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Stress, Neighborhood Context, and Breast Cancer Risk among Asian American, Native Hawaiian, and Pacific Islander Women


Breast cancer is the most common cancer among women in the United States (US), including all major ethnic groups of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) women. In contrast to recent trends of breast cancer incidence among other racial/ethnic groups in the US, the incidence of breast cancer among AANHPI women has been increasing rapidly over time. Incidence is also generally higher among women who are US-born relative to foreign-born and among those who have resided longer in the US, after controlling for age. These patterns suggest that factors related to living in the US context may increase breast cancer risk for these women. This dissertation draws upon the Stress-Exposure Disease Model and segmented assimilation theory to study the associations between psychosocial stress, social environments, and physical environments on odds of having breast cancer. Furthermore, breast cancer risk was assessed by examining health behaviors related to cancer (physical activity, alcohol use, fruit and vegetable consumption) and body mass index. Data was from the Asian Community Health Initiative (N=621), a case-control study of 139 breast cancer cases and 483 ethnicity- and age-matched controls, all self-identified AANHPI women living in the San Francisco Bay Area. Geographic Information Systems and multivariable linear regression were used to assess the roles of psychosocial stress, ethnic enclaves, and the built environment on breast cancer risk. Analyses controlled for well-known risk factors (e.g. age, family history of breast cancer, reproductive history, etc.). This research found that psychosocial stressors were not associated with having breast cancer. Greater general stress was associated with less physical activity. Low collective efficacy was associated with lower fruit consumption and low neighborhood safety was associated with lower vegetable consumption. Women living in high ethnic enclave, high socioeconomic status neighborhoods had the highest odds of having breast cancer. Additionally, living in high ethnic enclaves was associated with less strenuous physical activity and lower alcohol consumption. Features of the built environment were not associated with breast cancer risk. This research shows how social environments are associated with health for AANHPI women, contributing to our understanding of how health for this minority group is uniquely shaped by neighborhood contexts.

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