Minority Health Research Articles

When connecting with LGBTQ+ communities helps and why it does: A meta-analysis of the relationship between connectedness and health-related outcomes.

We conducted a multilevel meta-analysis of 390 effect sizes from 167 studies with 157,923 participants examining the relationship between connectedness with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) communities and health-related outcomes, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted our initial search in January 2023 in APA PsycInfo, ERIC, Medline, and Open Dissertations, selecting studies that (a) measured LGBTQ+ community connectedness, (b) measured health, and (c) provided an estimate of the relationship between LGBTQ+ community connectedness and health. We found that connectedness with LGBTQ+ communities promotes mental health (r = .11), well-being (r = .17), and physical health (r = .09). Conversely, we found that connectedness with LGBTQ+ communities promotes substance use among younger participants, likely through behavioral engagement with LGBTQ+ others. We found that connectedness with LGBTQ+ communities was related to less mental health and more suicidality for younger people, likely because younger LGBTQ+ people seek out connectedness in response to this psychological distress. We also found that connectedness was not as health-promoting for LGBTQ+ individuals with multiple marginalized identities and that psychological feelings of belongingness with LGBTQ+ communities are generally more health-promoting than behavioral community engagement. Results from a narrative review and moderation meta-analyses suggested that, contrary to predictions made by minority stress theory, connectedness with LGBTQ+ communities does not buffer the relationship between minority stressors and health. Rather, meta-analytic mediation analyses suggested that proximal minority stressors negatively impact health-related outcomes by reducing connectedness with LGBTQ+ communities and that distal minority stressors are often less impactful on health-related outcomes because they promote connectedness with LGBTQ+ communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social Determinants: Supporting the Mental Health of Minorities

Social Determinants: Supporting the Mental Health of Minorities

Operationalizing Macro-Level Structural Sexual Minority Stigma: A Scoping Review of the Literature

Abstract Background Structural stigma, including discriminatory laws, inequitable policies, and negative attitudes, has been conceptualized as the general societal climate and institutional conditions that shape sexual minorities’ lives, mental, and physical health. While multidimensional indices have been used globally, U.S.-based studies have largely relied on single indicators (e.g., a law or policy; presence of resources). This scoping review aimed to identify structural sexual minority stigma indicators relevant to the U.S. context, to inform comprehensive, multidimensional future operationalizations. Methods Systematic database searches in PubMed, PsycINFO, and JSTOR, and snowball techniques resulted in 70 articles. After duplicate deletion and abstract review, 25 unique indices were long-listed relevant to structural sexual minority stigma at country or state level (i.e., macro level). School (district) and county (i.e., exo level) indicators were excluded. Results From the long-listed indices, a total of 112 legal and policy indicators were narrowed down to relevant 33 macro-level indicators and grouped across seven domains: criminal justice, hate crime protections, non-discrimination, religious refusal, relationship recognition, parenting, and youth laws and policies. Two different quantifications of population attitudes were identified that aggregated social and policy opinions across states regarding sexual minority adoption, hate crimes, health benefits, labor and housing, public speaking or teaching, marriage, sodomy, and civil unions. Discussion While a large variety of legal and attitudinal indicators was identified, few U.S.-based studies used multidimensional operationalizations (e.g., law, policy, opinion) needed to reduce risk of confounding bias through population-attitudes-to-law/policy backdoor pathways. To further advance the science on structural sexual minority stigma and health globally, future studies may benefit from multidimensional approaches. Key messages • With many legal and attitudinal indicators identified, few studies used multidimensional operationalizations (e.g., law, policy, opinion) needed to reduce risk of confounding bias. • To further advance the science on structural sexual minority stigma and health globally, future studies may benefit from multidimensional approaches.

