"I'm Bored and I'm Stressed": A Qualitative Study of Exclusive Smokers, ENDS Users, and Transitioning Smokers or ENDS Users in the Time of COVID-19.

BACKGROUND: To better understand the various influences of COVID-19 on tobacco use, we examined three different tobacco user groups using qualitative methods. METHODS: Ten online focus groups with 61 adults from the Atlanta, GA area were held in October-November 2020: four with exclusive smokers (n = 16), three with Electronic Nicotine Delivery System (ENDS) users (dual and exclusive, n = 22), and three with transitioning (recently quit or currently quitting) smokers and/or ENDS users (n = 23). RESULTS: Exclusive smokers reported smoking more frequently, driven by COVID-19-related stress, time at home, and boredom. They were not motivated to quit during the pandemic, and some considered smoking to be protective against COVID-19. ENDS users reported vaping less, with dual users often increasing their smoking; many were concerned about health effects of smoking and ENDS use during the pandemic. Transitioning smokers/ENDS users worried about their health and wanted to quit, but many found the stress of COVID-19 unbearable without tobacco use. CONCLUSIONS: There were some similarities among the groups, but also pronounced differences. Educational campaigns should capitalize on the teachable moment of COVID-19 to increase perceived risk of smoking. Smokers need access to more adaptive ways to deal with stress (such as mindfulness training) in lieu of smoking and systems-level approaches should address structural determinants of health that cause high levels of stress. The proposed policy to lower nicotine in combusted tobacco products might help smokers choose other means of coping instead of cigarettes by reducing the stress-relieving properties of smoking particularly salient during the pandemic. IMPLICATIONS: Smokers believe that cigarettes help them deal with the stresses and challenges of the COVID-19 pandemic. This needs to be counteracted by educational campaigns to increase perceived harm of smoking, alternative stress-relief strategies, and mandated changes to the combusted tobacco products to make them less appealing.

Racial/ethnic disparities in use of surveillance mammogram among breast cancer survivors: a systematic review.

BACKGROUND: Increasing number of breast cancer survivors in the USA have led to greater focus on the long-term health outcomes and surveillance care among these women. However limited evidence exists of use of surveillance mammography among breast cancer survivors and how it varies across racial/ethnic groups. METHODS: We conducted a systematic review of the literature to explore disparities in use of surveillance mammogram among women breast cancer survivors by searching for relevant studies published between 2000 and 2020 from Medline (Ovid), PubMed (National Library of Medicine), and PsycINFO (Ovid) bibliographic databases. Two authors independently screened titles, abstracts, and full texts of all articles that reported surveillance mammography use across racial/ethnic groups. Data on study design, screening eligibility, sample size, operational definition, and/or measure of the use of a surveillance mammogram among breast cancer survivors and the association between race/ethnicity and use of a surveillance mammogram were summarized in the evidence tables. RESULTS: We identified 1544 records from the three databases, and 30 studies examined the use of surveillance mammograms among breast cancer survivors across race/ethnic groups. Of these, 21 provided adjusted estimates of racial/ethnic disparities in use of surveillance mammograms, and 15 of these reported statistically significant disparities. In summary, most studies reported that non-white women (mainly Blacks and Hispanics) were less likely to receive a timely surveillance mammogram compared to White. CONCLUSION: This study extends the evidence of racial/ethnic disparities beyond completion of initial treatment by finding similar disparities in receipt of surveillance mammograms among breast cancer survivors. IMPLICATION FOR CANCER SURVIVORS: Our findings identify a need to improve efforts to increase post-treatment use of surveillance mammography among racial/ethnic minority women to reduce these gaps and improve overall clinical and quality of life outcomes.

Perfluoroalkyl substances exposure and immunity, allergic response, infection, and asthma in children: review of epidemiologic studies.

