Community Engaged Perspectives on Oropharyngeal Cancer Risk in an Underserved Miami Neighborhood: A Qualitative Study of Barriers and Solutions

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This qualitative study aims to engage community stakeholders from an underserved neighborhood in Miami, FL to identify key problems and solutions related to high-risk behaviors in OOPSCC. Twelve participants, selected based on community involvement and residence around the studied neighborhood, participated in two focus groups with six participants each. Transcriptions of the 60-minute sessions were analyzed using directed qualitative content analysis (DQICA) to identify themes. Notable excerpts from the transcriptions were used to report data and support overarching themes. 12 participants of average age 45.6 years were interviewed. The majority were female (75.0%), had 0-1 years community involvement (83.3%), were Black or African American (100%), and were non-Hispanic (83.3%). DQICA revealed five key problems contributing to high-risk behaviors for OOPSCC: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol. Analysis identified five key solutions including continuity of care, community engagement and education, incentives, long-term relationships, and improved health accessibility. This study highlights the influence of social determinants on OOPSCC risk in this medically underserved community of Miami, FL. Through a community-engaged approach, this study uncovers underlying problems and potential solutions to reduce high-risk behaviors contributing to OOPSCC. This emphasizes the need for stakeholder input, community-specific research and service efforts, and longitudinal practices in improving the treatment within underserved communities. Level of Evidence : level 4 Biological sciences/Cancer Health sciences/Health care Oropharyngeal Community-engaged Health disparities Cancer Social determinants Figures Figure 1 Background Oral and oropharyngeal squamous cell carcinoma (OOPSCC) encompasses cancers of the oral cavity, throat, and tonsils. These cancers can invade surrounding tissues, metastasize, and be fatal without treatment. Symptoms include difficulty swallowing, sore throat, and weight loss. OOPSCC incidence has steadily increased, with approximately 59,660 new cases estimated in 2025 [ 1 ]. Despite rising rates, OOPSCC is largely preventable through reducing risk factors like tobacco use, alcohol consumption, and high-risk sexual behaviors that lead to HPV transmission [ 2 ]. Nearly half of cases are diagnosed at advanced stages, but targeted screening of high-risk populations can improve awareness and outcomes [ 3 – 4 ]. Significant disparities in OOPSCC survival persist due to demographic and socioeconomic factors. Barriers such as limited healthcare access, economic hardship, inadequate education, and lack of support systems contribute to poorer outcomes among racial and ethnic minorities. Despite increasing incidence among White Americans, Black Americans experience significantly poorer survival outcomes, with a five-year survival rate of 52% compared to 70% among White Americans [ 5 – 6 ]. Socioeconomic status, when combined with minority status, further worsens survival [ 6 – 8 ]. Disparities among Black Americans are linked to differences in care access, treatment variation, and HPV prevalence. HPV, a common sexually transmitted virus, can lead to oropharyngeal cancer, especially in immunocompromised individuals. Black Americans with HPV-negative OOPSCC have worse survival rates than White Americans, while no disparity exists for HPV-positive cases [ 9 ]. HPV-negative OOPSCC is primarily associated with tobacco and alcohol use, behaviors more prevalent in racial minority populations, exacerbating disparities [ 9 , 10 ]. Prevention through targeted screening remains limited when healthcare access is inadequate [ 3 – 4 ]. Social determinants of health significantly impact OOPSCC outcomes, as factors such as racial discrimination, affordability of care, and community support affect survival [ 7 , 11 – 13 ]. Persistent racial disparities in OOPSCC treatment outcomes have been documented in Florida. Feaster et al. (2023) found that Black patients had higher odds of being diagnosed with distant-stage oral cavity cancer compared to White non-Hispanic patients, with disparities linked to lack of insurance, lower income, and less education. This study focuses on a predominantly Black and Hispanic Miami neighborhood with a median household income below the national average. While most disparities research uses large-scale data, such analyses often overlook local-level nuances. Community-engaged research (CEnR) addresses this by involving residents to better understand local health behaviors and care access. CEnR uses collaborative partnerships between researchers and community members, ensuring studies reflect the lived experiences and priorities of the populations they aim to serve. Engaging communities as equal partners helps bridge gaps between academic research and affected populations [ 15 ]. This is crucial for addressing high-risk factors for HPV-negative OOPSCC in underserved communities, where tobacco and alcohol use are common coping mechanisms linked to adverse social determinants [ 16 , 17 ]. Focus groups offer direct, nuanced insights into community challenges, enabling tailored interventions aligned with cultural contexts [ 18 ]. This research team has conducted OOPSCC screenings in underserved Miami neighborhoods using a mobile unit, the Game Changer Vehicle, to provide care and education [ 19 ]. This study expands those efforts by gathering community stakeholder input to identify high-risk behaviors, address perceptions of researchers, and improve future care accessibility. Through qualitative analysis of focus group discussions, the study uncovers contributors to high-risk behaviors for OOPSCC and community-informed solutions. Feedback will guide future initiatives to enhance engagement and service delivery for minority and low-income populations disproportionately affected by OOPSCC. Theoretical/Conceptual Framework This study draws on the Social Determinants of Health (SDOH) framework to contextualize how education, systemic trust, substance use, and access to care influence oropharyngeal cancer risk in underserved communities. In addition, the project was guided by a Community-Based Participatory Research (CBPR) approach, which centers the perspectives and lived experiences of community stakeholders throughout the research process. These frameworks informed both the design of the focus groups and the interpretation of the resulting themes. Methods Participants This qualitative study used focus group feedback as the primary data source. Inclusion criteria required participants to be residents of Liberty City who were active in local community organizations, at least 21 years of age, and proficient in English. All participants were considered community stakeholders, with a history of informal collaboration with our research team through previous health outreach events. Our NCI-designated cancer center’s Behavioral and Community-based shared resource ( https://umiamihealth.org/en/sylvester-comprehensive-cancer-center/research/research-resources/shared-resources/behavioral-and-community-based-research-shared-resource ), trained in community-engaged research methods, led recruitment. Over several months, participants were recruited through phone calls, emails to past community contacts (not official partners), referrals, and in-person outreach at community events and health fairs. Potential participants were further identified via email based on their engagement in local initiatives. Roles of all potential participants were reviewed with the research team to ensure appropriate stakeholder representation. Participants were selected based on their residence in or around the underserved neighborhood and their active involvement in community work. All participants were considered community stakeholders, defined as individuals who provided services or organized community events. Some worked in community centers serving local and public housing residents, while others collaborated with case managers to ensure residents received necessary resources. Procedure Guiding questions were developed to facilitate focus group discussions on participant experiences, perceived health hazards, and attitudes toward external research and screenings (Appendix A). The protocol, recruitment materials and verbal consent procedure were approved by the University of Miami Internal Review Board. Participants had the study fully explained to them and completed a demographic and role-specific survey. Sessions were led by an experienced facilitator from the research team. Completion of the focus group verified their consent to participate.. Twelve participants were divided into two 60-minute in-person focus groups of six participants each. Research team members not involved in facilitation observed via Zoom to take notes. Sessions were recorded with confidentiality measures, and participants were informed of privacy protocols. Gift cards were provided as IRB-approved compensation. Recordings were transcribed verbatim by GMR Transcription Services and reviewed by multiple team members, including the principal investigator (PI). Inter-rater reliability was ensured through weekly meetings focused on transcript review, community familiarity, and social determinants of health. Data were analyzed using directed qualitative content analysis (DQICA) [ 20 , 21 ], a structured method for coding, categorizing, and interpreting qualitative data. This approach helps identify common themes and expand on existing OOPSCC research. The DQICA framework was informed by known OOPSCC risk factors, social determinants of health, researcher familiarity with the community, and relevant literature. Preparation included developing open-ended interview guides and reviewing transcripts. Two researchers independently analyzed the data, highlighting recurring themes based on discussion frequency and emphasis. Key messages were categorized into keywords, organized into overarching themes and subthemes, and discussed to resolve discrepancies (Fig. 1 ). Sample transcript excerpts were compiled into structured reporting tables. Results Demographics This focus group study included 12 participants, divided into two in-person focus groups of six participants each. Most participants were female (75.0%), had 0–1 years of community involvement (83.3%), were Black or African American (100%), and non-Hispanic (83.3%) (Table 1). All participants lived in or near the studied neighborhood and held various community roles, including board members, outreach coordinators, case managers, and program directors. Qualitative Analysis The DQICA of focus group transcripts revealed two overarching themes related to high-risk OOPSCC behaviors: key problems contributing to these behaviors and solutions for improving community outcomes. Each theme included five subthemes (Figure 2). Identified problems were historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol (Table 2). According to stakeholders, these factors significantly promote high-risk behaviors. Conversely, proposed solutions included providing continuity of care, engaging and educating, offering incentives, establishing relationships, and increasing healthcare accessibility (Table 3). Key Problems Historic Social Norms Cultural norms shape what is considered acceptable behavior [22]. Community stakeholders noted that high-risk health and safety concerns stem partly from a history of violence that remains pervasive. One participant described the difficulty of escaping negative conversations about recent violence (HSN1). These norms are generational, with drug use among older adults influencing increasing substance use in younger generations (HSN2). This entrenched behavior challenges efforts to promote healthier alternatives (HSN3). Mistrust of Healthcare System Multiple factors contribute to healthcare mistrust, including high provider turnover, past research exploitation, and poor communication. Participants noted that providers often arrive with good intentions but end up causing harm (MHS1). Mistrust arises when outside providers fail to understand or meet the community’s actual needs, instead imposing solutions based on assumptions (MHS2). Lack of Support Systems High crime rates, poverty, and insufficient support systems (e.g., recreational centers, religious groups, mental healthcare) leave residents vulnerable to high-risk coping behaviors like smoking, drinking, and violence (LSS1). Even those who previously avoided such behaviors may turn to them when facing stressors like grief or rising living costs (LSS2, LSS3). Limited Education Improving health outcomes requires accessible education on high-risk behaviors. Participants noted that, despite a willingness to learn, community members struggle to find affordable resources on health and finances (LE1). This knowledge gap fosters fear of seeking medical care (LE2) and poor physical and mental health management (LE3). Availability of Drugs and Alcohol Easy access to substances contributes to widespread high-risk behaviors. Drugs and alcohol are readily available in stores and on the streets (ADA1). Even those trying to quit face constant temptation (ADA2). Residents continue smoking despite rising cigarette prices (ADA3), and substance use remains normalized among youth (ADA4). Key Solutions Providing Continuity of Care Consistency in healthcare services is essential for engaging communities like this one. Focus group participants noted that consistent care helps monitor community progress, while inconsistency reveals areas of struggle (PCC1). Regular provider presence builds