Cancer-related Health Behaviors Research Articles

Initiatives to increase breast and cervical cancer-related knowledge, screening, and health behaviours among Black women.

In Canada, racialized and immigrant women are typically under-screened for breast and cervical cancer. Under-screening is linked to numerous barriers to access, including lack of awareness, fear of pain, the stigma of cancer, socio-cultural factors like language, and various socio-economic factors. To address these barriers, our team developed a series of initiatives to promote awareness of breast and cervical health among Black women. Building on the development of a breast cancer resource hub for Black women, and in partnership with relevant community organizations, we implemented a series of virtual educational and cancer screening events (two of each thus far). Both event series were targeted towards Black women and tailored to their needs. Each educational event attracted more than 450 attendees and had average attendance times > 1h. Most (> 87%) survey respondents agreed that an event specifically for Black women helped them feel supported. The 2022 and 2023 screening events provided breast and/or cervical cancer screening for 46 and 48 women, respectively. In both years, most women (> 90% of question respondents) noted that they were (extremely) likely to go for a mammogram or Pap test when next due. Both event series provided targeted opportunities for Black women to learn about prevention, risk factors, resources, and screening related to women's cancers. It is possible that, over time, such culturally tailored events can reduce or remove the stigmas associated with cancer and decrease differences in cancer-related knowledge and behaviours between racialized and non-racialized groups.

Abstract A045: Adhering to a culturally responsive framework: Integrating kinship into a multilevel community-based intervention for American Indian adults with comorbid type 2 diabetes and cancer

Abstract The prolific disparities of type 2 diabetes (T2D) and cancer in tribal communities is well documented. American Indian (AI) adults living with T2D are at greater risk of not only developing cancer, but also dying from it, with cooccurrence becoming increasingly prevalent. On rural tribal reservations, common environmental diabetogenic factors (e.g., obesity, lack of physical activity, poor diet, and stress) are considered as sources of elevated risk for both T2D and cancer. Critically important in improving both diabetes and cancer-related health behaviors and outcomes, particularly for AI people, is psychosocial support from family and community ties (e.g., kinship). Despite supporting evidence, few interventions include kinship as a key factor to promote best outcomes for T2D management among AI adults with a dual diagnosis of cancer. To address this growing issue, there is an urgent need for culturally and contextually adapted interventions aiming to address the cooccurrence of T2D and cancer that are, ideally, led by tribal communities. In this session, healthcare professional Early-Stage Investigators (ESIs), some of whom also identify as AI, will present community-based participatory research (CBPR) principles used to develop a multilevel Tribally tailored intervention, with kinship as a moderating factor, for AI adults living with both T2D and cancer. The ESIs represent a unique pool of providers invested in the community within which they work by co-creating an intervention which utilizes pre-existing strong community and familial norms. The ESIs further look to break away from the common trend in research to overgeneralize interventions and findings to all AI Tribal communities by tailoring the intervention to each specific Tribal Community engaged in the research intervention. To foster innovative research methods by emphasizing important historic and socio-cultural influences relevant to understanding the holistic context of health disparities in tribal communities, the guiding framework is the NIMHD Minority Health and Health Disparities Research Framework adapted for AI and Alaska Native Nations. In this research, individuals are viewed within the context of the broader social system where they function daily, while families and community are key stakeholders and leaders in the successful management of T2D and cancer. The approach focuses on diabetes-related barriers by providing family and social units with skills for successful T2D and cancer management, healthy communication, and shared commitment. In addition to these domains of influence, involving community systems is critical for a sustainable intervention that effectively addresses health disparities for T2D and cancer. Citation Format: Sheila L. Hammer, Timian M. Godfrey. Adhering to a culturally responsive framework: Integrating kinship into a multilevel community-based intervention for American Indian adults with comorbid type 2 diabetes and cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A045.

Evaluation of Family and Community Social Network Characteristics Among High-Risk Family Members to Improve Cancer-Related Health Behaviors.

