Prior studies show that socioeconomic status impacts hepatocellular carcinoma (HCC) outcomes. However, these have used larger geographic areas such as zip codes or counties for assessment. Using a statewide cancer registry the Area Deprivation Index (ADI), a granular measure of socioeconomic deprivation (SED), was used to assess receipt of treatment and overall survival (OS) for locally advanced and metastatic HCC. Methods: The incidence-based Florida Cancer Data System was used to identify stage III/IV HCC patients diagnosed from 2007-2015. The ADI was used to measure SED and is a validated dataset that ranks neighborhoods (census block groups) from 1-100 (higher scores = higher deprivation) based on income, education, housing, and other socioeconomic factors. Demographic, tumor, and treatment variables were assessed using descriptive statistics, regression plots, and survival analysis. Chemotherapeutic treatment (CT) included receipt of chemotherapy and/or chemoembolization. Results: The study identified 2,534 eligible patients. Males comprised 80.6% of the cohort. The median age was 63 years. By SED quartile, there were significant differences by age, race, insurance, and receipt of chemotherapy (p<0.05) but no difference by gender, ethnicity, stage, or survival. Overall, 39.1% received chemotherapeutic treatment. However, 41.0% of the lowest-deprivation patients received CT compared to 32.1% in the highest-deprivation cohort (p<0.01). After adjustment for potential confounders, the lowest deprivation quartile had increased odds of CT compared to the highest deprivation quartile (OR 1.47; 95% CI,1.15-1.87). The median OS for the cohort was 4.0 months and was 4.6 and 3.3 months, respectively, for the lowest and highest deprivation quartiles (p<0.01). For patients who received and did not receive CT, the median OS was 8.0 and 2.2 months, respectively (p<0.01). However, there was no difference in median OS by SED for those who received CT (p=0.14). Conclusions: In an incidence-based, statewide cancer registry, the median OS for locally advanced and metastatic HCC remains poor and most patients do not receive CT. While there were differences in receipt of CT by SED, when patients did receive CT, median OS was similar across SED quartiles. These data suggest that SED may impact receipt of treatment and efforts are needed to understand and address treatment disparities. Lowest Deprivation Low Deprivation High Deprivation Highest Deprivation p-Value N=624 N=650 N=589 N=629 Chemotherapeutic treatment 0.001 No 347 (55.6%) 345 (53.1%) 339 (57.6%) 411 (65.3%) Yes 256 (41.0%) 283 (43.5%) 235 (39.9%) 202 (32.1%) Unknown 21 (3.4%) 22 (3.4%) 15 (2.5%) 15 (2.6%) Vital Status 0.93 Alive 41 (5.7%) 44 (5.9%) 43 (6.0%) 44 (6.5%) Dead 682 (94.3%) 695 (94.1%) 673 (94.0%) 632 (93.5%)

Supplementary Table S4: Summary of models by neighborhood metric when only using clinical information to classify prostate tumor aggressiveness.

110 Background: Studies have shown that socioeconomic deprivation (SED) is associated with reduced treatment and overall survival (OS) for gastric cancer. However, these studies have typically used large geographic areas for assessment of SED and aggregated all stages. Using a statewide cancer registry, the Area Deprivation Index, a granular measure of SED, was used to assess receipt of treatment and OS for metastatic gastric cancer patients. Methods: Using the incidence-based Florida Cancer Data System, gastric adenocarcinoma patients diagnosed from 2007-2015were identified (n=8,304). The Area Deprivation Index (ADI) is a composite measure of SED and validated dataset that ranks neighborhoods (census block groups) from 1-100 (higher scores=higher deprivation). Demographic, tumor, and treatment variables were assessed using descriptive statistics, regression, and survival analysis. Results: Overall, 3,050 stage IV patients met inclusion criteria; 53.9% were male and the median age was 67. When assessed by SED quartile, there were significant differences by race, ethnicity, insurance, and receipt of chemotherapy (p<0.05). For the cohort, 55.3% of patients received chemotherapy. However, 61.3% of the lowest deprivation cohort received chemotherapy compared to 50.4% in the highest deprivation cohort (p<0.001). After adjustment for potential confounders, the lowest deprivation quartile had increased odds of chemotherapy compared to the highest deprivation quintile (OR 1.52; 95% CI,1.20-1.92). Of patients who received chemotherapy, the median time in months to initiation was 1.1 (interquartile range 0.6-1.7). Median OS was 5.8 months. The median OS for the lowest and highest SED quartiles was 7.5 and 5.1 months, respectively (p<0.001). For patients who received and did not receive chemotherapy, median OS was 10.0 and 1.9 months, respectively. The median OS of the lowest and highest SED quartiles for those who received chemotherapy was 11.3 and 8.8 months, respectively (p<0.001). Conclusions: In an incidence-based, statewide cancer registry examining metastatic gastric cancer, just over half of patients received chemotherapy and median OS was poor. Additionally, higher SED was associated with lower odds of chemotherapy and worse OS. These data suggest that SED impacts metastatic gastric cancer outcomes and future studies are needed to understand the multilevel factors driving disparities. Lowest Deprivation Low Deprivation High Deprivation Highest Deprivation p-value N=752 N=780 N=747 N=718 Chemotherapy 0.003 No 262 (34.8%) 315 (40.4%) 306 (41.0%) 314 (43.7%) Yes 461 (61.3%) 424 (54.4%) 410 (54.9%) 362 (50.4%) Unknown 29 (3.9%) 41 (5.3%) 31 (4.1%) 42 (5.8%)

BackgroundStructural racism is associated with alcohol and tobacco use among Black Americans. There is a need to understand how this relationship differs within varying groups of Black Americans. This study assessed the moderating roles of age, gender, and income in the association between structural racism and binge alcohol consumption and tobacco smoking status among Black Americans.MethodsA state-level index of structural racism was merged with data from a national probability sample of 1946 Black Americans. Hierarchical linear and logistic regression models tested associations between structural racism (measured by residential segregation, and economic, incarceration, and educational inequities) and binge alcohol use and smoking status among Black Americans by stratified by age, gender, and income. Moderating effects of age, gender, and income were tested using slope estimate comparisons.ResultsResults indicated statistically significant positive associations between incarceration disparities and binge drinking and smoking status among Black Americans below age 65. An inverse association was detected between education disparities and smoking status among Black Americans below age 65 and among higher-income Black Americans. Age, gender, and income were not significant moderators of these associations.ConclusionsAge, gender, and income do not moderate the association between state-level structural racism and binge alcohol or tobacco use behaviors among the current sample of Black Americans.ImpactAddressing structural racism may have implications for reducing participation in binge drinking and tobacco use behaviors among Black Americans, regardless of their age, gender, or income. This has implications for healthy equity and cancer prevention and control.

AbstractBackground: Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans. Methods: An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates. Results: Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status. Conclusions: Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans. Impact: Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.

Supplementary Table S2: Summary of sensitivity analyses for models by neighborhood metric.