OBJECTIVE:To determine associations between spiritual well-being (faith and meaning dimensions) with emotional suffering (anxiety, depression, hopelessness, and quality of life) in Latinos with advanced cancer and examine themes of existential coping. DESIGN:In a mixed-methods study, participants were recruited from cancer clinics in New York and Puerto Rico. Measures included the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale, the Hospital Anxiety and Depression Scale, and the Beck Hopelessness Scale. A subset of participants completed in-depth semi-structured interviews exploring the roles of existential and religious factors in adjustment to cancer. Correlations were conducted, and the interviews were analyzed with a thematic analysis approach. RESULTS:A sample of 142 Latinos with advanced cancer participated (67.6% stage IV and 32.4% stage III). The spiritual well-being, faith and meaning factor were associated with anxiety and depression symptoms. Meaning was associated with lower hopelessness and showed stronger associations with emotional suffering than the faith dimension. Lower acculturation was associated with higher hopelessness but not with depression/anxiety. In semi-structured interviews (n = 24), recurrent themes were: (1) receiving existential support from counselors; (2) receiving spiritual support from family and/or friends; (3) focusing on being spiritual and finding purpose rather than on a specific religion or faith; (4) religious coping; and (5) spiritual coping, focused on self-growth, finding meaning, and helping others to cope. Patients identified sources of meaning, including helping others, having a fighting spirit, a spirit of learning, enjoying work, enjoying life, family and children, confidence in providers/treatment, God/faith, and spirituality. SIGNIFICANCE OF RESULTS:Meaning had a more significant influence than faith on emotional suffering. Participants emphasized the importance of finding meaning and purpose, self-growth, and helping others as ways to cope with an advanced diagnosis. Interventions with a meaning-making approach, emphasizing finding purpose and growth, are needed for Latinos with advanced cancer.

The adoption of Community-Based Participatory Research (CBPR) approaches has increased due to its potential to reduce health disparities through Community-Academic Partnerships (CAP). Providing community members (CM) capacity-building opportunities is a way of empowering communities and promoting social change. To support the development of CAPs, the Community Training Institute for Health Disparities (CTIHD) was created in southern Puerto Rico to capacitate community leaders in the CBPR approach and basic research knowledge through the CTIHD-Community Research Program (CRP). In 2019, six syllabi-led courses were developed and implemented utilizing a problem-based curriculum design and competency-based learning model, with 12 community members enrolled. A mixed methodology assessed satisfaction, acceptance, feasibility, retention rate, and knowledge change from cognitive debriefing with semi-structured questions (qualitative), course evaluations, attendance, program documents, and pre-and post-tests (quantitative). Results indicate high levels of satisfaction from courses and retention rates of 100% and 91%, respectively. Post-course evaluation scores exceeded 70% in five of six courses, with two courses demonstrating statistically significant results ( p < .05). Cognitive debriefing results indicate the feasibility and acceptability of the curriculum with suggested modifications in practical applications, itinerary of courses, and research proposal development. The outcomes of the program include the formation of four partnerships and the development of three research proposals. Capacity-building efforts, such as those of the CTIHD-CRP, are essential to increase community participation in health research, foster the formation of Community-Academic Partnerships (CAPs), and support the development of research on health disparities in the long-term.

Latina breast cancer survivors often underuse psychosocial services due to cultural, linguistic, and structural barriers. Limited English proficiency, past negative experiences, and mistrust may enhance reluctance to engage with mental health support after a cancer diagnosis. This study aims to understand patient-related barriers to psychosocial services use among Latina breast cancer survivors and explore the association of these barriers with patient characteristics. The sample included 50 foreign-born, Spanish-speaking Latina breast cancer survivors at a comprehensive cancer center who endorsed symptom burden. Data on patient-related barriers to psychosocial services use, patient-clinician interaction, and sociodemographic characteristics were obtained. Regression models were used for data analysis (p<0.05). Patient-related barriers for not using psychosocial services included lack of knowledge (88%), stigma (86%), self-reliance attitudes (78%), preference for informal care from family, friends, or spiritual/religious leaders (70%), and desire to return to normalcy (62%). Patients who endorsed greater stigma reported lower English fluency (comprehension) (p=0.006) and less time since diagnosis (p=0.046). Similarly, stronger beliefs of self-reliance were associated to lower English fluency (p=0.016) and less time since diagnosis (p=0.020). Preference for informal care was linked to poorer patient-clinician interactions (p=0.003). Lastly, greater stigma and self-reliance attitudes were related to increased time in the U.S. (p=0.083, p=0.065), though these associations did not reach statistical significance. This study outlines patient-related barriers to psychosocial services use among Latina breast cancer survivors. Findings indicate a high prevalence of stigma, lack of knowledge, and self-reliance beliefs, especially among less acculturated and recently diagnosed patients. These attitudes can prevent appropriate psychosocial care during the early stages of a cancer journey, a period of heightened stress and vulnerability for patients. Additionally, patients may turn to informal support systems when facing difficult interactions with their care team. Future interventions should integrate early, ongoing conversations about mental health support into care. High-quality language support, professional interpreters, and culturally tailored provider education can be used to strengthen trust in patient-clinician interactions. Partnering with community and faith leaders may help align care with a patient's cultural values and preferences, reduce stigma, and foster engagement with psychosocial services. Melissa Gaviria Garrido, Bharat Narang, MPH, Ashley M. Rodriguez, Eida Castro, PsyD, MSc, Victoria Blinder, Rosario Costas Muñiz. Barriers to psychosocial services use among Latina breast cancer survivors: Insights to encourage patient engagement with mental health care [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 C068.

