Social networks and disparities in health behaviors and breast cancer outcomes in immigrant women

移民妇女的社交网络以及健康行为和乳腺癌结果的差异

基本信息

批准号：
9899953
负责人：
CANDYCE H KROENKE
金额：
$ 64.58万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9899953
关键词：
Affect Alcohol consumption Asians Behavior Behavioral Breast Cancer Risk Factor California Cancer Etiology Characteristics Chinese People Clinical Complex Consumption Country Data Diagnosis Ethnic Origin Ethnic group Family Frequencies Friends Health Health behavior Heterogeneity Hispanics Hour Household Immigrant Immigration Individual Institution Intake Internet Intervention Lead Life Linguistics Logistics Mediating Mexican Neighborhoods Not Hispanic or Latino Obesity Outcome Pacific Island Americans Pathway interactions Patient Self-Report Pattern Physical activity Play Population Race Recommendation Recurrence Research Research Personnel Resources Risk Risk Behaviors Risk Factors Role Smoking Social Network Social Obligations Social Processes Stage at Diagnosis Structure Subgroup Techniques Woman Work behavior change behavior measurement breast cancer diagnosis breast cancer survival cancer diagnosis cancer epidemiology cancer health disparity cigarette smoking cohort ethnic diversity ethnic minority population hazard health disparity improved improved outcome insight malignant breast neoplasm mortality mortality risk multilevel analysis residence resilience social social culture social disparities social factors social relationships socioeconomic disadvantage soy survivorship tumor western diet

项目摘要

ABSTRACT Breast cancer (BC) is the most commonly diagnosed cancer and cause of cancer mortality in Asian/Pacific Islander (API) and Hispanic women, the two most rapidly growing minority ethnic groups in the US due to immigration. Once diagnosed, immigrant API women have similar or worse, and immigrant Hispanic women have better, BC survival than ethnically similar, US-born women, the latter despite later stage at diagnosis. Investigators have frequently speculated that social networks play an important role in BC outcomes among immigrant populations, through beneficial health behaviors that are maintained due to living in neighborhoods characterized as “ethnic or immigrant enclaves” or through adverse behaviors related to reduced availability of resources. At the individual level, in largely non-Hispanic white populations, women with large supportive social networks have been shown to have better health behaviors and BC survival. However, no research has explored the multilevel (neighborhood and individual) influence of social networks on health behaviors and BC outcomes in diverse API and Hispanic immigrant women. Therefore, in a large (N=6,184), pooled northern California cohort of 683 Hispanic (41% immigrant), 851 API (59% immigrant), and 4,650 (8% immigrant) NHW women from the Pathways, the Life After Cancer Epidemiology, and the Asian CHI studies, diagnosed with stage I-IV BC, we propose to: 1) Evaluate associations between immigrant status and social networks at the neighborhood level (i.e., immigrant and ethnic enclaves and sociocultural institutions) and at the individual level (i.e., self-reported size, diversity, quality, and type of social ties), overall and by race/ethnicity; 2) Evaluate associations between immigrant status and multilevel social network characteristics with behavioral factors known to influence BC survival (Western diet, soy and dairy consumption, MET-hours of physical activity, amount and frequency of alcohol intake, current and pack years of smoking, obesity, and waist size), overall and by race/ethnicity; and 3) Evaluate associations between immigrant status, multilevel social network characteristics, and BC outcomes including recurrence, BC-specific mortality, and total mortality, overall and by race/ethnicity, evaluating the degree to which social network characteristics and health behaviors mediate associations. We will use meta-analytic techniques to evaluate study heterogeneity; linear, logistic, and generalized linear mixed effects (multilevel) models to analyze associations in Aims 1 and 2; and multi-level Cox proportional hazards regression to evaluate associations in Aim 3. The unique convergence of detailed data on immigrant status, race/ethnicity, multilevel social networks, highly detailed behavioral measures, and BC outcomes, provides the first opportunity to examine the multilevel influence of social networks on health behaviors and BC outcomes in diverse immigrant women with BC, adjusted for an extensive set of covariates. This work is central to identifying factors underlying BC disparities in ethnically diverse immigrant women, particularly those factors underlying favorable BC outcomes despite socioeconomic disadvantage.

抽象的乳腺癌（BC）是亚洲/太平洋中最常见的癌症和癌症死亡率的原因岛民（API）和西班牙裔妇女，由于移民。一旦被诊断出，移民API妇女的妇女和移民西班牙裔妇女的妇女相似或更糟比种族相似，出生于美国的妇女的生存更好，后者是后一个目的地。调查人员经常推测，社交网络在卑诗省的成果中起着重要作用移民人口，通过由于生活在社区中而维持的有益的健康行为被特征为“种族或移民飞地”或通过与降低的可用性相关的不利行为资源。在个人层面，在很大程度上是非西班牙裔白人人群中，具有庞大支持社会的女性已显示网络具有更好的健康行为和卑诗省的生存。但是，没有研究探索了社交网络对健康行为和卑诗省的多层次（社区和个人）影响潜水员API和西班牙裔移民妇女的结果。因此，在一个大的（n = 6,184）中，合并了北部加利福尼亚州的683个西班牙裔（41％移民），851 API（59％移民）和4,650（8％的移民）NHW 来自途径的妇女，癌症流行病学后的生活和亚洲卡研究，被诊断出患有 I-IV阶段BC，我们建议：1）评估移民身份与社交网络之间的关联社区层面（即移民和族裔飞地以及社会文化机构）以及个人一级（即自我报告的规模，多样性，质量和社交关系类型），总体和种族/种族； 2）评估移民身份与多层次社交网络特征与行为因素之间的关联已知会影响卑诗省的生存期（西方饮食，大豆和乳制品消费，体育锻炼的情况小时，酒精摄入量的数量和频率，当前和包装的吸烟，肥胖和腰部大小），总体上并通过种族/种族； 3）评估移民身份，多级社交网络之间的关联特征和卑诗省的结果，包括复发，卑诗省特定的死亡率和总死亡率，总体上以及种族/民族，评估社交网络特征和健康行为的程度协会。我们将使用荟萃分析技术评估研究异质性；线性，逻辑和广义线性混合效应（多级）模型，以分析目标1和2中的关联；和多层次 COX比例危害回归以评估AIM 3中的关联。细节的独特融合有关移民身份，种族/民族，多层次社交网络，高度详细的行为措施的数据以及卑诗省的成果，提供了第一个机会来检查社交网络对健康的多层次影响卑诗省潜水员移民妇女的行为和卑诗省的结果，为广泛的协变量进行了调整。这项工作对于确定种族多元化妇女的卑诗省差异的因素至关重要，尤其是卑诗省结果目的地社会经济障碍的基本因素。