Survivors of childhood cancer are at risk for obesity and associated chronic health conditions - risks that are potentially modifiable if survivors adopt a lifestyle with adequate physical activity and a healthy diet. Neighborhoods where survivors reside may influence uptake of health behaviors. We examined associations between neighborhood factors (e.g. neighborhood effect) and obesity in survivors.


Adult survivors participating in the St. Jude Lifetime cohort with addresses available for geocoding were eligible for analysis [N=2265, mean assessment age 32.5 (SD 9.1) years, 46% female, and 85% white]. Survivors completed questionnaires regarding individual behaviors; percent body fat was assessed via dual x-ray absorptiometry (obesity: ≥25% males; ≥35% females); and neighborhood effect was characterized using census tract of residence (e.g. neighborhood socioeconomic status (SES), rurality).Structural equation modeling (SEM) was used to determine associations between neighborhood effect, physical activity, diet, smoking, treatment exposures, and obesity.


Obese survivors (n=1420, 62.7%) were more likely to live in neighborhoods with less access to exercise opportunities (Relative risk [RR]: 1.12, 95% Confidence interval [CI]: 1.01-1.25), neighborhoods with lower SES (RR: 1.23, 95% CI: 1.10-1.38), and rural areas (RR: 1.22, 95% CI: 1.07-1.39) compared to normal percent fat survivors. Resource poor neighborhoods (standardized effect: 0.06, p<0.001) and cranial radiation (0.17, p<0.001) had direct effects on percent body fat. Associations between neighborhood of residence and percent body fat were increased (0.01, p=0.04) among individuals with a poor diet.


The neighborhood in which a childhood cancer survivor resides as an adult is associated with obesity. Interventions targeting survivors should incorporate strategies that address environmental influences on obesity.