Impact of Social and Built Environment Factors on Body Size among Breast Cancer Survivors: The Pathways Study.
Background:As social and built environment factors have been shown to be associated with physical activity, dietary patterns, and obesity in the general population, they likely also influence these health behaviors among cancer survivors and thereby impact survivorship outcomes.Methods:Enhancing the rich, individual-level survey and medical record data from 4,505 breast cancer survivors in the Pathways Study, a prospective cohort drawn from Kaiser Permanente Northern California, we geocoded baseline residential addresses and appended social and built environment data. With multinomial logistic models, we examined associations between neighborhood characteristics and body mass index and whether neighborhood factors explained racial/ethnic/nativity disparities in overweight/obesity.Results:Low neighborhood socioeconomic status, high minority composition, high traffic density, high prevalence of commuting by car, and a higher number of fast food restaurants were independently associated with higher odds of overweight or obesity. The higher odds of overweight among African Americans, U.S.-born Asian Americans/Pacific Islanders, and foreign-born Hispanics and the higher odds of obesity among African Americans and U.S.-born Hispanics, compared with non-Hispanic whites, remained significant, although somewhat attenuated, when accounting for social and built environment features.Conclusions:Addressing aspects of neighborhood environments may help breast cancer survivors maintain a healthy body weight.Impact:Further research in this area, such as incorporating data on individuals' perceptions and use of their neighborhood environments, is needed to ultimately inform multilevel interventions that would ameliorate such disparities and improve outcomes for breast cancer survivors, regardless of their social status (e.g., race/ethnicity, socioeconomic status, nativity).Cancer Epidemiol Biomarkers Prev; 26(4); 505-15. ©2017 AACRSee all the articles in thisCEBP Focussection, "Geospatial Approaches to Cancer Control and Population Sciences."
Cancer Prevention Institute of California, Fremont, California.|Stanford Cancer Institute, Stanford, California.
Salma
S
Shariff-Marco
Cancer Prevention Institute of California, Fremont, California.
Julie
J
Von Behren
Cancer Prevention Institute of California, Fremont, California.|Stanford Cancer Institute, Stanford, California.
Peggy
P
Reynolds
School of Medicine, University of California at Davis, Davis, California.
Theresa H M
TH
Keegan
Cancer Prevention Institute of California, Fremont, California.
Andrew
A
Hertz
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Marilyn L
ML
Kwan
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Janise M
JM
Roh
Zero Breast Cancer, San Rafael, California.
Catherine
C
Thomsen
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Candyce H
CH
Kroenke
Roswell Park Cancer Institute, Buffalo, New York.
Christine
C
Ambrosone
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Lawrence H
LH
Kushi
Cancer Prevention Institute of California, Fremont, California. scarlett@cpic.org.|Stanford Cancer Institute, Stanford, California.
Scarlett Lin
SL
Gomez
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D049628:Body Size; D001943:Breast Neoplasms / Q000453:epidemiology*; D002140:California; D000073116:Cancer Survivors / Q000706:statistics & numerical data*; D015331:Cohort Studies; D057140:Fast Foods / Q000600:supply & distribution; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors