Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
South Bay Latino Research Center, Department of Psychology, San Diego State University, San Diego, California.
Cancer Res Commun. 2023 Oct 2;3(10):1981-1991. doi: 10.1158/2767-9764.CRC-23-0187.
Neighborhood conditions are dynamic; the association of changing neighborhood socioeconomic factors with cancer preventive behaviors remains unclear. We examined associations of neighborhood socioeconomic deprivation, gentrification, and change in income inequality with adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The HCHS/SOL enrolled 16,415 adults, ages 18–74 years, at baseline (2008–2011), from communities in the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA. Geocoded baseline addresses were linked to the 2000 decennial Census and 5-year American Community Survey (2005–2009 and 2012–2016) tracts to operationalize neighborhood deprivation index (NDI), gentrification, and income inequality. Complex survey multinominal logistic regression models estimated the relative risk ratio (RRR) with overall guideline adherence level (low, moderate, high) and by components—diet, physical activity, body mass index (BMI), and alcohol intake. Overall, 14%, 60%, and 26% of the population had low, moderate, and high ACS guideline adherence, respectively. NDI was negatively associated with risk of high (vs. low) guideline adherence [RRR = 0.87, 95% confidence interval (CI) = 0.78–0.98], although attenuated after controlling for individual socioeconomic status (SES; RRR = 0.89, 95% CI = 0.80–1.00), and associated with lower adherence to BMI recommendations (low vs. moderate RRR = 0.90, 95% CI = 0.84–0.97; high RRR = 0.86, 95% CI = 0.77–0.97). Gentrification was associated with higher likelihood of meeting the dietary recommendations (low vs. moderate RRR = 1.04, 95% CI = 1.01–1.07), but not with overall adherence or individual components. Change in income inequality was not associated with outcomes. Neighborhood deprivation may be negatively associated with ACS guideline adherence among Hispanic/Latino adults.
This study provides new evidence on the link between neighborhood gentrification, changing income inequality and adoption and maintenance of cancer preventive behaviors in an understudied population in cancer research. We observed that while neighborhood deprivation may deter from healthy lifestyle behaviors, positive changes in neighborhood SES via the process of gentrification, may not influence lifestyle guideline adherence among Hispanic/Latino adults.
目的:社区环境是动态的,变化的社区社会经济因素与癌症预防行为之间的关联尚不清楚。我们研究了社区社会经济剥夺、高档化和收入不平等变化与《美国癌症协会营养和身体活动预防癌症指南》在西班牙裔社区健康研究/拉丁裔研究中的依从性之间的关系(HCHS/SOL)。HCHS/SOL 在基线(2008-2011 年)时招募了来自纽约布朗克斯、伊利诺伊州芝加哥、佛罗里达州迈阿密和加利福尼亚州圣地亚哥社区的 16415 名 18-74 岁的成年人。将基线的地理编码地址与 2000 年十年人口普查和 5 年美国社区调查(2005-2009 年和 2012-2016 年)进行了关联,以实施社区剥夺指数(NDI)、高档化和收入不平等。采用复杂调查多分类逻辑回归模型,根据整体指南依从水平(低、中、高)和饮食、体力活动、体重指数(BMI)和酒精摄入等组成部分,估计相对风险比(RRR)。总体而言,分别有 14%、60%和 26%的人群具有低、中、高 ACS 指南依从性。NDI 与高(而非低)指南依从性呈负相关[RRR=0.87,95%置信区间(CI)=0.78-0.98],但在控制个体社会经济地位(SES)后有所减弱(RRR=0.89,95%CI=0.80-1.00),并且与 BMI 建议的依从性较低有关(低 vs. 中 RRR=0.90,95%CI=0.84-0.97;高 RRR=0.86,95%CI=0.77-0.97)。高档化与更有可能符合饮食建议有关(低 vs. 中 RRR=1.04,95%CI=1.01-1.07),但与整体依从性或个体组成部分无关。收入不平等的变化与结果无关。社区贫困可能与西班牙裔/拉丁裔成年人的 ACS 指南依从性呈负相关。
意义:本研究为癌症研究中一个研究不足的人群中,邻里高档化、收入不平等变化与癌症预防行为的采用和维持之间的联系提供了新的证据。我们观察到,虽然社区贫困可能会阻碍健康的生活方式行为,但通过高档化过程中社区社会经济地位的积极变化,可能不会影响西班牙裔/拉丁裔成年人的生活方式指南依从性。