The influence of the built environment on outcomes after breast cancer

描述（由申请人提供）：对于乳腺癌（BC），美国女性最常见的癌症，诊断后的5年相对生存率现在接近90%，导致2005年估计有230万美国BC幸存者。然而，由于BC是癌症死亡的第二大原因，并且幸存者复发，第二种癌症，不良结局和过早死亡的风险增加，因此确定可以降低这些疾病风险并提高生存率的可改变因素至关重要，特别是在结果不太有利的种族/少数民族人群中。一些流行病学证据表明，身体大小和体力活动可能是这种可变因素，而且，它们与社区“建筑环境”的特点，如步行目的地的数量和娱乐设施和超市的可用性。鉴于公共卫生努力减少超重/肥胖和增加体力活动的成功有限，这是NIH的两个突出目标，重要的是要考虑对体力活动行为的替代影响。这一目标对于BC幸存者尤其重要，他们体重增加和体力活动减少的风险更大。到目前为止，没有研究直接评估建筑环境和BC结果之间的关系;因此，本研究旨在考虑身体活动，体型和建筑环境对总生存率，BC特异性生存率和BC诊断后第二原发癌的综合影响。在此过程中，本研究将评估这些变量和结果之间的独立关联，以及这些变量之间的关系。利用地理信息系统技术，这项研究有效地结合了客观表征加州州北方大弗朗西斯科湾区建筑环境的数据，基于人口的大湾区癌症登记处的癌症诊断和随访数据，以及来自4，000多个种族的个人水平风险因素的访谈数据。（非裔美国人、西班牙裔、亚裔美国人和非西班牙裔白色）参与两项基于人群的研究的BC患者。将使用回归模型评估关注变量之间的相关性，并在生存分析中使用多变量校正的考克斯比例风险模型。公共卫生相关性：这项研究有可能确定如何改变社区环境，以改善身体活动，从而改善BC幸存者的结果。如果建筑环境被证明会影响行为和结果，那么城市和公共卫生规划者可以利用这些知识来倡导改变建筑环境，卫生保健专业人员可以利用这些知识来设计诊断后治疗方案和/或建议，以更好地利用现有的建筑环境来改善BC幸存者的健康行为。

DESCRIPTION (provided by applicant): For breast cancer (BC), the most common cancer of US women, the 5-year relative survival after diagnosis is now nearing 90%, resulting in an estimated 2.3 million US BC survivors in 2005. Yet, because BC is the 2nd leading cause of cancer death, and survivors have increased risks of recurrence, second cancers, adverse outcomes, and premature death, it is critical to identify modifiable factors that can reduce the risk for these conditions and improve survival, particularly in racial/ethnic minority populations who have less favorable outcomes. Some epidemiologic evidence suggests that body size and physical activity may be such modifiable factors and, moreover, that they are associated with community "built environment" characteristics such as the number of walkable destinations and the availability of recreation facilities and supermarkets. Given the limited success of public health efforts to reduce overweight/obesity and increase physical activity, two prominent goals of the NIH, it is important to consider alternative influences on physical activity behavior. This goal is particularly important for BC survivors, who are at greater risk of weight gain and decreased physical activity. To date, no studies have directly assessed the relationship between the built environment and BC outcomes; therefore, this study aims to consider the combined effects of physical activity, body size, and a comprehensive set of measures of the built environment on overall survival, BC-specific survival and second primary cancer after BC diagnosis. In doing so, this study will assess the independent associations between each of these variables and outcomes, and the relationships of these variables to each other. Utilizing Geographic Information Systems technology, this study efficiently combines data that objectively characterizes the built environments of the Greater San Francisco Bay Area of northern California, data on cancer diagnosis and follow-up from the population-based Greater Bay Area Cancer Registry, and interview data on individual level risk factors from over 4,000 multiethnic (African-American, Hispanic, Asian-American and non-Hispanic white) BC patients who participated in two population-based studies. Regression models will be used to assess the association between variables of interest and multivariate adjusted Cox proportional hazards modeling will be used in the survival analyses. PUBLIC HEALTH RELEVANCE: This study has the potential to identify how community environments may be changed to improve physical activity that, in turn, may improve outcomes in BC survivors. If the built environment proves to influence behaviors and outcomes, then this knowledge can be used by urban and public health planners to advocate changes to the built environment, and by health care professionals to design post-diagnosis treatment programs and/or recommendations for taking greater advantage of the existing built environment to improve health behaviors among BC survivors.