The influence of the built environment on outcomes after breast cancer

建筑环境对乳腺癌术后预后的影响

• 批准号: 7739114
• 负责人: Theresa H M Keegan
• 金额: $ 15.95万
• 依托单位: CANCER PREVENTION INSTIT OF CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7739114
• 关键词: Advocate; African American; Area; Asian Americans; Automobile Driving; Behavior; Body Size; Body mass index; Breast Cancer Prognostic Factor; California; Cancer Etiology; Cancer Patient; Cancer Survivor; Cardiovascular Diseases; Cessation of life; Characteristics; Communities; Cox Proportional Hazards Models; Data; Destinations; Diabetes Mellitus; Diagnosis; Environment; Epidemiologic Studies; Food; Geographic Information Systems; Goals; Health; Health Professional; Health behavior; Hispanics; Individual; Interview; Joints; Knowledge; Life; Malignant Neoplasms; Measures; Modeling; Neighborhoods; Not Hispanic or Latino; Obesity; Osteoporosis; Outcome; Overweight; Patients; Physical activity; Pilot Projects; Population; Public Health; Recommendation; Recreation; Recurrence; Relative (related person); Risk; Risk Factors; San Francisco; Second Primary Cancers; Supermarket; Survival Analysis; Survivors; Technology; Time; United States; United States National Institutes of Health; Walking; Weight Gain; Woman; behavior influence; breast cancer diagnosis; cancer diagnosis; design; ethnic minority population; follow-up; improved; interest; malignant breast neoplasm; mortality; neoplasm registry; population based; premature; prognostic; public health relevance; racial and ethnic; racial and ethnic disparities; success; treatment program; urban public health

DESCRIPTION (provided by applicant): For breast cancer (BC), the most common cancer of US women, the 5-year relative survival after diagnosis is now nearing 90%, resulting in an estimated 2.3 million US BC survivors in 2005. Yet, because BC is the 2nd leading cause of cancer death, and survivors have increased risks of recurrence, second cancers, adverse outcomes, and premature death, it is critical to identify modifiable factors that can reduce the risk for these conditions and improve survival, particularly in racial/ethnic minority populations who have less favorable outcomes. Some epidemiologic evidence suggests that body size and physical activity may be such modifiable factors and, moreover, that they are associated with community "built environment" characteristics such as the number of walkable destinations and the availability of recreation facilities and supermarkets. Given the limited success of public health efforts to reduce overweight/obesity and increase physical activity, two prominent goals of the NIH, it is important to consider alternative influences on physical activity behavior. This goal is particularly important for BC survivors, who are at greater risk of weight gain and decreased physical activity. To date, no studies have directly assessed the relationship between the built environment and BC outcomes; therefore, this study aims to consider the combined effects of physical activity, body size, and a comprehensive set of measures of the built environment on overall survival, BC-specific survival and second primary cancer after BC diagnosis. In doing so, this study will assess the independent associations between each of these variables and outcomes, and the relationships of these variables to each other. Utilizing Geographic Information Systems technology, this study efficiently combines data that objectively characterizes the built environments of the Greater San Francisco Bay Area of northern California, data on cancer diagnosis and follow-up from the population-based Greater Bay Area Cancer Registry, and interview data on individual level risk factors from over 4,000 multiethnic (African-American, Hispanic, Asian-American and non-Hispanic white) BC patients who participated in two population-based studies. Regression models will be used to assess the association between variables of interest and multivariate adjusted Cox proportional hazards modeling will be used in the survival analyses. PUBLIC HEALTH RELEVANCE: This study has the potential to identify how community environments may be changed to improve physical activity that, in turn, may improve outcomes in BC survivors. If the built environment proves to influence behaviors and outcomes, then this knowledge can be used by urban and public health planners to advocate changes to the built environment, and by health care professionals to design post-diagnosis treatment programs and/or recommendations for taking greater advantage of the existing built environment to improve health behaviors among BC survivors.

描述（由申请人提供）：对于乳腺癌（BC），美国妇女最常见的癌症，诊断后的5年相对存活率现在接近90％，导致2005年美国卑诗省230万美国卑诗省的幸存者。但是，由于卑诗省是癌症死亡的第二个主要原因，而癌症死亡的第二个主要原因，而幸存者的死亡人数越来越多，因此造成了不良因素，而不利的造成了进度，而造成了不良的影响，而造成了进步，而造成了进步，那么成熟的成分，成熟的成分，是造成的。有这些条件并改善生存的风险，尤其是在种族/族裔少数民族中，结果较少。一些流行病学的证据表明，身体大小和体育锻炼可能是可修改的因素，而且它们与社区“建筑环境”特征相关联，例如可步行目的地的数量以及娱乐设施和超市的可用性。鉴于公共卫生为减少超重/肥胖和增加体育锻炼的成功而取得的成功有限，这是NIH的两个突出目标，因此重要的是考虑对体育活动行为的替代影响。对于卑诗省幸存者而言，这一目标尤为重要，他们的体重增加和减少体育锻炼的风险更大。迄今为止，还没有直接评估建筑环境与卑诗省结果之间的关系。因此，这项研究旨在考虑体育锻炼，体型的综合作用以及建筑环境对整体生存，卑诗省特异性生存和BC诊断后第二次原发性癌症的全面度量。在此过程中，这项研究将评估这些变量和结果中的每个变量之间的独立关联，以及这些变量之间的关系。利用地理信息系统技术，本研究有效地结合了北加州旧金山湾地区的建筑环境的数据，癌症诊断和基于人群的大湾地区癌症注册表的随访以及对个人水平风险因素的访谈数据的数据以及4,000多名多民族的个人水平风险因素（非洲人，裔美国人，比较两种居民，是对怀特的人，是对个人水平的数据，回归模型将用于评估感兴趣的变量和多元调整后的COX比例危害模型之间的关联。公共卫生相关性：这项研究有可能确定如何改变社区环境以改善体育锻炼，从而改善卑诗省幸存者的预后。如果建筑环境被证明会影响行为和结果，那么城市和公共卫生计划者可以使用这些知识来倡导对建筑环境的更改，以及由卫生保健专业人员设计诊断后治疗计划和/或建议，以更大地利用现有的建筑环境来改善BC幸存者之间的健康行为。