Abstract C065: Multilevel factors associated with depressive symptoms among long-term survivors of childhood cancer
Authors: Tobin Jessica , Cockburn Myles , Finch Brian K , Hamilton Ann S , Milam Joel E 
Published: September 2020

Abstract
Introduction Previous research has identified individual-level clinical and demographic factors associated with the mental health of childhood cancer survivors (CCS), but cultural and contextual factors have not been as thoroughly explored. Additionally, Hispanics are underrepresented in studies of CCS, so improved understanding of unique correlates of mental health among this population is needed. Methods Depressive symptoms were assessed among a sample of 1,106 young adult CCS. Participants were selected from the Los Angeles County SEER Cancer Registry, and were diagnosed at ages 0-19 between 1996-2010 with any cancer, at least 5 years post diagnosis, treated 2+ years ago, currently aged 18-39. Analyses were restricted to Hispanic participants currently living in California (n=522) who completed an acculturation measure. Multivariable linear regression was used to assess the association of depressive symptoms with neighborhood Hispanic ethnic enclave and individual acculturation, controlling for relevant demographic and clinical factors. Ethnic enclave residence was also explored as a potential moderator of the effect of acculturation on depressive symptoms. Ethnic enclave is a composite index based on census data reflecting household linguistic isolation, English language proficiency, and proportion of Hispanics, foreign born, and recent immigrants in a given census tract. This index score was dichotomized for analysis (based on the statewide distribution). A bi-dimensional acculturation scale measured Hispanic and Anglo orientation, but due to limited variability on the Anglo subscale (majority of the sample reported high Anglo orientation), it was excluded from the interaction model to focus on differences by Hispanic orientation. Results In a multivariable model of main effects controlling for age, sex, treatment intensity, years since diagnosis, and education, a significant negative association between Hispanic orientation and depressive symptoms was found (b=-0.17, p=0.03) while no significant association was found for ethnic enclave. When accounting for the interaction, ethnic enclave was found to moderate the association with Hispanic orientation. When stratifying models by enclave, Hispanic orientation was negatively associated with depressive symptoms for those residing in high ethnic enclaves (b=-0.24, p=0.01), while there was no significant association observed for those residing in low enclaves. Conclusions These results suggest that concordance between an individual’s ethnic orientation and the neighborhood cultural context may be protective against poor mental health. One potential mediating factor is increased social support and future research should examine this factor to better understand contributors to mental health across the survivorship continuum among CCS and to identify groups that may benefit from targeted intervention and/or survivorship support services.
Citation Format: Jessica Tobin, Myles Cockburn, Brian K Finch, Ann S Hamilton, Joel E Milam. Multilevel factors associated with depressive symptoms among long-term survivors of childhood cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C065.