In The Shadow of Smoke and Silence: Understanding Cancer Awareness and Care-Seeking Behavior in Louisiana’s Cancer Alley

1. Introduction

Cancer Alley, an 85-mile stretch along the Mississippi River between New Orleans and Baton Rouge, hosts about 200 petroleum refining and chemical manufacturing facilities, making it one of the most industrialized regions in the U.S. However, "Cancer Alley" does not exist on maps. Pollutants the chemical plants emit daily prompted that designation because of the high prevalence of cancer among locals. The coexistence of residents with fossil fuel and petrochemical industries exposes them to extreme pollution, making parts of Cancer Alley the highest-risk areas for cancer from industrial air pollution in the U.S. (US: Louisiana’s “Cancer Alley,” 2024). Health risks and disparities extend beyond cancer to respiratory issues and maternal and newborn health complications (US: Louisiana’s “Cancer Alley,” 2024), particularly Black and African American communities in Cancer Alley (Paul, 2023). The state's high poverty rate exacerbates these disparities, leading to disproportionately high mortality rates for all cancer types (State Cancer Profiles, 2024). Environmental-level exposures, lack of access to healthcare serviced due to geographical constraints, transportation issues, existing beliefs, and a lack of awareness about available services (Zahnd et al. 2019) are all barriers that contribute to the increasing rate of cancer patients (Terrell et al., 2024; Zahnd et al., 2019). Addressing these disparities is imperative to ensure equitable access to quality cancer care and improve health outcomes for underserved populations in Louisiana.

Grounded in three health behavioral theories, the comprehensive model of information seeking, the health belief model, and the theory of health-seeking behavior, this research addresses a critical gap in understanding healthcare-seeking behaviors in Cancer Alley, where severe health crises persist despite limited studies on residents’ knowledge of and access to cancer care. Investigating environmental and healthcare inequities in this polluted landscape, the study examines residents’ awareness of cancer treatment services within a 100-mile radius and how this impacts their care-seeking decisions. It identifies barriers to timely and adequate healthcare while exploring the interplay of environmental racism, healthcare access, and cancer outcomes. Perspectives from residents, environmental justice advocates, healthcare communication professionals, and journalists provide a comprehensive view of these challenges. Grounded in three health behavioral theories, the comprehensive model of information seeking, the health belief model, and the theory of health-seeking behavior, the study also offers participant-driven recommendations on effective communication strategies to better reach marginalized Black communities in Cancer Alley.

Pezzullo (2003) explored racial and ethnic health disparities and environmental racism in Baton Rouge, addressing concerns similar to this study about Cancer Alley’s hazardous landscape from a communication perspective. Her study remains the only communication-focused research on this issue, emphasizing the need to merge nature and culture to raise awareness and inspire action for environmental justice. She introduced “toxic tours” as cultural spectacles that politicize memory, unite activists, and restore communities. Despite its reprint in 2010, no scholar has expanded on her work to examine how communication informs Cancer Alley residents about environmental health risks or influences their cancer-related information-seeking behaviors. This absence may explain why racial and ethnic health disparities persist in the Southern U.S.

2. Literature Review

2.1. Environmental/Structural Racism

Once home to sugar and cotton plantations, the Louisiana Bayou is now one of the most polluted areas in the U.S. due to petrochemical manufacturing (Brownstein, 2013). Before becoming “Cancer Alley,” this region was known as “Plantation Country,” where enslaved Africans were forced to work. Pollution surged in the 1980s, bringing severe health issues (Surrusco, 2022).

Environmental racism and geographic disparities in Louisiana’s Cancer Alley heighten residents’ cancer risk (Song & Younes, 2022). Despite a 1987 Washington Post exposé on hazardous pollution (Juhasz, 2024), efforts to curb toxic emissions remain inadequate. This petrochemical corridor has polluted water and air, exposing its predominantly African American residents to cancer, respiratory diseases, and other health issues (Morello-Frosch, 2002). According to Terrell et al. (2024), socioeconomic factors exacerbate health risks in this area, as many residents lack financial resources for medical care or legal action. Human Rights Watch (2022, 2024) found 12 sites exceeding federal pollution limits and documented fossil fuel plants near schools, homes, and playgrounds in nine Cancer Alley parishes such as Ascension, Iberville, Orleans, St. Charles, St. James, St. John the Baptist, Jefferson, East Baton Rouge, and West Baton Rouge, forcing residents to endure constant toxic exposure. Research also highlights systemic environmental inequality. Mohai et al. (2009) found low-income, less-educated populations live closer to polluting sites, reinforcing how economic and racial inequities dictate exposure to harmful emissions.

