RESEARCH PROJECT SUMMARY Natural hazards pose risks to human health through both direct and indirect stressors. On tropical islands, some of these risks are accentuated. The population of the US Caribbean Territories, including Puerto Rico (PR) and the US Virgin Islands (USVI), is especially vulnerable to multiple concurrent hazards. These risks are exacerbated by extreme weather events and a public health infrastructure that is weak and vulnerable. PR and USVI are experiencing acute socioeconomic and health consequences from extreme weather events, including Hurricanes Irma and Maria (2017), as well as the COVID-19 pandemic (2020-2022). The proposed Caribbean Cancer Research Center on Environmental and Natural Hazards (CARIB-CARES) will employ a multimethod approach to identify effective strategies for addressing these problems. CARIB-CARES will include an epidemiological study to assess the risk of cancer in PR and USVI in relation to natural and environmental hazards and social factors. It will include a cross-sectional study to assess the understanding of extreme weather events and their effects on pollution mobilization and quality of life among cancer survivors. Additionally, a qualitative study will use key informants and focus groups to determine the needs, priorities, and capabilities of stakeholder groups, cancer patients, and residents living in high-risk areas with one or more environmental hazards. The primary aims of the proposed research project within the CARIB-CARES are to 1) Describe the risk of cancer in PR and USVI in relation to environmental stressors and social factors and 2) Conduct a community assessment of natural hazards and risk reduction capacity among cancer survivors and residents in PR and USVI. Information from the PR and USVI cancer registries will be used to assess cancer incidence and mortality risk in the context of historical and current environmental data. The study of the needs, priorities, and capabilities of stakeholder groups will identify gaps in cancer care within healthcare systems. This information will guide the development of targeted interventions and inform disaster preparedness and response planning in the US Caribbean region. The findings will be relevant for government-based planning and intervention efforts, including developing plans to mitigate local risks, plans for disaster preparedness, and improving the resilience of cancer control plans and infrastructure for these US territories. Lessons learned will be also applicable to other US states, territories, and communities facing similar challenges.