Journal of Behavioral Medicine

, Volume 41, Issue 1, pp 52–61 | Cite as

The association of neighborhood context with health outcomes among ethnic minority breast cancer survivors

  • Chenkai Wu
  • Kimlin Tam Ashing
  • Veronica C. Jones
  • Lisa Barcelo


While individual-level determinants of health, such as education and income, have been well documented among breast cancer survivors, little is known about the role of neighborhood context on survivorship outcomes among this population. The present study examined the association of neighborhood stress with multiple health outcomes among ethnic minority breast cancer survivors (BCS). A mixed-methods approach was used to recruit 320 African-American and Hispanic BCS who were 26–89 years and lived in metropolitan Los Angeles, CA. Neighborhood stress was assessed by six items taken from the Life Stress Scale. Health outcomes included (1) self-rated health, measured by the Short-Form-36 Health Survey, (2) number of comorbidities (0–14), (3) depressive symptoms, assessed by the Center for Epidemiological Studies-Depression scale, and (4) psychological difficulties. Greater neighborhood stress was significantly associated with poorer self-reported health (adjusted β = −.22, 95% confidence interval [CI] −.40, −.05), greater number of comorbidities (adjusted risk ratio = .19, 95% CI .07, .30), more depressive symptoms (adjusted β = .10, 95% CI .06, .15), and a higher likelihood of psychological difficulties (adjusted odds ratio = 2.28, 95% CI 1.51, 3.45) among ethnic minority BCS. These findings underscored the importance of taking neighborhood context into account in examining the determinants of health, survivorship, and quality of life outcomes among cancer patients. Our findings may inform population health, health services, and interventions addressing neighborhood and individual-level factors to promote post treatment health and survivorship outcomes as well as to identify high-risk patients, especially among medically vulnerable communities.


Minority health Mental health Residence characteristics Breast neoplasm Survivors African Americans Hispanic Americans 


Compliance with ethical standards

Conflict of interest

Chenkai Wu, Kimlin Tam Ashing, Veronica C. Jones, and Lisa Barcelo declare that they have no conflicts of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Supplementary material

10865_2017_9875_MOESM1_ESM.docx (45 kb)
Supplementary material 1 (DOCX 45 kb)


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Chenkai Wu
    • 1
  • Kimlin Tam Ashing
    • 2
  • Veronica C. Jones
    • 3
  • Lisa Barcelo
    • 4
  1. 1.School of Biological and Population Health SciencesOregon State UniversityCorvallisUSA
  2. 2.Department of Population Sciences, Center of Community Alliance for Research and Education (CCARE)City of Hope National Medical CenterDuarteUSA
  3. 3.Division of Surgical Oncology, Department of SurgeryCity of Hope National Medical CenterDuarteUSA
  4. 4.School of InformationUniversity of California at BerkeleyBerkeleyUSA

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