Association of neighborhood-level vulnerability with health behavior patterns in survivors of childhood cancer: A report from the St. Jude Lifetime Cohort (SJLIFE).

Abstract

10010 Background: Childhood cancer survivors face elevated risks for chronic health conditions and premature mortality. Engaging in healthy behaviors may mitigate these risks, yet neighborhood-level vulnerability may constrain survivors’ ability to adopt or sustain them. Methods: Among survivors (n=3,303) and community controls (n=652) in SJLIFE, neighborhood-level vulnerability was measured using census tract level overall and domain-specific (i.e. socioeconomic status, household composition, minority status, housing type and transportation) Social Vulnerability Index (SVI) scores, with higher values indicating higher vulnerability, and the U.S. Department of Agriculture’s persistent poverty measure. Health behaviors, including sedentary time/physical activity, smoking, alcohol, and illicit drug/marijuana use, were categorized as healthy, moderately unhealthy (1-2 unhealthy behaviors), and unhealthy (≥3 unhealthy behaviors). Multinomial logistic regression evaluated associations between neighborhood-level vulnerability at enrollment and health behavior patterns at most recent evaluation among survivors, adjusted for sociodemographic and cancer treatment factors as determined by backward selection. Interaction models compared associations between survivors and controls. Results: Survivors were 53.1% male, 82.5% non-Hispanic White, with a median age of 31.0 years (interquartile range: 23.5 – 38.5) at health behavior assessment. The most common childhood cancer diagnosis was acute lymphoblastic leukemia (28.8%). Survivors in the highest vs. lowest SVI tertile had higher odds of reporting moderately unhealthy (Odds Ratio [OR]: 1.46, 95% Confidence Interval [95% CI]: 1.08 – 1.98) or unhealthy (OR: 1.70, 95% CI: 1.13 – 2.56) behavior patterns, compared to a healthy behavior pattern. Socioeconomic and housing type SVI domains drove these associations, with survivors in the highest tertiles more likely than those in the lowest to have an unhealthy rather than healthy behavior pattern (Socioeconomic OR: 1.55, 95% CI: 1.02 – 2.35; Housing type OR: 1.53, 95% CI: 1.03 – 2.27). Persistent poverty was associated with greater odds of a moderately unhealthy behavior pattern (OR: 1.70, 95% CI: 1.09 – 2.66) in survivors. Housing type vulnerability was associated with disproportionately higher odds of an unhealthy behavior pattern among survivors compared to controls (ratio of ORs: 2.80, 95% CI: 1.19 – 6.60). Conclusions: Neighborhood-level vulnerability was associated with higher likelihood of unhealthy behavior patterns in childhood cancer survivors with housing type vulnerability having a greater impact on health behaviors in survivors compared to controls. Effective interventions to improve survivors’ health behaviors should incorporate neighborhood-level factors.