Objective: The present study explored the association between the losses incurred due to breast cancer diagnosis, symptoms of depression, PANIC/GRIEF, and contextual factors within the context of Hispanic/Latina (H/L) patients diagnosed with breast cancer (BC). Methods: This study was a cross-sectional study of adult H/L BC patients (n = 129). The participants were H/L women diagnosed with breast cancer (stages 0–4) in the past five years. Sociodemographic variables were assessed, as well as depression symptoms (Patient Health Questionnaire-9; Spanish version), grief (The Affective Neuroscience Personality Scales, Grief subscale; Spanish version), and general losses (Grief diagnostic instrument for general practice, loss categories section). Results: The mean age for the sample was 55.37 (SD = 11.57). The most frequent non-death-related losses were loss of liberty (f = 63, p = 48.8%), followed by fear of own death (f = 67, p = 51.9%) and loss of quality of life (f = 65, p = 50.4%). A higher mean rank was observed in depressive symptomatology scores for those who experienced loss of liberty (U = 73.91, p < 0.008), quality of life (U = 77.30, p < 0.001), and fear of their own death (U = 74.88, p < 0.002). The results indicate a significant positive relationship between the number of reported losses and depressive symptomatology (r = 0.340, p < 0.001). In terms of contextual factors, the participants who reported their income not being enough to cover their expenses reported a greater number of losses related to diagnosis (U = 74.67, p < 0.001) and more depressive symptomatology (U = 69.84, p = 0.041). Moreover, a relationship was observed between grief and academic levels (r = −0.234, p = 0.008). Likewise, a relationship was observed between age and the number of losses (r = −0.461, p < 0.001). Conclusions: Our results provide new evidence on how primary non-death-related losses due to a breast cancer diagnosis impact the mental health of H/L BC patients.

Background/Objective: Depression, anxiety, insomnia, and fatigue often occur concurrently in cancer patients, with Latinos reporting higher burdens compared to non-Latino Whites. These symptoms adversely affect cancer progression and are associated with elevated cancer mortality. Financial toxicity, the financial distress of patients after a cancer diagnosis, has been linked to poorer cancer outcomes. This study aims to explore the relationship between financial toxicity and depression, anxiety, insomnia, and fatigue in Latina breast cancer patients. Data was collected from 30 Spanish-speaking Latina breast cancer patients at Memorial Sloan Kettering Cancer Center who endorsed symptoms of depressed mood, insomnia, and fatigue. Depression and anxiety were assessed through the Hospital Anxiety and Depression Scale (HADS), fatigue was measured through the Fatigue Symptom Inventory (FSI), and insomnia was measured using the Insomnia Severity Index (ISI). Financial toxicity was assessed using the FACIT-Cost scale. An independent samples t-test was employed for the analysis, with a p-value of 0.05. The study participants included 30 Latina breast cancer patients with an average age of 58.9 years. 46.7% of patients were married, and most reported limited English proficiency (86.7%). Most patients had stage 1 or 2 breast cancer (86.7%), were currently receiving treatment (56.7%), and were within five years of their breast cancer diagnosis (73.3%). Patients experiencing higher financial toxicity had significantly higher anxiety scores (x̄ = 8.1, SD = 4.5, p = 0.003), depression scores (x̄ = 7.6, SD = 3.2, p = 0.001), insomnia levels (x̄ = 12.0, SD = 7.0, p = 0.035) and fatigue (x̄ = 66.2, SD = 31.0, p < 0.001) compared to those with lower financial toxicity (respectively, x̄ = 4.1, SD = 2.5; x̄ = 3.5, SD = 2.6; x̄ = 8.1, SD = 3.9; x̄ = 26.3, SD = 22.9). Latina breast cancer patients experiencing financial toxicity reported higher levels of depression, anxiety, insomnia, and fatigue compared to those with less financial toxicity, suggesting that financial toxicity has a relationship with symptom burden. Our findings highlight the need to understand how to mitigate financial toxicity to improve cancer care outcomes, or to improve symptom management to reduce financial hardship. Possible interventions might include financial planning with healthcare professionals; leveraging social networks to disseminate financial resource and symptom management information; engaging community health workers and navigators to guide patients and their families toward available financial resources and better symptom management strategies; and building financial self-efficacy and involving family members in financial planning may help lessen the financial distress and symptom burden experienced by Latina breast cancer patients. Melissa Gaviria, Bharat Narang, Ashley M. Rodriguez, Francesca Gany, Eida M. Castro-Figueroa, Victoria Blinder, Rosario Costas-Muñiz. Assessing financial toxicity as a correlate of symptom burden in Latina breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7093.