To evaluate the effects of social network characteristics of individuals with a family history of cancer on the use of cancer-related services (e.g., screening, genetic counseling/testing). 170 family members of individuals with the most common hereditary or familial cancers. Data collection occurred between March and September 2021 using an online survey. Having strong within-immediate family relationships and family members who underwent more screening procedures was associated with increased breast cancer screening, and having more family members with cancer was associated with colorectal cancer screening. Having a large family, having family members who underwent screening for more cancers, and having strong social cohesion among families were associated with an increased rate of genetic testing. Nurses working with families affected by cancer should focus on strategies to strengthen relationships among family members to improve knowledge of cancer screening and available genetic services.

33980 Skin cancer risk factors and screening among Asian Americans: Pooled cross-sectional surveys from 2000 to 2015

Asian Americans are underrepresented in health disparities research and little is known about skin cancer risk factors and screening among Asian Americans. We examined sunburns, sun-protective behaviors, indoor tanning, and total body skin examinations (TBSE) among Asian Americans as compared with non-Hispanic Whites. Cross-sectional survey data from the National Health Interview Survey were pooled from 2000-2015. Multivariate logistic regression models examined associations of skin cancer risk factors and screening with race. Models were weighed to provide nationally representative estimates and adjusted for survey year, sociodemographic factors, cancer-related health behaviors, and skin cancer history. Overall, 132,583 non-Hispanic Whites and 10,102 Asian Americans were included (2083 Chinese; 1928 Asian Indian; 2307 Filipino; 3784 other Asian). Asian Americans were more likely to seek shade, wear long clothing to ankles, and wear long-sleeved shirts but less likely to sunburn, apply sunscreen, tan indoors, and receive TBSE than non-Hispanic Whites (each P < .05). Asian Indians were less likely to sunburn (adjusted odds ratio 0.54; 95% CI 0.39-0.75) and more likely to wear long-sleeved shirts (1.54; 1.22-1.95) or long clothing to ankles (1.91; 1.53-2.40) than Chinese participants. Filipinos were more likely to engage in 1+ sun-protective behavior (1.30; 1.08-1.56) than Chinese participants. Limitations included self-reported data and no adjustment for skin tone. Asian American sun-protective behaviors may not be influenced by perceived skin cancer risk. Direct comparisons among Asian Americans subgroups revealed differences utilizable through culturally tailored interventions. Oversampling of Asian Americans will facilitate disaggregated analyses that may unmask health disparities among Asian American subgroups.

Moderators of the effects of perceived racism and discrimination on cancer-related health behaviors among two samples of African Americans

BackgroundAssumptions regarding within-race variation in the associations between measures of discrimination racism and health-related behaviors among African Americans have been largely unexplored. MethodsWe conducted secondary analyses of two studies to examine support for a model which describes several theoretical moderators of the effects of discrimination and racism on health behaviors. The first study examined the effects of group-based behavioral information and racial identity on the association between perceived racism and requests for at home colorectal cancer screening tests among a sample of 205 geographically diverse African Americans who participated in an online experiment from 2019 to 2020. ResultsGroup-based behavioral information attenuated the association between perceived racism and requests for at-home screening kit. In the absence of group-based behavioral information, perceived racism was positively associated with screening kit requests for African Americans with weaker racial identity and negatively associated with requests for African Americans with stronger racial identity. The second study examined the influence of personal and group-based perceived discrimination, and behavior-relevant affective information related to a breast cancer risk notification, on 89 Michigan dwelling African American women's self-reported physician communication from 2015 to 2016. Results showed that perceived group-based discrimination was positively associated with physician communication in the absence of negative affective information, and perceived personal discrimination was negatively associated with physician communication as positive affective information increased. ConclusionsTogether, these results support our theoretical model highlighting variation in the effects of discrimination and racism on health behaviors among African Americans, and indicates group-relevant behavioral information, racial identity, behavior relevant affective information, and target of discrimination as moderators of the effect. Implications for conceptualizing the effects of racism and discrimination and for examining racially targeted interventions are discussed.

The effectiveness of pharmacist-based coaching in improving breast cancer-related health behaviors: A randomized controlled trial.

