Abstract B26: The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors
Authors: Serrano Mayra , Ashing Kimlin , Barcelo Lisa , Wu Chenkai 
Published: October 2015

Background: Contextual determinants of health risk and outcomes, including physical and social environments, are increasing priority areas for health disparities research and practice. Individual-level social determinants of health among ethnic minority cancer survivors, such as education and income, have been well documented. However, little is known about the effect of neighborhood context on health among this vulnerable population. Learning more about the source and relative impact of health determinants is especially critical to public health and policy strategies to promote address health disparities and improve health equity.

Purpose: This study examined the relationship between neighborhood context and patient reported outcomes. Specifically, we hypothesized that greater neighborhood stress would be significantly related to poorer physical and mental health status in post-treatment Latina (LBCS) and African-American breast cancer survivors (AABCS).

Method: We used a mixed-methods recruitment approach to enroll 320 LBCS and AABCS from population-based sources. Neighborhood context was assessed using a self-rated neighborhood stress scale for the following aspects of neighborhood context: housing situation, neighborhood environment, transportation, availability of public services, crime and violence, and relation with police. Two domains of health were used: general health, measured by five-point Likert-type item along with the number of self-reported comorbidities; and mental health, assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, in conjunction with self-reported psychological difficulties.

Results: Of the participants, 88 (27.5%) self-identified as African American and 232 (72.5%) self-identified as Latina. Participant age ranged from 26 to 89 years with a mean of 54.49 years (SD =11.49). LBCS were older, less educated, and more financially disadvantaged (p&lt;0.5) compared to AABCS. In addition, LBCS were more likely to be married, to be homemakers, to be born outside of the US, to have spent fewer years residing in the U.S., and to receive chemotherapy. Generalized linear regression analyses show that among ethnic minority breast cancer survivors, higher self-reported neighborhood stress was significantly associated with worse self-rated health status (p &lt;0.05), more frequent depressive symptoms (p &lt;0.01), higher number of comorbidities (p &lt;0.01), and increased likelihood of having psychological difficulties (p &lt;0.001) after adjusting for important individual sociodemographic and medical covariates such as ethnicity, age, income, education, cancer treatment and cancer stage. Significantly, LBCS had higher likelihood of experiencing psychological difficulties than AABCS (OR=2.27, 95% CI: 1.03-5.00). In addition, self-rated health was shown to be significantly impacted by working status (p&lt;0.05). Unexpectedly, some seemingly important sociodemographic factors were not shown to have an impact on self-reported health status: education level and annual household income were not significantly correlated with health. However, individuals with annual incomes at or above the national median reported significantly less depressive symptoms than those individuals who made less than $15,000 per year.

Conclusion: Self-reported neighborhood contextual factors were shown to be an influential predictor of physical and mental health among both AABCS and LBCS. These findings underscore the importance of taking neighborhood context into account in investigating health outcomes. The impact of contextual determinants, including neighborhood resources, on cancer-related and overall physical and mental health requires further investigations. Future studies should incorporate population level data, e.g., census tract, to obtain a fuller picture of neighborhood status and resources to better inform interventions and/or policies to improve health outcomes among lower income and vulnerable populations.

Citation Format: Mayra Serrano, Kimlin Ashing, Lisa Barcelo, Chenkai Wu. The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B26.