Bridging gaps: A closer look at the health of sexual and gender minorities in Austria

Abstract Austria has long lacked comprehensive data on the health and well-being of sexual and gender minorities (SGMs). The 2022 LGBTIQ+ Health Report addresses this gap by presenting a comprehensive overview of the health status of SGMs in Austria. To contextualize SGM health issues, a review of the literature, health surveys, and action plans across Europe was conducted in the initial project phase. Then a questionnaire was developed in collaboration with an expert group for quantitative data collection. A total of 1,047 individuals participated in the survey; analyses of the quantitative data were enriched by insights from ten qualitative interviews. Detailed findings cover SGMs’ health status and experiences of discrimination as well as access to healthcare and health-promoting factors. Participants rated their health status lower than the average in Austria. A high number reported encountering discrimination in healthcare, especially among intersex and trans participants. While approximately half of the respondents were satisfied with healthcare provision, around 16% expressed dissatisfaction. Finally, a significant proportion of participants reported having foregone healthcare services at least once despite having health issues. Our work underscores the importance of recognizing the diverse needs of distinct groups within the SGM spectrum. It is crucial to avoid oversimplification by grouping them into a single SGM category as this obscures the unique challenges and inequalities faced by each subgroup. The rapid evolution of terms adds complexity to this work. Moreover, attention should be directed towards intersectionality within these groups as some are hard to reach with an online survey. Navigating the seas of public health innovation, our exploration of SGM health in Austria reveals not only the challenges but also the imperative for inclusive and tailored healthcare strategies. Key messages • The 2022 LGBTIQ+ Health Report Austria reveils SGM health realities: lower health status, discrimination, and unmet healthcare needs, urging targeted interventions. • Acknowledging diverse SGM groups and evolving terminologies, our study underscores the need for nuanced, intersectional healthcare approaches.

Empowering Early Career Researchers: The Jackson Heart Study Smith Scholars Program.

The University of Mississippi Medical Center Graduate Training and Education Center houses the Robert E. Smith, MD, Scholars Program, a two-year certificate program that equips predoctoral trainees from five Mississippi universities with advanced research skills in cardiovascular epidemiology. Funded by the National Heart, Lung, and Blood Institute (NHLBI), the program focuses on addressing health disparities, minority health, and health inequities in underserved communities. Trainees receive mentorship, career coaching, and a $7,500 annual stipend, building a foundation for postdoctoral opportunities and expanding professional networks. The Smith Scholars Program emphasizes population health and provides interdisciplinary training in areas such as biostatistics, scientific communication, and cardiovascular health. It is uniquely positioned to address systemic challenges, particularly in Mississippi, a state with high cardiovascular disease prevalence and limited research funding. The program's regional advantage and its partnership with the Jackson Heart Study offer scholars exposure to health disparities in Black/African American communities, preparing them to contribute to innovative, community-based research. Additionally, it fosters collaborative science, enabling participants to overcome academic barriers and engage with large-scale health equity research efforts. The Smith Scholars Program has been instrumental in shaping the career trajectories of its participants, facilitating their transition to postdoctoral positions and independent research roles.

"First, Trust Needs to Develop": Hematologists' Perspectives on Factors Influencing Black Persons' Participation in Clinical Trials.

Cancer clinical trials are crucial for treatment standards and innovation but lack racial-ethnic diversity. Understanding physician perspectives on recruiting participants is critical due to their role in decision-making about trial candidacy and enrollment. From August 2021 to January 2022 we recruited 13 Academic hematologists experienced with treating blood cancers and enrolling clinical trial participants. Each hematologist participated in a 60-75-minute semistructured interview and completed a sociodemographic survey. Using the National Institute on Minority Health and Health Disparities multilevel model as a framework, we characterized hematologists' perceived barriers to clinical trial participation among Black persons. ATLAS.ti v9 and later v 23.2.1 was used for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). All hematologists were White, with 70% being male. Three factors influenced their perspectives on enrolling Black individuals in clinical trials: individual attitudes and beliefs, such as perceptions that Black or socioeconomically disadvantaged persons will be less willing or less compliant with the requirements for trial participation and follow-up. The need to build trusting relationships between themselves and patients prior to discussing clinical trials and the prevailing legacy of medical mistrust among the Black community. Trust was found to be the underlying factor in determining communication between hematologists and Black persons about clinical trials across all three levels. This study highlights how hematologists' attitudes, beliefs, biases, and views on trust in patient relationships influence their communication with Black individuals about clinical trials. It emphasizes the need for further research to develop interventions that address the lack of racial and ethnic diversity in trials.

