PROJECT SUMMARY/ABSTRACTAs the leading cause of cancer death lung cancer represents the most significant cancer-related public healthchallenge in the United States. Although low-dose CT-based screening holds promise for earlier detectioncurrently most lung cancer cases are not diagnosed until advanced stages (III IV) and have 5-year survivalrates of 21% or less. In contrast to Black-White survival disparities Hispanic patients have markedly lowerage-adjusted death rates than their non-Hispanic White (NHW) counterparts despite later stage diagnoses andbroader SES and healthcare disparities; these findings are well established and consistent with the HispanicHealth Paradox a phenomenon characterized by Hispanic advantages in objective health outcomes (e.g.mortality) despite significant health and socioeconomic risk factors. The leading explanatory hypothesisconcerns the role of cultural factors facilitating social integration. Social integration is among the most robustpsychosocial predictors of a range of objective health outcomes including cancer survival. However nopublished work has directly tested this sociocultural hypothesis in relation to Hispanic resilience. Consistentwith the emerging science of resilience we propose a multisite two-study mixed-methods investigation toevaluate this sociocultural hypothesis. Study 1 is a multisite longitudinal observational study of 672 Hispanicand NHW individuals with advanced stage lung cancer sampled from three regions across the U.S. Interviewsusing gold-standard and culturally-informed survey measures (demographics social integration culturalvalues acculturation) will be conducted in English and Spanish from a centralized coordinating center with a 6-week follow-up to examine change in perceived support provision/needs. The primary outcome of survival andsecondary outcomes (e.g. treatment adherence) will be gathered from electronic medical records over meanfollow-up time of 33-months. Study 2 is a single-site 7-day intensive measurement investigation into the dailyunits of social integration that mediate outcomes. Study 2 integrates two novel in vivo sampling methods(Electronically Activated Recorder [EAR] and ecological momentary assessments [EMA]) using a mobile phoneplatform. The current aims are to (1) investigate whether the observed Hispanic survival advantage is mediatedby ethnic differences in social integration among recently diagnosed late-stage lung cancer patients and (2) toexamine the processes/mechanisms that underlie these relationships in daily life including the role ofindividual family network and neighborhood-level factors. The highly experienced investigator team includesleaders in all relevant content areas including the Hispanic health paradox lung cancer survivorship socialintegration and ecological sampling methodologies. The results will contribute to better understanding of socialprocesses among cancer patients inform psychosocial interventions based on social integration andcontribute to the emerging science of health resilience as well as racial/ethnic and cultural variations in healthoutcomes.