title: Neighborhood influences on recreational physical activity and survival after breast cancer.
abstract: OBJECTIVE
  Higher levels of physical activity have been associated with improved survival after breast cancer diagnosis. However, no previous studies have considered the influence of the social and built environment on physical activity and survival among breast cancer patients.
  
  
  METHODS
  Our study included 4,345 women diagnosed with breast cancer (1995-2008) from two population-based studies conducted in the San Francisco Bay Area. We examined questionnaire-based moderate/strenuous recreational physical activity during the 3 years before diagnosis. Neighborhood characteristics were based on data from the 2000 US Census, business listings, parks, farmers' markets, and Department of Transportation. Survival was evaluated using multivariable Cox proportional hazards models, with follow-up through 2009.
  
  
  RESULTS
  Women residing in neighborhoods with no fast-food restaurants (vs. fewer fast-food restaurants) to other restaurants, high traffic density, and a high percentage of foreign-born residents were less likely to meet physical activity recommendations set by the American Cancer Society. Women who were not recreationally physically active had a 22% higher risk of death from any cause than women that were the most active. Poorer overall survival was associated with lower neighborhood socioeconomic status (SES) (p(trend) = 0.02), whereas better breast cancer-specific survival was associated with a lack of parks, especially among women in high-SES neighborhoods.
  
  
  CONCLUSIONS
  Certain aspects of the neighborhood have independent associations with recreational physical activity among breast cancer patients and their survival. Considering neighborhood factors may aide in the design of more effective, tailored physical activity programs for breast cancer survivors.
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA, theresa.keegan@cpic.org.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.forename: Salma
authors.initials: S
authors.lastname: Shariff-Marco
authors.forename: Meera
authors.initials: M
authors.lastname: Sangaramoorthy
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Koo
authors.forename: Andrew
authors.initials: A
authors.lastname: Hertz
authors.forename: Clayton W
authors.initials: CW
authors.lastname: Schupp
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.forename: Esther M
authors.initials: EM
authors.lastname: John
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Gomez
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality*; D015444:Exercise; D005260:Female; D006801:Humans; D008875:Middle Aged; D011156:Population Density; D016016:Proportional Hazards Models; D011998:Recreation; D012111:Residence Characteristics / Q000145:classification*; D040242:Risk Reduction Behavior; D012495:San Francisco / Q000453:epidemiology; D012923:Social Class; D012931:Social Environment; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D014186:Transportation; D014481:United States
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