Acculturation and Adherence to Physical Activity Recommendations Among Chinese American and Non-Hispanic White Breast Cancer Survivors

Nutrition and Exercise Knowledge, Attitude, and Practice: A Scoping Review of Assessment Questionnaires in Cancer Survivorship

Cancer survivors are encouraged to maintain a healthy diet and engage in regular exercise to improve overall physical and psychosocial health, and to reduce the likelihood of cancer recurrence and related mortality. Consequently, nutrition and exercise (the structured component of physical activity) knowledge, attitude, and practice (NE-KAP) are frequently evaluated in research studies involving cancer survivors and are associated with various health outcomes. The aims of this scoping review were to (1) systematically map the types of NE-KAP assessment questionnaires used in cancer survivorship research (i.e., trend or use over the past five years), (2) provide a directory of questionnaires, and (3) identify the most frequently reported health outcomes that have been associated with them. A systematic search was conducted across four databases-Medline, Emcare, CINAHL, and Scopus-from 1 January 2019 to 9 May 2024, for studies addressing one or more aspects of NE-KAP (e.g., food frequency questionnaire for nutrition practice, attitude towards exercise scale for exercise attitude). Eligible studies were extracted, assessed, and reviewed by two independent authors, and data were summarized descriptively. Of the initial 5452 records screened, 1122 articles were screened for full text, and 852 were deemed eligible, with 262 studies included. There was an overall increasing trend in NE-KAP research in cancer survivorship research from 2019 to 2023. Of the 200 unique questionnaires aligning with at least one NE-KAP domain, 45 were untitled and created/adapted specifically for their respective studies, with limited information about their psychometric properties. Out of the 262 included studies, the most utilized questionnaires were those measuring nutrition or physical activity practices, such as study-specific food frequency questionnaires (n = 26, 10%) and the Godin-Shephard Leisure-Time Physical Activity questionnaire (n = 52, 20%). Out of studies that had reported health outcomes (nutrition, n = 23; exercise, n = 40), health-related quality of life was most commonly associated with nutrition (n = 12, 53%) and exercise (n = 9, 23%), and from cross-sectional studies (nutrition, n = 13; exercise, n = 23). An emphasis was placed on assessing nutrition and exercise practices, with limited attention towards the knowledge and attitude domains. Psychometric evaluation of questionnaires was also lacking.

Diet and Physical Activity Behaviors of Breast Cancer Survivors: A Scoping Review

OBJECTIVES

This scoping review explored insight into the current evidence on adherence to health behavior guidelines, specifically diet and physical activity among breast cancer survivors.

METHODS

A scoping review was conducted through databases including PubMed, CINAHL, Scopus, Web of Science, and SPORTDiscus with Full Text in November 2022, following the JBI methodology. The search strategy combined the keywords i) diet OR nutrition OR eating OR exercise OR physical activity OR fitness and ii) breast cancer survivors OR patients with breast cancer.

RESULTS

Twelve original research studies were included; most were conducted in the United States (50%), followed by the European countries (33.34%). Most studies exclusively focused on physical activity (83.33%) and assessed adherence to the physical activity guidelines for Americans (30%), along with the American Cancer Society (20%) and American College of Sports Medicine (20%) guidelines. Overweight or obesity, comorbidity, race, and quality of life were reported as factors associated with physical activity. Independence of disease status was significantly associated with fruit and vegetable intake.

CONCLUSION

Studies reported a wide range of prevalence of adherence to dietary and physical activity recommendations among breast cancer survivors. Further studies are needed to explore diet and physical activity in the context of factors affecting these behaviors among cancer survivors to support the development of healthy behavior, improve health outcomes, and reduce the disease burden among this population.

IMPLICATION FOR NURSING PRACTICE

Nurses have a key role in educating and coordinating multidiscipline teams to initiate and provide cancer survivorship care. These findings indicate that nurses should consider developing targeted strategies and education to promote dietary patterns and physical activity adherence among breast cancer survivors.