trust and encourages patients to follow up with their care (PCC2). Having designated contacts, such as case managers or community liaisons, promotes ongoing communication and follow-up (PCC3). Engaging and Educating Lack of education is a significant barrier to reducing high-risk health behaviors. Participants highlighted minimal knowledge about HPV, including its causes and link to oropharyngeal cancer (EE1). While pamphlets and health fairs increase awareness, community members also need guidance on using existing resources. Education should focus on accessing smoking cessation hotlines, alcoholism support groups, and budgeting for healthier lifestyles (EE2, EE3). Recreational activities at health fairs and community centers can foster support systems that deter high-risk behaviors (EE4). Offering Incentives Simple incentives can motivate people to engage with healthcare services. Participants noted that people are more interested in learning when health events are engaging and enjoyable (OI1). Giveaways like hand sanitizer, masks, and stress balls attract initial attention and encourage attendance (OI2, OI3). These incentives offer a tangible reason for community members to participate before engaging with health services (OI4). Establishing Relationships Building long-term relationships fosters trust between providers and community members. Communication and a genuine investment in resident wellbeing are crucial (ER1). Demonstrating patience and empathy strengthens provider trust (ER2). While past engagement was often distant, participants emphasized that in-person interactions and familiar faces show commitment to the community (ER3). Increasing Accessibility to Healthcare Services Providers can boost healthcare usage by improving accessibility. Transportation is a major barrier, but virtual appointments and mobile health services at community centers can help (IAHS1). Health fairs, which bring multiple services to one location, effectively motivate attendance (IAHS2). Timely, well-publicized information ensures that community members are aware of available health services (IAHS3). Discussion This study represents a substantial step in understanding the persistence of high-risk factors for OOPSCC in this community of Miami, FL and other medically underserved communities. Using the subjective experiences of community leaders, the study identified five key problems placing residents at higher risk for OOPSCC: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol. Community perspectives were also critical in identifying five potential solutions to improve future care and research and reduce OOPSCC risk: providing continuity of care, engaging and educating, offering incentives, establishing relationships, and increasing healthcare accessibility. By involving key stakeholders, this study reveals insights that illuminate the challenges these communities face and contributing factors to disparities in OOPSCC survival. Prior research has shown that social determinants such as housing, transportation, education, income, and racial discrimination play a substantial role in OOPSCC outcomes [ 12 , 13 ]. Studies assessing these determinants have traditionally relied on survey, clinical, and census-based data to provide macro-level information on OOPSCC. SEER database studies from Megwalu et al. found that counties with lower socioeconomic status and Black race had lower overall survival in oropharyngeal cancer [ 8 ]. These studies also emphasize the continued need to address how SES affects cancer survival and identify areas for public health intervention [ 20 , 21 ]. Quantitative data is essential to understanding OOPSCC risks and outcomes, but it cannot fully capture the lived experiences of those most affected. Our collaborative study used qualitative methods through focus group interviews and analysis to explore the nuances of high-risk behaviors for OOPSCC at the community level. The collaborative nature of the study came from involving community stakeholders throughout the research process—from shaping guiding questions to participating in discussions that informed the direction and interpretation of the dialogue. Drawing on prior knowledge of social determinants and experience treating this community, the research team facilitated conversations that allowed participants to expand on meaningful topics. This co-constructed approach enabled the identification of themes and subthemes that more accurately reflected the complexity of high-risk behaviors than traditional methods. It also fostered trust, empowerment, and mutual learning between researchers and community members. Understanding the root causes of these behaviors through a collaborative lens is crucial to developing effective interventions that reduce disparities in OOPSCC survival. Our study highlights the history of violence in this community and its role in perpetuating high-risk behaviors like drug, tobacco, and alcohol use due to deeply ingrained social norms (Table 2 HSN1, HSN3). Social and cultural norms strongly influence behaviors across generations [ 23 – 26 ]. Participants noted that persistent violence encourages substance use as a coping mechanism, compounded by the availability of drugs, alcohol, and limited support systems. One participant described these behaviors as “inevitable” (Table 2 ADA4), while another called them “an outlet, a release of grief” (Table 1 LSS1). Problems and Solutions Addressing these systemic issues requires cultural sensitivity, which improves health outcomes and service acceptability [ 26 ]. Stakeholders emphasized the importance of providers building community relationships through “patience, showing empathy, [and] showing compassion” (Table 3 ER2). Mistrust of the healthcare system, a known barrier in minority populations [ 27 , 28 ], stems from past discrimination and contributes to poor outcomes and low treatment adherence. Participants echoed this concern, recounting negative experiences (Table 2 MHS1). Solutions include continuity of care, engagement, education, and consistent provider presence. As one participant stated, “folks want to see your face and see that you care” (Table 3 ER3). Limited education on high-risk behaviors and preventive healthcare further worsens OOPSCC outcomes. Participants noted that lack of knowledge causes apprehension toward medical care (Table 2 LE1-2). While educational initiatives can improve health behaviors [ 29 , 30 ], long-term strategies remain scarce. Stakeholders observed that, despite community interest, learning opportunities are limited. Improving healthcare accessibility and offering incentives can help bridge these gaps. Mobile medical units address financial and transportation barriers, but timely, widespread communication is essential (Table 3 IAHS1-3). Creative engagement strategies such as giveaways and interactive activities were noted as effective (Table 3 OI1). Items like hand sanitizers, stress balls, and bingo have fostered participation. These incentives are more effective when used as meaningful gestures that build trust and sustained engagement. When aligned with community interests and culture, they help build lasting relationships and empower communities to take active roles in their health. This aligns with community engagement principles emphasizing trust and collaboration in designing effective interventions. Future programs should prioritize addressing educational gaps and mistrust. Improved communication, early notice, culturally relevant outreach, and incentives can boost engagement. Participants noted brochures and flyers were more effective when paired with provider presence. Building relationships and follow-up can strengthen program legitimacy. Tackling these barriers is crucial to improving healthcare engagement. Limitations This study has several limitations. Although focus group participants were selected as community stakeholders, most had less than a year of experience in their roles, which is a limitation that may affect the depth of their insights. However, their recent entry into these positions may also contribute to a heightened willingness to engage with the community and implement innovative strategies for improvement. Input from individuals with longer-term involvement could enhance understanding of longitudinal changes. Expanding participant age to include those under 21 may provide valuable perspectives on early exposure to high-risk behaviors. One participant highlighted youth involvement in substance use: “You see younger people, too… with the drugs and stuff like that” (Table 2 HSN2). Since many high-risk behaviors begin at a young age, including younger participants could clarify peer and family influences. Despite using validated DQICA methods and emphasizing inter-rater reliability, qualitative analysis inherently lacks complete standardization. Additionally, while this study identifies key challenges and solutions for improving OOPSCC care in a medically underserved Miami neighborhood, generalizability to other underserved areas may be limited due to varying local factors. Future Directions Building on community stakeholder input, future initiatives will apply key solutions to enhance participation in mobile health screenings and community events. Incentives like giveaways and gift cards, when used thoughtfully, should be viewed as tools for engagement and inclusion more so than compensation. These gestures demonstrate respect for community members’ time and foster a welcoming environment that encourages participation. Additionally, providing earlier and broader event notifications was noted as essential for improving accessibility and ensuring community-wide awareness. This study will guide future interventions, educational programs, and community initiatives. Stakeholders stressed that provider engagement and consistency are as crucial as service quality. As one participant noted, “In certain communities, when you’re consistent, you can tell the progress of the community…” (Table 3 PCC1). Sustained community relationships will be central to future outreach. Further research and service efforts targeting early OOPSCC detection and treatment are necessary to improve survival rates. Understanding community concerns will help providers and researchers implement sustainable, personalized, and long-term prevention strategies. New Contributions to the Literature This study of a medically underserved Miami neighborhood revealed the multidimensional nature of OOPSCC by identifying problems and solutions from community stakeholders. Using community-engaged measures, we summarized key contributing problems as historic social norms, healthcare mistrust, lack of support systems, limited education, and drug and alcohol availability. Key solutions included continuity of care, engagement, education, incentives, relationship-building, and accessibility to reduce high-risk OOPSCC behaviors. Community-engaged qualitative data provides insight into underlying issues, enabling targeted interventions that address long-term needs like continuity of care, specific concerns such as HPV education, and realistic incentives to improve OOPSCC disparities. This study highlights the need for stakeholder input, community-specific research, and longitudinal efforts to improve OOPSCC treatment in underserved communities. Declarations Data Availability The only data to come out of this study was from their responses to the focus group discussions. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study IRB# 20210724_Community Based Assessment of Oropharyngeal Cancer Prevention in the Liberty City community – A Focus Group was approved by the [Redacted], Social and Behavioral Sciences Institutional Review Board on 11/2/2021. Informed Consent Prior to participation in the focus group, members of the community who showed an interest in the study were fully informed of the study and verbally agreed to participate. Twelve community leaders (≥21 years old, English-speaking) residing from the underserved area agreed to participate and were divided into two groups of six to allow for better time management and participation. Each group of six attended a focus group led by [Redacted], MPH, [Redacted] at a community center within the underserved area. One focus group met on Oct 3, 2022, and the second on Oct 20, 2022. Written consent was waived by the [Redacted] Institutional Review Board for this study (IRB study #20210724 approved on November 2, 2021, to promote participant comfort and trust, and verbal consent was approved. The study was explained again to the participants by [Redacted], prior to each focus group session. A standardized consent script, approved by the IRB, was read aloud to all participants, and each participant verbally confirmed their agreement to participate before the start of the session. During the oral consent process, participants were informed that their participation was voluntary and that they could withdraw at any time without penalty. The purpose of the study, which was to gather community perspectives on oral and oropharyngeal cancer prevention, was explained in detail. Participants were told that their involvement would include a focus group discussion and a brief demographic questionnaire. They were informed that the sessions would be recorded via Zoom for transcription, but that all data would be de-identified, securely stored, and used only in aggregate for publication purposes. The script also described the minimal risks of participation, the assurance of anonymity, and the benefits of contributing to community-informed prevention strategies. Participants were told they would receive a $40 gift card as compensation for their time. They were provided with a copy of the consent script with contact information for the Principal Investigator and the [Redacted] Human Subject Research Office for any questions or concerns. Completion of the focus group was considered their consent to participate. References Oral Cavity & oropharyngeal cancer key statistics 202 5 . Oral Cavity & Oropharyngeal Cancer Key Statistics 2021 | American Cancer Society. 