BACKGROUND: Increased exposure to perfluoroalkyl substances (PFAS) potentially affects infant and childhood health through immunosuppression. Given rapidly evolving research on PFAS, it is important to comprehensively examine the impact of PFAS exposure among the pediatric population as new research becomes available due to potential fragility of the developing immune system. OBJECTIVES: This review assessed the effects of PFAS fetal, infant and childhood exposures upon the development of immune function during early life stages. METHODS: Researchers completed a literature review, searching PubMed for human studies published since 2010 for PFAS and health outcomes among infants and children. Included articles incorporated key search terms in the title or abstract; non-research reports and non-English papers were excluded. The search identified 518 studies for possible inclusion. Following hands-on review, 34 were determined relevant. Subsequent analyses found 8 additional relevant articles, totaling 42 studies. RESULTS: Major immune-related sequelae from PFAS exposures on infant and child health outcomes documented in recent literature include:• Strong indication of immunosuppression, with diminished childhood antibody response to vaccination, particularly with PFOA, PFOS and PFHxS exposures.• Some indication of increased risks of childhood infectious diseases/infections, particularly from PFOS exposures.• Limited indication of an effect of PFAS exposure on allergic reactions/allergen specific IgE antibodies.• Limited indication of an effect of PFAS exposure on atopic dermatitis (AD).• Limited indication of an effect of PFAS exposure on asthma and lung function. CONCLUSION: This review summarizes recent findings of PFAS effects on infant and childhood immune health. Evidence of immunosuppression, diminished vaccine efficacy, and increased risk of infections, allergies, asthma and AD were described following in utero, infant, and early childhood PFAS exposures. Further investigation is warranted to characterize PFAS exposure pathways and potential modes of action in relation to PFAS effects on the developing immune system. Incontrovertible proof of PFAS immunotoxic effects could optimally be obtained by a large prospective study cohort of mothers and children from infancy through school-age. Regular assessments of circulating antibodies and response to infant and childhood vaccines during growth years could prove invaluable.

Patterns and trends of dual use of e-cigarettes and cigarettes among U.S. adults, 2015-2018.

INTRODUCTION: If dual use of cigarettes and e-cigarettes is a transition state to tobacco and nicotine use cessation, it may be a tolerable temporary condition. But, if a long-term behavior, dual use may increase tobacco harm to the population as a whole, and efforts should aim to reduce it as much as possible. To develop effective tobacco control policy, the changes in dual use of e-cigarettes and cigarettes need to be better understood. METHODS: National probability samples of U.S. adults in 2015 (n = 6051), 2016 (n = 6014), 2017 (n = 5992), and 2018 (n = 5989) reported their smoking and e-cigarette use status, including frequency of use. Weighted multinomial logistic regression models were used to examine temporal trends and patterns of cigarette and e-cigarette use. RESULTS: Between 2015 and 2018, the prevalence of current e-cigarette use (29.8% in 2015, 22.3% in 2016, 29.1% in 2017, and 27.7% in 2018) did not change significantly among current smokers. This result was consistent among light, moderate, and heavy smokers, and did not change when stratified by sex, age and race. However, the prevalence of cigarette smoking in current e-cigarette users declined from 56.9% in 2015 to 40.8% in 2018 (p < 0.001). Among never (p = .012) and former (ps < 0.001) smokers the prevalence of current e-cigarette use increased significantly. CONCLUSION: The continued high prevalence of dual use and increased prevalence of current e-cigarette use among never smokers highlight the need for better communication about the risks of prolonged dual use for e-cigarette users, and the risks of nicotine initiation and addiction for nonusers.

Contribution of Smoking to Tuberculosis Incidence and Mortality in High-Tuberculosis-Burden Countries.

