Neighborhood Characteristics Related to Cancer Risk Factors and Outcomes

描述（由申请人提供）：较低水平的体力活动、“不健康”饮食和超重/肥胖的存在是几种类型癌症的既定风险因素。人们越来越有兴趣探索环境特征与慢性疾病（如女性乳腺癌）之间的潜在联系。我们小组以前的研究已经证明了社区特征（如步行能力）与慢性病风险因素之间的联系。因此，使用妇女健康倡议（WHI）的圣地亚哥队列，我们建议测试的假设，邻里特征可能会缓和常见的行为危险因素和乳腺癌，结直肠癌和总癌症之间的关联。为此，我们建议进行一项研究，具体目标如下： 1.评估社区环境因素（建成， 社会人口统计学和食物）和常见的行为癌症相关风险因素（体力活动，饮食，体重指数）。 2.在调整相关癌症风险因素后，以确定邻近环境因素对癌症结局（乳腺癌、结直肠癌、总癌）的潜在直接影响。 3.使用多变量模型，以确定直接，介导或调节的影响，邻里环境和癌症风险因素对事件的癌症结果。参与者居住地1公里范围内的邻里特征将使用地理信息系统（GIS）进行地理编码，并与人口普查、土地使用和营业执照数据相关联。然后将该数据与圣地亚哥WHI队列的现有数据合并，其中包括广泛的基线特征（即体力活动、饮食和身体形态测量）以及使用标准方案和中心医生裁定者裁定的偶发癌症事件。一旦联系起来，将进行适当的分析，以检验上文所列的具体目标。我们相信这项研究是创新的，因为随访的前瞻性，它将测试多个社区特征之间的联系，不仅是癌症风险因素，但多种类型的癌症。这项研究很重要，因为它将扩展现有的文献对社区特征的共同行为风险因素以外的癌症事件，它将告知和潜在影响理论模型之间的联系邻里结构和癌症事件。因此，这项研究可能对邻里设计和发展的政策制定产生影响。公共卫生相关性：较低水平的身体活动、“不健康”的饮食和超重/肥胖的存在是几种癌症的既定风险因素。人们越来越有兴趣确定一个人所生活的环境与慢性病（如妇女的乳腺癌）之间是否存在联系。因此，我们建议确定社区环境是否影响常见行为风险因素与新发乳腺癌、结直肠癌和总癌之间的关联。

DESCRIPTION (provided by applicant): Lower levels of physical activity, an "unhealthy" diet and the presence of overweight/obesity are established risk factors for several types of cancer. There is a growing interest in exploring the potential links between environmental characteristics and chronic diseases, such as breast cancer in women. Previous research done by our group has demonstrated a link between neighborhood characteristics, such as walkability, and risk factors for chronic diseases. Therefore, using the San Diego cohort of the Women's Health Initiative (WHI), we propose to test the hypothesis that neighborhood characteristics would potentially moderate the association between common behavioral risk factors and incident breast, colorectal and total cancers. To do so, we propose to conduct a study employing the following specific aims: 1. To assess the baseline associations among the neighborhood environment factors (built, sociodemographic, and food) and common, behavioral cancer related risk factors (physical activity, diet, body mass index). 2. After adjustment for pertinent cancer risk factors, to determine the potential direct effects of the neighborhood environmental factors on incident cancer outcomes (breast, colorectal, total). 3. Using multivariable models, to ascertain the direct, mediated or moderated effects of both the neighborhood environment and cancer risk factors on incident cancer outcomes. Participants' neighborhood characteristics within a 1 kilometer buffer of their residence will be geocoded using geographic information systems (GIS) and linked to census, land use and business license data. This data will then be merged to the existing data from the San Diego WHI cohort, which includes extensive baseline characteristics (i.e. physical activity, dietary and body morphology measurements) as well as incident cancer events that were adjudicated using a standard protocol and central physician adjudicators. Once linked, appropriate analyses will be conducted to test the specific aims listed above. We believe the proposed study is innovative because of the prospective nature of the follow-up and it will test links between multiple neighborhood characteristics and not only cancer risk factors but multiple types of cancer. This research is important because it would extend the existing literature on neighborhood characteristics beyond common behavioral risk factors to incident cancers and it would inform and potentially influence theoretical models on the associations between neighborhood structure and cancer events. As such, this study could have implications for policy formulation on neighborhood design and development. PUBLIC HEALTH RELEVANCE: Lower levels of physical activity, an "unhealthy" diet and the presence of overweight/obesity are established risk factors for several types of cancer. There is a growing interest in determining if there are links between the environment in which one lives and chronic diseases, such as breast cancer in women. Therefore we propose to determine if the neighborhood environment influences the association between common behavioral risk factors and new breast, colorectal and total cancers.