2.2. Environmental and Health Issues Prevalent in the Area

Human Rights Watch (HRW) (2022) reported that Cancer Alley residents face extreme pollution, increasing cancer, respiratory, and maternal health risks (US: Louisiana’s Cancer Alley, 2024). Terrell et al. (2024) found 27 in 100 newborns have low birthweight, over triple the national average, while preterm births (25.3%) are nearly 2.5 times the U.S. rate. Asthma and lung disease are also widespread. St. John Parish’s asthma rates for children are 2.5 times the state and national averages, with hospitalization rates equally high (Concerned citizens of St. John, n.d.). Lung cancer is common among those exposed to industrial pollutants (O’Leary, 2022), and workplace chemical exposure is a known risk factor (Lung Cancer Center, n.d.). Despite approximately 20,000 people still residing in Cancer Alley (Surrusco & Fragoso, 2024), HRW (2022) criticized Louisiana’s environmental agencies for failing to act. The EPA identified Cancer Alley as a toxic hotspot, with cancer risks 700 times the national average in some parishes (Hersher, 2019). Annually, 85 cancer cases in Louisiana are linked to air pollution (Terrell et al., 2024).

2.3. Barriers to Cancer Healthcare

One of the main barriers to cancer healthcare in Cancer Alley is transportation challenges. Study from the National Health Interview Survey (1997–2017) found that 5.8 million people in the United States (1.8%) postponed medical care due to a lack of transportation (Wolfe et al., 2020). Cochran et al. (2022) reached the same conclusion in their study, which revealed that 35.3% of 114 respondents and 18.3% of 59 respondents delayed or missed medical appointments or treatments in the past year due to transportation barriers, while 16.4% of 53 respondents reported arriving late. Another factor contributing to healthcare disparities is access. Levit et al. (2020) highlight that long travel times, limited access to medical and oncology professionals, and low clinical trial enrollment negatively affect patient care and outcomes. Poor financial conditions and limited healthcare services are also significant barriers for cancer patients as rising healthcare costs make it difficult for many patients to access necessary treatment. Mathur et al. (2015) found that 18.1% of individuals faced financial barriers to healthcare services, while 12.9% struggled with medication costs. Oncology providers are concerned about these economic obstacles hindering access to innovative treatments (Carrera et al., 2018), which can result in "financial toxicity" for low-income patients in Louisiana. Carrera et al. (2018) note that financial circumstances, including health insurance coverage, impact care-seeking decisions. Lack of insurance or high deductibles can prevent access to cancer screenings or treatments, indirectly leading to higher cancer mortality.

Medical mistrust remains a major obstacle to building strong patient–clinician relationships. Mistrust often stems from experiences of discrimination (Greer et al., 2014). A 2020 poll revealed that 7 out of 10 Black Americans believe the healthcare system treats them unfairly, with 55% expressing outright distrust (Hostetter & Klein, 2021). Such distrust is deeply rooted in historical injustices, including the 1932 Tuskegee Syphilis Experiment (Figueroa, 2024), 20th-century forced sterilizations of African American women (Alonso, 2018), and other unethical medical practices. For many vulnerable individuals, especially those who are doubly marginalized, these past and present experiences of mistreatment continue to fuel a profound distrust in the healthcare system (Alonso, 2018).

Racial disparities in healthcare remain a serious social issue, especially in the Southern U.S., where environmental and health challenges are widespread. Yet, little scholarly attention has been given to structural racism and healthcare barriers in Cancer Alley, leading to the central research question (RQ1).

RQ1: To what extent are residents of Cancer Alley aware of cancer care within a 100-mile radius of their homes and how does this, along with other influences, impact on their care-seeking behavior?

