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

摘要 乳腺癌是亚太地区最常见的癌症，也是癌症死亡的主要原因 岛民(API)和西班牙裔妇女，这两个美国增长最快的少数族裔群体，由于 移民局。一旦确诊，API移民妇女的病情与西班牙裔移民妇女相似或更差 BC的存活率比种族相似的美国出生的女性更好，后者尽管在诊断中处于后期。 调查人员经常推测，社交网络在以下人群的BC结果中扮演着重要角色 移民人口，通过因居住在社区而保持的有益健康行为 以“种族或移民飞地”为特征，或通过与减少可获得性有关的不良行为 资源。在个人层面，在大部分非西班牙裔白人人口中，拥有大量支持性社会地位的女性 网络已被证明具有更好的健康行为和BC存活率。然而，没有研究表明 探讨了社会网络对健康行为和BC的多层次(社区和个人)影响 在不同的API和西班牙裔移民妇女中的结果。因此，在大(N=6,184)的情况下，汇聚了北方 加利福尼亚州683名西班牙裔(41%移民)、851名API(59%移民)和4650名(8%移民)nhw 来自路径、癌症后生活流行病学和亚洲CHI研究的女性被诊断为 在第一至第四阶段，我们建议：1)评估移民身份与社会网络之间的关联。 邻里一级(即移民和族裔飞地以及社会文化机构)和个人一级 (即自我报告的社会关系的规模、多样性、质量和类型)，总体和按种族/族裔；2)评估 移民身份、多层次社会网络特征与行为因素的关系 已知影响卑诗省生存的因素(西方饮食、大豆和乳制品消费、体力活动时间、 饮酒量和频率、当前吸烟年限和背包年限、肥胖和腰围)，总体 以及3)评估移民身份、多层次社会网络 特征和BC结果，包括复发、BC特定死亡率和总死亡率，总体和 种族/民族，评估社会网络特征和健康行为的中介程度 联想。我们将使用元分析技术来评估研究的异质性；线性、逻辑和 分析目标1和目标2中的关联的广义线性混合效应(多水平)模型；以及多水平 用COX比例风险回归方法评价关联度在AIM 3中的唯一收敛细节 关于移民身份、种族/族裔、多层次社会网络、高度详细的行为测量以及 BC结果，为研究社会网络对健康的多层次影响提供了第一个机会 不同的患有BC的移民女性的行为和BC结局，调整了一组广泛的协变量。 这项工作对于确定不同种族移民女性BC差异的潜在因素至关重要， 特别是那些尽管在社会经济上处于不利地位，但具有良好的BC结果的因素。

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.