Research on The Status Quo And Problems of Mental Health of Sexual Minorities in China

In recent years, with the development of the Internet, the originally marginalized sexual minorities have appeared more and more frequently in the public field of vision, but due to the existence of proximal pressure and distal pressure, the psychological problems of sexual minorities still cannot be ignored. In order to better understand the living situation and mental health level of sexual minorities, reduce public opinion and disputes caused by gender knowledge errors, through literature collection, case interview, questionnaire survey, spss statistical analysis and other research methods, we integrated the definition, status and type of sexual minorities, stressors, social support status, mental health status and influence. The results show that the stressors faced by sexual minorities can reduce their perception of social support and thus reduce their mental health level. Therefore, increasing social support for sexual minorities can improve their mental health level. Finally, through the form of innovative programs to let more people pay attention to and understand this marginalized group, and strive to eliminate the public's cognitive bias towards sexual minorities.

Climate Change, Racism, and Food Insecurity: Cyclical Impacts of Stressors Exacerbate Health Disparities.

Disadvantaged populations have higher rates of chronic disease, including heart disease, cancer, and diabetes. Race, ethnicity, lower socioeconomic status, and poverty all contribute to these disproportionate rates. Other factors, including systemic racism, climate change, poor diet, lack of food access, and epigenetic influences, that are distributed and experienced differently across vulnerable populations also play a significant role in the development of chronic diseases. This comprehensive review of contributors to chronic diseases emphasizes a unique focus on these identified emerging factors. An ad hoc literature review using OVID Medline and Web of Science was conducted. Findings from prior studies indicate that multiple stressors, both in isolation and in combination, and their negative impacts on both physical and mental health of minorities are exacerbated by climate change. Various stressors dramatically increase chronic disease risk in minority groups. Recommendations for future research to elucidate the impacts of climatic, racial, and dietary adversity with minority populations are presented. Further study in this area is critical for achieving the UN Sustainable Development Goals and improving public health outcomes.

The impact of social determinants of health on international migrants’ health outcomes: a bibliometric analysis

Purpose The aim of this study is to conduct an in-depth exploration of the research landscape concerning the impact of social determinants of health (SDH) on the health outcomes of international migrants. Design/methodology/approach Leveraging the extensive Scopus database, this study retrieved a total of 2,255 articles spanning the years 1993–2023. The framework for analysis used the SDH categories outlined by the World Health Organization. Findings The research landscape exhibited an apparent increase in the number of publications, but not a net increase in the research productivity. The USA emerged as the leading contributor to research output, with the Journal of Immigrant and Minority Health emerging as the most prolific publication venue, and the University of Toronto ranking as the most prolific institution. The SDH category that received the highest number of publications was the “community and social context”. Migrants from different regions in Asia (East, Central and South Asia) and those from Latin America and the Caribbean region appeared to be the most commonly researched. Highly cited articles predominantly delved into mental health outcomes arising from discrimination and migration policies. Research limitations/implications The findings proffer valuable insights for shaping future research endeavors, accentuating the imperative for diversified studies encompassing underrepresented domains, broader health outcomes and the inclusion of migrant populations from different world regions in investigative pursuits. Originality/value This study delivers a comprehensive analysis of the research landscape, unveiling critical trends in the realm of SDH and migrant health outcomes.

An Equitable Communication and Dissemination Model for Linking Culturally Diverse Communities to COVID-19 Services.

In 2020, the Office of Minority Health (OMH) funded the establishment of the National COVID-19 Resiliency Network (NCRN) to engage priority communities that included African American, American Indian, Alaska Native, Asian, Hispanic, Native Hawaiian, and Pacific Islander persons to aggregate culturally relevant messages, education tools, and national data sources. A mobile application and Web site supported a culturally sensitive, equity-focused communication and dissemination initiative to link communities to COVID-19 clinical, social, and behavioral health services to address health determinants. (Am J Public Health. Published online ahead of print October 16, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307813).

Information About Sexual and Gender Minority Services and Policies on US Hospital Websites

This cross-sectional study assesses the extent to which hospitals provide information related to sexual and gender minority policies and health services on their websites.