3. Theoretical Background

3.1. Comprehensive Model of Information Seeking (CMIS)

CMIS predicts health information-seeking behaviors based on health beliefs and medium-related characteristics (Yang et al., 2023). It suggests that health-related factors influence information carrier factors, which in turn affect information-seeking behaviors (Johnson & Meischke, 1993). Four elements influence information seeking: demographic factors (age, gender, education, ethnicity, socioeconomic status), direct experiences (health conditions and social networks), salience (gaps or issues driving information need), and beliefs (shaping perceptions) (Lalazaryan & Zare-Farashbandi, 2014; Case, 2012; White, 2009). These factors affect how individuals seek information about health, yet it remains unclear how these influences impact residents of Cancer Alley in seeking cancer care, potentially contributing to knowledge and access gaps. As such, research question two is posed:

RQ2: What are the key factors that influence the decision-making process of residents in Cancer Alley regarding seeking cancer care and other medical treatment?

3.2. Health Belief Model (HBM)

According to HBM, health behavior is influenced by beliefs regarding disease severity, personal vulnerability, perceived benefits, and barriers to action (Etheridge et al., 2023). The four key constructs of HBM include perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, with the first two reflecting threat dimensions and the latter two representing net benefits. Additionally, "cues to action" and "self-efficacy" drive behavior change (Glanz, 2001; Roy, 2026).

Clinicians can use the model to understand how individuals in the precontemplation stage may need support to see the positive outcomes of behavior changes (Kushner, 2016). This model is crucial in understanding how Cancer Alley residents perceive health risks and how such perceptions might affect their healthcare-seeking behavior. Therefore, the research question is:

RQ3: How do residents of Cancer Alley perceive their susceptibility to cancer, and how does this perception influence their healthcare-seeking behavior?

3.3. Theory of Health-Seeking Behavior (THSB)

THSB suggests that individuals engage in health-seeking actions to treat or cope with symptoms, as they perceive themselves to have a health problem (Ward et al., 1997). Chrisman (1977) described health-seeking behavior as a complex process, starting with symptom recognition, followed by interpretation, cause attribution, and decisions on treatment options. This process is influenced by sociocultural factors and socioeconomic status, including exposure to the biomedical system (Chrisman, 1977).

The model highlights that health-seeking behavior is shaped by past experiences and can vary based on available treatment options. Understanding the health-seeking process is vital, particularly in communities like Cancer Alley, where exposure to healthcare options plays a crucial role in treatment decisions (Chrisman, 1977; Ward et al., 1997). Thus, research question four is:

RQ4: How does awareness and exposure to the healthcare system affect the treatment-seeking behavior of Cancer Alley residents?

4. Methodology

I am an Asian female graduate student in the Southern United States, motivated to study this topic by recent family experiences with cancer. While I have not personally had cancer, witnessing its impact and hearing family narratives has shaped my interest in how individuals and families navigate these journeys, especially as race, class, and environment influence health decisions. Since 2023, I have conducted research in health communication and human behavior, focusing on how conditions and awareness affect decision-making after diagnosis. My academic training and understanding of issues like marginalization, limited awareness, information deficiency, and access to care strengthen my credibility and inform the design of this study.

As Strauss and Corbin (1990) emphasized, qualitative methods capture experiences and behaviors without quantification, making them ideal for examining healthcare-seeking behavior, environmental racism, and healthcare access, this study used a qualitative research design for its effectiveness in exploring complex healthcare issues. A case study approach was employed, using semi-structured, in-depth interviews with Cancer Alley residents. These interviews offered the flexibility to explore sensitive topics through open-ended questions while allowing for follow-up probes as needed.

4.1. Study Design and Sampling

Following Kvale’s (1996) seven-stage interview process, thematizing, structuring, interviewing, transcribing, analyzing, verifying, and reporting, the study recruited participants through social advocacy organizations, social media, and direct outreach. Due to residents’ mistrust and limited research access in the region, snowball sampling was used to reach participants (Naderifar et al., 2017; Parker et al., 2019). All participants (see Table 1) gave informed consent before interviews, which were conducted via Zoom or phone (in cases of technical issues) and lasted between 30 and 60 minutes. To protect confidentiality, researchers replaced names with pseudonyms in transcripts, and participants had the option to use coded identifiers (e.g., 001, 002) on Zoom before recording began.

To interpret the study's findings, participants' pseudonyms and abbreviations for race and gender (e.g., Black Female= BF, Black Male=BM, White Female= WF, White Male=WM, Hispanic or Latino Female= HLF, and Asian Female= AF) are used. This coding allows for quick referencing and ensures an accurate understanding, considering the study's ethnographic and cultural elements.