Integration of the community into health research through community-engaged research has proven to be an essential strategy for reducing health inequities. It brings significant benefits by addressing community health concerns and promoting active community participation in research. The Community Training Institute for Health Disparities (CTIHD) was established to support this integration based on Community-Based Participatory Research (CBPR) principles. The main objective of this paper is to report the CTIHD program's implementation, evaluation, and outcomes from the first two cohorts. The CTIHD recruited Hispanic community members (N = 54) to be trained in health disparities research and health promotion to foster Community-Academic Partnerships (CAPs) and develop community-led health promotion interventions. Evaluation measures included satisfaction, knowledge change, retention rate, completion rate, and project proposals (research and community health promotion plans). The retention and completion rates were 83% and 78%, respectively, with forty-two (n = 42) community trainees receiving the completion certification. Both cohorts demonstrated a significant increase in knowledge (p < 0.05), and overall satisfaction exceeded 90%. Outcomes include seven (7) community-academic partnerships, leading to the co-development of research proposals, three (3) of which received funding. Additionally, twenty-two (22) community health promotion plans were developed, with seven (7) implemented, impacting 224 individuals. Findings from this study suggest that the CTIHD effectively provided capacity building, promoted the formation of CAPs, and increased community-led health promotion interventions, thereby advancing health disparity research and community initiatives.

Evidence suggests an association between exposure to electronic cigarette (e-cigarette) marketing and e-cigarette use (vaping) among adolescents. However, there is limited evidence on exposure to e-cigarette marketing and susceptibility to future vaping, especially among Black and Latino adolescents. This study aimed to examine associations between exposure to e-cigarette marketing and susceptibility to future vaping among Black and Latino adolescents in the United States (US). Participants (N = 362; equal representation between Black and Latino adolescents) completed a baseline assessment (available in English and Spanish) including sociodemographic characteristics (e.g., racial/ethnic group, age, gender, sexual orientation, etc.), exposure to e-cigarette marketing, and susceptibility to future vaping. Exposure to e-cigarette marketing was recoded and organized into two categories (high exposure = 2 to 3; low exposure = 0 to 1). Cochran–Mantel–Haenszel tests were used to evaluate the association between exposure to e-cigarette marketing and susceptibility to future vaping, stratified by racial/ethnic group. Multiple logistic regressions assessed the association between exposure to e-cigarette marketing and susceptibility to future vaping, controlling for gender, sexual orientation, grade, and academic performance within each racial/ethnic group. Black adolescents reported significantly higher frequencies of exposure to e-cigarette marketing (p = 0.005). A significant interaction was found between exposure to e-cigarette marketing and racial/ethnic group (X2 (1) = 6.294, p = 0.012). Among Black adolescents, high exposure to e-cigarette marketing (vs. low exposure) was associated with a higher probability of susceptibility to future vaping (OR: 2.399, 95% CI 1.147–5.021, p = 0.020). For Latino adolescents, exposure to e-cigarette marketing was not associated with susceptibility to future vaping (OR: 0.503, 95% CI 0.245–1.03, p = 0.062). Future studies should evaluate how and where adolescents are exposed to e-cigarette marketing. Prevention efforts must include the implementation of effective counter-marketing campaigns and the reduction of exposure to e-cigarette marketing among Black and Latino adolescents.