COVID-19 Deaths and Minority Health Social Vulnerability, in the U.S., January 1, 2020 through June 24, 2023.

Health disparities, leading to worse health outcomes such as elevated COVID-19 mortality rates, are rooted in social and structural factors. These disparities notably impact individuals from lower socioeconomic backgrounds and more socially vulnerable areas. We analyzed the relationship between COVID-19 deaths and social vulnerability using the Minority Health Social Vulnerability Index (MHSVI). COVID-19 death data in the U.S. was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, where COVID-19 deaths were defined using the ICD-10 code U07.1. MHSVI composite scores were calculated for 3089 U.S. counties and categorized into social vulnerability quartiles, where values ranged from 0 (lowest vulnerability) to 1 (highest vulnerability). Negative binomial regression was employed to determine death rate ratios for each quartile within each theme. Finally, a multivariate negative binomial regression including all MHSVI sub-themes, excluding the overall index ranking, was used to assess the association between each theme and COVID-19 death rates independently. There were 1,134,272 COVID-19 deaths from January 1, 2020 through June 24, 2023. Adjusted rate ratios for COVID-19 deaths in the overall index ranking were 1.06 (95% CI 0.99-1.13), 1.14 (95% CI 1.06-1.22), and 1.41 (95% CI 1.31-1.52) for the second, third and fourth quartiles, respectively. Sub-themes of socioeconomic status (SES), household characteristics (HC), racial and ethnic minority status (REMS), housing type and transportation (HTT), and medical vulnerability (MV) revealed increasing death rates in higher vulnerability quartiles. The healthcare infrastructure and access (HIA) theme had decreasing death rate ratios of 0.74 (95% CI 0.71-0.78), 0.59 (95% CI 0.56-0.62), and 0.42 (95% CI 0.39-0.44) for the second, third, and fourth quartiles, respectively. Finally, the multivariate analysis showed that the HC, HTT, HIA, and MV themes were associated with COVID-19 deaths (P < 0.05). Counties that were identified as more socially vulnerable experienced higher death rates from COVID-19. These areas may need additional public health and social support during future pandemics.

Sociocultural, Behavioral, and Physical Correlates of Excessive Social Media Use, Addiction, and Motivation Toward Reduction in a Hispanic College Student Sample.

Social media use has been associated with adverse health consequences. However, there is limited research assessing correlates of social media use, addiction, failure to control use, and motivation to reduce use in a Hispanic sample. This study aimed to fill this gap by assessing factors within the National Institute of Minority Health and Health Disparities Research Framework. Participants were Hispanic college students (n = 273) residing either in the United States or Mexico who completed an online survey. Univariate analyses determined independent variables to be assessed in four linear regression models. Results indicated that weekly social media use was negatively associated with sex, attentional impulsivity, and social comparison and positively associated with social media craving (SMC). Social media addiction was positively associated with frequency of posting in Spanish, Fear of Missing Out, SMC, and home restriction of social media use. Social media self-control failure was negatively associated with acculturative language and positively associated with frequency of posting in English, attentional impulsiveness, SMC, and home restriction of social media use. Motivation to reduce social media use was positively associated with residing in the United States. Clinical implications include targeting key factors through tailored interventions aimed at promoting adaptive social media use patterns.

Community-Level Social Vulnerability and Hip and Knee Joint Replacement Surgery Receipt Among Medicare Enrollees With Arthritis.

