Impact of social and built environments on health-related quality of life for cancer survivors

社会和建筑环境对癌症幸存者健康相关生活质量的影响

基本信息

批准号：
9673640
负责人：
Salma Shariff-Marco
金额：
$ 4.11万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-05 至 2019-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9673640
关键词：
Impact social built environments health

项目摘要

DESCRIPTION (provided by applicant): Neighborhoods have been shown to be a critical foundation for shaping individuals' opportunities for achieving optimal health. As the number of cancer survivors continues to increase, with over 13 million in the U.S. currently, understanding factors that improve health-related quality of life (HRQOL) after cancer diagnosis is critical. Unless we identify and address the relevant contextual factors, interventions that only target individual factors are likely to have limited effectiveness. However, only three studies have considered neighborhood factors, despite that neighborhoods have been shown to influence health outcomes through a number of pathways--environmental exposures, material deprivation, psychosocial mechanisms, health behaviors, and access to resources. Therefore, we propose to leverage and pool individual-level data on sociodemographic, clinical, social, and behavioral factors from three existing cancer survivorship studies and merge them with neighborhood data. Specifically, we aim to (1) examine the associations between a comprehensive suite of social and built environment features and HRQOL, (a) adjusting for important covariates (e.g., clinical, demographic, social and behavioral factors) and (b) evaluating whether these associations vary by race/ethnicity, age, or gender, and (2) assess racial/ethnic disparities in HRQOL and evaluate whether these disparities are explained by clinical, demographic, social and behavioral factors, neighborhood factors, or a combination of them. To achieve these aims, with harmonized data across three California population-based studies (n=2,563, 46% minority)-Assessment of Patients' Experience of Cancer Care (APECC), Experiences of Care and Health Outcomes of survivors of Non-Hodgkin's Lymphoma (ECHOS-NHL), and Follow-up Care Use among Survivors (FOCUS)-we will geocode address at interview and merge the individual-level data with our social (e.g., socioeconomic, racial/ethnic composition, immigration) and built (e.g., population density, street connectivity, commuting, amenities, food environment) environment data. The main HRQOL outcomes will include physical and mental component summary scores. Linear regression models will be used to estimate unadjusted and adjusted associations between neighborhood features and the two HRQOL outcomes. Further, we will document racial/ethnic disparities in HRQOL and evaluate whether neighborhood features explain these disparities. This efficient study will be powered to detect significant neighborhoods effects across all of the cancer sites, as well as for 5 specific sites -breast, colorectal, gynecologic, NHL, and prostate. Our findings will provide the preliminary evidence for associations between the built and social environment and HRQOL and contribute significantly to our understanding of which neighborhood features influence HRQOL. Our collaboration with the Shanti Project will ensure that our study will meaningfully inform the design of multilevel interventions that not only account for individual factors that contribute to HRQOL, but also the context through which those individual factors are shaped.

描述（由适用提供）：已证明社区是塑造个人实现最佳健康机会的关键基础。随着癌症存活的数量继续增加，目前在美国超过1300万，了解在癌症诊断后改善健康相关生活质量（HRQOL）的因素至关重要。除非我们确定并解决相关的上下文因素，否则仅针对个人因素的干预措施可能有限。但是，只有三项研究考虑了邻里因素，即通过多种环境暴露，物质剥夺，心理社会机制，健康行为和获得资源的机会来影响邻里的目的地。因此，我们建议从三个现有的癌症生存研究中利用和汇总有关社会人口统计学，临床，社会和行为因素的个人级别数据，并将其与邻里数据合并。具体而言，我们的目的是（1）检查社交和建筑环境特征和HRQOL的全面套件之间的关联，（a）调整重要的协变量（例如，临床，人口统计学，社会和行为因素），以及（b）评估这些关联因种族/族裔，年龄，年龄，（2）评估HER中的疾病是否有所不同临床，人口，社会和行为因素，邻里因素或它们的组合。为了实现这些目标，在三项基于加利福尼亚人群的研究（n = 2,563，46％的少数族裔）中进行了统一的数据 - 对患者的癌症护理经验（APECC）的经验，非霍奇金淋巴瘤（ECHOS-NHL）幸存者的护理和健康成果经验（ECHOS-NHL）（ECHOS-NHL）（ECHOS-NHL）（ECHOS-NHL）（ECHOS-NHL）（ECHOS-NHL）以及我们的社交习惯，我们将与我们的社会进行访问 - 我们将在Geecode（我们将在Geocode） - 我们（Will geocode） - 我们（WILL GEOCELE） - 我们（WILL GEOCELE） - 我们（我们将在Geocode） - 我们（我们）（例如，社会经济，种族/种族组成，移民）和建造（例如人口密度，街道连通性，承诺，设施，食品环境）环境数据。 HRQOL的主要结果将包括身体和心理成分摘要分数。线性回归模型将用于估计邻域特征与两个HRQOL结果之间未经调整和调整的关联。此外，我们将记录HRQOL中的种族/种族差异，并评估邻里特征是否解释了这些差异。这项有效的研究将有助于检测重要的社区所有癌症部位以及5个特定部位的影响 - 乳房，结直肠，妇科，NHL和前列腺。我们的发现将为建筑环境与社会环境与HRQOL之间的关联提供初步证据，并为我们对哪些社区特征影响HRQOL的理解做出了重大贡献。我们与Shanti项目的合作将确保我们的研究将有意义地为多层次干预措施的设计提供信息，这些干预措施不仅说明了对HRQOL有助的个体因素，而且还解释了这些单个因素所塑造的背景。