Smoking rates in the United States are stagnant, secondhand smoke continues to kill thousands of people every year, and obesity is epidemic and getting worse, contributing to many cancers. The problem is particularly evident in Black, Latino, and low SES populations, especially among women. Clinical practice and intervention research face numerous challenges in their efforts to sustain smoking cessation and weight loss among individuals, suggesting that further knowledge is urgently needed to inform practice and more effective interventions. Evidence exists that there are important contextual and geographic influences (measured by neighborhood SES and the built environment) on smoking and obesity.  However, methodological challenges are hampering scientific progress in moving the field forward.

This study will address a number of significant gaps in the understanding of how contextual and geographic factors together influence cancer risk among women and their young children. This will be done using one of the most comprehensive and ethnically diverse population-based data sources in the nation.  The study includes an innovative strategy to measure neighborhood SES over time, to take into account not only the respondents’ own neighborhood, but also those surrounding it, and to integrate built environment characteristics at diverse levels of aggregation (Aim 1). Next, the study extends current work to examine dose-response relationships between neighborhood SES and risk factors for cancer, and to identify specific features of the built environment that matter (Aim 2). Finally, to inform development of interventions and clinical practice, the study tests for interactive effects of residential exposures on subgroups of women and children (defined by race/ethnicity and SES) (Aim 3).

Successful completion of the proposed aims will advance our knowledge of disparities in important risk factors for cancer, inform clinical recommendations for what is achievable in this population, and define groups in need of tailored individual-level intervention and possible avenues for environmental-level intervention. To reduce disparities in risk factors for cancer—a primary health policy objective in the U.S.–population-based research that directs attention towards the social determinants of health are needed to complement basic science and behavioral interventions, with the ultimate goal of informing policy, interventions and clinical practice.