(1) Explore associations between county minority health social vulnerability index (MH-SVI) and total joint replacement (TJR), and (2) assess associations by individual-level race/ethnicity. An expanded understanding of relevant social determinants of health is essential to inform policies and practices that promote equitable access to hip and knee TJR. Retrospective cohort study of Medicare enrollees. Centers for Medicare and Medicaid Services claims data were linked with MH-SVI. Multivariable logistic regression models were used to evaluate the odds of TJR according to the MH-SVI quartile in which enrollees resided. A total of 10,471,413 traditional Medicare enrollees in 2018 aged 67 years or older with arthritis. The main outcome was enrollee primary TJR during hospitalization. The main exposure was the MH-SVI (composite and 6 themes) for the county of enrollee residence. Results were stratified by enrollee race/ethnicity. Asian American, Native Hawaiian, or Pacific Islander (AANHPI), Black or African American (Black), and Hispanic enrollees comparatively had 26%-41% lower odds of receiving TJR than White enrollees. Residing in counties within the highest quartile of composite and socioeconomic status vulnerability measures were associated with lower TJR overall and by race/ethnicity. Residing in counties with increased medical vulnerability for Black and White enrollees, housing type and transportation vulnerability for AANHPI and Hispanic enrollees, minority status and language theme for AANHPI enrollees, and household composition vulnerability for White enrollees were also associated with lower TJR. Higher levels of social vulnerability were associated with lower TJR. However, the association varied by individual race/ethnicity. Implementing multisectoral strategies is crucial for ensuring equitable access to care.

Inquérito telefónico sobre a utilização de medicina herbal em Portugal e aferição da validade científica dos usos reportados

Introduction: Portugal has a long tradition of plants and herbal preparations for medicinal purposes (herbal medicines - HMs), but few studies on their use today. The professions of phytotherapy have recently been regulated, enabling more efficacy and safety. Objectives: 1) assess the use of HMs in Portugal, including attitudes, behaviors, sources of information, acquisition methods and role of HMs in health management, and identify the most used plants and targeted conditions. 2) evaluate them according to scientific evidence. Material and methods: a structured telephone interview. Scientific validity was assessed using the monographs of European Medicines Agency (EMA) and systematic reviews. Results: in this sample of 272 individuals, HMs are considered mainly for prevention or minor health problems. Family knowledge is the main information source and supermarkets/herb shops the main places of purchase, infusions being the preferred form. Two cases of mild adverse effects were reported. Most targeted conditions are flu, cold, cough, digestive discomfort and insomnia. The most used plants are: eucalyptus, elderberry, thyme, lemon, peppermint, echinacea, lemon balm, chamomile, valerian and passionflower. Conclusions: HM is mainly used for mild pathologies and chronic conditions. Its uses are mostly supported by scientific evidence. More attention to HMs from the medical community is important, in collaboration with phytotherapy and naturopathy professionals.

Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States.

To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities.

Research on the Psychological Impact of the Policy Practice of Preventing Minors from Indulging in Online Games in China

With the expansion of online games, there is a relatively more severe issue involving minors excessive use of games. To this end, the Chinese government has issued several policy initiatives that are intended to stop minors from getting hooked on online games. This study aims to examine the psychological consequences of these policy practices on children. Through literature review, and case study, the changes in minors mental health status before and after the implementation of the policy were assessed, and the role of family, school and social environment in the implementation of the policy was also examined. This research identified that these policies have successfully limited the overuse of online games among minors to a certain extent but at the same time, it has introduced new psychological issues like anxiety and social isolation among the young people. Also, the issues that parents and educators encounter in the process of policy execution are also worth considering. Based on the findings of this study, the following recommendations, such as introducing flexible time limits and regular review of the policy, are made in order to enhance policy implementation towards the improvement of the mental health of minors.

Improving contraceptive care for minors in Israel: practice, policy, and training gaps among OBGYNs

BackgroundSexually active adolescents sometimes seek contraceptives without parental consent, posing challenges due to minors' confidentiality and consent regulations. This is especially the case under the un-nuanced Israeli legal scheme regarding adolescents' care.MethodsIsraeli OBGYNs were contacted through mailing lists and social media groups and asked to fill an online questionnaire regarding their experience and protocols concerning prescription of contraceptives to minors. They were also asked about their comprehension of the relevant legal obligations, the importance they ascribe to different ethical interests and considerations, as well as their training.ResultsOf the 177 responding gynecologists, 132 (74.58%) consulted minors about contraceptives during the past year, regardless of a vast lack of training on providing care to minors. More than a third of respondents believed that there is no legal requirement to involve parents in the process, and only 8% assumed a legal obligation for parental involvement in all minors under the age of 18. Three quarters would "almost always" prescribe contraceptives without parental knowledge, if requested, while 20% never would. No correlation was found between respondents' practices and their perception of the relevant legal obligations. Participants agreed that the risk to the health of the minor as a result of having sex without contraceptives is of utmost importance. Yet, those willing to prescribe gave greater weight to this consideration, while those who do not prescribe were more concerned with the legal ramifications of such an act. The majority identified the age of 15 as the threshold for consistently prescribing contraceptives to minors without parental involvement.ConclusionThis study highlights the significant gaps in both the legal framework and the training of Israeli OBGYNs, and further supports confidential prescription of contraceptives to minors 15 years and older, via Article 6 of the Israeli Legal Competence and Guardianship Law. Legislative reform, professional guidelines and education and training programs are all needed to ensure consistent and legally sound practices, that safeguard the health and rights of minors. It is imperative to guide healthcare providers, including OBGYNs prescribing contraceptives to minors, on managing the care of minors refusing parental involvement, clarifying the legal framework and ethical considerations involved.