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BMC Women's Health 23 , 249 (2023). https://doi.org/10.1186/s12905-023-02411-2 Tables Table 1: Demographics of Community Stakeholders Total Participants n = 12 Average Age in Years 45.6 (SD = 11.4) Gender Female Male 9 (75.0%) 3 (25.0%) Years of Community Involvement <1 Year 1-2 Years 10 (83.3%) 2 (16.7%) Race Black or African American White Native Hawaiian/ Pacific Islander American Indian/ Alaskan 12 (100%) 0 (0%) 0 (0%) 0 (0%) Ethnicity Hispanic Non-Hispanic 2 (16.7%) 83.3%) Table 1. Demographic Characteristics of Community Stakeholders Descriptive statistics of participants in two focus groups conducted in an underserved Miami neighborhood. The majority of participants were Black or African American, non-Hispanic, female, and had less than one year of community involvement. Table 2: Illustrative Participant Quotes Describing Contributors to High-Risk Behaviors Theme Quotes Historic Social Norms (HCN) HSN1: “Also, we know the history … as far as violence and things of that nature. So, that does impact them greatly. So, with our seniors, we use our seniors as much as possible because, No. 1, they are our pillars. If they cannot get away from the negative atmosphere that they so much soak in, because we know the first thing we talk about is who got shot and what’s going on with that. You very rarely hear positivity from a certain standpoint when you’re just focused and people are talking about all that is negative.” (FGD1 310) HSN2: “You asked if it’s getting better or worse. I believe it’s getting worse because you don’t only see older people. You see younger people, too… with the drugs and stuff like that.” (FGD2 524) HSN3: “And when you walk outside the door and the gates and where they reside, they are exposed to the norm of the community. So, here you are trying to teach against what they’ve already been taught that was the norm. So, it’s almost like you have to deprogram in order to reprogram them in a way that it’ll be beneficial for them.” (FGD2 458) Mistrust of the Healthcare System (MHS) MHS1: “I think because of some of the history of where some so-called health providers came out in the name of health providing, but they only caused more damage than they did providing health. So, I would say that, especially for our community.” “So, would you say there’s a mistrust? “Exactly.” (FGD1 1430) MHS2: “Most of the residents here, there’s been a lot of broken promises. You had different elected officials that came in. There’s been a lot of broken promises. Then you get the naysayers and folks who don’t live in this community who are out for profit for themselves and want to bring services here, what services that the residents don’t need… They just figured that the residents need these type of services just to bring profit for themselves. So, that’s been a lot going on, which I call the word ‘poverty pimps.’” (FGD1 820) Lack of Support Systems (LSS) LSS1: “I think people find their selves doing those type of things for an outlet, a release of grief, complications, those type things…” “So, would you say, sometimes, them engaging in high-risk behaviors may be kind like a coping mechanism.” “Yeah, so to speak.” (FGD1 480) LSS2: “All of us at the table deal with certain things, currently dealing with certain things. You see the cost of rent is skyrocketing. You have more bills than you do money. That’s the way it seems. It seems as though when you’re able to catch a break – you can breathe a little – here’s something else. It’s coming up. So, you resort to violence. You resort to drugs. You resort to smoking, what have you. (FGD1 497) “Just like with anyone else, grieving of a lost one, you got to have some kind of outlet. You may not be a smoker. But at the time, you want to have some kind of release, I think. Somebody may have some alcohol. “Look, give me a sip of that.” You’re trying to clear your head. It seems like nothing is working for you, maybe even an aspirin, and you may not be a pill-taker. So, I think they would engage in that peer pressure. (FGD1 463) Limited Education LE1: “Sometimes, when all you know is what you see, you become, not to say it’s a good thing, but you become a product of your society, because there’s nobody in here trying to teach, offer free vocational training, offer financial literacies in their community. Nobody in here trying to educate. They’re just letting them be… But if they haven’t been trained or taught to know better, how can they do better?” (FGD2 328) LE2: “Because people just don’t know. They don’t know what’s wrong with their body because they don’t like going to the doctor. And when you have a situation where you gotta go to the doctor because something is going on in your body, it’s a frightening thing.” (FGD1 1160) LE3: “So, what I do see, that there’s a lack of education in the area and lack of knowledge in certain areas, and especially when it’s dealing with mental health and the importance of your physical and mental wellbeing.” (FGD2 152) Availability of Drugs and Alcohol ADA1: “I’m gonna say that it’s accessible within the community. It’s nearby. There’s literally drugs across the street. The neighborhood itself, things are just easy to obtain, and then the environment doesn’t help. So, they have easy access to certain things, certain drugs, a gas station across the street, liquor store right there. (FGD2 340) ADA2: “…as well with a lot of liquor stores are around, a lot of drugs. So, some of them would tend to go… So, it’s like easy access. They’d rather go get drunk, do this… It’s not benefiting their health or if they wanted to change, because it’s – Here, if you have somebody who drinks every day or on the weekend, and they want to stop, if they see the liquor store while they’re walking, it’s gonna turn them to go to the liquor store…” (FGD2 213) ADA3: “The fact that they got smoke shops popping up now like liquor stores and everything else… no. I mean you can’t take away all the smoke shops and stop selling cigarettes. The prices of the cigarettes are sky high, and people are still buying them… And even if there’s no smoke shop or anything around, nowadays, they doing delivery.” (FGD2 720) ADA4: “It [drugs, alcohol, prostitution] becomes something that is the inevitable instead of glorifying going to school and not partaking in these different negative activities or listening… They kind of glorify. They tend to glorify what’s easier, what’s accessible, as everyone has stated. You know what I'm saying? What’s hot? What’s the now.” (FGD2 419) Table 2. Illustrative Participant Quotes Describing Contributors to High-Risk Behaviors Excerpts from focus groups categorized by thematic drivers of high-risk behaviors for OOPSCC: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol. Table 3: Illustrative Participant Quotes on Community-Based Strategies to Reduce High-Risk Behaviors Theme Quotes Providing Continuity of Care PCC1: “I believe, in certain communities, when you’re consistent, you can tell the progress of the community, when there’s consistency. When there is no consistency, you can see where the community may struggle. So, it depends on leadership in these different municipalities. It depends on the community actions in the community. It depends on the engagement in a community.” (FGD2 479) PCC2: “I think consistency is key, because communities don’t just need to see something happening one time. It needs to be on a consistent basis. “Oh, that’s such and such. They came back.” If you’re having something that’s consistent, they gonna keep coming. But if you just have something once this time, then another six months, that lose them.” (FGD1 1000) PCC3: “I know many organizations and especially medical facility have like case managers, like people who even call you to give you back your results, whether it’s a medical assistant who’s trained in the medical field. Maybe having somebody within each medical facility that’s like a community liaison that stays in communication with those particular people to make sure that they follow up on their appointments, offer tips and maybe incentives.” (FGD2 871) Engaging and Educating EE1: “I believe they need education on it [HPV]. Everybody needing that education on different type of sickness that gonna deteriorate their body.” (FGD1 1144) EE2: “They go to the food banks, but sometime the food don’t be great quality. Sometimes, it’s stuff that’s expired or about to expire, about to spoil. So, I think food is one of those major things besides health that is missing, the educational portion… Because of our resources and the limitations that we have, we kind of eat the poor ends of the food. So, we eat things that are fast given, fast food, because it’s accessible. It’s right there. I can go to Wendy’s and get a 4 for $4. I can’t afford a salad because I salad is $8.00. So, maybe showing them that educational component of how to eat on a budget, easier ways to be able to afford that, because the educational component is very important, even for us.” (FGD2 633) EE3: “Well, as far as like with smoking, I tend to give them the smoking cessation hotline number. That helps as well. Encourage them to attend support groups to help with drinking and different issues that they may be facing.” (FGD2 313) EE4: “Recreation is a must. It’s positive. And all these gangs and recreations that they sometimes, it blocks their mind out. If anything criminal or crime are going on, their mind is on recreation, like you say, that bingo, because they know they get the good prizes, the goodies or whatever. So, you will hardly see that. And for the young adults, they’re making ways that it’d be good recreation for them to be able to come in and do positive things for their self.” (FGD1 381) Offering Incentives OI1: “…you definitely have to be creative and keep them interested. You can’t just come… You have to have service providers who are gonna come out now and make it fun, make it fun, teach in a way of making it fun.” (FGD1 1342) OI2: “I’ll go back on the bingo party we had here for the elderly. They provided face masks, hand sanitizer – what you call it – brochures on different services that you have here. They provided all of that. If you’re gonna have a function and let people know, “Hey, listen. We got some little cute giveaways, stress balls.” You have to give people something. You can’t just have a function without something, especially here. The people like to come out and be able to listen to your services, but they like giveaways, too.” (FGD1 1313) OI3: “And so, if we were able to assist them with like a packet, something small, nothing really big, they’ll be grateful – masks, sanitizer, little things that will make them happy to be able come out and… you know.” (FGD1 299) OI4: “Of course, the topic [of the health fairs] would be HPV because a lot of people have never even heard of HPV, don’t even know what it is. And doing something in the community to kind of do the educational portion but also make it relative and catch their attention and do something incentive-wise, because that’s what really gets them to gather to places. It’s what is it you have to offer?” (FGD2 795) Establishing Relationships ER1: “He always says build the relationships, but everyone has their different ways of building relationships: Calling, talking, communicating, even one on one outside, or, “Hey. You okay? Everything all right?” knock on their doors and see what’s going on with them.” (FGD1 839) ER2: “I would say I noticed it’s a lot of patience is needed. So, I would say patience, showing empathy, showing compassion towards the residents in the community.” (FGD1 189) ER3: “Most service providers, they either from home or either at the office, at the desk making phone calls. Folks want to see your face and see that you care. So, I’m looking for service providers who, like yourself, who came. I met you at an event, and you’re back here today trying to find out what’s going on in the community. So, that’s what it’s about, that partnership and letting the residents see you and engaging with them.” (FGD 968) Increasing Accessibility to Healthcare Services IAHS1: “I think the difficulty is the transportation for most people. So, with resources coming to them, like you do provide, it’ll be more accessible to them to make it easier for them to come or have it available for them right here.” (FGD1 236) IAHS2: “ Well, medically, I think I have like a medical event that is positive where a lot of the people in the community don’t go to the doctor. So, they could have like medical vans come out. They could do different food shares with healthy foods for the community, things for the kids in a positive light, like a Boys’ & Girls’ Club type thing, activities for the kids, so they could see something positive outside of the negative daily things that they may see. On the weekends, sport events, different activities in the neighborhoods, I guess, on different days spread out, so they would actually have something to look forward to.” (FGD2 605) IAHS3: “…getting the information in time. Say, for instance, if you’re gonna do something next week, let’s say next Friday, we shouldn’t just be getting information on Monday. That’s not enough time for people to know what’s going on, what kind of service or services or screeners you’re gonna be providing.” (FGD1 1216) Table 3. Illustrative Participant Quotes on Community-Based Strategies to Reduce High-Risk Behaviors Excerpts highlighting stakeholder recommendations for reducing OOPSCC risk in underserved communities. Proposed strategies include continuity of care, community engagement and education, use of incentives, relationship-building, and improved healthcare accessibility. Additional Declarations Competing interest reported. There are no conflicts of interest, however we do have this that we wanted to add with the funding: Research reported in this publication was performed in part at the Behavioral and Community-Based Research Shared Resource (BCSR) (RRID: SCR022893) of the Sylvester Comprehensive Cancer Center at the University of Miami, which is supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under award number P30CA240139. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Since it was double blind we were unsure where to place this. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 Jan, 2026 Reviews received at journal 09 Jan, 2026 Reviewers agreed at journal 23 Dec, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviews received at journal 20 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers invited by journal 03 Sep, 2025 Editor assigned by journal 01 Sep, 2025 Editor invited by journal 29 Aug, 2025 Submission checks completed at journal 19 Aug, 2025 First submitted to journal 19 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7084925","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":509855979,"identity":"bae2244a-e1a4-4213-8919-da9e8e739b27","order_by":0,"name":"Priyashma Joshi, MD, MPH","email":"","orcid":"","institution":"Weill Cornell Medicine","correspondingAuthor":false,"prefix":"","firstName":"","middleName":"MD Priyashma","lastName":"Joshi","suffix":"MD"},{"id":509855980,"identity":"d775afd5-f7e7-407b-b03b-3f6654dbb453","order_by":1,"name":"Nicholas DiStefano, BA","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"BA","middleName":"Nicholas","lastName":"DiStefano","suffix":""},{"id":509855981,"identity":"f1d365c8-6f9d-4b76-ad31-09dc1f7ddac0","order_by":2,"name":"Liana Shtern, BS","email":"","orcid":"","institution":"Nova Southeastern University College of Dental Medicine","correspondingAuthor":false,"prefix":"","firstName":"BS","middleName":"Liana","lastName":"Shtern","suffix":""},{"id":509855982,"identity":"07372dd1-0268-4af7-84ef-d26493d60aed","order_by":3,"name":"Aida van Mossel, MPH","email":"","orcid":"","institution":"Sylvester Comprehensive Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"MPH","middleName":"Aida van","lastName":"Mossel","suffix":""},{"id":509855983,"identity":"e3bf6295-96a7-4b9f-a5e6-eba65992b750","order_by":4,"name":"Erin Kobetz-Kerman, PhD, MPH","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"PhD","middleName":"Erin","lastName":"Kobetz-Kerman","suffix":"PhD"},{"id":509855984,"identity":"924fbf99-db80-4cac-8ab1-e8cf1d5f8543","order_by":5,"name":"Natasha Solle, PhD, RN","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ph","middleName":"Natasha","lastName":"Solle","suffix":"PhD"},{"id":509855985,"identity":"9db5665a-8fa0-4b95-bd1b-5963dcb42841","order_by":6,"name":"Elizabeth Franzmann, MD","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYBAC+/kPoCz2BgYGHjBiBLLYcGsxkICxeA6QrEUiAaweCvBq4X34ueDPNnlzydeJD94wbJPhn3a4geFD2WHcfpFvN5aewXPbcOfs3M2Gcxhu80jcTmxgnHEOtxYDCTYGaaAyxg23c7dJ8wC1MAC1MPO24dXC/JvH4Lb9hptnt/8GaZEHafmLXwubNE/C7cQNN3i3MYO0GIC0MBLQYs1z4HbyhjO5myXnGNzmMQRqOdhzLh2392ewMd/m+XPbdsPxsxs/vKm4bS93O/3hgx9l1ji1oFsKoQ4Qq34UjIJRMApGAXYAAABKVRxcS+wkAAAAAElFTkSuQmCC","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Franzmann","suffix":"MD"}],"badges":[],"createdAt":"2025-07-09 14:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7084925/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7084925/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91071375,"identity":"1158230f-d6c7-41c6-a4a6-96afee7e32e8","added_by":"auto","created_at":"2025-09-11 10:51:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49768,"visible":true,"origin":"","legend":"\u003cp\u003eKey Problems and Key Solutions\u003c/p\u003e\n\u003cp\u003eFigure 1. Key Problems and Solutions Identified Through Directed Qualitative Content Analysis\u003c/p\u003e\n\u003cp\u003eA visual summary of themes and subthemes derived from community stakeholder focus groups using directed qualitative content analysis. Five key problems contributing to high-risk behaviors for oropharyngeal squamous cell carcinoma (OOPSCC) were identified: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol. Corresponding community-informed solutions included continuity of care, engaging and educating, offering incentives, establishing relationships, and increasing healthcare accessibility.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7084925/v1/5b7cd455c501bff69e8fb91a.png"},{"id":91079307,"identity":"def09356-36d2-4ff3-8a86-f9b081616fe5","added_by":"auto","created_at":"2025-09-11 11:24:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":879318,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7084925/v1/349a6a80-cf8c-4b3a-b3b7-120f1125104f.pdf"}],"financialInterests":"Competing interest reported. There are no conflicts of interest, however we do have this that we wanted to add with the funding: Research reported in this publication was performed in part at the Behavioral and Community-Based Research Shared Resource (BCSR) (RRID: SCR022893) of the Sylvester Comprehensive Cancer Center at the University of Miami, which is supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under award number P30CA240139. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.\n\nSince it was double blind we were unsure where to place this.","formattedTitle":"Community Engaged Perspectives on Oropharyngeal Cancer Risk in an Underserved Miami Neighborhood: A Qualitative Study of Barriers and Solutions","fulltext":[{"header":"Background","content":"\u003cp\u003eOral and oropharyngeal squamous cell carcinoma (OOPSCC) encompasses cancers of the oral cavity, throat, and tonsils. These cancers can invade surrounding tissues, metastasize, and be fatal without treatment. Symptoms include difficulty swallowing, sore throat, and weight loss. OOPSCC incidence has steadily increased, with approximately 59,660 new cases estimated in 2025 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite rising rates, OOPSCC is largely preventable through reducing risk factors like tobacco use, alcohol consumption, and high-risk sexual behaviors that lead to HPV transmission [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nearly half of cases are diagnosed at advanced stages, but targeted screening of high-risk populations can improve awareness and outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSignificant disparities in OOPSCC survival persist due to demographic and socioeconomic factors. Barriers such as limited healthcare access, economic hardship, inadequate education, and lack of support systems contribute to poorer outcomes among racial and ethnic minorities. Despite increasing incidence among White Americans, Black Americans experience significantly poorer survival outcomes, with a five-year survival rate of 52% compared to 70% among White Americans [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Socioeconomic status, when combined with minority status, further worsens survival [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDisparities among Black Americans are linked to differences in care access, treatment variation, and HPV prevalence. HPV, a common sexually transmitted virus, can lead to oropharyngeal cancer, especially in immunocompromised individuals. Black Americans with HPV-negative OOPSCC have worse survival rates than White Americans, while no disparity exists for HPV-positive cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. HPV-negative OOPSCC is primarily associated with tobacco and alcohol use, behaviors more prevalent in racial minority populations, exacerbating disparities [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Prevention through targeted screening remains limited when healthcare access is inadequate [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial determinants of health significantly impact OOPSCC outcomes, as factors such as racial discrimination, affordability of care, and community support affect survival [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Persistent racial disparities in OOPSCC treatment outcomes have been documented in Florida. Feaster et al. (2023) found that Black patients had higher odds of being diagnosed with distant-stage oral cavity cancer compared to White non-Hispanic patients, with disparities linked to lack of insurance, lower income, and less education.\u003c/p\u003e\u003cp\u003eThis study focuses on a predominantly Black and Hispanic Miami neighborhood with a median household income below the national average. While most disparities research uses large-scale data, such analyses often overlook local-level nuances. Community-engaged research (CEnR) addresses this by involving residents to better understand local health behaviors and care access. CEnR uses collaborative partnerships between researchers and community members, ensuring studies reflect the lived experiences and priorities of the populations they aim to serve.\u003c/p\u003e\u003cp\u003eEngaging communities as equal partners helps bridge gaps between academic research and affected populations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This is crucial for addressing high-risk factors for HPV-negative OOPSCC in underserved communities, where tobacco and alcohol use are common coping mechanisms linked to adverse social determinants [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Focus groups offer direct, nuanced insights into community challenges, enabling tailored interventions aligned with cultural contexts [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis research team has conducted OOPSCC screenings in underserved Miami neighborhoods using a mobile unit, the Game Changer Vehicle, to provide care and education [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study expands those efforts by gathering community stakeholder input to identify high-risk behaviors, address perceptions of researchers, and improve future care accessibility. Through qualitative analysis of focus group discussions, the study uncovers contributors to high-risk behaviors for OOPSCC and community-informed solutions. Feedback will guide future initiatives to enhance engagement and service delivery for minority and low-income populations disproportionately affected by OOPSCC.\u003c/p\u003e\n\u003ch3\u003eTheoretical/Conceptual Framework\u003c/h3\u003e\n\u003cp\u003eThis study draws on the Social Determinants of Health (SDOH) framework to contextualize how education, systemic trust, substance use, and access to care influence oropharyngeal cancer risk in underserved communities. In addition, the project was guided by a Community-Based Participatory Research (CBPR) approach, which centers the perspectives and lived experiences of community stakeholders throughout the research process. These frameworks informed both the design of the focus groups and the interpretation of the resulting themes.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e\n\n\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThis qualitative study used focus group feedback as the primary data source. Inclusion criteria required participants to be residents of Liberty City who were active in local community organizations, at least 21 years of age, and proficient in English. All participants were considered community stakeholders, with a history of informal collaboration with our research team through previous health outreach events. Our NCI-designated cancer center’s Behavioral and Community-based shared resource (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://umiamihealth.org/en/sylvester-comprehensive-cancer-center/research/research-resources/shared-resources/behavioral-and-community-based-research-shared-resource\u003c/span\u003e\u003cspan address=\"https://umiamihealth.org/en/sylvester-comprehensive-cancer-center/research/research-resources/shared-resources/behavioral-and-community-based-research-shared-resource\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), trained in community-engaged research methods, led recruitment. Over several months, participants were recruited through phone calls, emails to past community contacts (not official partners), referrals, and in-person outreach at community events and health fairs. Potential participants were further identified via email based on their engagement in local initiatives. Roles of all potential participants were reviewed with the research team to ensure appropriate stakeholder representation.\u003c/p\u003e\u003cp\u003eParticipants were selected based on their residence in or around the underserved neighborhood and their active involvement in community work. All participants were considered community stakeholders, defined as individuals who provided services or organized community events. Some worked in community centers serving local and public housing residents, while others collaborated with case managers to ensure residents received necessary resources.\u003c/p\u003e\u003ch3\u003eProcedure\u003c/h3\u003e\u003cp\u003eGuiding questions were developed to facilitate focus group discussions on participant experiences, perceived health hazards, and attitudes toward external research and screenings (Appendix A). The protocol, recruitment materials and verbal consent procedure were approved by the University of Miami Internal Review Board. Participants had the study fully explained to them and completed a demographic and role-specific survey. Sessions were led by an experienced facilitator from the research team. Completion of the focus group verified their consent to participate..