In this minireview, we examine the impacts of hurricanes and other extreme weather events on cancer survivors, focusing on structural and social determinants of health. We briefly explore influences on biological, psychosocial, and behavioral outcomes and discuss risk and resilience factors in cancer survivorship during and after hurricanes. Our goal is to inform future directions for research that can identify areas in which we can most efficiently improve cancer outcomes and inform changes in health systems, clinical practice, and public health policies. This timely minireview provides researchers and clinicians with an overview of challenges and opportunities for improving disaster preparedness and response for cancer survivors.

Community health promotion offers a potential solution to persistent healthcare challenges, with community health workers playing a pivotal role. The Community Training Institute for Health Disparities (CTIHD) implemented a problem-solving curriculum in Community Health Promotion, integrating a competency-based learning model through two courses: Introduction to Community Health Promotion and Design of an Action Plan for the Promotion of Community Health. Each course comprised ten three-hour sessions, featuring pre/post-tests, evaluations, and a cognitive debriefing. Knowledge change was assessed using pre/post-test scores among 27 community leaders from southern Puerto Rico. Cohort 1 and Cohort 2 demonstrated an overall retention rate of 62.6% and 96.7%, respectively. Although differences in knowledge gained between cohorts and courses weren't statistically significant, a trend toward increased knowledge was noted. Cohort 1 experienced a 22% knowledge increase in Course 1 and a 24% increase in Course 2. Cohort 2 demonstrated a 41% knowledge increase in Course 1 and a 25% increase in Course 2. The CTIHD's Community Health Promotion Program has made significant strides in elevating awareness and knowledge, marking a positive step toward reducing health disparities and fostering healthier, empowered communities in southern Puerto Rico.

Background: Studies evaluating the effects of natural disasters on cancer outcomes are scarce, especially among USA ethnic minority groups, and none have focused on the effects of concurrent natural disasters and the COVID-19 pandemic. The goal of this secondary data analysis is to explore the impact of concurrent exposure to COVID-19 and earthquakes on psychological distress and symptom burden among Puerto Rican cancer survivors. Methods: This secondary data analysis (n = 101) was part of a longitudinal case–control cohort study (n = 402) aimed at describing unmet psychological needs among Puerto Rican cancer patients and non-cancer subjects previously exposed to Hurricane María in 2017. The research team pooled data from participants (cancer survivors and non-cancer group) from their baseline assessments and from follow-up assessments conducted during January–July 2020 (earthquake and the lockdown period). A descriptive, paired t-test, non-parametric mean rank test, and two-sided Pearson correlation analyses were performed. Results: Psychological distress and cancer symptom burden diminished over time. Resilience was significantly correlated with all the psychological and symptom burden variables during both pre- and post-earthquake and COVID-19 assessment periods. Conclusions: The results support the role of resilience, social support, and post-traumatic growth as potential protective factors preventing psychological distress and diminishing cancer symptom burden among cancer survivors exposed to natural disasters and the COVID-19 pandemic.

Background: Puerto Rico (PR) is highly vulnerable to hurricanes, which severely impact cancer survivors by causing healthcare disruptions and increasing stress. This study investigates the reliability and factor structure of the Hurricane Hazards Inventory (HHI) and its relationship with psychological distress among cancer survivors and non-cancer controls in PR. Methods: Using secondary data from a longitudinal study following Hurricane Maria (HM), the baseline assessment included sociodemographic data from participants, HHI, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7). Statistical analyses involved descriptive statistics, Exploratory Factor Analysis (EFA), and Partial Least Squares Structural Equation Modeling (PLS-SEM). Results: Among 260 participants, 78.7% were women, with a median age of 58.0 years. EFA reduced the HHI to 17 items grouped into three factors explaining 62.6% of the variance with excellent reliability (Cronbach’s alpha 0.91). The three factors also showed good to excellent reliability (alpha 0.81 to 0.92). The median HHI score was 11.0 (range 4.0–26.5) out of 68. PLS-SEM revealed a direct effect of being a cancer survivor and tertiary hazards on depression and anxiety. Conclusion: The HHI is a valid and reliable tool for assessing mental health impact in cancer survivors after hurricanes. However, the study had limitations, including its small sample size and lack of control for all confounding variables. Future research with larger and more diverse samples is needed to further validate the HHI and examine its generalizability.