Background:Although pharmacists are trusted and easily accessible by the public, their role in changing health behaviours related to breast cancer has been rarely investigated.Objective:To investigate the effectiveness of pharmacist-based coaching in improving BC-related health behaviors and knowledge in females, and to measure the comfort level toward this program.Methods:This was a randomized controlled study carried out in community pharmacies in Egypt. Pharmacies included were asked to enroll 240 females into a trial, then equally allocate them into either active or control arms, and provide 12 weekly face-to-face coaching sessions to those assigned to the active arm. Pharmacists were also asked to survey females and fill a standardized data collection form at baseline, in the middle of coaching, at the end of coaching, and three months after coaching.Results:The proportions of doing high physical activity, practicing healthy diet, and practicing breast self-exam three months after the end of coaching programme across the active and control arms were 52.17% versus 17.09% (p=0.002), 62.60% versus 28.20% (p=0.003), and 81.73% versus 23.07% (p=0.005), respectively. The mean scores of knowledge on BC symptoms, risk factors, and detection methods three months after coaching across the active and control arms were 4.10±2.47 versus 2.72±1.19 (p=0.038), 4.25±2.20 versus 3.28±1.48 (p=0.020), and .34±1.80 versus 1.72±0.68 (p=0.001) respectively. While most of the females participated in the active arm were comfortable toward the financial 94.78% and social 88.69% sides of the program, more than one-third (34.78%) of the participants were uncomfortable toward the competency of coaches.Conclusion:Despite the need for some modifications, BC-related health behaviors and knowledge can be improved through pharmacist-based health coaching.

Multifactorial causal beliefs and colorectal cancer screening: A structural equation modeling investigation.

We tested a conceptual model that describes the relationship between individuals' understanding of the multifactorial nature of cancer and their self-reported colorectal cancer screening. We collected cross-sectional survey data from 205 men and women age 50-75. Data were analyzed using structural equation modeling. The proposed model had reasonable fit (RMSEA = 0.09, CFI = 0.65). Multifactorial causal beliefs were associated with cancer risk perceptions (β = 0.16, p = 0.019) and more optimistic cancer cognitions (β = 0.17, p = 0.013). However, these constructs were not associated with colorectal cancer screening (p's > 0.05). Further testing could reveal whether this model can be applied to other cancer-related health behaviors including lifestyle changes and genetic testing.

Knowledge, perception, and attitude of the general population toward cancer and cancer care

Background: Despite the advances in the field of oncology, the diagnosis of cancer is often considered a death sentence, owing to the misconceptions and myths about cancer treatment. Moreover, improvements in health literacy and awareness about cancer have also not been able to change the attitude of people toward cancer-related health behaviors. Objective: In this study, we aimed to evaluate the knowledge, perception, and attitude of the general population toward cancer and cancer care. Materials and Methods: This cross-sectional study was conducted at Malabar Cancer Center, a tertiary cancer center in Kerala, India, between June 2017 and February 2018. A survey was conducted in the general population in the northern part of Kerala in the districts of Kannur, Kasargod, and Wayanad during a medical camp. People who were aged above 18 years and could read the Malayalam language were included in the study. The participants were administered a questionnaire comprising 26 questions, and the knowledge, perception, and attitude of the general population toward cancer and cancer care were evaluated. Results: A total of 487 people responded to the survey. Of these, 354 (72.7%) were women and 133 (27.3%) were men. The mean age of the cohort was 43.7 years. About 74% of the participants disagreed that all cancers can be treated using the same treatment modalities. A total of 84% of the participants agreed that cancer can be detected early with screening. Almost 95% of the participants were aware of the importance of cancer screening and strongly recommended establishing cancer screening clinics in government setups. Conclusion: There is a positive attitude among the general public toward cancer. Almost all the people surveyed were interested in attending cancer awareness programs, believed in the role of screening and felt that establishing cancer screening programs would be useful. This may help provide a road map for cancer policy-makers.

