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• Lung cancer outcomes are related to neighborhood context. • Low segregation/high deprivation predicts receiving surgery for white patients. • High segregation/ low deprivation predicts receiving surgery for black patients. • Living in rural areas increased risk of death for black and white patients. • High Hispanic segregation/high deprivation increased risk of death for black patients. The purpose of this study was to investigate the relationship between neighborhood environment and lung cancer outcomes among Florida residents younger than 65 years of age. This was a retrospective cohort study that included patients diagnosed with non-small cell lung cancer (NSCLC) in Florida from January 2005 to December 2014 (n = 22,750). Multi-level, mixed-effect logistic regression models were used for two outcomes: receipt of treatment and receipt of surgery. Survival analyses, using proportional subdistribution hazard models, were conducted to examine the impact of neighborhood characteristics on risk of death due to lung cancer with adjustment for individual-level variables. Neighborhood exposures of interest were census tract level black and Hispanic segregation combined with economic deprivation. White patients who lived in low black segregation/high deprivation areas had 15 % lower odds of receiving surgery (95 % CI: 0.76-0.93). However, the likelihood of receiving surgery for black patients who lived in high black segregation/low deprivation and high black segregation/high deprivation was lower than for black patients who lived in low black segregation/low deprivation neighborhoods (level 3 AOR = 0.56 [0.38-0.85]; level 4 AOR = 0.69 [0.54-0.88]). Living in suburban and rural areas increased the risk of lung cancer death for white patients by 14 % (95 % CI: 1.05–1.24) and 26 % (95 % CI: 1.08–1.46), respectively. Living in rural areas increased the risk of death for black patients by 54 % r (SHR = 1.54 [1.19–2.0]). Black patients who live in high Hispanic segregation/high deprivation had 36 % increased risk of death compared to black patients who lived in low Hispanic segregation/low deprivation areas. This study suggests that when investigating cancer disparities, merely adjusting for race/ethnicity does not provide sufficient explanation to understand survival and treatment variations. Lung cancer outcomes are impacted by neighborhood environments that are formed based on the distribution of race, ethnicity and class. [ABSTRACT FROM AUTHOR]

In this study, we examined the lived experiences of an understudied subgroup, Portuguese American gay men, within the context of sexual script theory. We employed a phenomenological study design with eight men to provide a more in-depth analysis of their sociocultural sexual behaviours. Recruitment was conducted through word of mouth and a snowball approach beginning with two well-known HIV education and prevention outreach centres in southeastern Massachusetts. In this study, the sexual scripts of the participants were conceptualised within the three domains of cultural, interpersonal and intrapsychic scripts. Our findings suggest the three scripts are constantly interacting and informing one another. This ongoing negotiation influences the way our participants position their sexuality within the broader context of their everyday life within the US Portuguese community. Participants script their sexuality while they navigate multiple but separate entities within their culture, their religion and their families. Learning from these experiences could have important implications for the development of HIV prevention programmes for specific subgroups of men who have sex with men. [ABSTRACT FROM PUBLISHER]

Introduction: Although spatial examination of mortality and morbidity is becoming more common in health studies, the investigation of suicide death clusters within the neighborhood context is underutilized. The purpose of this ecological study is to detect high- and low-risk clusters of suicide deaths in Florida and determine which neighborhood characteristics distinguish clusters from non-clusters.Methods: The scan statistic method was used to detect overall clusters of completed suicides in Florida from 2001 to 2010. Regression analysis was used to investigate the association of neighborhood characteristics with identified clusters. All data synthesis and statistical analyses were conducted in 2015.Results: Twenty-four high-risk and 25 low-risk clusters were identified. The risk of suicide was up to 3.4 times higher in high-risk clusters than in areas outside of clusters (relative risk ranged from 1.36 to 3.44, p≤0.05). Low-risk clusters were associated with 30%-94% decreased risk of suicide (relative risk ranged from 0.06 to 0.70, p≤0.05). Areas with high levels of elderly concentration and household singularity were more likely to be in high-risk clusters, whereas areas with higher economic deprivation and residential density were more likely to be in low-risk clusters.Conclusions: This study identified general suicide patterns across space in the state of Florida and described the characteristics of those areas. [ABSTRACT FROM AUTHOR]

Background: In our recent study, advanced disease stage and nonreceipt of surgery were the most important mediators of the racial disparity in breast cancer survival. The purpose of this study was to quantify the racial disparity in these two intermediate outcomes and investigate mediation by the more proximal mediators of insurance status and neighborhood poverty. Methods: This was a cross‐sectional study of non‐Hispanic Black and non‐Hispanic White women diagnosed with first primary invasive breast cancer in Florida between 2004 and 2015. Log‐binomial regression was used to obtain prevalence ratios (PR) with 95% confidence intervals (CIs). Multiple mediation analysis was used to assess the role of having Medicaid/being uninsured and living in high‐poverty neighborhoods on the race effect. Results: There were 101,872 women in the study (87.0% White, 13.0% Black). Black women were 55% more likely to be diagnosed with advanced disease stage at diagnosis (PR, 1.55; 95% CI, 1.50–1.60) and nearly twofold more likely to not receive surgery (PR, 1.97; 95% CI, 1.90–2.04). Insurance status and neighborhood poverty explained 17.6% and 5.3% of the racial disparity in advanced disease stage at diagnosis, respectively; 64.3% remained unexplained. For nonreceipt of surgery, insurance status explained 6.8% while neighborhood poverty explained 3.2%; 52.1% was unexplained. Conclusions: Insurance status and neighborhood poverty were significant mediators of the racial disparity in advanced disease stage at diagnosis with a smaller impact on nonreceipt of surgery. However, interventions designed to improve breast cancer screening and receipt of high‐quality cancer treatment must address additional barriers for Black women with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Few population-based studies have assessed the effectiveness of adjuvant chemotherapy (ACT) in stage III colon cancer patients according to age. We sought to quantify the prevalence of ACT use and the absolute and relative survival benefit of ACT overall and by age in a population-based cohort.Methods: Stage III patients with adenocarcinoma of the colon identified by the Georgia Comprehensive Cancer Registry for the years 2000-07 were eligible (final N=3057). We utilized Poisson regression to obtain adjusted mortality rates (MR) and Cox proportional hazards models to obtain adjusted hazard ratios (HRs) for 5-year overall survival. We evaluated control of confounding by comparing HRs obtained via multivariable modeling (MM), propensity score weighting (PSW), and propensity score matching (PSM).Results: Just over one-third of colon cancer patients did not receive ACT, and the proportion increased with age. Overall, receipt of ACT conferred an absolute (MR difference [No ACT rate-ACT rate] 25.4 deaths/1000 person-years [py], 95% confidence interval [CI]: 19.1-32.7 deaths/1000 py) and relative (MM HR=0.67, 95% CI: 0.59-0.76) survival benefit. The survival benefit was demonstrated across age groups. MM and propensity score methods yielded highly similar HRs.Conclusion: Unless contraindicated, efforts to ensure receipt of ACT for stage III colon cancer patients up to 84 years of age are needed to improve the prognosis of patients with node-positive disease. [ABSTRACT FROM AUTHOR]