Analysis of physical activity levels and influencing factors in cancer survivors after pancreaticoduodenectomy

Introduction

Physical activity is becoming more important in cancer patient care. However, there are limited studies investigating physical activity levels in cancer survivors after pancreaticoduodenectomy. This study aims to assess the present status of physical activity levels in cancer survivors after pancreaticoduodenectomy and whether perioperative metrics and length of follow-up have an impact on physical activity levels in survivorship.

Methods

This is a cross-sectional study. The study included cancer survivors who were treated at a tertiary general teaching hospital for pancreaticoduodenectomy from December 2019 to January 2022 following surgery. We quantified physical activity frequency, duration, and intensity using the International Physical Activity Questionnaire-Short Form. Patient demographic and clinical characteristics were obtained via an electronic medical record system. Postoperative complication data were obtained from our survival cohort. Variables univariately associated with the physical activity level at an alpha level of less than 0.1 were included in the logistic regression analysis of factors influencing physical activity in cancer survivors after pancreaticoduodenectomy.

Results

A total of 223 patients who met the eligibility criteria completed a telephone survey. The main form of physical exercise is walking, 69.5% of participants' physical activity belongs to the active category, but only 16.6% of participants met the aerobic guideline. Logistic regression showed that cancer survivors without pancreatic fistula were 2.453 times more likely to perform active physical activity in survival than those with pancreatic leakage (p = 0.041). For a one-unit increase in operation duration, there is approximately a 0.5% reduction in the level of active physical activity participation among cancer survivors after pancreaticoduodenectomy (p = 0.015). For each unit increase in follow-up time, post-pancreaticoduodenectomy patients were 1.046 times more likely to participate in active physical activity (p = 0.030).

Conclusion

Although half of the cancer survivors after pancreaticoduodenectomy experienced active physical activity, only a small percentage of individuals met the guideline-recommended level of aerobic exercise. More physical activity support should be provided to cancer survivors after pancreaticoduodenectomy. Moreover, operation duration, postoperative pancreatic fistula, and follow-up time should be taken into consideration when giving exercise instructions to postoperative survivors of pancreaticoduodenectomy.

Fatalism and Psychological Distress Among Chinese American Breast Cancer Survivors: Mediating Role of Perceived Self-control and Fear of Cancer Recurrence

BACKGROUND

Extant literature on the relationship between cancer fatalism and psychological distress among Chinese American breast cancer survivors has been mixed, and few studies have examined potential mediators of this relationship. The current study examined how cancer fatalism is associated with psychological distress by investigating perceived personal control and fear of cancer recurrence as mediators, and acculturation as a moderator of these relationships.

METHOD

A total of 220 Chinese American women diagnosed with stage 0-III breast cancer were recruited from California cancer registries and completed a telephone survey. The measurement of cancer fatalism examined one's view of health as a result of destiny. Validated measures of psychological distress (i.e., depressive and anxiety symptoms), fear of cancer recurrence, and perceived personal control were used. Acculturation was defined by English proficiency, preferred interview language, and number of years lived in the USA.

RESULTS

Higher cancer fatalism was directly associated with greater depressive and anxiety symptoms after controlling for covariates. This association was also mediated by higher fear of cancer recurrence, but not by perceived control. The mediation was not moderated by acculturation.

CONCLUSION

Our findings suggest that Chinese American breast cancer survivors' fatalistic beliefs may exacerbate fear of cancer recurrence, and, in turn, depressive and anxiety symptoms. Fear of recurrence was more salient than perceived control in their associations with psychological distress among Chinese American cancer survivors. Future intervention research may adopt cognitive approaches to alter Chinese survivors' fatalistic views of health outcomes to reduce their psychological distress.

Multiple Levels of Influence on Lifestyle Behaviors among Cancer Survivors in Racial and Ethnic Minority Groups: A Systematic Review

Objective

This systematic review aimed to provide a critical summary of studies of physical activity (PA) and diet among racial/ethnic minority cancer survivors. Guided by the socio-ecological model, we identified factors across multiple levels-individual, family/social support, provider/team, and organization/local community/policy environment-that affect PA and diet among racial/ethnic minority survivors.