The effect of a minor health shock on labor market outcomes: The case of concussions.

The literature on health shocks finds that minor injuries have only short-term labor market impacts. However, mild traumatic brain injuries (mTBIs, commonly referred to as concussions) may be different as the medical literature highlights that they can have longer-term health and cognitive effects. Moreover, TBIs are one of the most common causes of disability globally, with the vast majority being mild. Thus, it is important to understand the impact of mTBIs on labor market outcomes. We use administrative data on all medically-diagnosed mild traumatic brain injuries (mTBIs) in New Zealand linked to monthly tax records to examine the labor market effects of a mTBI. We use a comparison group of those who suffer a mTBI at a later date to overcome potential endogeneity issues, and employ a doubly-robust difference-in-differences method. We find that suffering a mTBI has negative labor market effects. Rather than dissipating over time, these negative effects grow, representing a decrease in employment of 20 percentage points and earning losses of about a third after 48months. Our results highlight the need for timely diagnosis and treatment to mitigate the effect of mTBIs to reduce economic and social costs.

Neighborhood Vulnerability and Associations with Poor Health-Related Quality-of-Life Among Adult Survivors of Childhood Cancer.

Few studies investigate the relationship between neighborhood vulnerability and health-related quality-of-life (HRQOL) in the childhood cancer population. This study evaluated the impact of neighborhood vulnerability on HRQOL among adult survivors of childhood cancer. This cross-sectional study included 4,393 adult survivors of childhood cancer from the St Jude Lifetime Cohort Study. At the baseline (2007-2020), HRQOL was assessed using the SF36v2's physical/mental components summaries (PCS/MCS). Neighborhood vulnerability was assessed using the overall, domain, and indicator-specific scores of the Social Vulnerability Index (SVI) and Minority Health SVI (MHSVI). Multivariable logistic regression was used to evaluate associations of neighborhood vulnerability (quartiles: Q1-Q4) with impaired HRQOL (1SD below the norm), adjusting for diagnosis, demographics, personal socioeconomic status (SES), lifestyle, and chronic health condition burden. Interactions of SVI/MHSVI with personal SES on impaired HRQOL were analyzed. Among survivors, 51.9% were male, averaging 30.3 years of age at evaluation and 21.5 years since diagnosis. Comparing neighborhoods with higher vs lower vulnerability (Q4 vs Q1), overall (OR = 1.60, 95%CI = 1.19-2.16) and domain-specific vulnerability (socioeconomic: OR = 1.59, 95%CI = 1.18-2.15; household composition: OR = 1.54, 95%CI = 1.16-2.06; housing/transportation: OR = 1.33, 95%CI = 1.00-1.76; medical vulnerability: OR = 1.60, 95%CI = 1.22-2.09) were significantly associated with impaired PCS, but not MCS. Residing in neighborhoods lacking urgent care clinics was significantly associated with impaired PCS (OR = 1.39, 95%CI = 1.08-1.78). Having lower vs higher personal education and living in higher vulnerability neighborhoods were associated with more impaired PCS (P interaction=0.021). Specific aspects of neighborhood vulnerability increase the risk for impaired physical HRQOL. Addressing these neighborhood factors is essential to enhance the HRQOL of survivors.