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Early puberty is associated with adverse health outcomes over the life course, and Black and Hispanic girls experience puberty earlier than girls of other racial/ethnic backgrounds. Neighborhood racial and economic privilege may contribute to these disparities by conferring differential exposure to mechanisms (e.g., stress, obesity, endocrine disruptors) underlying early puberty. We examined associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), and age at pubic hair onset (pubarche) and breast development onset (thelarche) in a large multiethnic cohort.A cohort of 46,299 girls born 2005-2011 at Kaiser Permanente Northern California medical facilities were followed until 2021. Pubertal development was assessed routinely by pediatricians using the Sexual Maturity Rating scale. ICE quintiles for race/ethnicity, income, and income + race/ethnicity were calculated using American Community Survey 2010 5-year estimates and linked to census tract at birth. We fit multilevel Weibull regression models accommodating left, right, and interval censoring for all analyses.ICE measures were monotonically associated with pubertal onset, with the strongest associations observed for ICE-race/ethnicity. Adjusting for maternal education, age at delivery, and parity, girls from the least versus most privileged ICE-race/ethnicity quintiles were at increased risk for earlier pubarche (hazard ratio: 1.30, 95% confidence interval: 1.21, 1.38) and thelarche (hazard ratio: 1.45, 95% confidence interval: 1.36, 1.54). These associations remained significant after adjusting for girls' race/ethnicity and childhood body mass index. Additionally, adjustment for ICE partially attenuated Black-White and Hispanic-White disparities in pubertal onset.Neighborhood privilege may contribute to pubertal timing and related disparities.

Background Cancer is the leading cause of death among Asian Americans, who face barriers to cancer care. Cancer supportive care needs among Asian Americans remain understudied. Methods We recruited 47 Asian American adults with colorectal, liver, or lung cancer who spoke Chinese, English, or Vietnamese, and were starting or undergoing cancer treatment. We assessed cancer supportive care needs in four domains: cancer information, daily living, behavioral health, and language assistance. Hierarchical cluster analysis was used to identify clusters of participants based on their need profiles to further examine the association between need profiles and quality of life (QoL) assessed by the Functional Assessment of Cancer Therapy (FACT-G). Results Participants (mean age=57.6) included 72% males and 62% spoke English less than very well. Older participants (age >65) and those with annual income Conclusions Cancer supportive care needs among Asian American patients with colorectal, liver and lung cancer were associated with patient characteristics and QoL. Understanding cancer supportive care needs will inform future interventions to improve care and QoL for Asian American cancer patients.

Dietary acculturation is the process by which diet and dietary practises prevalent in a new environment are adopted and/or those from the environment of origin are retained or changed. Knowledge gaps exist on chracterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI), despite rapid population growth the USA. This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics. Data were from a 2013–2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for Chinese, Filipinx, Vietnamese, Japanese, Korean, and Asian Indian and Pakistani populations. Validated measures assessed social networks, social standing, discrimination and immigration experiences. A principle components factor analysis characterise dietary patterns of acculturation. Three dietary patterns were identified: “Asian,” “Western,” and a distinct “Multicultural” factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents who ate a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy. The finding of a distinct “Multicultural” factor beyond the typical “Asian” and “Western” factors may reflect the multidirectional nature of dietary acculturation, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.

Supplemental Table 1. Neighborhood Characteristics for Pathways Participants by Race/Ethnicity/Nativity (n=4,354)