\u003c/p\u003e\u003cp\u003eTwelve participants were divided into two 60-minute in-person focus groups of six participants each. Research team members not involved in facilitation observed via Zoom to take notes. Sessions were recorded with confidentiality measures, and participants were informed of privacy protocols. Gift cards were provided as IRB-approved compensation.\u003c/p\u003e\u003cp\u003eRecordings were transcribed verbatim by GMR Transcription Services and reviewed by multiple team members, including the principal investigator (PI). Inter-rater reliability was ensured through weekly meetings focused on transcript review, community familiarity, and social determinants of health.\u003c/p\u003e\u003cp\u003eData were analyzed using directed qualitative content analysis (DQICA) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], a structured method for coding, categorizing, and interpreting qualitative data. This approach helps identify common themes and expand on existing OOPSCC research. The DQICA framework was informed by known OOPSCC risk factors, social determinants of health, researcher familiarity with the community, and relevant literature. Preparation included developing open-ended interview guides and reviewing transcripts. Two researchers independently analyzed the data, highlighting recurring themes based on discussion frequency and emphasis. Key messages were categorized into keywords, organized into overarching themes and subthemes, and discussed to resolve discrepancies (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Sample transcript excerpts were compiled into structured reporting tables.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis focus group study included 12 participants, divided into two in-person focus groups of six participants each. Most participants were female (75.0%), had 0–1 years of community involvement (83.3%), were Black or African American (100%), and non-Hispanic (83.3%) (Table 1). All participants lived in or near the studied neighborhood and held various community roles, including board members, outreach coordinators, case managers, and program directors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe DQICA of focus group transcripts revealed two overarching themes related to high-risk OOPSCC behaviors: key problems contributing to these behaviors and solutions for improving community outcomes. Each theme included five subthemes (Figure 2). Identified problems were historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol (Table 2). According to stakeholders, these factors significantly promote high-risk behaviors. Conversely, proposed solutions included providing continuity of care, engaging and educating, offering incentives, establishing relationships, and increasing healthcare accessibility (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Problems\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHistoric Social Norms\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCultural norms shape what is considered acceptable behavior [22]. Community stakeholders noted that high-risk health and safety concerns stem partly from a history of violence that remains pervasive. One participant described the difficulty of escaping negative conversations about recent violence (HSN1). These norms are generational, with drug use among older adults influencing increasing substance use in younger generations (HSN2). This entrenched behavior challenges efforts to promote healthier alternatives (HSN3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMistrust of Healthcare System\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple factors contribute to healthcare mistrust, including high provider turnover, past research exploitation, and poor communication. Participants noted that providers often arrive with good intentions but end up causing harm (MHS1). Mistrust arises when outside providers fail to understand or meet the community’s actual needs, instead imposing solutions based on assumptions (MHS2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLack of Support Systems\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigh crime rates, poverty, and insufficient support systems (e.g., recreational centers, religious groups, mental healthcare) leave residents vulnerable to high-risk coping behaviors like smoking, drinking, and violence (LSS1). Even those who previously avoided such behaviors may turn to them when facing stressors like grief or rising living costs (LSS2, LSS3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLimited Education\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eImproving health outcomes requires accessible education on high-risk behaviors. Participants noted that, despite a willingness to learn, community members struggle to find affordable resources on health and finances (LE1). This knowledge gap fosters fear of seeking medical care (LE2) and poor physical and mental health management (LE3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Drugs and Alcohol\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEasy access to substances contributes to widespread high-risk behaviors. Drugs and alcohol are readily available in stores and on the streets (ADA1). Even those trying to quit face constant temptation (ADA2). Residents continue smoking despite rising cigarette prices (ADA3), and substance use remains normalized among youth (ADA4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKey Solutions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProviding Continuity of Care\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsistency in healthcare services is essential for engaging communities like this one. Focus group participants noted that consistent care helps monitor community progress, while inconsistency reveals areas of struggle (PCC1). Regular provider presence builds trust and encourages patients to follow up with their care (PCC2). Having designated contacts, such as case managers or community liaisons, promotes ongoing communication and follow-up (PCC3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEngaging and Educating\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLack of education is a significant barrier to reducing high-risk health behaviors. Participants highlighted minimal knowledge about HPV, including its causes and link to oropharyngeal cancer (EE1). While pamphlets and health fairs increase awareness, community members also need guidance on using existing resources. Education should focus on accessing smoking cessation hotlines, alcoholism support groups, and budgeting for healthier lifestyles (EE2, EE3). Recreational activities at health fairs and community centers can foster support systems that deter high-risk behaviors (EE4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOffering Incentives\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimple incentives can motivate people to engage with healthcare services. Participants noted that people are more interested in learning when health events are engaging and enjoyable (OI1). Giveaways like hand sanitizer, masks, and stress balls attract initial attention and encourage attendance (OI2, OI3). These incentives offer a tangible reason for community members to participate before engaging with health services (OI4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEstablishing Relationships\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBuilding long-term relationships fosters trust between providers and community members. Communication and a genuine investment in resident wellbeing are crucial (ER1). Demonstrating patience and empathy strengthens provider trust (ER2). While past engagement was often distant, participants emphasized that in-person interactions and familiar faces show commitment to the community (ER3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIncreasing Accessibility to Healthcare Services\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProviders can boost healthcare usage by improving accessibility. Transportation is a major barrier, but virtual appointments and mobile health services at community centers can help (IAHS1). Health fairs, which bring multiple services to one location, effectively motivate attendance (IAHS2). Timely, well-publicized information ensures that community members are aware of available health services (IAHS3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents a substantial step in understanding the persistence of high-risk factors for OOPSCC in this community of Miami, FL and other medically underserved communities. Using the subjective experiences of community leaders, the study identified five key problems placing residents at higher risk for OOPSCC: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol. Community perspectives were also critical in identifying five potential solutions to improve future care and research and reduce OOPSCC risk: providing continuity of care, engaging and educating, offering incentives, establishing relationships, and increasing healthcare accessibility. By involving key stakeholders, this study reveals insights that illuminate the challenges these communities face and contributing factors to disparities in OOPSCC survival.\u003c/p\u003e\n\u003cp\u003ePrior research has shown that social determinants such as housing, transportation, education, income, and racial discrimination play a substantial role in OOPSCC outcomes [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. Studies assessing these determinants have traditionally relied on survey, clinical, and census-based data to provide macro-level information on OOPSCC. SEER database studies from Megwalu et al. found that counties with lower socioeconomic status and Black race had lower overall survival in oropharyngeal cancer [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. These studies also emphasize the continued need to address how SES affects cancer survival and identify areas for public health intervention [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Quantitative data is essential to understanding OOPSCC risks and outcomes, but it cannot fully capture the lived experiences of those most affected.\u003c/p\u003e\n\u003cp\u003eOur collaborative study used qualitative methods through focus group interviews and analysis to explore the nuances of high-risk behaviors for OOPSCC at the community level. The collaborative nature of the study came from involving community stakeholders throughout the research process\u0026mdash;from shaping guiding questions to participating in discussions that informed the direction and interpretation of the dialogue. Drawing on prior knowledge of social determinants and experience treating this community, the research team facilitated conversations that allowed participants to expand on meaningful topics. This co-constructed approach enabled the identification of themes and subthemes that more accurately reflected the complexity of high-risk behaviors than traditional methods. It also fostered trust, empowerment, and mutual learning between researchers and community members. Understanding the root causes of these behaviors through a collaborative lens is crucial to developing effective interventions that reduce disparities in OOPSCC survival.\u003c/p\u003e\n\u003cp\u003eOur study highlights the history of violence in this community and its role in perpetuating high-risk behaviors like drug, tobacco, and alcohol use due to deeply ingrained social norms (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e HSN1, HSN3). Social and cultural norms strongly influence behaviors across generations [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Participants noted that persistent violence encourages substance use as a coping mechanism, compounded by the availability of drugs, alcohol, and limited support systems. One participant described these behaviors as \u0026ldquo;inevitable\u0026rdquo; (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e ADA4), while another called them \u0026ldquo;an outlet, a release of grief\u0026rdquo; (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e LSS1).\u003c/p\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003eProblems and Solutions\u003c/h2\u003e\n \u003cp\u003eAddressing these systemic issues requires cultural sensitivity, which improves health outcomes and service acceptability [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Stakeholders emphasized the importance of providers building community relationships through \u0026ldquo;patience, showing empathy, [and] showing compassion\u0026rdquo; (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e ER2). Mistrust of the healthcare system, a known barrier in minority populations [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e], stems from past discrimination and contributes to poor outcomes and low treatment adherence. Participants echoed this concern, recounting negative experiences (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e MHS1). Solutions include continuity of care, engagement, education, and consistent provider presence. As one participant stated, \u0026ldquo;folks want to see your face and see that you care\u0026rdquo; (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e ER3).\u003c/p\u003e\n \u003cp\u003eLimited education on high-risk behaviors and preventive healthcare further worsens OOPSCC outcomes. Participants noted that lack of knowledge causes apprehension toward medical care (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e LE1-2). While educational initiatives can improve health behaviors [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e], long-term strategies remain scarce. Stakeholders observed that, despite community interest, learning opportunities are limited.