Several risk factors are prevalent during early adulthood that can lead to cancer later in life. Emerging adults
(EAs) aged 18-26 residing in rural areas of the United States engage in many cancer risk behaviors, especially
sedentary lifestyles, poor eating patterns, nicotine product use, excess alcohol intake, infrequent sun
protection, and inadequate uptake of the HPV vaccine. This application responds to RFA-CA-20-051, “Social
and Behavioral Intervention Research to Address Modifiable Risk Factors for Cancer in Rural Populations.”
The goal is to improve cancer risk behavioral factors among diverse EAs aged 18-26 living in rural counties in
the Four Corners states, a unique, underserved region, using a social media campaign designed with
community advisors. EAs, including in rural communities, are heavy consumers of online content, especially
over social media, and social media provide responsive, engaging, and low-cost platforms for distributing
cancer prevention information with high dissemination potential. But, social media also circulate inaccurate,
misleading, and harmful information. The specific aims of this research are to: 1) Develop a social media
intervention for diverse EAs in rural communities via a community-engaged process that combines expert
advice, user-generated content, and online instruction to communicate about behavioral cancer risks, cancer
misinformation, counter marketing, digital and media literacy, and family communication; 2) evaluate the
effect of a theory-based social media intervention on moderate to vigorous physical activity (MVPA), healthy
eating patterns, nicotine product use, alcohol intake, sunburn prevalence, and HPV vaccination with the
diverse population of EAs aged 18-26 in rural counties in AZ, CO, NM, and UT (Four Corners states) recruited
from Qualtrics' survey panel and enrolled in a pragmatic randomized trial using a stepped-wedge design in
which individual EAs will be randomized to 1 of 4 cohorts and receive the social media feed for varying
durations in separate Facebook private groups; 3) test if improvements in EAs' cancer risk knowledge and
beliefs, digital and media literacy skills, accurate cancer prevention information, and family communication
mediate impact of the social media campaign; and 4) explore whether the impact of the social media campaign
differs according to: a) level of EAs' engagement with campaign, b) cancer risk factors, and c) biological sex of
the participants (as required by NIH). The research is innovative because it tests a theory-based, multi-risk
factor approach to cancer prevention with diverse EAs in rural counties, an under-studied population, in a very
popular new media. Social media may reach EAs more than interventions through other community channels
(e.g., clinics, schools, and workplaces) and for lower cost in the geographically-dispersed, underserved rural
communities in the Mountain West. The overall impact is extremely high because it will aid rural EAs in
making informed decisions that reduce cancer risk factors and prevent cancer later in life and help EAs
critically evaluate and resist misinformation and marketing that promote cancer risk behaviors.