PROJECT SUMMARY: Cancer continues to be the top cause of death for American Indians (AIs) in North Carolina. With higher rates of colorectal cancer (CRC) late stage diagnosis and mortality and the highest smoking rate among all race/ethnic groups in the state, there remains a critical need to reduce the use of tobacco among AIs while also improving early detection of lung and CRC cancers in order to improve disparities and outcomes. The Atrium Health Wake Forest Baptist Comprehensive Cancer Center’s (AHWFBCCC) Community Outreach and Engagement (COE) efforts are focused on addressing the disproportionate burden of cancer in the catchment area. NC has the largest AI population east of the Mississippi River, making addressing the cancer-related health needs of AI communities critical to this mission. Our recent integration with Atrium Health presents a unique opportunity to leverage complementary strengths across both cancer campuses to expand our reach by building on existing foundational collaborations and activities. Together, we propose to apply an innovative, multi-channel outreach and educational campaign to increase cancer awareness, preventive behaviors, and lifesaving screenings, to help address cultural and demographic issues contributing to disparities in health literacy and cancer in AIs. To accomplish this, we have two Specific Aims that are an extension of our Year 1 MICEO project: 1) To build on the culturally sensitive communication campaign initiated in Year 1, we will develop a comprehensive dissemination plan, including community and paid social media campaigns, and expand our reach to all tribes in NC; and 2) Using the Audience-Channel-Message-Evaluation (ACME) framework for health communications campaigns as a guide, we will enhance plans in Year 1 to conduct a more comprehensive evaluation across campaign development, implementation and outcome measurement.. We will continue partnering with our tribal communities in an iterative process to create, implement, and evaluate culturally tailored educational cancer communication messaging to increase cancer awareness, preventive behaviors, and lifesaving screenings. Leveraging established infrastructure and foundational collaborations will facilitate development of a community outreach and education intervention that is sustainable and can disseminate best practice for future adaptation and implementation.