Abstract
BACKGROUND: Social adversity from neighborhood disadvantage (ND), objectively measured using the area deprivation index, is a known factor contributing to breast cancer disparities and has been associated with heightened psychophysiologic stress response processes, more aggressive tumor biology, and worse disease outcomes. Although many aspects of ND may be less accessible for modification, some subjective experiences of ND may be modifiable through psychosocial intervention. This study investigates a critical gap in the literature with regard to the link between objective ND and potentially modifiable subjective perceptions of ND. METHODS: From 2020 to 2024, 610 adult patients (English-, Spanish-, and Creole-speaking) receiving care for breast cancer at a South Florida NCI-Designated Cancer Center and sister safety-net hospital enrolled in a cohort study and completed measures for neighborhood-level adversity (Neighborhood Social Environment Adversity Survey) and individual-level (Perceived Stress Scale and Impact of Event Scale-Intrusions) perceived stress as well as coping mechanisms (John Henryism Active Coping Scale, Social Provisions Scale, and Management of Current Stress). The area deprivation index was derived from residential addresses. RESULTS: Multiple regression analyses found that: (i) women living in areas of higher objective ND reported greater levels of perceived ND (Neighborhood Social Environment Adversity Survey), (ii) greater subjective ND related to greater general (Perceived Stress Scale) but not cancer-specific stress (Impact of Event Scale-Intrusions), and (iii) women with greater coping mechanisms (John Henryism Active Coping Scale, Social Provisions Scale, and Management of Current Stress) reported lower levels of subjective ND (all P < 0.05). CONCLUSIONS: This study clarified relationships among sources of social adversity, stress, and coping mechanisms. IMPACT: These findings may help inform intervention design for patients with breast cancer living in social adversity.