4.2. Data Analysis

Using a deductive, semantic approach (Terry et al., 2017), the analysis was guided by previous literature and theoretical framework that shaped how data were categorized. The study adhered to Braun and Clarke’s (2006) six-step process: familiarizing with the data, generating initial codes, searching for themes, reviewing them, defining and naming them, and producing the final report. After transcribing the interviews, data segments were coded based on core keywords such as “healthcare seeking,” “factors,” “susceptibility,” “mistrust,” “awareness,” and “recommendations.” These codes were then grouped into meaningful themes such as “Awareness of Cancer Care within 100 Miles and Influences,” “Key Factors Influencing Cancer Care Decisions,” “Perception of Cancer Susceptibility and Its Influence on Healthcare-Seeking Behavior,” and “Awareness and Exposure to Healthcare System Affecting Treatment-Seeking.” to reveal linkages and patterns (Naeem et al., 2023). Finally, the findings were synthesized into a conceptual model that addressed the research questions.

5. Results

The participant pool was ethnically diverse, including five Black or African American residents, one White, and one Hispanic or Latino resident. Among professionals, one was White, and the other Asian. Participants spanned five age groups, with most aged 65+. Five residents were from St. James Parish, two from Iberville, and both professionals from East Baton Rouge. Educational backgrounds varied: two had a high school diploma or GED, five held bachelor’s degrees, and two had postgraduate degrees, though education level showed no clear link to healthcare-seeking behavior. Three residents working in chemical plants had cancer. Income disparities were evident, with plant workers in St. James earning less than those in Iberville, while higher education correlated with higher income in other sectors. Data from nine in-depth interviews (6 female, 3 male) addressed the research questions, with key findings summarized in Table 2.

Five residents had lived in Cancer Alley their entire lives, recalling cleaner air and water in childhood. Some remained due to proximity to Baton Rouge and New Orleans, while others stayed for family roots. According to Latoya (BF), “St. James is home to me, and I have been here all my life. And I would not want to be any other place in this world, because this is where my roots are.” Tyrone (BM), on the other hand, says, “I pledged myself to stay in this area to take care of the people who took care of me, and that is my mom and my dad. I am living in the family house right now, but that is the reason why I am still here.”

All seven residents were mostly aware that pollution was causing health issues such as cancer, low birth weight, and respiratory illnesses. Six of them know that the area they are living is called “Cancer Alley” and expressed distress over it. Lucia (HLF) said, “It makes me feel less confident about living in that area because it, you know, makes me think that I have a higher risk for cancer than somebody else.” All seven residents also agreed that the plant has a major influence on their health and causes death through the pollution it emits. Melisa (BF) argued that there were no plants in this area when she grew up, and it was in the late ‘70s when the plants started to come in. She also said, “The impact of these chemical companies is that it's causing us to be sick.”

Residents have differing views on the financial impact of industrial plants. Five strongly oppose the idea that these facilities benefit residents, while two believe they create job opportunities despite the health risks. Demographic data shows those opposing financial gain are Black or African American, while those seeing benefits are non-Black or African American, including white, Hispanic, or Latino. According to Latoya (BF), “there is no financial gain for the residents; the financial gains are for the industries. The industries are polluting us, and they are getting profits. We are getting sick and fighting for our lives, not them.” Conversely, Lucia (HLF) said, “Financially, I think they're in a better situation because our taxes are lower, and a lot of us work for the plants. So, financially, they were affected positively.” April (WF) said that “Although I should mention that a lot of people are employed at these companies, and they have top-notch healthcare if they are employed there, I don't think it necessarily makes up for it. Overall, I think it's a negative effect.” Although April (WF) acknowledges the employment and healthcare benefits from industries but, unlike Lucia (HLF), sees the overall impact as negative, aligning more with Latoya's view on the harmful effects.

5.1. RQ1: Awareness of Cancer Care Within 100 Miles and Influences on Care-Seeking in Cancer Alley

This study revealed mixed awareness of cancer care within a 100-mile radius of Cancer Alley. Residents' knowledge varied based on personal experiences and family history of cancer. While some residents were very aware of the healthcare provided by nearby hospitals within or near the parishes, some residents showed limited awareness. For example, April (WF) and Lucia (HLF) were highly aware of the available cancer care within Cancer Alley and mentioned a couple of facilities they are aware of, such as Our Lady of the Lake in Baton Rouge, Mary Bird Perkins Cancer Center in Baton Rouge, and Women's Hospital. Both April and Lucia live in Iberville, and these healthcare centers are 32.8 miles, 32.5 miles, and 37.4 miles away, respectively, from Iberville. Both had a family history of cancer, and both learned about these cancer care facilities from their mother’s cancer care journeys. Lucia herself is also a cancer survivor who suffered from breast cancer. Another participant, Marcus (BM), who lives in St. James Parish, also showed awareness and talked about Ochsner in New Orleans (50.2 miles), Baton Rouge Medical (44.1 miles), Mary Bird Perkins Cancer Center in Baton Rouge (36.4 miles), and Thibodaux Regional Health System (36.3 miles). It is important to note that he also has personal experience with and has suffered from cancer.