Background: Neighborhood socioeconomic status (nSES) has been found to be associated with breast cancer risk. It remains unclear whether this association applies across racial/ethnic groups independent of individual-level factors and is attributable to other neighborhood characteristics.Methods: We examined the independent and joint associations of education and nSES with odds of breast cancer. Residential addresses were geocoded for 2,838 cases and 3,117 controls and linked to nSES and social and built environment characteristics. We estimated ORs and 95% confidence intervals (CI) using multilevel logistic regression controlling for individual-level breast cancer risk factors and assessed the extent to which nSES associations were due to neighborhood characteristics.Results: Women living in the highest versus lowest nSES quintile had a nearly 2-fold greater odds of breast cancer, with elevated odds (adjusted ORs, 95% CI) for non-Hispanic whites (NHWs; 2.27; 1.45–3.56), African Americans (1.74; 1.07–2.83), U.S.-born Hispanics (1.82; 1.19–2.79), and foreign-born Hispanics (1.83; 1.06–3.17). Considering education and nSES jointly, ORs were increased for low education/high nSES NHWs (1.83; 1.14–2.95), high education/high nSES NHWs (1.64; 1.06–2.54), and high education/high nSES foreign-born Hispanics (2.17; 1.52–3.09) relative to their race/ethnicity/nativity-specific low education/low nSES counterparts. Adjustment for urban and mixed-land use characteristics attenuated the nSES associations for most racial/ethnic/nativity groups except NHWs.Conclusions: Our study provides empirical evidence for a role of neighborhood environments in breast cancer risk, specifically social and built environment attributes.Impact: Considering the role of neighborhood characteristics among diverse populations may offer insights to understand racial/ethnic disparities in breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(4); 541–52. ©2017 AACR.

Supplemental Table 3. Sociodemographic characteristics of the California Breast Cancer Survivorship Consortium by pre-diagnosis BMI.

Study diagram of Multiethnic Cohort participants eligible and included in analytic cohort.

Ultrafine particles (UFP; diameter less than or equal to 100 nm) may reach the brain via systemic circulation or the olfactory tract and have been implicated in the risk of brain tumors. The effects of airport-related UFP on the risk of brain tumors are not known. Here we determined the association between airport-related UFP and risk of incident malignant brain cancer (n = 155) and meningioma (n = 420) diagnosed during 16.4 years of follow-up among 75,936 men and women residing in Los Angeles County from the Multiethnic Cohort study. UFP exposure from aircrafts was estimated for participants who lived within a 53 km × 43 km grid area around the Los Angeles International Airport (LAX) from date of cohort entry (1993–1996) through December 31, 2013. Cox proportional hazards models were used to estimate the effects of time-varying, airport-related UFP exposure on risk of malignant brain cancer and meningioma, adjusting for sex, race/ethnicity, education, and neighborhood socioeconomic status. Malignant brain cancer risk in all subjects combined increased 12% [95% confidence interval (CI), 0.98–1.27] per interquartile range (IQR) of airport-related UFP exposure (∼6,700 particles/cm3) for subjects with any address in the grid area surrounding the LAX airport. In race/ethnicity-stratified analyses, African Americans, the subgroup who had the highest exposure, showed a HR of 1.32 (95% CI, 1.07–1.64) for malignant brain cancer per IQR in UFP exposure. UFP exposure was not related to risk of meningioma overall or by race/ethnicity. These results support the hypothesis that airport-related UFP exposure may be a risk factor for malignant brain cancers.Significance:Malignant brain cancer risk increases with airport-related UFP exposure, particularly among African Americans, suggesting UFP exposure may be a modifiable risk factor for malignant brain cancer.

Supplemental Table 1: Complete CBCSC cohort description, by all baseline model variables (N=12,098). Supplemental Table 2: Project specific sub-cohort description. Supplemental Table 3: Hazard ratio (HR) estimates and 95% confidence intervals from Cox regression analysis of breast cancer-specific mortality, for the racial/ethnic groups only model vs the full baseline model. (AJCC Stage I-II cases only). Supplemental Table 4: Hazard ratio (HR) estimates and 95% confidence intervals from Cox regression analysis of breast cancer-specific mortality, for the full baseline model vs the baseline model + specific domain variables, for the subsets of cases for which domain data were available(AJCC stage III cases Only). Supplemental Figure 1: Same as Figure 1, but with analysis restricted to AJCC stage I-II cases only.