\u003c/p\u003e\n \u003cp\u003eImproving healthcare accessibility and offering incentives can help bridge these gaps. Mobile medical units address financial and transportation barriers, but timely, widespread communication is essential (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e IAHS1-3). Creative engagement strategies such as giveaways and interactive activities were noted as effective (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e OI1). Items like hand sanitizers, stress balls, and bingo have fostered participation. These incentives are more effective when used as meaningful gestures that build trust and sustained engagement. When aligned with community interests and culture, they help build lasting relationships and empower communities to take active roles in their health. This aligns with community engagement principles emphasizing trust and collaboration in designing effective interventions.\u003c/p\u003e\n \u003cp\u003eFuture programs should prioritize addressing educational gaps and mistrust. Improved communication, early notice, culturally relevant outreach, and incentives can boost engagement. Participants noted brochures and flyers were more effective when paired with provider presence. Building relationships and follow-up can strengthen program legitimacy. Tackling these barriers is crucial to improving healthcare engagement.\u003c/p\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003eLimitations\u003c/h2\u003e\n \u003cp\u003eThis study has several limitations. Although focus group participants were selected as community stakeholders, most had less than a year of experience in their roles, which is a limitation that may affect the depth of their insights. However, their recent entry into these positions may also contribute to a heightened willingness to engage with the community and implement innovative strategies for improvement. Input from individuals with longer-term involvement could enhance understanding of longitudinal changes. Expanding participant age to include those under 21 may provide valuable perspectives on early exposure to high-risk behaviors. One participant highlighted youth involvement in substance use: \u0026ldquo;You see younger people, too\u0026hellip; with the drugs and stuff like that\u0026rdquo; (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e HSN2). Since many high-risk behaviors begin at a young age, including younger participants could clarify peer and family influences.\u003c/p\u003e\n \u003cp\u003eDespite using validated DQICA methods and emphasizing inter-rater reliability, qualitative analysis inherently lacks complete standardization. Additionally, while this study identifies key challenges and solutions for improving OOPSCC care in a medically underserved Miami neighborhood, generalizability to other underserved areas may be limited due to varying local factors.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003ch2\u003eFuture Directions\u003c/h2\u003e\n \u003cp\u003eBuilding on community stakeholder input, future initiatives will apply key solutions to enhance participation in mobile health screenings and community events. Incentives like giveaways and gift cards, when used thoughtfully, should be viewed as tools for engagement and inclusion more so than compensation. These gestures demonstrate respect for community members\u0026rsquo; time and foster a welcoming environment that encourages participation. Additionally, providing earlier and broader event notifications was noted as essential for improving accessibility and ensuring community-wide awareness.\u003c/p\u003e\n \u003cp\u003eThis study will guide future interventions, educational programs, and community initiatives. Stakeholders stressed that provider engagement and consistency are as crucial as service quality. As one participant noted, \u003cem\u003e\u0026ldquo;In certain communities, when you\u0026rsquo;re consistent, you can tell the progress of the community\u0026hellip;\u0026rdquo;\u003c/em\u003e (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e PCC1). Sustained community relationships will be central to future outreach.\u003c/p\u003e\n \u003cp\u003eFurther research and service efforts targeting early OOPSCC detection and treatment are necessary to improve survival rates. Understanding community concerns will help providers and researchers implement sustainable, personalized, and long-term prevention strategies.\u003c/p\u003e\n \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n \u003ch2\u003eNew Contributions to the Literature\u003c/h2\u003e\n \u003cp\u003eThis study of a medically underserved Miami neighborhood revealed the multidimensional nature of OOPSCC by identifying problems and solutions from community stakeholders. Using community-engaged measures, we summarized key contributing problems as historic social norms, healthcare mistrust, lack of support systems, limited education, and drug and alcohol availability. Key solutions included continuity of care, engagement, education, incentives, relationship-building, and accessibility to reduce high-risk OOPSCC behaviors. Community-engaged qualitative data provides insight into underlying issues, enabling targeted interventions that address long-term needs like continuity of care, specific concerns such as HPV education, and realistic incentives to improve OOPSCC disparities. This study highlights the need for stakeholder input, community-specific research, and longitudinal efforts to improve OOPSCC treatment in underserved communities.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Availability\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe only data to come out of this study was from their responses to the focus group discussions. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study IRB# 20210724_Community Based Assessment of Oropharyngeal Cancer Prevention in the Liberty City community – A Focus Group was approved by the [Redacted], Social and Behavioral Sciences Institutional Review Board on 11/2/2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInformed Consent\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to participation in the focus group, members of the community who showed an interest in the study were fully informed of the study and verbally agreed to participate. Twelve community leaders (≥21 years old, English-speaking) residing from the underserved area agreed to participate and were divided into two groups of six to allow for better time management and participation. Each group of six attended a focus group led by [Redacted], MPH, [Redacted] at a community center within the underserved area. One focus group met on Oct 3, 2022, and the second on Oct 20, 2022. Written consent was waived by the [Redacted] Institutional Review Board for this study (IRB study #20210724 approved on November 2, 2021, to promote participant comfort and trust, and verbal consent was approved. The study was explained again to the participants by [Redacted], prior to each focus group session. A standardized consent script, approved by the IRB, was read aloud to all participants, and each participant verbally confirmed their agreement to participate before the start of the session. During the oral consent process, participants were informed that their participation was voluntary and that they could withdraw at any time without penalty. The purpose of the study, which was to gather community perspectives on oral and oropharyngeal cancer prevention, was explained in detail. Participants were told that their involvement would include a focus group discussion and a brief demographic questionnaire. They were informed that the sessions would be recorded via Zoom for transcription, but that all data would be de-identified, securely stored, and used only in aggregate for publication purposes. The script also described the minimal risks of participation, the assurance of anonymity, and the benefits of contributing to community-informed prevention strategies. Participants were told they would receive a $40 gift card as compensation for their time. They were provided with a copy of the consent script with contact information for the Principal Investigator and the [Redacted] Human Subject Research Office for any questions or concerns. Completion of the focus group was considered their consent to participate.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cem\u003eOral Cavity \u0026amp; oropharyngeal cancer key statistics 202\u003c/em\u003e\u003cem\u003e5\u003c/em\u003e. Oral Cavity \u0026amp; Oropharyngeal Cancer Key Statistics 2021 | American Cancer Society. (n.d.). https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eOral and oropharyngeal cancer - statistics\u003c/em\u003e. Cancer.Net. (2023, May 9). https://www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/statistics\u003c/li\u003e\n \u003cli\u003eFord, P. J., \u0026amp; Farah, C. S. (2013). Early detection and diagnosis of oral cancer: Strategies for improvement. \u003cem\u003eJournal of Cancer Policy\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(1\u0026ndash;2). https://doi.org/10.1016/j.jcpo.2013.04.002\u003c/li\u003e\n \u003cli\u003eAwan K.h (2014). Oral Cancer: Early Detection is Crucial. \u003cem\u003eJournal of international oral health : JIOH\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(5), i\u0026ndash;ii.\u003c/li\u003e\n \u003cli\u003eU.S. Department of Health and Human Services. (2023). \u003cem\u003eOral cancer 5-year survival rates by race, gender, and stage of diagnosis\u003c/em\u003e. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/oral-cancer/survival-rates\u003c/li\u003e\n \u003cli\u003eMorse, D. E., \u0026amp; Kerr, A. R. (2006). Disparities in oral and pharyngeal cancer incidence, mortality and survival among black and white Americans. \u003cem\u003eJournal of the American Dental Association (1939)\u003c/em\u003e, \u003cem\u003e137\u003c/em\u003e(2), 203\u0026ndash;212. https://doi.org/10.14219/jada.archive.2006.0146\u003c/li\u003e\n \u003cli\u003eMegwalu, U. C. (2017). Impact of county‐level socioeconomic status on oropharyngeal cancer survival in the United States. \u003cem\u003eOtolaryngology\u0026ndash;Head and Neck Surgery\u003c/em\u003e, \u003cem\u003e156\u003c/em\u003e(4), 665\u0026ndash;670. https://doi.org/10.1177/0194599817691462\u003c/li\u003e\n \u003cli\u003eMegwalu, U. C., \u0026amp; Ma, Y. (2017). Racial disparities in oropharyngeal cancer survival. \u003cem\u003eOral oncology\u003c/em\u003e, \u003cem\u003e65\u003c/em\u003e, 33\u0026ndash;37. https://doi.org/10.1016/j.oraloncology.2016.12.015\u003c/li\u003e\n \u003cli\u003eStein, E., Lenze, N. R., Yarbrough, W. G., Hayes, D. N., Mazul, A., \u0026amp; Sheth, S. (2020). Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by hpv status. \u003cem\u003eHead \u0026amp;amp; Neck\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(10), 2985\u0026ndash;3001. https://doi.org/10.1002/hed.26328\u003c/li\u003e\n \u003cli\u003eElrefaey, S., Massaro, M. A., Chiocca, S., Chiesa, F., \u0026amp; Ansarin, M. (2014). HPV in oropharyngeal cancer: the basics to know in clinical practice. \u003cem\u003eActa otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(5), 299\u0026ndash;309.\u003c/li\u003e\n \u003cli\u003eAgarwal, P., Agrawal, R. R., Jones, E. A., \u0026amp; Devaiah, A. K. (2020). Social Determinants of Health and Oral Cavity Cancer Treatment and Survival: A Competing Risk Analysis. \u003cem\u003eThe Laryngoscope\u003c/em\u003e, \u003cem\u003e130\u003c/em\u003e(9), 2160\u0026ndash;2165. https://doi.org/10.1002/lary.28321\u003c/li\u003e\n \u003cli\u003eSocial Determinants of Health. Social Determinants of Health - Healthy People 2030. Accessed June 10, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health.\u003c/li\u003e\n \u003cli\u003eMoore, C. E., Warren, R., \u0026amp; Maclin, S. D., Jr (2012). Head and neck cancer disparity in underserved communities: probable causes and the ethics involved. \u003cem\u003eJournal of health care for the poor and underserved\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(4 Suppl), 88\u0026ndash;103. https://doi.org/10.1353/hpu.2012.0165\u003c/li\u003e\n \u003cli\u003eFeaster, T. S., Ramos, D., Meade, C. D., \u0026amp; Gwede, C. K. (2023). Racial and ethnic disparities in oral cavity cancer stage at diagnosis and associated social determinants of health in Florida. Cancer Causes \u0026amp; Control, 34(1), 75\u0026ndash;84. https://doi.org/10.1007/s10552-025-01992-7\u003c/li\u003e\n \u003cli\u003eMichener, L., Cook, J., Ahmed, S. M., Yonas, M. A., Coyne-Beasley, T., \u0026amp; Aguilar-Gaxiola, S. (2012). Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. \u003cem\u003eAcademic medicine : journal of the Association of American Medical Colleges\u003c/em\u003e, \u003cem\u003e87\u003c/em\u003e(3), 285\u0026ndash;291. https://doi.org/10.1097/ACM.0b013e3182441680\u003c/li\u003e\n \u003cli\u003eSimmons, V. N., Pineiro, B., Hooper, M. W., Gray, J. E., \u0026amp; Brandon, T. H. (2016). Tobacco-Related Health Disparities Across the Cancer Care Continuum. \u003cem\u003eCancer control : journal of the Moffitt Cancer Center\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(4), 434\u0026ndash;441. https://doi.org/10.1177/107327481602300415\u003c/li\u003e\n \u003cli\u003eAuluck, A., Walker, B.B., Hislop, G. \u003cem\u003eet al.\u003c/em\u003e Population-based incidence trends of oropharyngeal and oral cavity cancers by sex among the poorest and underprivileged populations. \u003cem\u003eBMC Cancer\u003c/em\u003e\u003cstrong\u003e14\u003c/strong\u003e, 316 (2014). https://doi.org/10.1186/1471-2407-14-316\u003c/li\u003e\n \u003cli\u003eWang, S., Richardson, M.B., Evans, M.B. \u003cem\u003eet al.