In contrast, Jasmine (BF), another St. James resident, demonstrated limited knowledge of nearby cancer care and said, “It would have to be Ochsner in New Orleans. I don't think our local hospital does any cancer care.” The parish is 50.2 miles from Ochsner. Her awareness of this healthcare provider grew because of her daughter and some family members having to use Ochsner's services for all their general healthcare needs. Another participant expressed mixed awareness about the services provided by surrounding hospitals, claiming that Terrebonne General Medical Center lacked cancer care facilities, even though it has. St. Elizabeth Hospital is located in Gonzales, Louisiana, approximately 20.1 miles from St. James Parish. St. James Hospital is 7.8 miles from the parish, whereas Terrebonne General Medical Center is 50.7 miles away.

As an important element, the proximity to high-quality cancer care influenced participants’ decisions regarding where to seek treatment. Almost all the participants were ready to travel long distances to have quality cancer care if they knew they had cancer. For example,

Latoya (BF): “I will travel all the way. I will travel because I want to live. So whatever treatment or whatever I must do to get rid of it, I am going to take it.”

Jasmine (BF): “For cancer care specifically, I would definitely be willing to travel. And this might sound insane, but a lot of my family does travel to Texas to receive cancer care because it's supposed to be the best type of care that you could receive in proximity to us.”

According to the findings, factors such as financial considerations, convenience, and family experiences impacted participants’ care-seeking behavior. Tyrone (BM) said, “As long as the trip that I take is taken care of financially, I don't have a problem going anywhere.” This suggests that although people are willing to travel long distances, financial constraints play a great role in decision-making. Previous experience and family history with cancer is another important factor that influences cancer care-seeking decisions. When asked, participants offered the following responses:

April (WF): “If I had cancer or was worried about cancer, I would drive as far as I had to. Luckily, Our Lady of the Lake in Baton Rouge is really good. I saw them myself to screen for breast cancer, and my mom also went there.”

Lucia (HLF): “My mother had breast cancer. And in the course of her getting treated, I looked into the cancer treatment centers in the area.

Family history and personal experiences with cancer, as shown by April and Lucia, strongly influence their decisions to seek care. Both participants mention their experiences with cancer screening and treatment for themselves or family members, indicating that individuals who have witnessed cancer firsthand are more proactive and knowledgeable about available healthcare options. This underlines the role of personal and familial medical history in motivating healthcare-seeking behaviors.

5.2. RQ2: Key Factors Influencing Cancer Care and Medical Treatment Decisions in Cancer Alley

This study uncovered several interrelated factors, such as distrust in the healthcare system, financial limitations, cost of transportation, cost of medical treatment and medications, absence of cancer specialists in nearby hospitals, proximity to healthcare, and accessibility. Individually and collectively, these factors affect people’s overall healthcare-seeking actions. Another key outcome is that these factors are frequently influenced by trust, individual circumstances, generational differences, and personal experiences with the healthcare system.

Trust emerged as one of the key determinants in seeking cancer care. The study found that older Black or African American residents, in particular, expressed deep mistrust toward the healthcare system. Tyrone (BM) thinks that “A lot of people do not believe in certain medicines or certain treatments, and so they won't do it.” Other participants share similar concerns and observations:

Jasmine (BF): “The older community definitely has a lot of distrust towards going to the doctor. I know that they are usually very hesitant about things like surgeries, be they minor or major, even routine checkups. They do not feel comfortable enough to go to the doctor to take care of themselves. It takes a lot of persuasion, but the younger generation is realizing the importance of maintaining our health and becoming more aware of it.”

Tyrone (BM): “The doctors are with the hospital, the hospital is with the doctor, and they are both with pharmaceutical companies. They can cure people quicker. They can cure more people, but they are not doing it because the money is in the treatment. The pharmaceutical companies have the cure for almost every disease that we have. But it is thinking better business if they treat the symptoms. Not the cure.”