Background: While obesity is well-understood to increase breast cancer risk, the role of the neighborhood obesogenic environment, encompassing social and built environment attributes that influence body size, is poorly understood.Methods: Using principal components factor analysis, five composite factors [neighborhood socioeconomic status (nSES), urban, mixed-land development, unhealthy food environment, parks] on the basis of geospatial data were developed to characterize the obesogenic environment for 48,247 postmenopausal women in the Multiethnic Cohort, residing predominately in Los Angeles County. We used Cox proportional hazards regression to examine the association between neighborhood obesogenic factors and breast cancer risk (n = 2,341 cases after 17 years of follow-up), adjusting for body mass index (BMI), weight gain since age 21, education, established risk factors, other neighborhood factors, and clustering by block group.Results: Lower nSES was associated with lower breast cancer risk [quintile 1 vs. 5: HR, 0.79; 95% confidence interval (CI), 0.66–0.95], with a more pronounced association observed in Latinos (quintile 1 vs. 5: HR, 0.60; 95% CI, 0.43–0.85). More urban environments were associated with lower breast cancer risk in Japanese Americans (quintile 5 vs. 1: HR, 0.49; 95% CI, 0.26–0.90), and lower mixed-land development was associated with higher breast cancer risk in Latinos (quintile 1 vs. 5: HR, 1.46; 95% CI, 1.10–1.93).Conclusions: Obesogenic neighborhood environment factors, especially nSES, urbanicity, and mixed-land development, were differentially and independently associated with breast cancer risk in this multiethnic population.Impact: These findings highlight the need for additional studies of the driving contextual aspects of nSES that influence breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(4); 480–9. ©2017 AACR.See all the articles in this CEBP Focus section, “Geospatial Approaches to Cancer Control and Population Sciences.”

Addition methods describing construction of the cohort, data harmonization, and statistical details

Supplemental Table 4. Clinicopathologic and treatment characteristics of the California Breast Cancer Survivorship Consortium by pre-diagnosis BMI.

Supplemental Table 1. Neighborhood characteristics of the California Breast Cancer Survivorship Consortium by pre-diagnosis BMI.

Little is known about neighborhood attributes that may influence opportunities for healthy eating and physical activity in relation to breast cancer mortality. We used data from the California Breast Cancer Survivorship Consortium and the California Neighborhoods Data System (CNDS) to examine the neighborhood environment, body mass index, and mortality after breast cancer. We studied 8,995 African American, Asian American, Latina, and non-Latina white women with breast cancer. Residential addresses were linked to the CNDS to characterize neighborhoods. We used multinomial logistic regression to evaluate the associations between neighborhood factors and obesity and Cox proportional hazards regression to examine associations between neighborhood factors and mortality. For Latinas, obesity was associated with more neighborhood crowding [quartile 4 (Q4) vs. Q1: OR, 3.24; 95% confidence interval (CI), 1.50–7.00]; breast cancer–specific mortality was inversely associated with neighborhood businesses (Q4 vs. Q1: HR, 0.46; 95% CI, 0.25–0.85) and positively associated with multifamily housing (Q3 vs. Q1: HR, 1.98; 95% CI, 1.20–3.26). For non-Latina whites, lower neighborhood socioeconomic status (SES) was associated with obesity [quintile 1 (Q1) vs. Q5: OR, 2.52; 95% CI, 1.31–4.84], breast cancer–specific (Q1 vs. Q5: HR, 2.75; 95% CI, 1.47–5.12), and all-cause (Q1 vs. Q5: HR, 1.75; 95% CI, 1.17–2.62) mortality. For Asian Americans, no associations were seen. For African Americans, lower neighborhood SES was associated with lower mortality in a nonlinear fashion. Attributes of the neighborhood environment were associated with obesity and mortality following breast cancer diagnosis, but these associations differed across racial/ethnic groups. Cancer Epidemiol Biomarkers Prev; 24(8); 1282–90. ©2015 AACR.

Background: As social and built environment factors have been shown to be associated with physical activity, dietary patterns, and obesity in the general population, they likely also influence these health behaviors among cancer survivors and thereby impact survivorship outcomes.Methods: Enhancing the rich, individual-level survey and medical record data from 4,505 breast cancer survivors in the Pathways Study, a prospective cohort drawn from Kaiser Permanente Northern California, we geocoded baseline residential addresses and appended social and built environment data. With multinomial logistic models, we examined associations between neighborhood characteristics and body mass index and whether neighborhood factors explained racial/ethnic/nativity disparities in overweight/obesity.Results: Low neighborhood socioeconomic status, high minority composition, high traffic density, high prevalence of commuting by car, and a higher number of fast food restaurants were independently associated with higher odds of overweight or obesity. The higher odds of overweight among African Americans, U.S.-born Asian Americans/Pacific Islanders, and foreign-born Hispanics and the higher odds of obesity among African Americans and U.S.-born Hispanics, compared with non-Hispanic whites, remained significant, although somewhat attenuated, when accounting for social and built environment features.Conclusions: Addressing aspects of neighborhood environments may help breast cancer survivors maintain a healthy body weight.Impact: Further research in this area, such as incorporating data on individuals' perceptions and use of their neighborhood environments, is needed to ultimately inform multilevel interventions that would ameliorate such disparities and improve outcomes for breast cancer survivors, regardless of their social status (e.g., race/ethnicity, socioeconomic status, nativity). Cancer Epidemiol Biomarkers Prev; 26(4); 505–15. ©2017 AACR.See all the articles in this CEBP Focus section, “Geospatial Approaches to Cancer Control and Population Sciences.”

Background: Racial/ethnic disparity in breast cancer–specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer–specific mortality can explain this disparity.Methods: The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer–specific mortality.Results: The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer–specific HRs relative to Whites were 1.69 (95% CI, 1.46–1.96), 1.00 (0.84–1.19), and 0.52 (0.33–0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96–1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity.Conclusions: Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer–specific mortality, they do not explain racial/ethnic mortality disparity.Impact: Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality. Cancer Epidemiol Biomarkers Prev; 25(7); 1064–72. ©2016 AACR.

Associations between neighborhood contextual characteristics and breast cancer risk by race/ethnicity and nativity, the Neighborhoods and Breast Cancer Study, 1995-2002.

Distributions of obesogenic neighborhood factors by race/ethnicity, postmenopausal women residing in California at baseline (n=48,247), Multiethnic Cohort, 1993-2010.

Purpose Cancer is the leading cause of death for Asian Americans. However, few studies have documented supportive care needs from the perspective of Asian American cancer patients. This study describes the needs reported by Asian American patients with colorectal, liver, or lung cancer over a 6-month period during their treatment. Methods Participants were recruited through the Greater Bay Area Cancer Registry and from cancer care providers in San Francisco. Participants self-identified as Asian or Asian American; were age 21 or older; spoke English, Chinese, or Vietnamese; and had stage I–III colon, rectum, liver, or lung cancer. Participants were matched with a language concordant patient navigator who provided support during a 6-month period. Needs were assessed by surveys at baseline, 3, and 6 months. Results Among 24 participants, 58% were 65 years or older, 42% did not complete high school, and 75% had limited English proficiency (LEP). At baseline, the most prevalent needs were cancer information (79%), nutrition and physical activity (67%), language assistance (54%), and daily living (50%). At the 3- and 6-month follow-up surveys, there was a higher reported need for mental health resources and healthcare access among participants. Conclusion In this pilot study of Asian American cancer patients who predominantly had LEP, participants reported many needs, with cancer information and language assistance as the most prominent. The findings highlight the importance of culturally and linguistically appropriate patient navigators in addressing supportive care needs among cancer patients with LEP. Trial registration ClinicalTrials.gov identifier: NCT03867916.

OBJECTIVE: To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. METHODS: Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007–2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n = 904,232). RESULTS: AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age < 20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors. CONCLUSIONS: Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into “AANHPI” is not appropriate for outcome reporting.