Globally, 10 million incident cases of tuberculosis (TB) are reported annually, and 95% of TB cases and 80% of tobacco users reside in low- and middle-income countries. Smoking approximately doubles the risk of TB disease and TB mortality. We estimated the proportion of annual incident TB cases and TB mortality attributable to tobacco smoking in 32 high-TB-burden countries. We obtained country-specific estimates of TB incidence, TB mortality, and smoking prevalence from the World Health Organization Global TB Report (2017), tobacco surveillance reports (2015), and the Tobacco Atlas. Risk ratios for the effect of smoking on TB incidence and TB mortality were obtained from published meta-analyses. An estimated 17.6% (95% confidence interval (CI): 8.4, 21.4) of TB cases and 15.2% (95% CI: 1.8, 31.9) of TB mortality were attributable to smoking. Among high-TB-burden countries, Russia had the highest proportion of smoking-attributable TB disease (31.6%, 95% CI: 15.9, 37.6) and deaths (28.1%, 95% CI: 3.8, 51.4). Men had a greater proportion of TB cases attributable to smoking (30.3%, 95% CI: 14.7, 36.6) than did women (4.3, 95% CI: 1.7, 5.7). Our findings highlight the need for tobacco control in high-TB-burden countries to combat TB incidence and TB mortality.

'No, the government doesn't need to, it's already self-regulated': a qualitative study among vape shop operators on perceptions of electronic vapor product regulation.

While the market share of electronic vapor products (EVPs), sold primarily through vape shops and other outlets, has increased rapidly, these products remained largely unregulated until 2016. This study, conducted prior to announcement of the deeming regulations, provides insights into vape shop operator attitudes toward potential government regulations of EVPs. In 2015, we conducted 37 in-person interviews of vape shop operators across nine US cities. Shops were identified through extensive web-searches. We used QSR International's NVivo 11 qualitative data analysis software to analyze the transcripts. Many vape shop operators viewed regulations requiring safe production of e-liquids, child-resistant bottles and listing e-juice ingredients as acceptable. They disagreed with the elimination of free samples and bans on flavored e-liquid sales, which generate significant revenue for their stores. Many held negative perceptions of pre-market review of new product lines and EVP-specific taxes. All agreed that EVPs should not be sold to minors, but most felt that owners should not be fined if minors visited vape shops. Findings from this study offer insights into the acceptability of proposed regulations, as well as barriers to effective regulation implementation.

Assessing information needs and use of online resources for disease self-management in patients with rheumatoid arthritis: a qualitative study.

To explore the information needs of patients with rheumatoid arthritis (RA) and their acceptance of online resources and Facebook in particular, as a source of information, interaction, and support among peers. Participants were adults with RA of ≤ 10 years duration, had ongoing or prior treatment with disease-modifying anti-rheumatic drugs or biologic agents, and internet access. We conducted 20 in-depth interviews using semi-structured interview guide to explore: (1) RA information needs, (2) use of self-management health behaviors, (3) use of internet resources for disease management, (4) role of peer support in health self-management, and (5) use of social networking sites (SNS) such as Facebook in disease management. Data were analyzed using content analysis and constant comparative methods. Participants were mainly female (85%), White (70%), and over 50 years old (70%). Specific information needs included knowledge regarding medications, disease course, pain control, diet, and exercise. Most participants had a narrow perception of SNS as a tool for disease management. However, they found SNS acceptable and were open to participating in a support group on Facebook with reasonable assurance of privacy. Although the overarching theme was RA information needs, the other themes contribute in supporting the robust emergence of Internet media in informing patients about their health and support systems. Our findings can inform the choice and format of materials to be considered for online education on self-management and social networking for RA patients.

Reassessing the importance of 'lost pleasure' associated with smoking cessation: implications for social welfare and policy.

INTRODUCTION: Benefit-cost analyses of tobacco regulations include estimates of the informed choice of smokers to continue smoking. Few studies have focused on subjective feelings associated with continued smoking. This study estimates how smoker discontent and regret relate to risk perceptions and health concerns. METHODS: We analysed data from a 2015 nationally representative, online survey of 1284 US adult current smokers. Information was collected on regret, intention to quit, perceived addiction, risk perceptions and health concerns. Multivariate logistic regression adjusting for sociodemographics and health status was used to examine factors associated with smoker discontent. RESULTS: More than 80% of current smokers report high (22.5%) or very high (59.8%) discontent due to inability to quit, perceived addiction and regret about having started to smoke. Higher levels of discontent did not vary significantly by sex, age, race/ethnicity, education or income (adjusted odds ratios (AORs) 0.5-1.2). Compared with the smokers expressing low (5.9%) or very low (3.6%) discontent, those expressing higher levels of discontent perceived their health status as fair/poor (AOR=2.3), worried most of the time about lung cancer (AOR=4.6) and felt they were more likely to develop lung cancer in the future (AOR=5.1). CONCLUSION: The proportion of smokers who might be characterised as having a preference to continue smoking are greatly outnumbered by addicted, discontent and concerned smokers who want to quit and regret ever having started to smoke. These discontent smokers could have a substantial net welfare gain if new regulations helped them escape their concerns about the health effects from continuing smoking.