Tyrone, a 65+ Black male, expressed deep skepticism toward the healthcare system, believing it to be "an agenda to decrease certain amounts of people in certain ethnic groups," making it difficult for him to trust any healthcare providers. Jasmine (BF) echoed this sentiment, stating that it is hard to entrust one's life to someone without full confidence in them. In contrast, non-Black participants displayed a higher level of trust in healthcare. For instance, Lucia (HLF) stated that she believes doctors are trustworthy and act in her best interest.

This study found that all seven residents, regardless of race or gender, have lost faith in the government and local authorities. While at least half trust local leaders, all seven mistrust the government. Tyrone (BM) said, “I think the government may act like they are supporting us in Cancer Alley, but they are not.” Lucia (HLF) noted, “I do not think my neighbors and I trust the government. No, not Louisiana state government at least. There is more trust for local governments because, I guess, it is closer to home.”

Financial hardship and healthcare accessibility also limit residents' access to cancer care. The high cost of transportation, treatment, and medications remain a significant barrier. Living in rural areas with limited local healthcare forces residents to travel long distances for treatment. Tyrone (BM) stated, “If they do not have transportation or the financial means, they will not go. Who's going to pay for it?” Jasmine (BF) echoed the concern, emphasizing financial hardship. She said,

“I know how tough it is to obtain the necessary care if you do not have financial resources. And, because this is a rural region, a common topic of discussion is transportation and access to care.”

In response to accessibility, Latoya (BF) highlighted the absence of cancer specialists in their immediate area, necessitating trips to Baton Rouge or New Orleans for specialized care. She said, “We do not have a specialist over here in this area because we live out in a rural area.” April also said, as she thinks, that good doctors are far away. This study also finds instances like traveling up to five to seven hours to Texas to get adequate cancer care. For certain residents like Jasmine (BF), Melisa (BF), Tyrone (BM), and Marcus (BM), their proximity to healthcare is an essential factor that influences their care-seeking behavior. Tyrone (BM) said, “Due to financial constraints, they are unable to travel far from home to receive cancer treatment. The only thing stopping them is that they do not finance transportation.”

5.3. RQ3: Residents’ Perception of Cancer Susceptibility and Its Influence on Healthcare-Seeking Behavior in Cancer Alley

The study found a strong connection between residents’ perceived cancer risk and their healthcare-seeking behavior. All seven participants were acutely aware of Cancer Alley’s high cancer rates and felt vulnerable due to nearby chemical plants and pollution. Personal and community experiences reinforced this perception, each reported at least one family member or themselves affected by cancer, with some citing four to six cases. Commonly mentioned cancers included throat, breast, colon, and prostate. Participants also reported other serious conditions, such as chemical-related genetic mutations, asthma, autoimmune hepatitis, and Hashimoto's thyroiditis, and Hashimoto's encephalopathy.[1]

Latoya (BF): “There are a lot that already have died from cancer. My neighbor on one side had throat cancer. The other one had cancer, I think in the bone or the blood, or whatever; she died. And down this stretch in the 5th district (St. James Parish), we have a lot.”

Tyrone (BM): “I am going to start with my grandfather. My grandfather had one arm, and that's from working in the plant. My grandmother had breast cancer. I believe she had one of them amputated. My mother did the same thing. My aunt did the same thing. My brother, who worked in chemical industries, developed liver cancer. Working inside those gas and oil tanks damaged his liver, and he died as a result. And three to four other individuals who worked with us died, while two of us already had cancer. I was one of them. I am currently undergoing chemotherapy after being diagnosed with colon cancer.”

As these narratives show, participants have experienced cancer either personally or through close relationships, leading to a heightened sense of vulnerability. The frequency of cancer cases among family, friends, coworkers, and neighbors made residents feel more susceptible. Participants expressed that living in Cancer Alley undermines their confidence in their health and makes them believe they are more likely to develop cancer than others. For example, Marcus (BM) shared that he suffered from throat cancer, which he believes was caused by inhaling the various chemicals in the area. His wife also suffered from breast cancer.

