Social networks and disparities in health behaviors and breast cancer outcomes in immigrant women

移民妇女的社交网络以及健康行为和乳腺癌结果的差异

• 批准号: 10454120
• 负责人: CANDYCE H KROENKE
• 金额: $ 65.66万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10454120
• 关键词: Affect; Alcohol consumption; Asian; Asian Pacific Islander; Behavior; Behavioral; Breast Cancer Risk Factor; California; Cancer Etiology; Characteristics; Chinese; Clinical; Complex; Consumption; Country; Data; Diagnosis; Ethnic Origin; Family; Frequencies; Friends; Health; Health behavior; Heterogeneity; Hispanic; Hispanic Populations; Hour; Household; Immigrant; Immigration; Individual; Institution; Intake; Internet; Intervention; Lead; Life; Linguistics; Logistics; Mediating; Mexican; Neighborhoods; Not Hispanic or Latino; Obesity; Outcome; Pathway interactions; Patient Self-Report; Pattern; Physical activity; Play; Population; Quality of life; Race; Recommendation; Recurrence; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Role; Smoking; Smoking History; Social Network; Social Obligations; Social Processes; Stage at Diagnosis; Structure; Subgroup; Techniques; Woman; Work; behavior change; behavior measurement; breast cancer diagnosis; breast cancer survival; cancer diagnosis; cancer epidemiology; cancer health disparity; cigarette smoking; cohort; ethnic diversity; ethnic minority; ethnic minority population; hazard; health disparity; improved; improved outcome; insight; malignant breast neoplasm; mortality; mortality risk; multilevel analysis; residence; resilience; social; social culture; social disparities; social factors; social influence; social relationships; socioeconomic disadvantage; soy; survivorship; tumor; western diet

ABSTRACT Breast cancer (BC) is the most commonly diagnosed cancer and cause of cancer mortality in Asian/Pacific Islander (API) and Hispanic women, the two most rapidly growing minority ethnic groups in the US due to immigration. Once diagnosed, immigrant API women have similar or worse, and immigrant Hispanic women have better, BC survival than ethnically similar, US-born women, the latter despite later stage at diagnosis. Investigators have frequently speculated that social networks play an important role in BC outcomes among immigrant populations, through beneficial health behaviors that are maintained due to living in neighborhoods characterized as “ethnic or immigrant enclaves” or through adverse behaviors related to reduced availability of resources. At the individual level, in largely non-Hispanic white populations, women with large supportive social networks have been shown to have better health behaviors and BC survival. However, no research has explored the multilevel (neighborhood and individual) influence of social networks on health behaviors and BC outcomes in diverse API and Hispanic immigrant women. Therefore, in a large (N=6,184), pooled northern California cohort of 683 Hispanic (41% immigrant), 851 API (59% immigrant), and 4,650 (8% immigrant) NHW women from the Pathways, the Life After Cancer Epidemiology, and the Asian CHI studies, diagnosed with stage I-IV BC, we propose to: 1) Evaluate associations between immigrant status and social networks at the neighborhood level (i.e., immigrant and ethnic enclaves and sociocultural institutions) and at the individual level (i.e., self-reported size, diversity, quality, and type of social ties), overall and by race/ethnicity; 2) Evaluate associations between immigrant status and multilevel social network characteristics with behavioral factors known to influence BC survival (Western diet, soy and dairy consumption, MET-hours of physical activity, amount and frequency of alcohol intake, current and pack years of smoking, obesity, and waist size), overall and by race/ethnicity; and 3) Evaluate associations between immigrant status, multilevel social network characteristics, and BC outcomes including recurrence, BC-specific mortality, and total mortality, overall and by race/ethnicity, evaluating the degree to which social network characteristics and health behaviors mediate associations. We will use meta-analytic techniques to evaluate study heterogeneity; linear, logistic, and generalized linear mixed effects (multilevel) models to analyze associations in Aims 1 and 2; and multi-level Cox proportional hazards regression to evaluate associations in Aim 3. The unique convergence of detailed data on immigrant status, race/ethnicity, multilevel social networks, highly detailed behavioral measures, and BC outcomes, provides the first opportunity to examine the multilevel influence of social networks on health behaviors and BC outcomes in diverse immigrant women with BC, adjusted for an extensive set of covariates. This work is central to identifying factors underlying BC disparities in ethnically diverse immigrant women, particularly those factors underlying favorable BC outcomes despite socioeconomic disadvantage.

抽象的 乳腺癌 (BC) 是亚太地区最常诊断的癌症，也是癌症死亡的原因 岛民 (API) 和西班牙裔女性是美国增长最快的两个少数族裔群体，原因是 移民。一旦确诊，移民 API 女性的症状与移民西班牙裔女性相似或更严重 与种族相似的美国出生的女性相比，乳腺癌的生存率更高，尽管后者在诊断时处于晚期。 研究人员经常推测社交网络在BC结果中发挥着重要作用 移民人口通过居住在社区而保持的有益健康行为 被定性为“种族或移民飞地”或通过与减少可得性相关的不良行为 资源。在个人层面上，在大部分非西班牙裔白人群体中，拥有大量社会支持的女性 网络已被证明具有更好的健康行为和 BC 生存率。然而，尚无研究 探讨了社交网络对健康行为和BC的多层次（邻居和个人）影响 不同 API 和西班牙裔移民妇女的结果。因此，在一个大型（N = 6,184）中，汇集了北方 加州队列由 683 名西班牙裔（41% 移民）、851 名 API（59% 移民）和 4,650 名 NHW（8% 移民）组成 来自 Pathways、癌症流行病学后的生活和亚洲 CHI 研究的女性被诊断患有 在 BC 第一至第四阶段，我们建议： 1) 评估移民身份与社交网络之间的关联 社区层面（即移民和民族飞地以及社会文化机构）和个人层面 （即自我报告的规模、多样性、质量和社会关系类型），总体和按种族/族裔分类； 2）评估 移民身份和多层次社交网络特征与行为因素之间的关联 已知会影响 BC 存活率（西方饮食、大豆和乳制品消费、体力活动的 MET 小时数、 饮酒量和频率、当前吸烟情况和吸烟年数、肥胖情况和腰围），总体 以及按种族/民族分类； 3) 评估移民身份、多层次社交网络之间的关联 特征和 BC 结果，包括复发率、BC 特异性死亡率和总死亡率（总体和按比例） 种族/民族，评估社交网络特征和健康行为的中介程度 协会。我们将使用荟萃分析技术来评估研究异质性；线性、逻辑和 用于分析目标 1 和 2 中关联的广义线性混合效应（多级）模型；和多层次的 Cox 比例风险回归评估目标 3 中的关联。 有关移民身份、种族/族裔、多层次社交网络、高度详细的行为测量的数据，以及 BC 结果提供了第一个研究社交网络对健康的多层次影响的机会 患有 BC 的不同移民女性的行为和 BC 结果，根据一组广泛的协变量进行了调整。 这项工作对于确定不列颠哥伦比亚省不同种族的移民妇女之间的差异背后的因素至关重要， 特别是那些尽管社会经济处于不利地位但仍能带来有利的 BC 结果的因素。