Background: Obesity is associated with risk of aggressive prostate cancer. It is not known whether neighborhood obesogenic factors are independently associated with prostate cancer risk. Methods: Neighborhood socioeconomic status (nSES) and four neighborhood obesogenic environment factors (urbanicity, mixed-land development, unhealthy food environment, and parks) were assessed for associations with prostate cancer risk among 41,563 African American, Japanese American, Latino, and White males in the Multiethnic Cohort (MEC) Study, California site. Multivariable Cox proportional hazards regression was used to estimate HRs and 95% confidence intervals (CI) for nonaggressive and aggressive prostate cancer, adjusting for individual-level sociodemographic, behavioral, and prostate cancer risk factors. Analyses were stratified by race, ethnicity, and, among Latino males, nativity. Results: Males residing in low-SES, compared with high-SES, neighborhoods had lower risk of nonaggressive prostate cancer [lowest vs. highest quintile HR = 0.81; 95% confidence interval (CI) = 0.68–0.95, Ptrend 0.024], driven by a similar trend among foreign-born Latino males. Foreign-born Latino males in neighborhoods with low mixed-land development had increased risk of non-aggressive disease (lowest vs. highest quintile HR = 1.49; 95% CI = 1.07–2.09). For aggressive disease, the only association noted was between lower mixed-land development and lower risk among White males (Ptrend = 0.040). Conclusions: nSES and obesogenic environment factors were independently associated with prostate cancer risk; associations varied by race, ethnicity, nativity, and disease aggressiveness. Impact: Upstream structural and social determinants of health that contribute to neighborhood obesogenic characteristics likely impact prostate cancer risk differently across groups defined by race, ethnicity, and nativity and by disease aggressiveness.

We examined the association between racialized economic segregation and late-stage colorectal cancer (CRC) in the US. All CRC cases diagnosed during 2009-2017 were identified using the United States Cancer Statistics database. Late-stage CRC was determined according to the presence of distant involvement (node or site) of the tumor at diagnosis. Racialized economic segregation was measured at the county level by the Index of Concentration at the Extremes (ICE) using the 2013-2017 American Community Survey estimates. ICE was calculated to show the extent to which individuals’ residence at diagnosis was located in counties of concentrated advantage or disadvantage. Four ICE metrics were considered, consisting of the difference between the number of households with White individuals reporting incomes in the top quintile of the US distribution, and the number of households with non-White (all people of color (POC), Black, Latino, or Asian American/Pacific Islander) individuals reporting incomes in the lowest quintile, divided by the total of households in the county. ICE metrics were further divided into quintiles based on the distribution of all counties in the US, with Q1 denoting least advantaged counties and Q5 the most advantaged counties. Multilevel logistic regression models accounting for clustering at counties were fit. Models were adjusted for age at diagnosis, sex, race and ethnicity, census region and year of diagnosis. A total of 1,356,053 cases were included in the analysis; mean age at diagnosis was 67 years, 52% were men, and 20% of cases had a late-stage diagnosis. In adjusted analysis for ICE-POC, people residing in less advantaged counties had higher odds of late-stage diagnosis than people residing in the most advantaged counties (OR [95% CI], Q1: 1.08 [1.05-1.11], Q2: 1.06 [1.04-1.09], Q3: 1.04 [1.02-1.07], Q4: 1.03 [1.01-1.05], Q5: reference). Similar results were observed on all four ICE metrics. Racialized economic segregation was associated with higher odds of late-stage CRC. These findings underscore the role of institutionalized racism as a driver of health inequities, with laws and policies that led to residential segregation also impacting the conditions for timely preventive care. Citation Format: Eduardo J. Santiago-Rodriguez, Salma Shariff-Marco, Zinzi D. Bailey, Justin S. White, Isabel E. Allen, Robert A. Hiatt. Racialized economic segregation and late-stage colorectal cancer in the United States, 2009-2017 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1931.

Although racial/ethnic disparities in healthcare access, treatment, and cancer outcomes are well documented, the impact of racial/ethnic discrimination on cancer survivorship is unclear. We examined associations between quality of life (QoL) and self-reported discrimination among 3,991 women with breast cancer recruited 2006-2013 from the Pathways Study in the Kaiser Permanente Northern California integrated health care system, using linear regression models. Overall, 31% of women reported experiencing racial/ethnic discrimination, with differences by race/ethnicity (82% among non-Hispanic Black women to 19% among non-Hispanic White women) and nativity (40% among foreign-born Hispanic women to 76%to U.S.-born Asian American women). Experiencing racial/ethnic discrimination was associated with lower QoL in fully adjusted models with mean QoL score=119.6 (95% confidence interval (CI)=102.0-137.1) for those who did not report discrimination, 115.5 (98.0-133.0) for those who reported some discrimination/median, and 110.2 (92.7-127.7) for those who reported more discrimination/≥ median). Discrimination was associated with lower QoL among women who used passive coping strategies, or lived in neighborhoods with high neighborhood socioeconomic status, high levels of segregation, or non-enclaves. Among breast cancer survivors, clinically meaningful differences in QoL scores were associated with racial/ethnic discrimination. Studies are needed to understand potential pathways through which these social factors impact survivorship outcomes.