Prevalence of use and perceptions of risk of novel and other alternative tobacco products among sexual minority adults: Results from an online national survey, 2014-2015.

Sexual minority (lesbian, gay, and bisexual [LGB]) populations experience disparities in cigarette use, but sparse evidence exists about novel and other alternative tobacco product use. In this study, we compared rates of novel and other alternative tobacco product use, risk perceptions, and worldview between LGB and heterosexual (HET) adults. An online survey administered in 2014-2015, using a weighted probability sample of 11,525 U.S. adults, assessed awareness of tobacco products; ever and current use of e-cigarettes, cigars, little cigars and cigarillos, and hookahs; perceptions of e-cigarettes; and worldview (individualism vs. communitarianism). Bivariate and adjusted multivariable analyses were performed to determine differences between LGB and HET groups. In the adjusted analyses, LGB adults were 1.5 times more likely to have ever used e-cigarettes (95% CI 1.2-1.9) and 1.9 times more likely to have ever used hookahs (95% CI 1.5-2.4) as compared to HET adults. A lower percentage of LGB adults, as compared to HET adults (16.7% vs. 19.2%), believed that exposure to vapors from e-cigarettes was "harmful" and reported that they "did not know" of any harm (35.1% vs. 39.8%). LGB were 20% less likely than were HET adults to endorse an individualistic worldview. These results suggest that a disparity exists, whereby LGB adults are more likely to have used e-cigarettes and hookahs. In addition, although vapor from e-cigarettes contains nicotine and other chemicals, LGB adults are less likely to perceive exposure to secondhand vapor as harmful. Tailored awareness campaigns and interventions are needed to convey the risks and curb use of these products.

Regretting Ever Starting to Smoke: Results from a 2014 National Survey.

Background: The majority of smokers regret ever starting to smoke, yet the vast majority continue to smoke despite the fact that smoking kills nearly 50% of lifetime users. This study examined the relationships between regret and smoker characteristics, quit history, risk perceptions, experiential thinking, and beliefs and intentions at time of smoking initiation. Methods: Data from the 2014 Tobacco Products and Risk Perceptions Survey, a nationally representative survey of United States adults, were analyzed to provide the latest prevalence estimates of regret and potential predictors. Relationships among predictor variables and regret were analyzed using correlations, t-tests, and multinomial logistic regression. Results: The majority of smokers (71.5%) regretted starting to smoke. Being older and non-Hispanic white were significant predictors of regret. Smokers having a high intention to quit, having made quit attempts in the past year, worrying about getting lung cancer, believing smoking every day can be risky for your health, perceiving a risk of being diagnosed with lung cancer during one's lifetime, and considering themselves addicted to cigarettes were significant predictors of regret for smoking initiation. Conclusions: This study provides updated prevalence data on regret using a national sample, and confirms that regret is associated with perceived risk. The findings from this study can be used to inform smoking intervention programs and support the inclusion of smoker regret in cost-benefit analyses of the economic impact of tobacco regulations.

Impact of Rheumatoid Arthritis on the Mortality of Elderly Patients Who Develop Cancer: A Population-Based Study.

