Introduction When it is offered, sexuality education in the USA is far from standardized. While studies have explored differences in delivery and type of sexuality education across the USA, sexual and reproductive health inequities persist among historically marginalized groups (Latino/a/x, Black, African American, LGBTQ +). There is a critical need to better understand the systemic barriers to receiving effective sexuality education in these communities. Methods Participatory research methods were used in working with a community advisory board (CAB)—consisting of emerging adults and service providers from community-based organizations (CBOs) serving youth—to examine how structural barriers contribute to adolescent sexual and reproductive health (ASRH) inequities in Massachusetts. CAB meetings and semi-structured interviews were conducted in the cities of Springfield ( n = 14) and Lynn ( n = 9) between December 2020 and May 2021. Results Inflexible funding guidelines, a related evidence-based curricular mandate, and a lack of community-responsive sexuality education fail to meet the sexual and reproductive health (SRH) needs of these youth. Conclusions Current evidence-based mandates must be revisited to improve young people’s access to quality sexuality information in public schools. To guarantee sexuality education curricula is centered in the context of the community and population in which it is implemented, collaboration between youth-serving CBOs and school districts could improve students’ overall experience and social-emotional growth by providing comprehensive, positive, and community-responsive curricula. Policy Implications Funders and programming should prioritize community responsiveness by financially supporting and developing and/or adapting evidence-based curricula to better match the community’s needs, which can be completed through culture-centered training and community-based partnership.

e24178 Background: The COVID-19 pandemic has caused unprecedented stressors on the mental health of patients with cancer as well as with cancer survivors. Little is known regarding anxiety among breast cancer survivors during and following the pandemic. Methods: We performed a cross-sectional study evaluating the mental health impacts of the COVID-19 pandemic on a cohort of breast cancer survivors (n = 1333). Between January and March 2022, participants enrolled in the Rays of Hope Breast Cancer Research Registry were invited to complete an online study questionnaire. We analyzed the data collected from a series of questions regarding outcomes and perspectives representing three distinct time periods: before (prior to March 2020), during (March 2020-June 2021) and after the COVID-19 pandemic (January-March 2022), based on the dates of the Massachusetts State of Emergency declaration. The COVID-19 Anxiety Scale (CAS) was used to measure anxiety specific to COVID-19. Generalized anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item (GAD-7) scale. Multinomial logistic regression was used to identify factors related to increased or decreased anxiety symptoms. Results: A total of 272 independent participants (21.5%) completed the survey. Of these, 230 respondents with a confirmed history of breast cancer were included in the final analysis. While 26.2% met GAD-7 criteria for moderate to severe anxiety after the pandemic, only 13% self-reported a prior diagnosis of any mental health condition. Approximately 17% reported experiencing more anxiety symptoms after the pandemic compared to before. A history of smoking was associated with a higher likelihood of experiencing increased symptoms of generalized anxiety (OR = 1.97, 95% CI 0.93-4.14); whereas exercise frequency of at least three times per week was associated with experiencing a decrease in anxiety symptoms over this period (OR = 7.00, 95% CI 1.39-35.14). The CAS and reporting that the pandemic had a negative impact on cancer care were associated with a higher likelihood of increased generalized anxiety after the pandemic (OR = 2.21, 95% CI 1.19-4.09; OR = 3.05, 95% CI 1.06-8.83, respectively). Conclusions: Increased symptoms of anxiety were prevalent among breast cancer survivors during the pandemic and, in some, have not returned to pre-pandemic levels. Less than half of participants with symptoms meeting criteria for moderate to severe anxiety reported having a formal medical diagnosis, suggesting that clinically significant anxiety may be underrecognized in breast cancer survivors following the pandemic.