BACKGROUND: Colorectal cancer screening rates among South Asian Americans are among the lowest of US population groups. Few population-based studies have examined determinants of screening in this population. The purpose of this study was to identify factors associated with colorectal cancer screening among South Asian Americans. METHODS: Data from the 2001–2009 California Health Interview Survey and multivariable logistic regression were used to examine determinants of being non-adherent with colorectal cancer screening recommendations. Independent variables include sociodemographic and healthcare access measures. RESULTS: Overall, 49% of 459 South Asian Americans were non-adherent to screening recommendations. Characteristics associated with non-adherence were the absence of flu shot, absence of doctor visits, sole use of non-English language at home and ≤40% life spent in the United States. In the multivariable model, screening non-adherence was associated with ≤40% life in the United States (odds ratio [95% confidence interval] 3.0 [1.4–6.5]), use of non-English at home (2.8 [1.0–7.8]) and no flu shot (2.5 [1.3–4.8]). Obese (BMI > 27.5 kg/m2) versus normal-weight patients were less likely to be non-adherent (0.4 [0.2–0.9]). CONCLUSIONS: Length of time in the United States and language spoken at home rather than English proficiency were associated with non-adherence to colorectal cancer screening, reflecting the importance of acculturation and retention of cultural values. Health conditions and behaviors reflecting more proactive healthcare utilization may reinforce the importance of provider recommendations and perceived efficacy of health prevention. Qualitative research would inform cultural tailoring necessary to improve colorectal cancer screening rates among the rapidly growing South Asian American population.

Background: This study examines how neighborhood socioeconomic status (nSES) and ethnic composition are associated with breast cancer risk for Asian American women. Methods: We linked individual level data from a population-based case–control study of breast cancer among Asian American women with neighborhood level data in the Greater San Francisco Bay Area (cases: n = 118, controls: n = 390). Multivariable logistic regression models examined the association between nSES, ethnic composition, and odds of having breast cancer. Results: Asian American women living in neighborhoods with high nSES and high ethnic composition had the highest odds of breast cancer, compared to those living in neighborhoods with high nSES and low ethnic composition (OR = 0.34, 95% CI [0.16–0.75]) or in neighborhoods with low nSES and high ethnic composition (OR = 0.37, 95% CI [0.17–0.83]). Discussion: Neighborhood socioeconomic and ethnic contexts are associated with breast cancer for Asian American women. We discuss explanations and avenues for future research.

Background: Black men are more likely than Non-Hispanic White (NHW) men to be diagnosed with high-risk prostate cancer. We examined the extent to which social factors were associated with differences in prostate cancer risk profiles between Black men and NHW men [using a modification to the original D'Amico risk groups based on prostate specific antigen (PSA), Gleason score (GS), and TNM stage (stage)], based on individual and combined clinicopathologic characteristics. Methods: We conducted a cross-sectional population-based study of 23,555 Black men and 146,889 NHW men diagnosed with prostate cancer in the California Cancer Registry from 2004 to 2017. We conducted multivariable logistic regression to examine the association of year of diagnosis, block group-level neighborhood socioeconomic status (nSES), marital status, and insurance type on differences in prostate cancer risk profiles between Black and NHW men. Results: High PSA (>20 ng/mL), GS, stage, individually and combined prostate cancer risk profiles were more common among Black men versus NHW men. In fully adjusted models, relative to NHW men, we observed a persistent 67% increased odds of high PSA among Black men. nSES was the factor most strongly associated with racial disparity in high PSA, accounting for 25% of the difference. Marital status was the factor that was second most associated with a racial disparity. Conclusions: nSES was the factor most strongly associated with racial disparities in high PSA prostate cancer. Impact: The influence of nSES on racial disparities in PSA, GS, stage, and prostate cancer risk profiles warrants further consideration.

