Research That Matters (January 17 - 20, 2008)

Background and Purpose: Breast cancer remains a significant problem in the United States. Although White women are more likely than African American women to develop breast cancer, African American woman are more likely to die from it. As 70-80 percent of breast cancers are due to sporadic mutations of breast cancer genes, it is important to understand the social and ecological factors that influence these sporadic mutations. Clues to the social and ecological realities of women with breast cancer can be found in the built environments of their neighborhoods, including an examination of the physical characteristics of the neighborhood and its use. In disadvantaged neighborhoods, abandoned buildings, commercial depletion, violent crime, degraded infrastructure and unsafe spaces are frequent features examined to understand neighborhood effects on health. However, traditional measures have been unable to capture these key features and how they influence health and well-being. In this study, commonly used census track data cannot provide the level of information about neighborhood characteristics that is specific to the neighborhoods in which women live, and thus any health salient characteristics of the built environment using census information cannot be precisely measured. Few studies have examined the built environment through observer-rated neighborhood surveys that capture the immediate physical environment of the neighborhood and determine its correlation to social factors and processes.

Method: Following face-to-face interviews with 230 African-American women from Chicago who were newly diagnosed with breast cancer, teams of researchers map the ecology of the four-block area around each participant's home, noting features known to inhibit or encourage social interaction, such as dangerous vacant buildings and lots (and their use), the amount of foot traffic at 2:00 and 9:00 p.m., and the availability of open spaces. These and other characteristics are compared to participants' interviews to determine how the independent features of the built environment are correlated with measures such as social isolation, depression, and vigilance. Geo-coded data from the public domain will allow us to measure crime, population density, housing quality and other features of the participants' neighborhoods.

Results: The inner-city women in the study were more isolated than a more affluent group of African-American residents of Cook County, Illinois, using the same instrument (t=4.89, p<0.001). Animal models demonstrate that socially isolated rats have higher rates of malignant mammary tumors. We extend this finding to examine how social isolation, depression, and vigilance interact with biological responses and the built environment in women with breast cancer. Findings will show how the built environment, measured at the four-block level of detail, impedes women's movement through the neighborhood and affects social isolation, depression and vigilance.

Implications: This research will inform policies that focus on “cleaning up” aspects of neighborhoods that create dangerous spaces and contribute to social isolation, depression, and vigilance. Also, understanding psychosocial factors that link to features within the built environment and contribute to a woman's vulnerability to stress will assist treatment providers in identifying high-risk individuals, promote efforts to increase community capacity and collective efficacy, and aid in earlier detection and treatment.