Creating a Structural Resource Prevention Index for Breast Cancer in a Southwestern US City with Historic Neighborhood Segregation

BackgroundHistorically segregated neighborhoods in the United States continue to experience disproportionate health disparities, including cancer outcomes. The social vulnerability index (SVI) and similar indices are widely used to measure community disadvantage, but they do not directly capture contextual infrastructure relevant to cancer prevention. In Tucson, Arizona, where racially restrictive housing covenants, conditions, and restrictions (CCRs) remain as a legacy of segregation, we developed an alternative approach to assess neighborhood-level access to breast cancer prevention resources. MethodsWe developed the Structural Prevention Resources Index (SPRI), calculated as arithmetic mean of scores for access to free screening clinics, grocery stores with fresh produce, and parks. Each component was equally weighted to produce a composite score ranging from 1 (better access) to 6 (poorer access). We compared the SPRI to the Social Vulnerability Index (SVI). ResultsDrive-time analyses highlighted poor access to clinics providing free breast cancer screening for the eastern study area. Park access and quality were more evenly distributed with 56% of women ages 40-64 having access to high-quality parks. SPRI showed that minoritized women ages 40-64 more often resided in high or very high resource areas (67%) vs. non-minoritized women ages 40-64 (56%). SPRI captured geographic variation distinctly different than the SVI, notably a large central eastern portion of the study area with few prevention resources and low SVI scores. ConclusionDisease-specific indices such as SPRI can uncover structural barriers to chronic disease prevention, like breast cancer, often overlooked by general measures of geospatial vulnerability, offering more precise tools for guiding equitable public health planning and strategies. HighlightsO_LIDevelops the Structural Prevention Resource Index (SPRI) for breast cancer. C_LIO_LICompares disease-specific index (SPRI) with the Social Vulnerability Index (SVI). C_LIO_LIFinds SPRI captures geographic disparities not reflected in SVI in Tucson, Arizona. C_LIO_LIDemonstrates value of disease-specific indices for public health planning. C_LI