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

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Abstract

Purpose

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.

Methods

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.

Results

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 (χ2(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.

Conclusions

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.

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Acknowledgments

We thank the staff of the Missouri Cancer Registry and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri, for the use of the Health Behavior, Communications, and Outreach Core, which is supported in part by the National Cancer Institute Cancer Center Support Grant (P30 CA091842) to the Siteman Cancer Center. This research also was supported in part by grants from the National Cancer Institute (CA112159). Dr. Pruitt was supported by the National Center for Research Resources Clinical and Translational Science Award to Washington University (KL2 RR024994) and a faculty recruitment award from the Cancer Prevention Research Institute of Texas (CPRIT). Dr. McQueen was supported by an American Cancer Society Mentored Research Scholar Grant (CPPB-113766). Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health or the American Cancer Society. The funders did not have any role in the design of the study; the analysis and interpretation of the data; the decision to submit the manuscript for publication; or the writing of the manuscript.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd E1.410D, Dallas, TX, 75390-9169, USA

    Sandi L. Pruitt

  2. Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA

    Sandi L. Pruitt

  3. Department of Medicine, Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, MO, USA

    Amy McQueen, Anjali D. Deshpande, Donna B. Jeffe & Mario Schootman

  4. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA

    Amy McQueen, Anjali D. Deshpande, Donna B. Jeffe & Mario Schootman

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  1. Sandi L. Pruitt
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Correspondence to Sandi L. Pruitt.

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Pruitt, S.L., McQueen, A., Deshpande, A.D. et al. Mediators of the effect of neighborhood poverty on physical functioning among breast cancer survivors: a longitudinal study. Cancer Causes Control 23, 1529–1540 (2012). https://doi.org/10.1007/s10552-012-0030-y

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