title: Influence of neighborhood-level factors on social support in early-stage breast cancer patients and controls.
abstract: BACKGROUND
  Low social support has been linked to negative health outcomes in breast cancer patients.
  
  
  OBJECTIVE
  We examined associations between perceived social support, neighborhood socioeconomic deprivation, and neighborhood-level social support in early-stage breast cancer patients and controls.
  
  
  METHODS
  This two-year longitudinal study in the United States included information collected from telephone interviews and clinical records of 541 early-stage patients and 542 controls recruited from 2003 to 2007. Social support was assessed using the Medical Outcomes Study Social Support Survey (MOS-SS). Residential addresses were geocoded and used to develop measures including neighborhood social support (based on MOS-SS scores from nearby controls) and neighborhood socioeconomic deprivation (a composite index of census tract characteristics). Latent trajectory models were used to determine effects of neighborhood conditions on the stable (intercept) and changing (slope) aspects of social support.
  
  
  RESULTS
  In a model with only neighborhood variables, greater socioeconomic deprivation was associated with patients' lower stable social support (standardized estimate = -0.12, p = 0.027); neighborhood-level social support was associated with social support change (standardized estimate = 0.17, p = 0.046). After adding individual-level covariates, there were no direct neighborhood effects on social support. In patients, neighborhood socioeconomic deprivation was associated with support indirectly through marriage, insurance status, negative affect, and general health. In controls, neighborhood socioeconomic deprivation was associated with support indirectly through marriage (p < 0.05).
  
  
  CONCLUSIONS
  Indirect effects of neighborhood socioeconomic deprivation on social support differed in patients and controls. Psychosocial and neighborhood interventions may help patients with low social support, particularly patients without partnered relationships in deprived areas.
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA. Electronic address: tessthompson@wustl.edu.
authors.forename: Tess
authors.initials: T
authors.lastname: Thompson
authors.affiliation: Department of Psychology, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Rodebaugh
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Pérez
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: James
authors.initials: J
authors.lastname: Struthers
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Julianne A
authors.initials: JA
authors.lastname: Sefko
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Min
authors.initials: M
authors.lastname: Lian
authors.affiliation: College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000523:psychology*; D016022:Case-Control Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009367:Neoplasm Staging; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Breast cancer; Health disparities; Longitudinal cohort study; Neighborhood socioeconomic deprivation; Perceived social support