The SC CADRE initiative aimed to build a bi-directional relationship with the community so that community priorities would guide the center’s research projects and communities would be aware of and engaged in the center’s research. Consequently, this community survey was administered to participants residing in predominantly AA communities across different regions in SC to document perceptions about the health problems (cancer risk factors) prevalent in their communities, their prioritization for cancer education topics, and their attitudes toward cancer prevention. Findings from this study revealed that obesity/overweight, poor diet, and low physical inactivity emerged as the top three major health concerns overall. Thus, community members’ perceptions about their community’s major health concerns are well-aligned with the strong link between these three conditions, as poor diet and physical inactivity, if unchecked, can result in obesity.

In a 2018 study, obesity/overweight was attributed to cause 7.8% of incident cancers and 6.5% of cancer deaths [12]. The proportion of obese adults in the USA increased from 30.5% (between 1999 and 2000) to 41.9% (between 2017 and 2020) [5]. Furthermore, in 2019, an estimated $173 billion was spent on medical costs related to obesity in the USA [5]. Obesity has a higher prevalence among African Americans compared to other racial groups [5, 13, 14]. In our study, African Americans ranked obesity/overweight as their topmost concern, and this finding is supported by a 2022 Centers for Disease Prevention and Control (CDC) report, which revealed that non-Hispanic Blacks in South Carolina had the highest prevalence of obesity (44.5%) in comparison to other racial groups, Whites (32%), Hispanics (35.2%), American Indians (28.6%), and Asians (8.8%) [15]. Furthermore, obesity/overweight was considered more of a problem among women than men in our study, and this aligns with another study that reported a higher prevalence of obesity among women than men [16]. In our study, obesity was a problem among middle-aged adults, and this finding is supported by the CDC report that middle-aged adults had a relatively higher prevalence of obesity (44.3%) compared to young adults (39.8%) and older adults aged ≥ 60 years (41.5%) [5]. Considering that obesity is a major risk factor for cancer and some cardiovascular diseases [14], these reports provide evidence that obesity is a growing public health concern that needs to be addressed urgently.

Poor diet was the second most crucial health problem identified by community members in this study; however, it was a risk factor of most significant concern among young adults compared to other age groups. A 2021 report revealed that fruit consumption among adults in South Carolina was 42.5%, while vegetable consumption (< once daily) was 20.7% (less than half of the adult population) [15]. Socioeconomic disparities such as reduced access to healthy and affordable food options and an abundance of calorie-dense fast food franchises in communities occupied by racial minority groups have been associated with poor food choices and obesity [14, 17]. Young adults are more likely to engage in physical activities either by the nature of their jobs or their exercise routines; however, their busy lifestyles make them more prone to patronizing fast food outlets, increasing their exposure to unhealthy food choices. Similarly, this might explain why poor diet emerged as a more significant health problem among males than females. Therefore, community health education programs and policies must be implemented to increase awareness among African Americans on the importance of healthy eating choices. Policies should also be extended to fast-food franchises to encourage the inclusion of more healthy eating options at reduced costs.

In our study, low physical activity was especially considered a problem among middle-aged adults, males, and White participants. In a 2017 study, physical inactivity accounted for 2.9% of all cancer cases in the USA [12]. Only 47.0% achieved at least 150 min of recommended moderate-intensity or 75 min of vigorous-intensity aerobic physical activity per week (as recommended by the American Cancer Society), and as high as 26% of adults in South Carolina did not engage in any leisure-time physical activity in 2022 [15]. Traffic congestion, inadequate parks, unavailability of pedestrian walkways, leisure or sports facilities, insecurity, and air pollution may have contributed to sedentary lifestyles [18]. This emphasizes the need to enact policies to improve the living environment of racial minority groups by increasing the number of and access to leisure facilities, secured community parks, and pedestrian walkways, among other interventions.

Excess alcohol consumption, tobacco smoking, and substance (drug) use were ranked in fourth, fifth, and sixth places, respectively, overall and across the subgroups. Excessive alcohol consumption (binge drinking) has been associated with an increased risk for several cancers [19], and about 5.6% of cancers were attributed to alcohol consumption in 2017 [12]. Tobacco smoking is the leading preventable risk factor for cancer and has been attributed to causing approximately 19% of incident cancer cases [12, 17]. However, participants in our study ranked tobacco and drug use as the least important health concern. Smoking and drug/substance (opioids, fentanyl) abuse are becoming more popular among young people in multiple communities in the USA. A recent study reported an alarming prevalence of smoking among middle and high school students (11.3% as of 2022) [20], and this calls for sustained efforts to ensure tobacco-control strategies are implemented at community-wide levels to reduce tobacco smoking exposure among adolescents.

Although all the suggested cancer education topics in this study were considered necessary, educating people on the cause of cancer emerged as the topmost priority, revealing that there are still many people who, despite the cancer awareness campaigns in SC, do not have an adequate understanding of the cause of cancer. Also, how to access healthcare, knowing behaviors that increase cancer risk, and where to go for free/low-cost cancer screening were topics that appealed to the participants. The ACS guidelines support risk reduction through several recommendations for nutrition, physical activity, vaccination, and screening [13]. However, studies have reported low compliance rates with these guidelines. A study conducted in South Carolina reported a relatively lower rate of lung cancer screening uptake among Blacks/African Americans compared to Whites [21]. It has also been reported that communities in rural areas may have longer travel distances to screening sites, which could result in lower rates of utilization of screening services [21]. There is also a possibility that some members of minority communities are not aware of screening sites closest to them; hence, it is essential to educate community members on the benefits of compliance with ACS screening guidelines and inform them of where and how to access screening centers. This will facilitate early detection, diagnosis, and initiation of treatment protocols and increase survival rates.

A recent study reported that implementation of a community-based cancer educational program resulted in increased screening knowledge and awareness among their participants [22]. In addition, the study reported a high proportion of community members had intent to talk to a healthcare provider about screening for breast, cervical, and colorectal cancers (85–97%), 88–97% had the intent to get the screening test done in the next 12 months, and 90–97% had the intention to discuss these cancers with their family members and friends [22]. These findings emphasize the importance of targeted culturally appropriate cancer educational interventions and other health programs for racial minority groups to help build their confidence in identifying cancer symptoms and making a choice for healthy lifestyle habits.

Participants in our survey had a relatively high level of education (66% had at least a college degree), but many still expressed some uncertainty about cancer prevention guidelines. For example, 42.7% reported agreement/strong agreement with feeling like everything causes cancer, and 51.4% reported agreement/strong agreement with feeling like there are so many recommendations for preventing cancer; it is hard to know which ones to follow. On a positive note, only 13.5% reported agreement/strong agreement with feeling like there is very little you can do to prevent cancer. One reason for these results may be due to the increasing complexity of guidelines for cancer prevention and screening, as guidelines are updated over time to reflect more precise understanding of cancer epidemiology and to incorporate new cancer prevention innovations that become available [13].

A few limitations to this study are acknowledged: first, the sample size was relatively small, particularly for evaluating sub-group differences. Second, other studies have documented the contributions of urbanity and rurality to cancer disparities [17], but we did not assess geographical differences in the prioritization of health problems in our study. Third, the survey did not collect data on study participants’ health behaviors, which could have provided more insight into the perceived importance of health problems, influencing the ranking. Fourth, the findings from this study may not fully represent the population in South Carolina because of the convenience sampling technique employed for participant recruitment.