Obesity Status on associations between cancer-related beliefs and health behaviors in cancer survivors: Implications for patient-clinician communication

ObjectiveAssociations between cancer beliefs and health behavior engagement are largely unexplored in cancer survivors, particularly among those with overweight and obesity. We investigated belief-behavior associations for cancer survivors, and whether obesity altered these associations. MethodsCancer survivors were identified from the National Cancer Institute HINTS Survey 5 data and classified as having had an obesity-related cancer or not. Linear and multiple logistic regression analyses examined whether cancer risk beliefs and self-efficacy predicted dining out behaviors and physical activity (PA). Restricted analyses were conducted in those with overweight or obesity. ResultsLow self-efficacy to take care of one’s health was associated with longer sitting time in the overall sample (p = 0.04). In cancer survivors with overweight or obesity, engagement in healthier behaviors was associated with 1) feeling less overwhelmed by cancer risk recommendations and 2) believing that PA or obesity influences cancer development (both p < 0.05). Among those with overweight and obesity, associations between cancer beliefs and health behaviors were not significantly different by cancer type (obesity-related vs. not). ConclusionsObesity altered associations between cancer risk beliefs and health behavior engagement from the overall sample. Practice ImplicationsWeight status may be a useful tailoring factor when delivering health-promoting interventions for cancer survivors.

Abstract B030: See, Test, and Treat: Engaging vulnerable populations in cancer screening

Abstract Background: The breast cancer and cervical cancer mortality rates among women in Mississippi are higher than the national averages. Early detection and early treatment are associated with longer survival rates among women who are diagnosed with breast cancer or cervical cancer. However, the percentage of women in Mississippi who report having regular mammograms and in cervical cancer screenings is lower than the national average. Purpose: Clinicians and investigators at UMMC are actively working within transdisciplinary teams to implement evidence-based interventions aimed at reducing breast and cervical cancer mortality disparities in the state. Methods: See, Test, and Treat was a community-based cancer screening event that occurred on June 1, 2019 at the UMMC Cancer Center and Research Institute. The UMMC team provided breast, cervical and oral cancer screenings to 103 women. Healthy cooking and exercise demonstrations, were conducted to actively engage patients in health education activities. Participants completed a brief exit survey that was used to gather data on the effect of the program on the patients’ knowledge and attitudes towards cancer screenings, and intentions to changed cancer related health behaviors. Results: The short-term outcomes showed that 21 patients had abnormal mammograms. All of the patients with abnormal mammograms were immediately linked to follow-up care. No Pap tests were returned with abnormal results. However, the clinicians diagnosed 8 patients with Trichomonas. The majority of the patients indicated that their knowledge of and attitudes towards breast and cervical cancer screening changed positively and the majority intended to change their cancer related health behaviors. Conclusion: See, Test, and Treat is an effective community-based activity that can increase access to breast, cervical and oral cancer screenings by uninsured and underinsured women. Citation Format: Michelle S Williams, Jimmie Wells, Roy Duhe, Timothy Allen. See, Test, and Treat: Engaging vulnerable populations in cancer screening [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B030.

The FLASHE Study: A Publicly Available Data Resource

Abstract Objectives The Family Life, Activity, Sun, Health and Eating (FLASHE) survey was conducted in 2014 to collect information on eating, physical activity, sedentary behaviors, and behavioral correlates from a national sample of parent-adolescent dyads in the United States. It is a publicly available data resource which can be used to research questions about psychosocial, generational, household and neighborhood correlates of health behaviors. Methods Data were collected from dyads of caregivers and their adolescent children (ages 12–17) (n = 1072 completed dyads) between April – October 2014. Two surveys for each respondent: one on diet-related behaviors and one on physical activity-related behaviors were collected. An additional 407 dyads wore an accelerometer for seven days and completed an activity log. A ‘geoFLASHE’ dataset used parent-provided address information for home and school to geocode these locations and compute a set of variables applied to several different neighborhood definitions, including both circular and street-network buggers with distances ranging from 400 – 1200 meters. Accelerometer variables were computed for a subset of adolescents who wore an Actigraph Gt3x+ for seven days and includes estimates from raw and activity counts data. Training webinars on dyadic analytical methods, models and applications were provided. Results The geoFLASHE dataset includes variables for neighborhood, socioeconomic status factor, factor scores for built environment characteristics (high density, older neighborhood, and short commutes), and other variables for each buffer configuration. The adolescent accelerometer dataset offers summary variables of accelerometer data and minute-level estimates of light, moderate, and vigorous activity using Crouter, Chandler, and GGIR processing methods. Additionally, training webinar, questionnaires, survey data files and codebooks are available. Conclusions The FLASHE study data resources can be used to understand cancer-related health behaviors in family dyads. Funding Sources FLASHE study was funded by the National Cancer Institute under contract number HHSN2612012000391 issued to Westat, Inc.