Background: Using more recent cancer registry data, we analyzed disparities in hepatocellular carcinoma (HCC) incidence by ethnic enclave and neighborhood socioeconomic status (nSES) among Asian American/Pacific Islander (AAPI) and Hispanic populations in California. Methods: Primary, invasive HCC cases were identified from the California Cancer Registry during 1988–1992, 1998–2002, and 2008–2012. Age-adjusted incidence rates (per 100,000 population), incidence rate ratios, and corresponding 95% confidence intervals were calculated for AAPI or Hispanic enclave, nSES, and the joint effects of ethnic enclave and nSES by time period (and the combination of the three periods), sex, and race/ethnicity. Results: In the combined time period, HCC risk increased 25% for highest versus lowest quintile of AAPI enclave among AAPI males. HCC risk increased 22% and 56% for lowest versus highest quintile of nSES among AAPI females and males, respectively. In joint analysis, AAPI males living in low nSES areas irrespective of enclave status were at 17% to 43% increased HCC risk compared with AAPI males living in areas of nonenclave/high nSES. HCC risk increased by 22% for Hispanic females living in areas of low nSES irrespective of enclave status and by 19% for Hispanic males living in areas of nonenclave/low nSES compared with their counterparts living in areas of nonenclave/high nSES. Conclusions: We found significant variation in HCC incidence by ethnic enclave and nSES among AAPI and Hispanic populations in California by sex and time period. Impact: Future studies should explore how specific attributes of enclaves and nSES impact HCC risk for AAPI and Hispanic populations.

Objectives: Racial/ethnic minority women have disproportionately lower breast cancer survival rates compared to white women. As minorities in the US are exposed to higher levels of discrimination, ...

Background Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent. Methods The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18 years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract. Results Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes. Conclusions Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions.

Objective Our objective was to incorporate social and built environment factors into a compendium of multilevel factors among a cohort of very low birth weight infants to understand their contributions to inequities in NICU quality of care and support providers and NICUs in addressing these inequities via development of a health equity dashboard. Study design We examined bivariate associations between NICU patient pool and NICU catchment area characteristics and NICU quality of care with data from a cohort of 15,901 infants from 119 NICUs in California, born 2008–2011. Result NICUs with higher proportion of minority racial/ethnic patients and lower SES patients had lower quality scores. NICUs with catchment areas of lower SES, higher composition of minority residents, and more household crowding had lower quality scores. Conclusion Multilevel social factors impact quality of care in the NICU. Their incorporation into a health equity dashboard can inform providers of their patients’ potential resource needs.

Background: With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors. Methods: We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a three-level mixed linear regression model (participants nested within block groups and study/regions), we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores. Results: For the 2,477 survivors, 46% were 70+ years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non–single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared with upper middle-class suburb, Hispanic small town and inner city had lower PCS, and high status had higher MCS. Conclusions: Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL. Impact: Elucidating the pathways through which neighborhood attributes influence HRQOL is important in improving survivorship outcomes.

