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Rogers LQ, Pekmezi D, Schoenberger-Godwin YM, Fontaine KR, Ivankova NV, Kinsey AW, Hoenemeyer T, Martin MY, Pisu M, Farrell D, Wall J, Waugaman K, Oster RA, Kenzik K, Winters-Stone K, Demark-Wahnefried W. Using the TIDieR checklist to describe development and integration of a web-based intervention promoting healthy eating and regular exercise among older cancer survivors. Digit Health 2023; 9:20552076231182805. [PMID: 37434730 PMCID: PMC10331096 DOI: 10.1177/20552076231182805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Objective To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the AiM, Plan, and act on LIFestYles (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. Methods The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. Results A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. Conclusions Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.
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Affiliation(s)
- Laura Q. Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA, USA
| | - Yu-Mei Schoenberger-Godwin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R. Fontaine
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA, USA
| | - Nataliya V. Ivankova
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber W. Kinsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y. Martin
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Maria Pisu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Kaitlyn Waugaman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Oster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Kaur H, Hoenemeyer T, Parrish KB, Demark-Wahnefried W. Dietary Supplement Use among Older Cancer Survivors: Socio-Demographic Associations, Supplement Types, Reasons for Use, and Cost. Nutrients 2022; 14:3402. [PMID: 36014907 PMCID: PMC9414522 DOI: 10.3390/nu14163402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Most Americans take dietary supplements (DSs) and use is even higher among cancer survivors. This secondary analysis seeks to identify types, reasons, and costs of supplements used by 367 older cancer survivors enrolled in the Harvest for Health vegetable gardening trial and evaluate associations between supplement intake and medical/socio-demographic factors. Descriptive statistics were used to identify supplement type and reasons for use. Average market price was used to estimate cost. Fifty-nine percent of the sample reported supplement use. Female (OR 2.11, 95% CI 1.35-3.30), non-Hispanic White (OR 1.77, 95% CI 1.05-3.0), and breast and gynecological survivors (OR 1.57, 1.03-2.38) were significantly more likely to report DS use compared to males, minorities, and survivors of other cancers. Use of vitamins (39%), multivitamins (23%), and minerals (12%) were the most prevalent. Commonly reported reasons for supplement use were to improve general health (47%) or treat medical conditions (39%) and cancer-related symptoms (12%). DSs daily costs ranged from USD 0.02 to 19.81, with a mean of USD 1.28 ± 1.74, a median of USD 0.78, and a mode of USD 0.34. DS use is prevalent among older cancer survivors, with overall health reported as the leading reason for use. Out-of-pocket recurrent costs can be substantial and underscore the need to promote a nutrient-rich diet whenever possible in this vulnerable population.
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Affiliation(s)
- Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
| | - Kelsey B. Parrish
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
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Salvador C, Mark P, Hoenemeyer T, McDonald V. Prospective feasibility study of a mindfulness-based program for breast cancer patients in the southeastern US. Complement Ther Clin Pract 2022; 49:101639. [PMID: 35841719 DOI: 10.1016/j.ctcp.2022.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mindfulness interventions can improve psychological distress and quality of life (QoL) in cancer survivors. Few mindfulness programs for cancer recovery exist in Southeastern U.S. The primary objective of this study was to assess the feasibility of a modified mindfulness-based stress reduction (MBSR) program for breast cancer patients in Birmingham, Alabama. The secondary objective was to explore potential program effects on mindfulness skills and QoL. METHODS This study was a prospective, quasi-experimental feasibility study conducted over 10 months at a university hospital. Feasibility was achieved if 80% of eligible patients screened enrolled in the study and 70% of enrolled patients attended all 8 program sessions. Effectiveness was estimated by changes in mindfulness and QoL indicators measured with validated scales administered at 3 time points and assessed with a non-parametric Friedman test. Sessions included meditation, yoga, and an attention practice called body scan. There were 3 groups of 2-5 patients. RESULTS The sample totaled 12 patients. Forty-four percent (12/27) of eligible patients enrolled in the study, and two out of 12 enrolled patients completed 8 program sessions, resulting in 16.7% (2/12) retention. However, more than half (66.7%) of participants completed at least 7 sessions. Between baseline and 8-week follow-up, patients demonstrated statistically significant improvements in distress, general wellbeing, and fatigue-related QoL. CONCLUSIONS Feasibility objectives were not achieved. However, a majority of participants (66.7%) completed 7 of 8 program sessions. Program effects were promising for distress, fatigue, and wellbeing. Results warrant further research on MBSR-like programs for breast cancer patients in Alabama.