Geographical Disparities in Screening and Cancer-Related Health Behaviour

This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014–2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.

How structural racism can kill cancer patients: Black patients with breast cancer and other malignancies face historical inequities that are ingrained but not inevitable. In this article, the second of a 2-part series, we explore the consequences of and potential solutions to racism and inequality in cancer care.

How structural racism can kill cancer patients: Black patients with breast cancer and other malignancies face historical inequities that are ingrained but not inevitable. In this article, the second of a 2-part series, we explore the consequences of and potential solutions to racism and inequality in cancer care.

Exploring the causes of chronic cancer pain and possible remedies.

Exploring the causes of chronic cancer pain and possible remedies.

Celebrity disclosure prompts public discourse regarding appearance changes related to breast cancer care: a content analysis of Internet comments

ABSTRACT Background: In an op-ed posted on the New York Times (NYT) website, Angelina Jolie disclosed that she carries the BRCA1 genetic mutation and received a preventive mastectomy. Studies have since demonstrated a positive impact of Ms. Jolie's disclosure on breast cancer-related health behaviors. This qualitative study used conventional content analysis of comments to the op-ed to explore intermediate outcomes of the disclosure; specifically, how the disclosure influenced public discourse regarding appearance changes related to breast cancer surgery. Method: After downloading all comments from the NYT website and using an iterative process to develop a standardized codebook, two researchers applied the codes using NVivo 10. Result: Five subthemes were identified in sixty-one comments discussing physical appearance or body image in the context of breast cancer treatment or preventive care: appearance versus health, perception of breast appearance following surgery, partner acceptance of appearance following surgery, beliefs about others’ reactions regarding appearance, and beliefs about reconstructive surgery. While some commenters shared body image concerns following surgery, many were relieved to have undergone the procedure, valuing health over appearance. Most women stated that their romantic partners praised their appearance following surgery, although some worried about how they were perceived in public. Conclusion: This study clarifies how celebrity disclosures about cancer may influence intermediate outcomes (e.g. interpersonal communication and beliefs about appearance-related surgical outcomes) hypothesized to contribute to changes in cancer prevention and treatment behaviors. More research is needed to further elucidate the relationships between celebrity disclosure, intermediate outcomes, and behavioral outcomes.

The FLASHE Study: Racial and Sex Disparities in Adolescent and Parent Modifiable Cancer Risk Behavior.

Objectives: Understanding modifiable risk factors related to cancer among adolescents and their parents may help identify at-risk populations and intervention aims for reducing cancer risk among families. Methods: Participants were 1336 adolescent-parent dyads who participated in the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) conducted by the National Cancer Institute. Using independent samples t-test and one-way ANOVA, we assessed differences in mean behavioral scores by sex and race/ethnicity, respectively. Results: For this nationwide sample, non-Hispanic black adolescents and parents were significantly (p < .05) more likely to participate in multiple dietary and sedentary behaviors than their Hispanic and non-black counterparts. Male adolescents reported significantly higher consumption of sugar-sweetened beverages and processed and red meats than their female peers (p < .02 for all). We also found a strong positive association between adolescents' and their parents' dietary and sedentary behaviors (p < .001 for all). Conclusions: Sex and racial differences in cancer-related health behaviors among adolescents and their parents suggest current guidelines for cancer may benefit from inclusion of younger populations and families. Effective health interventions targeting adolescent-parent dyads may help reduce cancer risk among multiple populations simultaneously.

Challenges of using nationally representative, population-based surveys to assess rural cancer disparities

Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of “rural” in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.

Two Peas in a Pod? An Exploratory Examination Into Cancer-Related Psychosocial Characteristics and Health Behaviors Among Black Immigrants and African Americans.