Background: Within the Multiethnic Cohort (MEC), we examined the association between air pollution and mortality among African American, European American, Japanese American, and Latina American women diagnosed with breast cancer. Methods: We used a land use regression (LUR) model and kriging interpolation to estimate nitrogen oxides (NOx , NO2) and particulate matter (PM2.5, PM10) exposures for 3,089 breast cancer cases in the MEC, who were diagnosed from 1993 through 2013 and resided largely in Los Angeles County, California. Cox proportional hazards models were used to examine the association of time-varying air pollutants with all-cause, breast cancer, cardiovascular disease (CVD), and non-breast cancer/non-CVD mortality, accounting for key covariates. Results: We identified 1,125 deaths from all causes (474 breast cancer, 272 CVD, 379 non-breast cancer/non-CVD deaths) among the 3,089 breast cancer cases with 8.1 years of average follow-up. LUR and kriged NOX (per 50 ppb) and NO2 (per 20 ppb), PM2.5 (per 10 µg/m3), and PM10 (per 10 µg/m3) were positively associated with risks of all-cause (Hazard Ratio (HR) range = 1.13–1.25), breast cancer (HR range = 1.19–1.45), and CVD mortality (HR range = 1.37–1.60). Associations were statistically significant for LUR NOX and CVD mortality (HR = 1.60; 95% CI: 1.08–2.37) and kriged NO2 and breast cancer mortality (HR = 1.45; 95% CI 1.02–2.07). Gaseous and PM pollutants were positively associated with breast cancer mortality across racial/ethnic group. Conclusion: In this study, air pollutants have a harmful impact on breast cancer survival. Additional studies should evaluate potential confounding by socioeconomic factors. These data support maintaining clean air laws to improve survival for women with breast cancer.

Ultrafine particles (UFP; diameter less than or equal to 100 nm) may reach the brain via systemic circulation or the olfactory tract and have been implicated in the risk of brain tumors. The effects of airport-related UFP on the risk of brain tumors are not known. Here we determined the association between airport-related UFP and risk of incident malignant brain cancer (n = 155) and meningioma (n = 420) diagnosed during 16.4 years of follow-up among 75,936 men and women residing in Los Angeles County from the Multiethnic Cohort study. UFP exposure from aircrafts was estimated for participants who lived within a 53 km × 43 km grid area around the Los Angeles International Airport (LAX) from date of cohort entry (1993–1996) through December 31, 2013. Cox proportional hazards models were used to estimate the effects of time-varying, airport-related UFP exposure on risk of malignant brain cancer and meningioma, adjusting for sex, race/ethnicity, education, and neighborhood socioeconomic status. Malignant brain cancer risk in all subjects combined increased 12% [95% confidence interval (CI), 0.98–1.27] per interquartile range (IQR) of airport-related UFP exposure (∼6,700 particles/cm3) for subjects with any address in the grid area surrounding the LAX airport. In race/ethnicity-stratified analyses, African Americans, the subgroup who had the highest exposure, showed a HR of 1.32 (95% CI, 1.07–1.64) for malignant brain cancer per IQR in UFP exposure. UFP exposure was not related to risk of meningioma overall or by race/ethnicity. These results support the hypothesis that airport-related UFP exposure may be a risk factor for malignant brain cancers. Significance: Malignant brain cancer risk increases with airport-related UFP exposure, particularly among African Americans, suggesting UFP exposure may be a modifiable risk factor for malignant brain cancer.

Purpose In the United States, Black females are burdened by more aggressive subtypes and increased mortality from breast cancer compared to non-Hispanic (NH) White females. Institutional racism may contribute to these inequities. We aimed to characterize the association between home mortgage discrimination, a novel measure of institutional racism, and incidence of Luminal A and triple-negative breast cancer (TNBC) subtypes among NH Black and NH White females in California metropolitan areas. Methods We merged data from the California Cancer Registry on females aged 20 + diagnosed with primary invasive breast cancer between 2006 and 2015 with a census tract-level index of home mortgage lending bias measuring the odds of mortgage loan denial for Black versus White applicants, generated from the 2007–2013 Home Mortgage Disclosure Act database. Poisson regression estimated cross-sectional associations of census tract-level racial bias in mortgage lending with race/ethnicity- and Luminal A and TNBC-specific incidence rate ratios, adjusting for neighborhood confounders. Results We identified n = 102,853 cases of Luminal A and n = 15,528 cases of TNBC over the study period. Compared to NH Whites, NH Black females had higher rates of TNBC, lower rates of Luminal A breast cancer, and lived in census tracts with less racial bias in home mortgage lending. There was no evidence of association between neighborhood racial bias in mortgage lending at the time of diagnosis and either subtype among either racial/ethnic group. Conclusion Future research should incorporate residential history data with measures of institutional racism to improve estimation and inform policy interventions.