Mediators of the effect of neighborhood poverty on physical functioning among breast cancer survivors: a longitudinal study

Sandi L Pruitt; Amy McQueen; Anjali D Deshpande; Donna B Jeffe; Mario Schootman

doi:10.1007/s10552-012-0030-y

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Mediators of the effect of neighborhood poverty on physical functioning among breast cancer survivors: a longitudinal study

Journal article

Peer reviewed

Mediators of the effect of neighborhood poverty on physical functioning among breast cancer survivors: a longitudinal study

Sandi L Pruitt, Amy McQueen, Anjali D Deshpande, Donna B Jeffe and Mario Schootman

Cancer causes & control, Vol.23(9), pp.1529-1540

09/2012

DOI: 10.1007/s10552-012-0030-y

PMCID: PMC3425435

PMID: 22833236

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https://www.ncbi.nlm.nih.gov/pmc/articles/3425435View

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Abstract

Female breast cancer survivors, a large and growing population, experience impaired physical functioning after treatment. Survivors living in impoverished neighborhoods may suffer even greater impairment, but the mechanisms linking neighborhood poverty and individual outcomes are poorly understood. This study sought to identify mediators of the effect of neighborhood poverty on physical functioning using longitudinal data from a Missouri cancer registry-based sample of 909 female breast cancer survivors. Survivors were recruited 1 year after diagnosis (Y1) and completed two telephone interviews, at Y1 and 1 year later (Y2). The association between census-tract-level poverty and physical functioning (RAND SF-36) was tested using a multilevel a priori path model with 19 hypothesized mediators, demographic and socioeconomic confounders, and covariates. Hypothesized mediators included clinical and treatment variables, psychosocial factors (depression, stress, social support), perceived neighborhood characteristics, behavioral risk factors (physical activity, smoking, body mass index, alcohol use), and comorbidity. In unadjusted analysis, women living in neighborhoods with higher poverty were more likely to report lower physical functioning at Y2 (β = -.19, p < .001). The final mediated model fit the data well (χ(2)(8) = 12.25, p = 0.14; CFI = .996; RMSEA = .024). The effect of neighborhood poverty on physical functioning was fully mediated by physical activity and body mass index. Breast cancer survivors living in neighborhoods with greater poverty reported lower physical functioning, but this effect was fully explained by physical activity and body mass index. Community-based lifestyle interventions sensitive to the unique challenges faced by cancer survivors and the challenges of living in a high-poverty neighborhood are needed to ameliorate neighborhood socioeconomic disparities in physical functioning.

Demography

Life Style

Poverty

Breast Neoplasms - economics

Humans

Middle Aged

Risk Factors

Survivors

Breast Neoplasms - physiopathology

Socioeconomic Factors

Missouri - epidemiology

Breast Neoplasms - psychology

Residence Characteristics - statistics & numerical data

Aged, 80 and over

Adult

Breast Neoplasms - mortality

Female

Aged

Longitudinal Studies

Details

Title: Subtitle: Mediators of the effect of neighborhood poverty on physical functioning among breast cancer survivors: a longitudinal study
Creators: Sandi L Pruitt - Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd E1.410D, Dallas, TX 75390-9169, USA. sandi.pruitt@utsouthwestern.edu
Amy McQueen
Anjali D Deshpande
Donna B Jeffe
Mario Schootman
Resource Type: Journal article
Publication Details: Cancer causes & control, Vol.23(9), pp.1529-1540
DOI: 10.1007/s10552-012-0030-y
PMID: 22833236
PMCID: PMC3425435
NLM abbreviation: Cancer Causes Control
ISSN: 0957-5243
eISSN: 1573-7225
Publisher: Netherlands
Grant note: P30 CA091842 / NCI NIH HHS KL2 RR024994 / NCRR NIH HHS KL2 TR000450 / NCATS NIH HHS R01 CA112159 / NCI NIH HHS UL1 TR000448 / NCATS NIH HHS CA112159 / NCI NIH HHS
Language: English
Date published: 09/2012
Academic Unit: Epidemiology
Record Identifier: 9983996083302771

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