Neighborhood Characteristics Related to Cancer Risk Factors and Outcomes

描述(由申请人提供)：较低的体力活动水平、“不健康”的饮食和超重/肥胖的存在是几种癌症的既定危险因素。人们对探索环境特征与慢性疾病之间的潜在联系越来越感兴趣，例如女性的乳腺癌。我们小组之前所做的研究表明，社区特征，如步行能力，与慢性病的风险因素之间存在联系。因此，利用妇女健康倡议(WHI)的圣地亚哥队列，我们建议测试这一假设，即社区特征可能会缓和常见行为风险因素与乳腺癌、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.评估邻里环境因素之间的基线关联性(建筑、 与癌症相关的常见风险因素(体力活动、饮食、体重指数)。 2.在调整相关的癌症危险因素后，确定周围环境因素对发生癌症的潜在直接影响(乳腺癌、结直肠癌、总体)。 3.使用多变量模型，确定周围环境和癌症危险因素对癌症预后的直接、中介或缓和影响。参与者住所1公里缓冲区内的社区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联系起来。然后，这些数据将被合并到圣地亚哥WHI队列的现有数据中，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央医生裁判员判定的癌症事件。一旦联系起来，将进行适当的分析，以测试上面列出的具体目标。我们相信，这项拟议的研究是创新的，因为它具有前瞻性，它将测试多种社区特征与癌症风险因素和多种癌症类型之间的联系。这项研究很重要，因为它将现有的关于邻里特征的文献从常见的行为风险因素扩展到癌症发生，它将提供信息并潜在地影响关于邻里结构与癌症事件之间关联的理论模型。因此，这项研究可能会对社区设计和发展的政策制定产生影响。与公共健康相关：较低的体力活动水平、“不健康”的饮食以及超重/肥胖的存在是几种癌症的既定危险因素。人们越来越感兴趣的是确定一个人所处的环境与慢性疾病之间是否存在联系，比如女性的乳腺癌。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、结直肠癌和总癌症之间的关联。

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.