Project Summary
Cancer is a leading cause of morbidity and mortality among Black women with a substantial burden due to
alcohol use, smoking, and obesity. Despite growing evidence of the importance of early life adverse
experiences on long-term health, little is known about how chronic exposure to adverse experiences across the
life course influences cancer risk factors or risk behaviors among Black women. African American women are
particularly vulnerable to a higher burden of adverse experiences. Due to high levels of racial residential
segregation in the United States, African American women are also more likely than women of other races to
live in poor, segregated neighborhoods irrespective of individual education and income. Neighborhood context
may exacerbate effects of individual level adverse experiences. There is some evidence suggesting that
modifying the neighborhood may attenuate the effects of adverse experiences in early life. We hypothesize
that adverse experiences across the life course, compounded by living in a highly racially segregated
neighborhood in adulthood will result in a higher risk of unhealthy coping behaviors. Using the Black Women’s
Health Study, a cohort of 59,000 African American women (followed from 1995-present), we aim to 1) examine
the association between trajectories of adverse experiences in childhood, adolescence, and adulthood and
adult alcohol use, smoking, and body size in African American women and 2) determine if the association of
adverse experiences with adult alcohol use, smoking, and body size is modified by neighborhood racial
segregation and socioeconomic status.
This study will fill a critical gap in understanding the influence of early life adverse experiences on cancer risk
factors among Black women. Identifying critical periods and intervening earlier in the life course will yield
greater gains in reducing cancer disparities in this population. The proposed research incorporates several
innovative elements: 1) We are using a large, well powered dataset that was exclusive designed to elucidate
the drivers of a multitude of health outcomes among Black women;; 2) by incorporating a trajectory approach
we are able to assess how the timing and continuity of adverse experiences influence health behaviors;; 3) By
employing multilevel models we can examine the influence of multilevel (both individual and neighborhood)
stressors on health behaviors in this population;; 4) we are examining multiple measures of body size including
waist-to-hip ratio (WHR) and BMI. The interdisciplinary training environment for this proposal will provide the
applicant an opportunity to enhance methodological skills, build research competency, and enhance content
expertise, in order to become an expert in the intersection of cancer and social epidemiology.