Methods

We searched the Ovid MEDLINE, EBSCO CINAHL, Ovid PsycInfo, and PubMed databases. We extracted the behavior of focus (i.e., PA and diet), cancer type, race/ethnicity, and the level(s) of influence (and the corresponding factor(s)), and each eligible study investigated individual (e.g., demographic characteristics, psychological factors), family/social support, provider/team (e.g., healthcare provider recommendations), and organization/local community/policy environment (e.g., neighborhood/social environment).

Results

Of 1,603 studies identified, 23 unique studies were eligible. Most studies included breast cancer survivors (n = 19) and Black survivors (n = 13). Seventeen studies assessed associations between PA and factors at the level of the individual (16 studies), family/social support (two studies), provider/team (one study), or organization/local community/policy environment (four studies). Eleven studies assessed associations between diet and factors at the level of the individual (11 studies), family/social support (two studies), provider/team (one study), or organization/local community/policy environment (two studies). Only five studies simultaneously investigated factors across multiple levels. Most demographic and cancer-related factors were not associated with PA or diet. Overall, factors from social-cognitive theories (e.g., self-efficacy) were positively associated with PA. Less consensus was found regarding diet because fewer studies existed, and they also investigated a diverse range of eating behaviors.

Conclusions

There is a critical need for studies of PA and diet that investigate multiple levels of influence particularly for Asian American survivors, male survivors, and cancers other than breast cancer. Social-cognitive theories may help guide the designing of multilevel PA interventions for racial/ethnic minority survivors. Studies assessing overall eating quality or adherence to dietary guidelines are needed.

Acculturation and leisure-time physical activity among Asian American adults in the United States

ABSTRACTObjectives: To examine the association between acculturation and leisure-time physical activity among Asian Americans.Design: Data came from the 2011-2016 National Health and Nutrition Examination Survey, restricting to non-Hispanic Asian adults aged 20 years and older (n = 1989). Acculturation was assessed by language preference at home, birth locations, and length of residency in the United States (US). Self-reported physical activity was used to estimate leisure-time moderate-to-vigorous physical activity (MVPA) in MET-minutes/week and meeting the World Health Organization's physical activity guidelines. Multiple linear and logistic regression models were used to model MVPA as continuous and categorical variables, respectively.Results: A quarter of Asian Americans spoke only English and 47.8% spoke only non-English at home; 13.0% were born in the US. Asians who spoke only English (adjusted prevalence ratio [aPR]:1.5) and Asians who spoke both English and non-English at home (aPR: 1.4) had greater proportions of meeting physical activity guidelines compared to those who spoke only non-English at home. The US-born Asians had higher a proportion of meeting the physical activity guidelines (aPR:1.4) and performed 547.6 more MET-minutes of MVPA each week than foreign-born Asians; they also had a higher proportion of meeting the physical activity guidelines than foreign-born Asians who stayed in US for ≤10 years (aPR:1.5). Length of time staying in the US was associated with a higher proportion of meeting physical activity guidelines. Among foreign-born Asian Americans, higher acculturation measures were also positively associated with meeting physical activity guidelines.Conclusions: Acculturation was positively associated with physical activity levels among Asian Americans. More acculturated Asian Americans such as those who spoke more English at home and US-born Asians, performed more MVPA than less acculturated Asian Americans. Interventions are needed to promote physical activity among non-English speaking Asian immigrants and recent immigrants.

Associations Between Acculturation and Weight, Diet Quality, and Physical Activity Among Latina Breast Cancer Survivors: The ¡Mi Vida Saludable! Study

BACKGROUND

Among Latinos, greater acculturation to the United States (US) is associated with risk of obesity and obesity-related comorbidities. Less is known about the associations between acculturation and obesity-related modifiable risk factors, such as diet quality and physical activity (PA) among Latina breast cancer survivors.

OBJECTIVE

The aim of this study was to explore associations between acculturation and weight status, diet quality, and PA among Latina breast cancer survivors.

DESIGN

This is a cross-sectional secondary analysis of baseline data on demographic and clinical characteristics, acculturation, anthropometric measures, diet quality, and PA collected from Latina breast cancer survivors enrolled in the ¡Mi Vida Saludable! (My Healthy Life) behavioral diet and PA intervention trial.

