PROJECT SUMMARY Hispanic cancer patients and survivors face social and structural inequalities perpetuating mental health disparities. Despite these challenges, the study team and community partners are convinced that psychosocial and mental health inequities perpetrated by socio-environmental factors can be overcome through community- based multilevel interventions; yet none currently exist. This project is highly transformative and innovative because it disrupts traditional psycho-oncology mental health care to address upstream structural (limited access to psychosocial and mental health inequities and psychological distress screening), social (mental health stigma), and biological (stress and inflammation biomarkers) determinants of mental health among Hispanic cancer patients and survivors. This transformation will be achieved by simultaneously integrating grassroots (community leaders) and top-down (institutional) resources to increase access to specialized psycho-oncology mental health care services and psychological distress screening while eradicating mental health stigma. First, the team will train lay community leaders to become community health workers addressing psycho-oncology mental health prevention efforts. Second, the investigators, along with community stakeholders, will package the proposed multilevel community-based intervention by integrating and adapting a suite of individual/community interventions and service initiatives previously developed and implemented by members of the research team and proven to positively impact Puerto Rican Hispanic cancer patients and survivors’ psychosocial and mental health wellbeing. At the community level, the team will first train lay community leaders to become community mental health workers through the PHSU-RCMI Community Training Institute for Health Disparities. At the interpersonal level, the community-based intervention will integrate family-communications skills to impact Hispanic cancer patients' and survivor family caregivers’ support quality. At the individual level, the intervention will impact all phases of the mental health prevention continuum to prevent and address psychological distress resulting from cancer and its treatment. At the biological level, investigators will assess the effect of the community intervention on psychological stress biomarkers (cortisol and catecholamine metabolites) and inflammation markers (cytokines and chemokines) related to chronic stress and cancer health outcomes. The team anticipates this project will push a transformative population-level impact through a multilevel approach that empowers communities to understand and address mental health among individuals.

NARRATIVE Hispanic cancer patients and survivors face social and structural inequalities perpetuating mental health disparities while no interventions exist to address these health inequities perpetrated by structural, social, and social-environmental adverse events. This project is innovative because it disrupts traditional psycho-oncology mental health care to address upstream structural (limited access to psycho-oncology mental health care and psychological distress screening), social (mental health stigma), and biological (psychological stress and inflammation biomarkers) determinants of mental health among Hispanic cancer patients and survivors. The team anticipates this project will push a transformative population-level impact through a multilevel approach that empowers communities to understand and address mental health among individuals.