These highlight how direct experiences with cancer among family and friends intensify feelings of vulnerability within the community. Despite awareness of pollution, its link to health issues, and the perceived susceptibility to cancer, this study found minimal proactive healthcare-seeking behavior among participants. Financial constraints, accessibility, and mistrust of the healthcare system hindered their ability to seek medical care. Additionally, skepticism about healthcare influenced their behavior. Many participants with cancer or other complex health conditions only learned of their disease during routine or annual checkups. Despite awareness of the health issues around them, they did not engage in preventive actions such as frequent checkups or screenings. Lucia (HLF) said, “I never really got sick. They found a lump on me, and they had to do surgery to remove it.” Tyrone (BM) said, “I was hurting so much; my nose was bleeding, and I was getting wet. But I never got checked.” Jasmine (BF) explained she will not seek healthcare unless it is something extremely serious, or something that risks her life.

In this study, just one resident out of all participants underwent screening for breast cancer proactively. That followed her family's history of cancer, as both her mother and grandmother had cancer. The statements above clearly demonstrate a disparity in behavior between being aware of the problem and seeking a solution.

5.4. RQ4: Awareness and Exposure to Healthcare System Affecting Treatment-Seeking in Cancer Alley

This study revealed mixed levels of awareness about available healthcare services among Cancer Alley residents. While two residents (April and Latoya) believed some programs might exist, others expressed a clear lack of information. Despite quality healthcare facilities within 100 miles, Latoya (BF) also an environmental justice advocate, felt cancer screening efforts were poorly communicated: “I am pretty sure they have something. They might screen for something, but I never heard them say they screen for cancer just out of the blue.” In contrast, Romela (AF), a healthcare communication specialist, said, “Our organization (Cancer Center) does a lot of outreaches. And we have a free screening program for cancer screenings.”

A close look at these two responses clearly indicates that there is a gap in awareness, where residents are unsure about the services provided by the healthcare organization. This is where a two-way communication gap arises. Two-way communication works with both the sender and the receiver to acknowledge and understand the message in question and send a response via the same channel (Ma, 2022). Terrell et al. (2024) said one-way communication is an imbalanced point of view, whereas two-way communication represents a harmonic viewpoint.

The study also revealed that little or no health information about different health issues had been circulated in their community in the last six months. Latoya (BF) said, “I don't think there was any special communication. Not in St. James. If it is, I have not seen it.” April (WF) echoed the same emotion, saying, “What is it? Basically, nothing ever.” While seven residents and one journalist admitted that there is a lack of communication, information, and action for cancer care in this high-risk geographical location, at least three residents mentioned community environmental advocates and advocacy organizations that are working to raise awareness among these vulnerable individuals, such as Rise St. James in the St. James Parish. One even talked about how the healthcare organization is still talking about COVID. Lucia (HLF) said the only thing she had heard about was COVID-19 and the flu and RSV (respiratory syncytial virus). John (WM), a journalist who worked for Cancer Alley News, also emphasized the communication efforts during COVID-19. He said, “I mean, there were definitely efforts during COVID-19 to reach some of those communities and get shots out.” He added, “Recently, I don't know. Nothing comes to my mind.”

These perceptions suggest that awareness is driven more by personal effort than by systematic outreach. A lack of information about available services and preventive care directly affects treatment-seeking behavior. Building healthcare knowledge requires ongoing communication, especially in communities with deep-rooted mistrust.

6. Discussion

Previous research on Cancer Alley linked air pollution to cancer and other health issues (Fos, 2021) but struggled to analyze healthcare-seeking behavior in an environmentally challenges landscape. Given the critical need for medical care in Louisiana’s chemical corridor, this study examined residents' healthcare awareness and care-seeking behaviors through nine in-depth interviews.

Findings align with prior research identifying Cancer Alley as a major U.S. hotspot for toxic pollutants (Herscher, 2019). Consistent with Terrell et al. (2024), this study found that environmental and systemic inequities fueled mistrust in healthcare and government, impacting health behaviors. While many residents knew of nearby cancer hospitals, awareness of specific services and preventive care was lacking. Health-seeking behaviors were influenced not only by finances, convenience, and accessibility but also by personal and familial cancer experiences. Financial constraints, proximity to healthcare, lack of specialists, and distrust in the system further shaped behavior. These results align with the Comprehensive Model of Information Seeking (CMIS), which emphasizes demographic factors and personal experiences in health decisions (Johnson & Meischke, 1993; Lalazaryan & Zare-Farashbandi, 2014). Unlike Carrera et al. (2018), who linked financial constraints to insurance coverage, this study found no mention of insurance as a barrier. A key issue was distrust, particularly among older African Americans, with Tyrone’s belief that pharmaceutical companies prioritize profit over care reflecting broader skepticism (Greer et al., 2014).