PARTICIPANTS/SETTING

Participants were Latina women (n = 167) residing in New York City, with a medical history of stage 0 to III breast cancer, no evidence of recurrent or metastatic disease, and at least 90 days post cancer treatment who participated in the ¡Mi Vida Saludable! randomized controlled trial between July 2016 and October 2018.

MAIN OUTCOME MEASURES

Acculturation status was measured by the Short Acculturation Scale for Hispanics score, language preference, place of birth, and duration of US residence. Weight, height, and waist and hip circumferences were measured at an in-person clinic visit. Diet information was collected via 3 telephone-based 24-hour dietary recalls and PA information was collected via staff administered 7-day recalls.

STATISTICAL ANALYSES PERFORMED

Linear regression models examined associations between acculturation and weight status, diet quality, and PA.

RESULTS

Based on the Short Acculturation Scale for Hispanics acculturation score, more acculturated compared with less acculturated Latinas were younger in age, more educated, and had higher annual household incomes (all, P < .05). Compared with Spanish-speaking Latinas, English-speaking Latinas had larger waist circumference (103 vs 96.1 cm; P = .01) and poorer-quality diets (Healthy Eating Index 2015 scores, 57.3 vs 71.5; P < .001). Greater levels of acculturation were also associated with higher levels of leisure walking at a moderate-to-vigorous intensity (265.8 vs 179.0 min/wk; P =.04).

CONCLUSIONS

Greater levels of acculturation were associated with higher central obesity and poorer-quality diets. Future lifestyle modification trials tailored to the unique role of acculturation on adopting behavior change recommendations is a promising next step in this line of research.

Acculturation, Physical Activity, and Metabolic Syndrome in Asian American Adults

INTRODUCTION

Asian Americans (AsAms) have a high prevalence of metabolic syndrome (MetS) and are one of the least physically active racial groups in America. The purpose of this study was to examine the relationship between MetS and moderate-to-vigorous physical activity (MVPA) among AsAm adults and whether acculturation modifies this relationship.

METHOD

Data were from 2,259 AsAms participating in the 2011-2016 National Health and Nutrition Examination Survey. Physical activity (PA) was self-reported as minutes of weekly MVPA. Acculturation included nativity, length of residency in America, and language preference. The International Diabetes Federation criteria was used to determine the presence of MetS.

RESULTS

About 64.4% of AsAms did not meet the PA recommendation (MVPA ≥150 min/week). The prevalence of MetS was 39.2%. The odds of having MetS were greater among AsAms who did not meet MVPA recommendations compared with those who did meet MVPA recommendations (odds ratio [OR] = 1.5, 95% confidence interval [CI] = [1.11, 2.07]). When stratified by acculturation, this association remained statistically significant in the groups who immigrated to America more than 15 years ago and who spoke English only.

CONCLUSION

MVPA reduces MetS risk in AsAm adults, especially among more acculturated AsAms. Culturally adapted programs are warranted to promote PA and adequate knowledge of disease prevention in this population.

The Association Between Social Support and Psychological Distress in Latina Mothers Living in Miami-Dade County, Florida

BACKGROUND

This study analysed the relationship between social support and psychological distress in Latina women in Miami-Dade County. Acculturation was examined as a modifying factor.

METHODS

A 2005 data set from interviews of 155 Latina mothers in Miami-Dade County, from mother-daughter dyads, was analysed. Social support was measured using the Interpersonal Support Evaluation List (ISEL) score. Psychological distress was based on self-reporting symptoms of depression, anxiety, or suicidality. Acculturation was based on English proficiency and length of U.S. residency.

RESULTS

Compared to those with high social support, women with low social support had greater odds of reporting psychological distress (odds ratio = 7.8 [95% CI 2.70-22.10]). Acculturation did not modify the association (p=0.74).

CONCLUSIONS

Social support was inversely associated with psychological distress among Latina women. Acculturation was not an effect modifier, likely due to inadequate power. The study has clinical implications for mental illness prevention in this population.