Associations Between Neighborhood Environment, Childhood Adversity, and Cancer Risk: A Geospatial Analysis.

OBJECTIVE: Using a socio-ecological perspective that includes consideration for the effects of the built environment, this study investigated the association between neighborhood-level measures of childhood trauma, adult cancer prevention behaviors, and cancer mortality in Philadelphia. METHODS: Cancer registry data and five neighborhood-level risk factors, including three measures related to trauma and two indices related to adherence to cancer prevention guidelines, were utilized. Multivariate linear regression analyses were performed to assess how risk factors relate to variation in cancer mortality. Associations between each of the neighborhood risk factors and high cancer mortality were identified and visualized geospatially. RESULTS: Trauma and adherence to cancer prevention guidelines together accounted for 50% of the variation in neighborhood cancer mortality in Philadelphia. Neighborhoods near each other were likely to have common prevalent risk factors, and the majority of neighborhoods with the highest cancer mortality rates were also high in trauma measures. CONCLUSIONS: Results expand upon prior research in this area to the neighborhood level, suggesting that neighborhoods with high cancer mortality are more likely to have high levels of trauma and low cancer prevention behaviors. Neighborhood-level measures of trauma can be used to prioritize and tailor trauma-informed cancer prevention efforts.