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Affiliation(s)
- Carolina Salvador
- University of Alabama at Birmingham, Division of Hematology/Oncology, 615 18th St S, Suite 2500, Birmingham, AL, 35233, United States.
| | - Phyllis Mark
- University of Alabama at Birmingham, Division of Hematology/Oncology, 615 18th St S, Suite 2500, Birmingham, AL, 35233, United States
| | - Teri Hoenemeyer
- University of Alabama at Birmingham, Division of Hematology/Oncology, 615 18th St S, Suite 2500, Birmingham, AL, 35233, United States
| | - Victoria McDonald
- University of Alabama at Birmingham, Division of Hematology/Oncology, 615 18th St S, Suite 2500, Birmingham, AL, 35233, United States
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Kaur H, Hoenemeyer T, Parrish K, Demark-Wahnefried W. Supplement Intake Among Older Cancer Survivors: Socio-Demographic Associations, Supplement Types, Reasons for Use, and Cost. Curr Dev Nutr 2022. [PMCID: PMC9194034 DOI: 10.1093/cdn/nzac074.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To evaluate associations between supplement intake and socio-demographic factors among older cancer survivors and to identify type of supplements, reasons for use, and cost. Methods This secondary analysis was performed on baseline data from 368 older cancer survivors enrolled in the Harvest for Health vegetable gardening intervention trial. Survivors self-identifying as supplement users reported data on prescribed, over-the counter, and dietary supplements. Chi-square tests were performed to identify associations among supplement use, cancer type, and socio-demographic variables. Descriptive analyses were used to identify common types, reasons of supplement intake, and total daily cost of supplements. Results More than half (59%) of the sample reported taking supplements. Female (OR 2.12, 95% CI 1.35–3.32), Non-Hispanic White (OR 1.78, 95% CI 1.06–3.01), and breast and gynecological cancer survivors (OR 1.58, 1.04–2.40) were significantly more likely to take a supplement compared to males, minorities, and other cancer-types (p-value < 0.05). Survivors reported a mean intake of three supplements, with vitamins (38%), multivitamins (22%), and minerals (12%) as the most prevalent. Commonly-reported reasons for supplement intake were to improve general health (47%), medical conditions (39%), and cancer-related symptoms (12%). Bone health was the most prevalent reason cited under medical conditions, and hair loss, fatigue, and sleep were most commonly reported under cancer-related symptoms. The daily cost of supplements ranged from $0.02–$19.81, with the mean, median and mode being $1.29/day, $0.78/day, and $0.34/day, respectively. Conclusions Nutritional supplement use is prevalent among older cancer survivors with overall health identified as the most common reason for supplement intake. Moreover, out-of-pocket recurrent costs can be substantial. These data emphasize the need to encourage a diet rich in nutrients to minimize daily cost of supplements among older survivors who may live on fixed incomes. Survivors should discuss proper use of supplements with their healthcare providers. Funding Sources This work was supported by the National Cancer Institute and the American Cancer Society.
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Pisu M, Omairi I, Hoenemeyer T, Halilova KI, Schoenberger YMM, Rogers LQ, Kenzik KM, Oster RA, Ivankova NV, Pekmezi D, Fontaine K, Demark-Wahnefried W, Martin MY. Developing a virtual assessment protocol for the AMPLIFI Randomized Controlled Trial due to COVID-19: From assessing participants' preference to preparing the team. Contemp Clin Trials 2021; 111:106604. [PMID: 34757221 PMCID: PMC8555106 DOI: 10.1016/j.cct.2021.106604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 11/01/2022]
Abstract
Background During the COVID-19 pandemic, in-person research assessments needed to be adapted to ensure safety of participants and staff. Participants' willingness to participate in research activities, how to prepare assessors to ensure data integrity, and the feasibility of modified protocols, were unknown. Within the AMPLIFI randomized clinical trial (RCT) for cancer survivors, we elicited participants' preferences and willingness to participate in Clinic, Home, or Virtual assessments, prepared assessors for, and implemented virtual assessments. Methods 1) We conducted phone surveys of potential AMPLIFI participants; 2) Based on survey results, we modified assessments from in-person to virtual visits (VV) by videoconference. Assessors were trained and certified, i.e., assessors recorded 3 assessments that were reviewed and scored by 2 investigators. The modified protocol was proposed to 62 participants: we report numbers of those who agreed to attend VV. Results 1) Survey results: Among 74 survey respondents, 44.6% preferred, 75.7% were willing to attend Clinic Visits; 32.4% preferred, 83.8% were willing to do VV; 23% preferred, 77% were willing to do Home Visits. Survivors 70+ were less likely than 50-69 years old to be willing to do VV: no other differences were noted by gender, race, rural status or education. 2) Assessment uptake: 66.1% agreed to attend VV, and of them 75.6% completed them. Conclusion Diverse research participants adapted to protocols that prioritize their safety, although older participants may be reluctant to do virtual assessments. Virtual assessments are feasible and research teams can rigorously prepare to collect quality data through them.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Iman Omairi
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teri Hoenemeyer
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karina I Halilova
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yu-Mei M Schoenberger
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q Rogers
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly M Kenzik
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Oster
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nataliya V Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Kevin Fontaine
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y Martin