OBJECTIVE: Comorbidity among cancer patients poses additional risks for mortality. The possible impact of rheumatoid arthritis (RA) on cancer patient survival is unclear. Our objective was to examine survival among elderly patients with RA who develop cancer. METHODS: Patients diagnosed with breast, prostate, colorectal, or lung cancer between 2001 and 2010 were identified from the Texas Cancer Registry and Medicare-linked databases. The cohort was categorized into 3 groups according to the number of claims patients had with a diagnosis of RA in the year prior to the cancer diagnosis: 2-RA (patients with ≥2 claims), 1-RA (1 claim), and no claims. Overall survival was estimated for these groups and for each cancer, using Cox proportional hazards models adjusting for covariates. RESULTS: The cohort included 139,097 patients with cancer (35,026 breast, 43,181 prostate, 31,103 colorectal, and 29,787 lung); 1.7% had 1 RA claim, and 1.1% had 2 or more. Adjusted hazard ratios for patients in the 2-RA group were 1.41 (95% confidence interval [95% CI] 1.21-1.65) for breast and 1.53 (95% CI 1.26-1.85) for prostate. No significant differences were observed for those with colorectal or lung cancer. CONCLUSION: Mortality was increased by 40% and 50%, respectively, in elderly patients with RA who developed breast or prostate cancer, after controlling for other comorbidities. This association was not seen in cancers with shorter survival time (colorectal or lung). Research is needed to determine whether the increased risk is related to comorbid burden or to differential utilization of cancer or rheumatoid therapies in patients with both diseases.

Electronic nicotine delivery system dual use and intention to quit smoking: Will the socioeconomic gap in smoking get greater?

INTRODUCTION: Electronic nicotine delivery systems (ENDS) are popular among cigarette smokers; however, it is not known whether the use of ENDS assists or delays quitting cigarettes, especially among certain priority populations. We examined predictors of intention to quit smoking and patterns of dual use of ENDS and traditional cigarettes among priority populations. METHODS: This study used data from a 2014 survey of a national probability sample of 5717 USA adults. Descriptive statistics were used to examine differences in intention to quit cigarette use among current cigarette smokers (n=1014) and dual users of cigarettes and ENDS (n=248). Multivariable logistic regression analysis was conducted on the overall sample and the subsample of dual users to determine whether dual use (versus cigarette only use) and demographic characteristics predict self-reported intention to quit and having attempted to quit in the past year. Significance was set at p<0.05. RESULTS: Compared to cigarette smokers, dual users were slightly more educated (p<0.05), more likely to intend to quit smoking (adjusted odds ratio [AOR]=1.8, p=0.001), and more likely to have attempted to quit smoking in the past year (AOR=1.7, p=0.003). Blacks reported higher intention to quit than Whites (AOR=1.8, p=0.003). Compared with high school education or less, dual users with some college (AOR=1.5, p=0.007) or a college degree (AOR=2.5, p≤0.0001) had high intention to quit. CONCLUSIONS: Dual users of ENDS and traditional cigarettes are more likely to intend to quit smoking and have recently made quit attempts. If using ENDS contributes to increased smoking cessation among more educated individuals, disparity in smoking by level of education will increase.

The Potential That Electronic Nicotine Delivery Systems Can be a Disruptive Technology: Results From a National Survey.