Contrary to the Health Belief Model (HBM), awareness of Cancer Alley’s high cancer rates did not lead to preventive healthcare-seeking (Etheridge et al., 2023). While participants recognized cancer risks, they primarily sought medical care only after a diagnosis. Consistent with the Theory of Health-Seeking Behavior (THSB), lack of healthcare information and service awareness hindered preventive care (Carrera et al., 2018). Residents must know about early screenings to use them, yet findings show little communication or special campaigns in recent months. This communication gap, combined with healthcare mistrust, further limits proactive health-seeking behaviors, reinforcing THSB’s links between health actions and sociocultural factors.

6.1. Recommendation for Preferred Information Channels for Residents

Raising awareness among residents exposed to pollutants is crucial for early detection and reducing mortality. Most participants, except the healthcare communication professional, agreed that the current outreach is insufficient. When asked about preferred methods for receiving healthcare information, participants suggested TV ads, brochures, mailers, billboards, community outreach events, town halls, libraries, and in-person communication at churches and grocery stores. Three emphasized social media, and one mentioned webinar as effective for young people, though two noted digital methods often exclude older individuals. While some preferred brochures in mailboxes, others stressed the need for frequent updates. One participant stated, “The best way to get information is to research yourself,” but acknowledged this is difficult for elderly individuals due to digitization.

John (WM), a journalist, argued that building more healthcare facilities alone will not solve the issue, emphasizing the need to address poverty and cultural attitudes toward healthcare. He stressed that, "People do not have access to healthcare in general. They do not have a doctor. They do not have a gynecologist. They just show up at the hospital, are pregnant, and ready to have a baby." This highlights the need for an entire re-education of health seeking to shift people from reactive healthcare behaviors (only seeking care in emergencies) to a more proactive approach that emphasizes prevention and regular checkups.

Romela (AF), another professional who worked in healthcare communication, described how unawareness could create mistrust in the healthcare system and recommends health communication professionals work on building trust among vulnerable individuals by sharing adequate information they need and reassure them about the care they will receive. She recommended the grassroots communication efforts in local communities, such as in churches, grocery stores, and community events that they might have in that area. A grassroots effort is an initiative that brings together a significant number of people to advocate for subjects that they care about. These people are organized and mobilized at the local level rather than by central leadership (Johanna-Mai, 2022). Residents recommended learning opportunities that can help establish trust. They emphasize the importance of having individuals on the ground to come out and speak with people face to face in order to create trust. Another essential suggestion is to raise awareness and facilitate early screening for cancer. Grassroots communication strategies, such as local gatherings, church events, and community health fairs hosted by healthcare organizations, could raise awareness about the necessity of early screening and educate people about the region's high cancer prevalence. Another technique to assist residents in distributing information is to provide important phone numbers and contacts of essential healthcare services on a proactive basis. If not the government, local legislators should ensure that everyone in the area has a list of clinics and hospitals, complete with phone numbers.

6.3. Recommendations for Future Research

The researcher recommends further studies on healthcare-seeking behavior among vulnerable populations, particularly in areas with significant environmental health impacts. Exploring healthcare-seeking opportunities and awareness in regions like Cancer Alley is crucial, as is examining trust in healthcare providers and proactive healthcare usage, which emerged as key themes in this study.

7. Conclusions

This study highlights that healthcare-seeking behavior and awareness in Cancer Alley are influenced by factors such as distrust in healthcare, financial limitations, transportation issues, and the lack of specialized care. Personal and familial health histories, impacted by industrial pollution and health disparities, also play a role. The study identifies effective communication methods for this underserved community and suggests a multifaceted approach to overcome barriers to proactive healthcare. Residents and professionals emphasized the importance of health education and direct outreach to build trust. A key finding was the lack of proactive care-seeking behavior, such as waiting until issues are severe or avoiding early screenings. To address this, healthcare organizations should focus on trust-building through culturally appropriate messaging and grassroots outreach, using trusted local figures and collaborating with advocacy groups. Two-way communication is critical to address concerns and empower the community to seek healthcare. While healthcare providers should promote services, residents must also be more proactive in seeking care and participating in preventive activities like screenings, which can improve outcomes through early detection.