Introduction. Most studies lump Black immigrants (BIs) and African Americans (AAs) as "Black/African American" during investigation. Such categorization assumes that the sociocultural determinants that influence BIs are the same as for AAs. This study attempts to disentangle the AA and BI subgroups to recognize the differences in cancer-related psychosocial characteristics and health behaviors. Methods. Merged data from the Health Information National Survey (2011-2017) were used. Two groups were created: those who identified as AA and those who identified as AA but were born outside the United States (BI). Between-group differences were assessed with Mann-Whitney U and chi-square tests. Results. Positive communication patterns with health care providers were significantly higher among AAs (M [mean] = 3.41, SD [standard deviation] = 0.68) compared with BIs (M = 3.28, SD = 0.71) (p = .004). A greater proportion of BIs indicated that their health was excellent (14.2%), compared with AAs (7.9%). AAs reported higher cancer family history (75.1%) than BIs (46.5%). More AAs had smoked at least 100 cigarettes in their lifetime (41.5%) than BIs (16.7%). BIs consumed significantly more fruits each day (M = 2.77, SD = 1.43) than AAs (M = 2.40, SD = 1.44) (p < .001). BIs also reported more physical activity (M = 2.62, SD = 2.15) than AAs (M = 2.37, SD = 2.18) (p = .030). AA women were more likely to have had a pap smear test (M = 2.07, SD = 1.44) compared with BI women (M = 1.73, SD = 1.21) (p = .002). Discussion. Evidence suggests the need to disentangle the "Black/African American" ethnic grouping. Lumping the BI populations together with the AAs, who have been in the United States for generations, may limit the ability to uncover and consequently address culturally driven disease prevention efforts and promote understanding of the biological, environmental, and psychosocial risk factors within Black heterogeneous populations.

Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States.

Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and utilization of health information and in cancer-related beliefs and behaviors. Methods: We used data from the Health Information National Trends Survey 5, Cycle 1 conducted from January 25 through May 5, 2017. Using survey-weighted logistic regression, we explored potential differences in health information-seeking behavior, trusted sources of health care information, engagement with the health care system, awareness of cancer risk factors, cancer fatalism, cancer-related health behaviors, and historical cancer screening between 117 LGB and 2857 heterosexual respondents. Results: LGB respondents were more likely to report looking for information about health or medical topics than heterosexual respondents (adjusted odds ratio [aOR]: 3.12; confidence interval [95% CI]: 1.07-9.06), but less likely to seek health information first from a doctor (aOR: 0.17; 95% CI: 0.06-0.50) after adjusting for age, race, and sex. LGB persons were less likely to report that they trust receiving health or medical information from friends and family and more likely to be worried about getting cancer (aOR: 2.30; 95% CI: 1.04-5.05). Conclusions: Our findings indicate a growing need for the production of tailored cancer prevention and control materials for members of sexual minority groups. More work is needed to understand barriers that LGB populations face in accessing this health information and building informative social support networks.

Patterns of cancer-related health behaviors among middle-aged and older adults: Individual- and area-level socioeconomic disparities

Multiple health behaviors could have greater impact on chronic diseases than single behaviors, but correlates of behavioral clusters are relatively understudied. Using data from NIH-AARP Diet and Health Study (initiated in 1995) for 324,522 participants from the U.S. (age 50–71), we conducted exploratory factor analysis to identify clusters of adherence to eight cancer prevention behaviors. Poisson regressions examined associations between cluster scores and neighborhood socioeconomic deprivation, measured with census block group (1) poverty and (2) low education. Four clusters emerged: Movement (adequate physical activity/less TV); Abstinence (never smoked/less alcohol); Weight control (healthy body mass index/high fruits and vegetables); and Other (adequate sleep/receiving cancer screenings). Scores on all clusters were lower for participants in neighborhoods with the highest poverty (most deprived quintile versus least deprived: relative risk [RR] = 0.95 (95% confidence interval [CI] = 0.94–0.96) for Movement, 0.98 (95% CI = 0.97–0.99) for Abstinence, 0.94 (95% CI = 0.92–0.95) for Weight control, and 0.94 (95% CI = 0.93–0.95) for Other; all p < 0.001). Scores on three clusters were lower for participants in neighborhoods with the lowest education (RR = 0.88 (95% CI = 0.87–0.89) for Movement, 0.89 (95% CI = 0.88–0.90) for Weight control, and 0.90 (95% CI = 0.89–0.91) for Other; all p < .001). Health behaviors among older adults demonstrated four clusters. Neighborhood deprivation was associated with lower scores on clusters, suggesting that interventions to reduce concentrated deprivation may be an efficient approach for improving multiple behaviors simultaneously.