\u003c/em\u003e A community-engaged approach to understanding environmental health concerns and solutions in urban and rural communities. \u003cem\u003eBMC Public Health\u003c/em\u003e\u003cstrong\u003e21\u003c/strong\u003e, 1738 (2021). https://doi.org/10.1186/s12889-021-11799-1\u003c/li\u003e\n \u003cli\u003eLee MS, Elliott NS, Bethel VD, Balise RR, Kobetz EN. Identifying Neighborhoods with Cervical Cancer Disparities for Targeted Community Outreach and Engagement by an NCI-Designated Cancer Center: A Geospatial Approach. Cancer Epidemiol Biomarkers Prev. 2023 Oct 2;32(10):1275-1283. doi: 10.1158/1055-9965.EPI-23-0132. PMID: 37540496.\u003c/li\u003e\n \u003cli\u003eAssarroudi, A., Heshmati Nabavi, F., Armat, M. R., Ebadi, A., \u0026amp; Vaismoradi, M. (2018). Directed qualitative content analysis: The description and elaboration of its underpinning methods and Data Analysis process. \u003cem\u003eJournal of Research in Nursing\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 42\u0026ndash;55. https://doi.org/10.1177/1744987117741667\u003c/li\u003e\n \u003cli\u003eHsieh, H. F., \u0026amp; Shannon, S. E. (2005). Three approaches to qualitative content analysis. \u003cem\u003eQualitative health research\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(9), 1277\u0026ndash;1288. https://doi.org/10.1177/1049732305276687\u003c/li\u003e\n \u003cli\u003eNational Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Committee on Law and Justice; Board on Children, Youth, and Families; Board on Global Health; Forum on Global Violence Prevention. Addressing the Social and Cultural Norms That Underlie the Acceptance of Violence: Proceedings of a Workshop\u0026mdash;in Brief. Washington (DC): National Academies Press (US); 2018 Apr 6. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493719/ doi: 10.17226/25075\u003c/li\u003e\n \u003cli\u003eEcheverr\u0026iacute;a, S. E., Gundersen, D. A., Manderski, M. T., \u0026amp; Delnevo, C. D. (2015). Social norms and its correlates as a pathway to smoking among young Latino adults. \u003cem\u003eSocial science \u0026amp; medicine (1982)\u003c/em\u003e, \u003cem\u003e124\u003c/em\u003e, 187\u0026ndash;195. https://doi.org/10.1016/j.socscimed.2014.11.034\u003c/li\u003e\n \u003cli\u003eNational Academies Press. (2018). \u003cem\u003eAddressing the Social and Cultural Norms That Underlie the Acceptance of Violence\u003c/em\u003e. https://doi.org/10.17226/25075\u003c/li\u003e\n \u003cli\u003eCopello, A. G., Velleman, R. D., \u0026amp; Templeton, L. J. (2005). Family interventions in the treatment of alcohol and drug problems. \u003cem\u003eDrug and alcohol review\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(4), 369\u0026ndash;385. https://doi.org/10.1080/09595230500302356\u003c/li\u003e\n \u003cli\u003eLatif, A. S. (2020). The importance of understanding social and cultural norms in delivering quality health care\u0026mdash;a personal experience commentary. \u003cem\u003eTropical Medicine and Infectious Disease\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(1), 22. https://doi.org/10.3390/tropicalmed5010022\u003c/li\u003e\n \u003cli\u003eArmstrong, K., Rose, A., Peters, N., Long, J. A., McMurphy, S., \u0026amp; Shea, J. A. (2006). Distrust of the health care system and self-reported health in the United States. \u003cem\u003eJournal of general internal medicine\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(4), 292\u0026ndash;297. https://doi.org/10.1111/j.1525-1497.2006.00396.x\u003c/li\u003e\n \u003cli\u003eBazargan, M., Cobb, S., \u0026amp; Assari, S. (2021). Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. \u003cem\u003eAnnals of family medicine\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 4\u0026ndash;15. https://doi.org/10.1370/afm.2632\u003c/li\u003e\n \u003cli\u003eSingh, K., Sharma, D., Kaur, M., Gauba, K., Thakur, J. S., \u0026amp; Kumar, R. (2017). Effect of health education on awareness about oral cancer and oral self-examination. \u003cem\u003eJournal of education and health promotion\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e, 27. https://doi.org/10.4103/jehp.jehp_82_15\u003c/li\u003e\n \u003cli\u003eNajafi, S., Mohammadkhah, F., Harsini, P.A. \u003cem\u003eet al.\u003c/em\u003e Effect of educational intervention based on theory of planned behaviour on promoting preventive behaviours of oral cancer in rural women. \u003cem\u003eBMC Women\u0026apos;s Health\u003c/em\u003e\u003cstrong\u003e23\u003c/strong\u003e, 249 (2023). https://doi.org/10.1186/s12905-023-02411-2\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Demographics of Community Stakeholders\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eTotal Participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003en = 12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eAverage Age in Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e45.6 (SD = 11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (75.0%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eYears of Community Involvement\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt;1 Year\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 1-2 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (83.3%)\u003c/p\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Black or African American\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; White\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Native Hawaiian/ Pacific Islander\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; American Indian/ Alaskan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (100%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Hispanic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Non-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003e83.3%)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1. Demographic Characteristics of Community Stakeholders\u003c/p\u003e\n\u003cp\u003eDescriptive statistics of participants in two focus groups conducted in an underserved Miami neighborhood. The majority of participants were Black or African American, non-Hispanic, female, and had less than one year of community involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIllustrative Participant Quotes Describing Contributors to High-Risk Behaviors\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eQuotes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eHistoric Social Norms (HCN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eHSN1: \u0026ldquo;Also, we know the history \u0026hellip; as far as violence and things of that nature. So, that does impact them greatly. So, with our seniors, we use our seniors as much as possible because, No. 1, they are our pillars. If they cannot get away from the negative atmosphere that they so much soak in, because we know the first thing we talk about is who got shot and what\u0026rsquo;s going on with that. You very rarely hear positivity from a certain standpoint when you\u0026rsquo;re just focused and people are talking about all that is negative.\u0026rdquo; (FGD1 310)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eHSN2: \u0026ldquo;You asked if it\u0026rsquo;s getting better or worse. I believe it\u0026rsquo;s getting worse because you don\u0026rsquo;t only see older people. You see younger people, too\u0026hellip; with the drugs and stuff like that.\u0026rdquo; (FGD2 524)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eHSN3: \u0026ldquo;And when you walk outside the door and the gates and where they reside, they are exposed to the norm of the community. So, here you are trying to teach against what they\u0026rsquo;ve already been taught that was the norm. So, it\u0026rsquo;s almost like you have to deprogram in order to reprogram them in a way that it\u0026rsquo;ll be beneficial for them.\u0026rdquo; (FGD2 458)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMistrust of the Healthcare System (MHS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eMHS1: \u0026ldquo;I think because of some of the history of where some so-called health providers came out in the name of health providing, but they only caused more damage than they did providing health. So, I would say that, especially for our community.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;So, would you say there\u0026rsquo;s a mistrust?\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Exactly.\u0026rdquo; (FGD1 1430)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003col\u003e\n \u003cli\u003eMHS2: \u0026ldquo;Most of the residents here, there\u0026rsquo;s been a lot of broken promises. You had different elected officials that came in. There\u0026rsquo;s been a lot of broken promises. Then you get the naysayers and folks who don\u0026rsquo;t live in this community who are out for profit for themselves and want to bring services here, what services that the residents don\u0026rsquo;t need\u0026hellip; They just figured that the residents need these type of services just to bring profit for themselves. So, that\u0026rsquo;s been a lot going on, which I call the word \u0026lsquo;poverty pimps.\u0026rsquo;\u0026rdquo; (FGD1 820)\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eLack of Support Systems (LSS)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eLSS1: \u0026ldquo;I think people find their selves doing those type of things for an outlet, a release of grief, complications, those type things\u0026hellip;\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;So, would you say, sometimes, them engaging in high-risk behaviors may be kind like a coping mechanism.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Yeah, so to speak.\u0026rdquo; (FGD1 480)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eLSS2: \u0026ldquo;All of us at the table deal with certain things, currently dealing with certain things. You see the cost of rent is skyrocketing. You have more bills than you do money. That\u0026rsquo;s the way it seems. It seems as though when you\u0026rsquo;re able to catch a break \u0026ndash; you can breathe a little \u0026ndash; here\u0026rsquo;s something else. It\u0026rsquo;s coming up. So, you resort to violence. You resort to drugs. You resort to smoking, what have you. (FGD1 497)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003e\u0026ldquo;Just like with anyone else, grieving of a lost one, you got to have some kind of outlet. You may not be a smoker. But at the time, you want to have some kind of release, I think. Somebody may have some alcohol. \u0026ldquo;Look, give me a sip of that.\u0026rdquo; You\u0026rsquo;re trying to clear your head. It seems like nothing is working for you, maybe even an aspirin, and you may not be a pill-taker. So, I think they would engage in that peer pressure. (FGD1 463)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eLimited Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eLE1: \u0026ldquo;Sometimes, when all you know is what you see, you become, not to say it\u0026rsquo;s a good thing, but you become a product of your society, because there\u0026rsquo;s nobody in here trying to teach, offer free vocational training, offer financial literacies in their community. Nobody in here trying to educate. They\u0026rsquo;re just letting them be\u0026hellip; But if they haven\u0026rsquo;t been trained or taught to know better, how can they do better?\u0026rdquo; (FGD2 328)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eLE2: \u0026ldquo;Because people just don\u0026rsquo;t know. They don\u0026rsquo;t know what\u0026rsquo;s wrong with their body because they don\u0026rsquo;t like going to the doctor. And when you have a situation where you gotta go to the doctor because something is going on in your body, it\u0026rsquo;s a frightening thing.\u0026rdquo; (FGD1 1160)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eLE3: \u0026ldquo;So, what I do see, that there\u0026rsquo;s a lack of education in the area and lack of knowledge in certain areas, and especially when it\u0026rsquo;s dealing with mental health and the importance of your physical and mental wellbeing.\u0026rdquo; (FGD2 152)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAvailability of Drugs and Alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eADA1: \u0026ldquo;I\u0026rsquo;m gonna say that it\u0026rsquo;s accessible within the community. It\u0026rsquo;s nearby. There\u0026rsquo;s literally drugs across the street. The neighborhood itself, things are just easy to obtain, and then the environment doesn\u0026rsquo;t help. So, they have easy access to certain things, certain drugs, a gas station across the street, liquor store right there. (FGD2 340)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eADA2: \u0026ldquo;\u0026hellip;as well with a lot of liquor stores are around, a lot of drugs. So, some of them would tend to go\u0026hellip; So, it\u0026rsquo;s like easy access. They\u0026rsquo;d rather go get drunk, do this\u0026hellip; It\u0026rsquo;s not benefiting their health or if they wanted to change, because it\u0026rsquo;s \u0026ndash; Here, if you have somebody who drinks every day or on the weekend, and they want to stop, if they see the liquor store while they\u0026rsquo;re walking, it\u0026rsquo;s gonna turn them to go to the liquor store\u0026hellip;\u0026rdquo; (FGD2 213)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eADA3: \u0026ldquo;The fact that they got smoke shops popping up now like liquor stores and everything else\u0026hellip; no. I mean you can\u0026rsquo;t take away all the smoke shops and stop selling cigarettes. The prices of the cigarettes are sky high, and people are still buying them\u0026hellip; And even if there\u0026rsquo;s no smoke shop or anything around, nowadays, they doing delivery.