Pathways between objective and perceived neighborhood factors among Black breast cancer survivors

Jesse J Plascak,Stephen J Mooney,Adana A M Llanos,Karen S Pawlish,Chi-Chen Hong,Elisa V Bandera,Andrew G Rundle,Kitaw Demissie,Yong Lin,Bo Qin

doi:10.1186/s12889-021-12057-0

Abstract

BackgroundMounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort.MethodsDemographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women’s Circle of Health Follow-up Study – a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant’s residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals.ResultsHigher perceived neighborhood disorder was associated with higher objective neighborhood disorder (β = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (β = − 0.11, 95% CI: − 0.24, 0.02).ConclusionObjective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Highlights

Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied
30% of participants were single and never married, average household income was less than 3 times the federal poverty level, 33% of participants had a high school education or less, and 86% were born in the US
Participants resided in census tracts of moderate-to-high African American/Black residential segregation as indicated by average Gini, Isolation, and African American/ Black composition values of 56.5, 52.2, and 45.2%, respectively

Summary

Introduction

Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. Reviews of ‘neighborhood disorder‘, ‘social capital’, ‘neighborhood disadvantage’, and ‘residential segregation’ have appeared in public health journals since 2017 [1,2,3,4] Many of these reviews provide evidence for associations between adverse neighborhood factors and poorer health, and that numerous sub-measures exist within each broader construct (e.g., observed and perceived versions of both physical and social neighborhood disorder). Despite abundant literature on relationships between various urban neighborhood characteristics and health behaviors and outcomes, few studies have investigated pathways between various neighborhood measures. This is a critical gap because social and built environmental factors are inter-related [2, 5]. Knowledge of relationships among various neighborhood factors is especially important to urban health for several reasons, including: quantifying magnitudes of association to inform relative influence of factors, motivating data collection protocols of future studies, understanding relevant pathways and mechanisms to health, and identifying points of intervention

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