Objective: The current study aimed to explore changes in health-related behaviors and social practices in Hispanic cancer patients during a government-mandated lockdown and their relationship to Methods: Secondary analyses were conducted on data gathered by a longitudinal cohort study to describe the unmet needs of Hispanic cancer patients living in Puerto Rico exposed to Hurricane Maria in 2017, earthquakes in 2020, and COVID-19. However, our study solely focuses on the data from the COVID-19 pandemic period. Results: Most participants were women (n = 72) with breast cancer (81.2%). Participants exhibited changes in religious practices (60%), physical activity (58.4%), and sedentary behavior (50%); 31.4% experienced changes in eating habits and sleeping patterns. Responses to the study questionnaire involved staying connected with family (85.5%) through phone calls (78.2%); 69.9% of the participants reported observing shifts in the family dynamics. A strong majority endorsed the government-imposed isolation measures (95.6%). Patients not undergoing treatment were likelier (r = -0.324; P = .010) to support the measures. Finally, younger patients experienced more work-related changes (r = -0.288; P = .017) and were less inclined (r = -0.293; P = .011) to find the isolation measures appropriate. Conclusion: This paper describes the lockdown-related changes in health and social behaviors sustained by cancer patients, changes which could potentially impact their overall health and health-related quality of life. Our results fill an existing gap in our findings and contribute to understanding the experiences of cancer patients (in particular, Hispanic patients) during the COVID-19 pandemic.

OBJECTIVE:Acculturation stress can negatively impact Latinos immigrant mental and physical health related behaviors such as smoking. It is essential to have validated and updated instruments that allow the evaluation of acculturation stress on this population. This study aims to evaluate the psychometric properties of an abbreviated version of the Hispanic Stress Inventory Version 2 (HSI2) immigration scale among Latinos who smoke. METHODS:The study consisted of a secondary data analysis from a baseline assessment of Decídetexto, a mobile health (mHealth) smoking cessation randomized clinical trial. Of 457 Latinos included in the parent study, 352 immigrants who smoke were included. Construct validity was analyzed by completing a Pearson correlation coefficient matrix. Structural validity was analyzed using an Exploratory Factor Analysis (EFA). Cronbach alpha analysis was used to estimate the internal consistency of the items constituting a factor. RESULTS:The results included an abbreviated version of the HSI2 including 52 items. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 of the 52 items were excluded. From the Pearson correlation coefficient matrix with a cutoff point of 0.4, 22 items were excluded. Exploratory Factor Analysis (EFA) results in six factors extracted, explaining 69.1% of the variance. According to the EFA, two items were relocated in different factors from the original scale. The HSI2 30 items scale reflected excellent reliability with a Cronbach's alpha coefficient of 0.93. The six factors reflect acceptable to excellent reliability, ranging from 0.77-0.93 across factors. The median for the HSI2 total score was 34.00 (25-45) out of a possible total score of 150. CONCLUSION:Results confirmed acceptable psychometric properties of the HSI2 simplified 30-item version and provided a reliable and shorter measure of acculturation stress for Latinos groups. Having a valid and reduced measure of acculturation stress is the first step in understanding diverse ethnic groups of Latinos that are at higher risk of presenting health risk behaviors such as smoking. The present results provided the possibility of assessing the impact of acculturation stress among adults who smoke.

Introduction:Latino people with cancer might face additional health, emotional, and socioeconomic burdens of the COVID-19 pandemic.Methods:This study included data from two waves of (independent) assessments with providers of mental health services to Latino/Hispanic people with cancer from the United States, Spain, and Latin America (first wave: May-July 2020; second wave: March-July 2021) who completed a cross-sectional online survey with open-ended and closed-ended questions, including concerns of people with cancer with/without COVID-19.Results:The response rates were 15% for Wave 1 (N = 88) and 14% for Wave 2 (N = 115). For Wave 1, 74 surveys were completed by clinicians and included in the analyses; for Wave 2, 115 surveys were included. Providers (first [77%] and second [84%] waves) reported that most patients had concerns about stress/symptoms of anxiety, followed by concerns about COVID-19 exposure (first [74%] and second [82%] waves) and family members' exposure (second wave 75%), hospital visits or appointments (82%, 79%, respectively), treatment/testing delays (69%, 72%, respectively), general health (58%, 71%, respectively), and income/salary loss or reduction (60%, 50%, respectively). According to providers, concerns of patients diagnosed with COVID-19 included fear of death and dying, spreading the disease, getting worse, and lack of appropriate medical care.Conclusion:Our findings reveal the need to address health, emotional, and socioeconomic burdens of the COVID-19 pandemic throughout Latin America, Spain, and the United States for Latino people with cancer. Interventions targeting the health care access, emotional, and socioeconomic needs of Latino people with cancer are warranted.