\u0026rdquo; (FGD2 720)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eADA4: \u0026ldquo;It [drugs, alcohol, prostitution] becomes something that is the inevitable instead of glorifying going to school and not partaking in these different negative activities or listening\u0026hellip; They kind of glorify. They tend to glorify what\u0026rsquo;s easier, what\u0026rsquo;s accessible, as everyone has stated. You know what I\u0026apos;m saying? What\u0026rsquo;s hot? What\u0026rsquo;s the now.\u0026rdquo; (FGD2 419)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Illustrative Participant Quotes Describing Contributors to High-Risk Behaviors\u003c/p\u003e\n\u003cp\u003eExcerpts from focus groups categorized by thematic drivers of high-risk behaviors for OOPSCC: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Illustrative Participant Quotes on Community-Based Strategies to Reduce High-Risk Behaviors\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eQuotes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eProviding Continuity of Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003ePCC1: \u0026ldquo;I believe, in certain communities, when you\u0026rsquo;re consistent, you can tell the progress of the community, when there\u0026rsquo;s consistency. When there is no consistency, you can see where the community may struggle. So, it depends on leadership in these different municipalities. It depends on the community actions in the community. It depends on the engagement in a community.\u0026rdquo; (FGD2 479)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003ePCC2: \u0026ldquo;I think consistency is key, because communities don\u0026rsquo;t just need to see something happening one time. It needs to be on a consistent basis. \u0026ldquo;Oh, that\u0026rsquo;s such and such. They came back.\u0026rdquo; If you\u0026rsquo;re having something that\u0026rsquo;s consistent, they gonna keep coming. But if you just have something once this time, then another six months, that lose them.\u0026rdquo; (FGD1 1000)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003ePCC3: \u0026ldquo;I know many organizations and especially medical facility have like case managers, like people who even call you to give you back your results, whether it\u0026rsquo;s a medical assistant who\u0026rsquo;s trained in the medical field. Maybe having somebody within each medical facility that\u0026rsquo;s like a community liaison that stays in communication with those particular people to make sure that they follow up on their appointments, offer tips and maybe incentives.\u0026rdquo; (FGD2 871)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eEngaging and Educating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eEE1: \u0026ldquo;I believe they need education on it [HPV]. Everybody needing that education on different type of sickness that gonna deteriorate their body.\u0026rdquo; (FGD1 1144)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eEE2: \u0026ldquo;They go to the food banks, but sometime the food don\u0026rsquo;t be great quality. Sometimes, it\u0026rsquo;s stuff that\u0026rsquo;s expired or about to expire, about to spoil. So, I think food is one of those major things besides health that is missing, the educational portion\u0026hellip; Because of our resources and the limitations that we have, we kind of eat the poor ends of the food. So, we eat things that are fast given, fast food, because it\u0026rsquo;s accessible. It\u0026rsquo;s right there. I can go to Wendy\u0026rsquo;s and get a 4 for $4. I can\u0026rsquo;t afford a salad because I salad is $8.00. So, maybe showing them that educational component of how to eat on a budget, easier ways to be able to afford that, because the educational component is very important, even for us.\u0026rdquo; (FGD2 633)\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eEE3: \u0026ldquo;Well, as far as like with smoking, I tend to give them the smoking cessation hotline number. That helps as well. Encourage them to attend support groups to help with drinking and different issues that they may be facing.\u0026rdquo; (FGD2 313)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eEE4: \u0026ldquo;Recreation is a must. It\u0026rsquo;s positive. And all these gangs and recreations that they sometimes, it blocks their mind out. If anything criminal or crime are going on, their mind is on recreation, like you say, that bingo, because they know they get the good prizes, the goodies or whatever. So, you will hardly see that. And for the young adults, they\u0026rsquo;re making ways that it\u0026rsquo;d be good recreation for them to be able to come in and do positive things for their self.\u0026rdquo; (FGD1 381)\u003c/p\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003e\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eOffering Incentives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eOI1: \u0026ldquo;\u0026hellip;you definitely have to be creative and keep them interested. You can\u0026rsquo;t just come\u0026hellip; You have to have service providers who are gonna come out now and make it fun, make it fun, teach in a way of making it fun.\u0026rdquo; (FGD1 1342)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eOI2: \u0026ldquo;I\u0026rsquo;ll go back on the bingo party we had here for the elderly. They provided face masks, hand sanitizer \u0026ndash; what you call it \u0026ndash; brochures on different services that you have here. They provided all of that. If you\u0026rsquo;re gonna have a function and let people know, \u0026ldquo;Hey, listen. We got some little cute giveaways, stress balls.\u0026rdquo; You have to give people something. You can\u0026rsquo;t just have a function without something, especially here. The people like to come out and be able to listen to your services, but they like giveaways, too.\u0026rdquo; (FGD1 1313)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eOI3: \u0026ldquo;And so, if we were able to assist them with like a packet, something small, nothing really big, they\u0026rsquo;ll be grateful \u0026ndash; masks, sanitizer, little things that will make them happy to be able come out and\u0026hellip; you know.\u0026rdquo; (FGD1 299)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003col start=\"5\"\u003e\n \u003cli\u003eOI4: \u0026ldquo;Of course, the topic [of the health fairs] would be HPV because a lot of people have never even heard of HPV, don\u0026rsquo;t even know what it is. And doing something in the community to kind of do the educational portion but also make it relative and catch their attention and do something incentive-wise, because that\u0026rsquo;s what really gets them to gather to places. It\u0026rsquo;s what is it you have to offer?\u0026rdquo; (FGD2 795)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eEstablishing Relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eER1: \u0026ldquo;He always says build the relationships, but everyone has their different ways of building relationships: Calling, talking, communicating, even one on one outside, or, \u0026ldquo;Hey. You okay? Everything all right?\u0026rdquo; knock on their doors and see what\u0026rsquo;s going on with them.\u0026rdquo; (FGD1 839)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eER2: \u0026ldquo;I would say I noticed it\u0026rsquo;s a lot of patience is needed. So, I would say patience, showing empathy, showing compassion towards the residents in the community.\u0026rdquo; (FGD1 189)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eER3: \u0026ldquo;Most service providers, they either from home or either at the office, at the desk making phone calls. Folks want to see your face and see that you care. So, I\u0026rsquo;m looking for service providers who, like yourself, who came. I met you at an event, and you\u0026rsquo;re back here today trying to find out what\u0026rsquo;s going on in the community. So, that\u0026rsquo;s what it\u0026rsquo;s about, that partnership and letting the residents see you and engaging with them.\u0026rdquo; (FGD 968)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eIncreasing Accessibility to Healthcare Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eIAHS1: \u0026ldquo;I think the difficulty is the transportation for most people. So, with resources coming to them, like you do provide, it\u0026rsquo;ll be more accessible to them to make it easier for them to come or have it available for them right here.\u0026rdquo; (FGD1 236)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eIAHS2: \u0026ldquo; Well, medically, I think I have like a medical event that is positive where a lot of the people in the community don\u0026rsquo;t go to the doctor. So, they could have like medical vans come out. They could do different food shares with healthy foods for the community, things for the kids in a positive light, like a Boys\u0026rsquo; \u0026amp; Girls\u0026rsquo; Club type thing, activities for the kids, so they could see something positive outside of the negative daily things that they may see. On the weekends, sport events, different activities in the neighborhoods, I guess, on different days spread out, so they would actually have something to look forward to.\u0026rdquo; (FGD2 605)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 490px;\"\u003e\n \u003cp\u003eIAHS3: \u0026ldquo;\u0026hellip;getting the information in time. Say, for instance, if you\u0026rsquo;re gonna do something next week, let\u0026rsquo;s say next Friday, we shouldn\u0026rsquo;t just be getting information on Monday. That\u0026rsquo;s not enough time for people to know what\u0026rsquo;s going on, what kind of service or services or screeners you\u0026rsquo;re gonna be providing.\u0026rdquo; (FGD1 1216)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Illustrative Participant Quotes on Community-Based Strategies to Reduce High-Risk Behaviors\u003c/p\u003e\n\u003cp\u003eExcerpts highlighting stakeholder recommendations for reducing OOPSCC risk in underserved communities. Proposed strategies include continuity of care, community engagement and education, use of incentives, relationship-building, and improved healthcare accessibility.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Oropharyngeal, Community-engaged, Health disparities, Cancer, Social determinants","lastPublishedDoi":"10.21203/rs.3.rs-7084925/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7084925/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDespite the preventable nature of oral and oropharyngeal squamous cell carcinoma (OOPSCC) through risk factor avoidance, disparities persist regarding OOPSCC survival in medically underserved communities. This qualitative study aims to engage community stakeholders from an underserved neighborhood in Miami, FL to identify key problems and solutions related to high-risk behaviors in OOPSCC. Twelve participants, selected based on community involvement and residence around the studied neighborhood, participated in two focus groups with six participants each. Transcriptions of the 60-minute sessions were analyzed using directed qualitative content analysis (DQICA) to identify themes. Notable excerpts from the transcriptions were used to report data and support overarching themes. 12 participants of average age 45.6 years were interviewed. The majority were female (75.0%), had 0-1 years community involvement (83.3%), were Black or African American (100%), and were non-Hispanic (83.3%). DQICA revealed five key problems contributing to high-risk behaviors for OOPSCC: historic social norms, mistrust of the healthcare system, lack of support systems, limited education, and availability of drugs and alcohol. Analysis identified five key solutions including continuity of care, community engagement and education, incentives, long-term relationships, and improved health accessibility. This study highlights the influence of social determinants on OOPSCC risk in this medically underserved community of Miami, FL. Through a community-engaged approach, this study uncovers underlying problems and potential solutions to reduce high-risk behaviors contributing to OOPSCC. This emphasizes the need for stakeholder input, community-specific research and service efforts, and longitudinal practices in improving the treatment within underserved communities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence\u003c/strong\u003e: level 4\u003c/p\u003e","manuscriptTitle":"Community Engaged Perspectives on Oropharyngeal Cancer Risk in an Underserved Miami Neighborhood: A Qualitative Study of Barriers and Solutions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 10:51:45","doi":"10.21203/rs.3.rs-7084925/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-10T16:26:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-09T16:18:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91005258111948147219351208601979549476","date":"2025-12-23T18:51:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315276199700157469549906134349558983022","date":"2025-11-10T16:59:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T20:43:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274529607729355700705787376204697706799","date":"2025-09-29T13:03:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T17:16:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-01T12:31:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T07:11:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-20T02:15:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-08-20T02:12:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1a467293-84b6-449b-ba32-fd479724a2c2","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":54155009,"name":"Biological sciences/Cancer"},{"id":54155010,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2026-02-14T00:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 10:51:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7084925","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7084925","identity":"rs-7084925","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}