Cancer prevention, mental health and social capital of segregated Black Americans
The proposed dissertation multi-level study will investigate the social determinants of breast and prostate cancer preventive screening behaviors and mental health outcomes on African-American residents of racially, residentially segregated urban neighborhoods of Philadelphia, Pennsylvania. The Specific Aims of this proposal focus on the following questions: 1. Do different levels of bonding social capital and different measures (structural, cognitive) of social capital predict mental health outcomes and cancer preventive behaviors within racially and residentially segregated urban settings, net of individual-level compositional characteristics (age, gender, socioeconomic position, foreign-born status)? 2. Is the effect of social capital on cancer preventive behaviors and mental health outcomes in segregated communities mediated by neighborhood characteristics (level of poverty, amount of violence, presence of non-acute health care facilities, level of segregation). A mentoring team of experienced investigators has been assembled to pursue this study, including leading national experts on social epidemiology (Ichiro Kawachi), mental health disparities (David Williams), cancer epidemiology (Katrina Armstrong), and demography (Dolores Acevedo-Garcia). The proposed dissertation accords with the National Cancer Institute's mission "to eliminate suffering and death due to cancer and to preempt cancer at every opportunity". The knowledge gained from this study can aid in understanding the role of social capital in promoting cancer preventive behaviors in African-Americans - a group with higher cancer mortality rate -- which fits NCI's desire to accelerate progress in cancer prevention and improve early detection and diagnosis. This study will draw on three main sources of data: the 2004 Southeastern Pennsylvania Health Household Survey (SPHHS) administered by the Philadelphia Health Management Corporation data, US Census Data, and local public record. The 2004 version of the SPHHS includes the self-report of mental health conditions, cancer preventive screening behaviors, and social capital measures from the Social Capital Community Benchmark Survey. Presence of block parties will be assessed using data from the City of Philadelphia Department of Streets and presence of non-acute care facilities from the the US Department of Health and Human Services Health Resources and Service Administratrion website. Data will be aggregated and geocoded to segregated areas of Philadelphia County using a novel measure of segregation based on 2000 US Census Data.