A Multilevel Approach to Cardiovascular Health in African American Breast Cancer Survivors: from Neighborhoods to Metabolomics - ABSTRACT
This application will provide the candidate, Dr. Qin, with needed training and research experiences for her to
grow into an independent investigator in cancer health disparities. Dr. Qin’s long-term career goal is to
integrate multilevel and transdisciplinary components into cancer epidemiology research that will increase the
understanding of multilevel modifiable factors affecting cancer health, especially in minority cancer populations,
and will ultimately reduce cancer health disparities. African American (AA) breast cancer (BrCa) survivors have
worse cardiovascular health (CVH, e.g., obesity, diabetes, unhealthy diet) compared to their white counterparts,
which contributes to sizable racial disparities in BrCa mortality. Although the disproportionate burden of poor
CVH among AA BrCa survivors is hypothesized to result from multilevel determinants ranging from
neighborhood social and built environments to biological and molecular pathways, most studies have
examined either biological or behavioral factors, neglecting the influence from neighborhood social and built
environments, and cross-level associations and mechanisms. Thus, conceptualized on the NIMHD research
framework, the goal of the proposed study is to investigate multilevel modifiable factors affecting BrCa
survivorship (with a targeted focus on CVH) and survival among AA women. To achieve this goal, Dr. Qin will
utilize the Women’s Circle of Health Follow-Up Study (WCHFS), an existing and ongoing population-based
longitudinal study of AA breast cancer survivors, for four specific aims. In Aim 1, she will integrate
neighborhood environment measures with WCHFS to enrich this individual-level survey and medical record
data. In Aims 2 and 3, she will investigate specific modifiable neighborhood factors influencing CVH and
survival of AA BrCa patients. In Aim 4, she will examine the underlying biological mechanisms between CVH
and both BrCa-specific and overall survival through serum metabolomic profiling. Results from the proposed
study may improve BrCa outcomes among AA women in two ways. First, in addition to a much better risk
stratification of the BrCa population, investigating potentially modifiable neighborhood factors can inform
stakeholder efforts in developing evidence-based, wide-reaching strategies such as land use regulations,
zoning, and street design. Second, evaluating metabolomic signatures that medicate CVH and BrCa survival
will have great potential to advance the use of biomarkers to monitor CVH and to guide pharmacologic
interventions that will improve BrCa survival. Dr. Qin will develop additional expertise in multilevel and
geospatial methods, cancer health disparities in survivorship and survival, and cancer metabolism and
metabolomics through structured training and career development activities and didactic mentoring from an
interdisciplinary team. The proposed training and research together with protected time are crucial to facilitate
Dr. Qin’s transition into an independent investigator in cancer health disparities with expertise in conducting
multilevel epidemiological studies.
