UCSF

Cancer is a leading cause of morbidity and mortality among Black men and women with a substantial burden due to alcohol use, smoking, obesity, and physical activity. Despite growing evidence of the importance of early life adverse experiences on long-term health, little is known about the independent and joint effects of adverse experiences and neighborhood racial segregation on cancer-related risk factors among Black men and women. Black Americans are particularly vulnerable to a higher burden of adverse experiences. In addition, due to high levels of racial residential segregation in the United States, Black Americans are also more likely than other races to live in poor, segregated neighborhoods irrespective of individual education and income. There is some evidence suggesting that modifying the neighborhood may attenuate the effects of adverse experiences. Understanding the potential joint effects of adverse experiences and neighborhood context may provide insights into potential pathways and effective intervention strategies to reduce the cancer burden in this population. For this dissertation I employ two data sets, the Black Women’s Health Study and RESPOND, to answer three questions. In the first chapter, I assessed the association between patterns of lifetime abuse, physical and sexual, and smoking, drinking, and obesity as measured by BMI and waist-to-hip ratio. We found that although exposure in specific life periods is important, chronic exposure to physical and sexual abuse across the life course also matters for cancer-related health factors. In the second chapter, I examined if the association of lifetime abuse with adult alcohol use, smoking, and body size (BMI, waist-to-hip ratio) was modified by neighborhood racial segregation and neighborhood socioeconomic status. We found the association between lifetime abuse and cancer-related factors was modified by neighborhood SES and neighborhood racial segregation. In the final chapter, I examined 1) the association between adverse childhood experiences and health behavior in adult life, including alcohol use, smoking, BMI, and physical activity in Black men with prostate cancer, and 2) determined if the association of adverse childhood experiences with health behaviors in adult life among Black men with prostate cancer was modified by coping style, neighborhood racial segregation as measured using neighborhood typology, and neighborhood socioeconomic status. We that adverse childhood experiences influence smoking in adulthood and that both neighborhood SES and coping style modify the relationship between adverse experiences and physical activity. These findings provide evidence for the joint effects of experiencing adverse experiences and living in racially segregated neighborhoods