- Center for Innovation in Health Equity Research, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Pekmezi DW, Crane TE, Oster RA, Rogers LQ, Hoenemeyer T, Farrell D, Cole WW, Wolin K, Badr H, Demark-Wahnefried W. Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study. Nutrients 2021; 13:nu13103472. [PMID: 34684474 PMCID: PMC8539255 DOI: 10.3390/nu13103472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 02/01/2023] Open
Abstract
Scalable, effective interventions are needed to address poor diet, insufficient physical activity, and obesity amongst rising numbers of cancer survivors. Interventions targeting survivors and their friends and family may promote both tertiary and primary prevention. The design, rationale, and enrollment of an ongoing randomized controlled trial (RCT) (NCT04132219) to test a web-based lifestyle intervention for cancer survivors and their supportive partners are described, along with the characteristics of the sample recruited. This two-arm, single-blinded RCT randomly assigns 56 dyads (cancer survivor and partner, both with obesity, poor diets, and physical inactivity) to the six-month DUET intervention vs. wait-list control. Intervention delivery and assessment are remotely performed with 0-6 month, between-arm tests comparing body weight status (primary outcome), and secondary outcomes (waist circumference, health indices, and biomarkers of glucose homeostasis, lipid regulation and inflammation). Despite COVID-19, targeted accrual was achieved within 9 months. Not having Internet access was a rare exclusion (<2%). Inability to identify a support partner precluded enrollment of 42% of interested/eligible survivors. The enrolled sample is diverse: ages 23-81 and 38% racial/ethnic minorities. Results support the accessibility and appeal of web-based lifestyle interventions for cancer survivors, though some cancer survivors struggled to enlist support partners and may require alternative strategies.
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Affiliation(s)
- Dorothy W. Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Correspondence: ; Tel.: +1-205-975-8061
| | - Tracy E. Crane
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA;
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL 35294, USA
| | - Laura Q. Rogers
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL 35294, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
| | | | - William W. Cole
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
| | | | - Hoda Badr
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
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Aly S, Daniel CL, Bae S, Scarinci IC, Hardy CM, Fouad MN, Baskin ML, Hoenemeyer T, Acemgil A, Demark-Wahnefried W. Cancer-related Beliefs and Preventive Health Practices among Residents of Rural versus Urban Counties in Alabama. Cancer Prev Res (Phila) 2021; 14:593-602. [PMID: 33526429 DOI: 10.1158/1940-6207.capr-20-0458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/11/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Abstract
Higher prevalence of cancer-related risk factors, for example, tobacco use, obesity, poor diet, and physical inactivity, is observed in the U.S. Deep South and likely contributes to its increased cancer burden. While this region is largely rural, it is unknown whether cancer-related beliefs and lifestyle practices differ by rural-urban status or are more influenced by other factors. We contacted 5,633 Alabamians to complete a cross-sectional survey to discern cancer-related beliefs and lifestyle practices, and compared data from respondents residing in rural- versus urban-designated counties. Findings were summarized using descriptive statistics; rural-urban subgroups were compared using two-tailed, χ 2 and t tests. Multivariable logistic regression models were used to explore associations by rural-urban status and other sociodemographic factors. Surveys were completed by 671 rural- and 183 urban-county respondents (15.2% response rate). Overall, the prevalence for overweight and obesity (77.8%) and sugar-sweetened beverage intake (273-364 calories/day) was higher than national levels. Most respondents (58%) endorsed raising the state tobacco tax. Respondents from rural- versus urban-designated counties were significantly more likely to be racial/ethnic minority, have lower education, employment, income, food security, and internet access, and endorse fatalistic cancer-related beliefs (<0.05; although regression models suggested that cancer belief differences are more strongly associated with education than counties of residence). Lifestyle practices were similar among rural-urban subgroups. Few rural-urban differences in cancer-related beliefs and lifestyle practices were found among survey respondents, although the high overall prevalence of fatalistic health beliefs and suboptimal lifestyle behaviors suggests a need for statewide cancer prevention campaigns and policies, including increased tobacco taxation.Prevention Relevance: Cancer incidence and mortality are higher in the U.S. Deep South, likely due to increased tobacco-use, obesity, poor diet, and physical inactivity. This study explores whether cancer-related beliefs and lifestyle practices differ by rural-urban status or other sociodemographic factors in a random sample of 855 residents across Alabama.
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Affiliation(s)
- Salma Aly
- Department of Medicine, Alexandria University, Alexandria, Egypt
| | - Casey L Daniel
- University of South Alabama College of Medicine, Mobile, Alabama
| | - Sejong Bae
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Isabel C Scarinci
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Claudia M Hardy
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Mona N Fouad
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Monica L Baskin
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Teri Hoenemeyer
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Aras Acemgil
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), Birmingham, Alabama.
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