Fuemmeler Bernard F, Boyle Joseph, Miller Carrie A, Ghosh Debarchana, Knott Cheryl L
Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23219, United States.
Massey Comprehensive Cancer Center, Richmond, VA 23219, United States.
JNCI Cancer Spectr. 2025 Jan 3;9(1). doi: 10.1093/jncics/pkaf015.
Emerging literature notes the importance of neighborhood-level factors for cancer control behaviors beyond that of individual factors. Markers of neighborhood-level disadvantage have been linked to greater likelihood of nonsalutary cancer control behaviors. There has been less examination of many neighborhood factors simultaneously, which more accurately reflects individuals' daily experiences. We estimated associations of neighborhood deprivation indices with cancer control behaviors, identifying the relative importance of neighborhood-level deprivation index components for these outcomes.
We used data from the Religion and Health in African Americans study, a national probability sample of African American adults. We separately considered 4 screening and 4 prevention behaviors as outcomes. We constructed neighborhood deprivation indices using census tract-level data and estimated their associations with outcomes using bayesian index models, adjusting for individual-level covariates. We reported odds ratios (ORs), credible intervals, and exceedance probabilities.
Participants in our sample engaged in relatively high levels of screening behaviors and lower levels of prevention behaviors. Neighborhood deprivation indices were statistically significantly associated with a greater likelihood of binge drinking (OR = 1.13, exceedance probability = 98.5%), smoking (OR = 1.07, exceedance probability = 99.4%), and insufficient colonoscopy (exceedance probability = 99.9%), Papanicolaou (exceedance probability = 99.7%), and prostate-specific antigen (exceedance probability = 99.1%) screening. Within neighborhood deprivation indices, median household income, percentage of individuals without some college education, and percentage of individuals unemployed received large estimated importance weights.
We identified statistically significant associations between neighborhood disadvantage and nonsalutary cancer control behaviors as well as important neighborhood-level deprivation index components for each outcome. These and similar findings from future studies should be used to target specific neighborhood factors for specific cancer control behaviors rather than using a one-size-fits-all approach.
新出现的文献指出，社区层面的因素对癌症控制行为的重要性超过了个体因素。社区层面不利因素的指标与不良癌症控制行为的可能性增加有关。同时对许多社区因素进行的研究较少，而这能更准确地反映个体的日常经历。我们估计了社区贫困指数与癌症控制行为之间的关联，确定了社区层面贫困指数各组成部分对这些结果的相对重要性。
我们使用了“非裔美国人的宗教与健康”研究的数据，这是一个非裔美国成年人的全国概率样本。我们分别将4种筛查行为和4种预防行为作为结果进行考虑。我们使用人口普查区层面的数据构建社区贫困指数，并使用贝叶斯指数模型估计它们与结果之间的关联，同时对个体层面的协变量进行调整。我们报告了优势比（OR）、可信区间和超越概率。
我们样本中的参与者进行筛查行为的水平相对较高，而预防行为的水平较低。社区贫困指数与暴饮暴食（OR = 1.13，超越概率 = 98.5%）、吸烟（OR = 1.07，超越概率 = 99.4%）以及结肠镜检查不足（超越概率 = 99.9%）、巴氏涂片检查（超越概率 = 99.7%）和前列腺特异性抗原筛查不足（超越概率 = 99.1%）的可能性显著相关。在社区贫困指数中，家庭收入中位数、未接受过大学教育的个体百分比以及失业个体百分比获得了较大的估计重要性权重。
我们发现社区不利因素与不良癌症控制行为之间存在统计学上的显著关联，并且确定了每个结果中重要的社区层面贫困指数组成部分。这些以及未来研究中的类似发现应用于针对特定癌症控制行为的特定社区因素，而不是采用一刀切的方法。
