Neighbourhood socioeconomic status (nSES) and built environment features strongly influence diet, physical activity and cancer screening adherence, potentially affecting colorectal cancer (CRC) incidence and prognosis. The aim of this study is to assess the association between neighbourhood obesogenic environments (eg, nSES, restaurant and retail food indices, recreational facilities, and business district residence) and CRC risk and mortality.

A secondary data analysis was performed using prospectively collected data from the Southern Community Cohort Study.

12 states in the Southeastern USA.

We analysed data from 70 519 participants enrolled in the Southern Community Cohort Study.

The primary outcomes in this study are CRC risk and mortality.

We used multivariable Cox proportional hazards models, adjusting for individual-level factors to investigate neighbourhood-level risk factors associated with CRC risk and mortality. We further performed race-stratified analyses (Black/White) to examine potential disparities in CRC risk.

Among 70 519 participants (69.49% Black, 30.51% White), 927 (1.31%) were diagnosed with CRC (1.37% Black and 1.19% White participants). Of these, 255 (27.5%) died from CRC. Compared with participants residing in the highest (fifth) nSES quintile, those residing in the wealthier (fourth) quintile of nSES exhibited a higher CRC risk (adjusted HR (aHR) 1.27 (95% CI 1.03 to 1.57)). The Retail Food Environment Index was associated with an increased risk of CRC among participants residing in the fifth (wealthiest) nSES quintile (aHR 3.07 (95% CI 1.23 to 7.61) for Tertile 1 vs None; aHR 3.06 (95% CI 1.23 to 7.60) for Tertile 2 vs None). Similar associations were observed among both Black participants (aHR 3.65 (95% CI 1.19 to 11.20) for Tertile 1 vs None) and White participants (aHR 5.20 (95% CI 1.29 to 20.97) for Tertile 2 vs None) living in the same neighbourhoods, although these subgroup estimates should be interpreted cautiously due to wide CIs. Living in a low-walkability neighbourhood was associated with a higher risk of CRC (aHR 2.42 (95% CI 1.09 to 3.56)) among residents in the second-lowest nSES quintile, particularly among Black participants (aHR 3.41 (95% CI 1.29 to 9.02)). Compared with residents of the most walkable neighbourhoods, those in the least walkable (aHR 2.23 (95% CI 1.10 to 4.54)), below-average walkable (aHR 2.10 (95% CI 1.08 to 4.07)) and above-average walkable areas (aHR 2.33 (95% CI 1.24 to 4.39)) had significantly higher CRC mortality risk.

Our findings suggest that nSES and unhealthy food environments are associated with CRC risk, while less walkable environments were associated with higher CRC mortality. These findings highlight the need for a more detailed assessment of neighbourhood-level deprivation and support enhanced public policies targeting neighbourhood deprivation in low-income populations in the Southeastern USA.

The Comprehensive High-dose Aphasia Treatment (CHAT) programme is an intensive comprehensive aphasia programme, which aims to address evidence-practice gaps in aphasia rehabilitation where there are known barriers to service delivery requiring implementation strategies. The aims of this study are to (1) evaluate the clinical implementation of the CHAT programme, (2) assess the clinical effectiveness of CHAT compared with usual care in rehabilitation services and (3) determine whether the real-world implementation of CHAT compared with usual care is cost-effective.

Four participant groups will be recruited across six hospital and health services Australia-wide to participate in a type 3 hybrid effectiveness-implementation study: (1) people with aphasia, (2) support persons, (3) treating clinicians and students and (4) clinical stakeholders (eg, managers). This before-and-after study will include three time periods: (1) ‘usual care’ where people with aphasia will receive their usual care aphasia therapy, (2) ‘implementation transition’ where clinicians will be trained to deliver CHAT and (3) ‘intervention implementation’ where people with aphasia will receive the CHAT programme (ie, 50 hours of evidence-based aphasia therapy over 8 weeks). Evidence-based implementation strategies will be used to facilitate implementation within participating rehabilitation services. The primary outcome is delivery of evidence-based aphasia treatment (ie, CHAT) as measured by a composite score of quality indicators. Clinical effectiveness outcomes, measuring change in language impairment, communication effectiveness, confidence and quality of life, and implementation outcomes will also be examined. We will also conduct an embedded mixed-methods process evaluation and economic evaluation.

This study has been approved by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC/2021/QRBW/72154). Outputs will include conference presentations, publications and a training package to optimise implementation of aphasia treatment in rehabilitation service contexts.

Australian New Zealand Clinical Trials Registry (ANZCTR) prospective registration ACTRN12621001765819. Trial registered 23 December 2021. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381365&isReview=true.