INTRODUCTION: This study evaluates the reasons for use and acceptance of Electronic Nicotine Delivery Systems (ENDS) among current and former cigarette smokers to assess if ENDS may become a satisfying alternative to cigarettes. METHODS: Data are from a national probability sample of 5717 US adults, surveyed June-November 2014. The survey contained questions on awareness, usage, and reasons for use of traditional and novel tobacco products. The analytic sample was current and former smokers who ever used ENDS (n = 729) and was divided into four mutually exclusive categories. Among the 585 current smokers, 337 were no longer using ENDS ("E-Cig Rejecters"), and 248 were continuing to use both ENDS and cigarettes ("E-Cig Dual Users"). Among 144 former cigarette smokers, 101 were non-recent users of ENDS ("Quit All Products"), and 43 were continuing to use ENDS exclusively ("Switchers"). RESULTS: Former smokers (the "Switchers") report finding ENDS a satisfying alternative to regular cigarettes, with only 15.8% (95% confidence interval [CI] 4.4-27.1) rating ENDS as less enjoyable than regular cigarettes. However, greater than fivefold more current smokers did not find them satisfying and stopped using them (77.3%; 95% CI 72.1-82.4 of "E-Cig Rejecters" rated ENDS as less enjoyable). Being less harmful was the most highly rated reason for continuing to use ENDS among "Switchers." Most (80.9%) "Switchers" reported that ENDS helped them quit cigarettes. CONCLUSION: Since many current smokers who have tried ENDS reject them as a satisfying alternative to regular cigarettes, ENDS will not replace regular cigarettes unless they improve. IMPLICATIONS: Since about one-half of recent former smokers are trying ENDS with about one-fourth continuing to use them, and many reporting that these products have helped them quit regular cigarettes, the potential impact of ENDS on population quit rates deserves continued surveillance. However, since most current smokers who have tried ENDS reject them as a satisfying alternative to regular cigarettes, the potential of ENDS becoming a disruptive technology replacing regular cigarettes remains uncertain. ENDS need to improve as a satisfying alternative or the attractiveness and appeal of the regular cigarette must be degraded to increase the potential of ENDS replacing regular cigarettes.

A Qualitative Study of Vape Shop Operators' Perceptions of Risks and Benefits of E-Cigarette Use and Attitude Toward Their Potential Regulation by the US Food and Drug Administration, Florida, Georgia, South Carolina, or North Carolina, 2015.

INTRODUCTION: Approximately 8,500 vape shops in the United States sell a variety of electronic nicotine delivery systems (ENDS). This study examined vape shop operators' perceptions of benefits and risk of ENDS use, what they perceive to be the reasons for ENDS use, their source of product information, what information they shared with customers, and the impact of existing and future regulation of ENDS on its use and on their business. METHODS: We conducted qualitative interviews with 20 vape shop operators located in Florida, Georgia, South Carolina, and North Carolina in spring 2015. A semi-structured interview guide was used, and interviews were audio-recorded and transcribed verbatim. The transcripts were analyzed using NVIVO software. RESULT: Vape shop owners perceived ENDS to be less harmful and more economical than conventional cigarettes and indicated that most of their customers used ENDS as a smoking cessation tool. Most owners were former smokers and used ENDS to quit. Shop owners relied on their personal experiences and the Internet for information, and shared information with customers at point of sale by using the shop's website and social media. Most expressed concern that complying with potential regulations, including banning flavors or tax increases, would jeopardize their business. Some felt that ENDS should not be regulated as tobacco products and felt that big tobacco was behind these proposed regulations. Most owners supported age restrictions and quality controls for e-liquid. CONCLUSION: Vape shop owners are in a unique position to serve as frontline consumer educators. Interventions should focus on providing them with current information on benefits and risks of ENDS and information on national, state, and local regulations and compliance requirements.

Functional Impairment and Physical Activity Adherence Among Gynecologic Cancer Survivors: A Population-Based Study.

OBJECTIVE: Adherence to physical activity guidelines after cancer diagnosis improves physical functioning. The purpose of this study was to estimate the prevalence of physical activity in a population-based sample of gynecologic cancer survivors (GCSs) and to examine the association between functional impairment and adherence to physical activity guidelines. METHODS: Using the 2009 Behavioral Risk Factor Surveillance System survey, we identified 5,015 GCSs aged 20 years or older who were 1 year or more after diagnosis. We used multinomial logistic regression with survey weighting to examine the association between functional impairment and adherence to physical activity guidelines (using 3 levels: sedentary, somewhat active, and meeting physical activity guidelines), controlling for demographic and clinical factors. RESULTS: We found that 55% of GCSs did not adhere to physical activity guidelines and that 38% reported functional impairment. Gynecologic cancer survivors with functional impairment were less likely to meet guidelines (adjusted odds ratio [AOR], 0.34; 95% confidence interval [CI], 0.25-0.47) or to be somewhat active (AOR, 0.43; 95% CI, 0.31-0.59) compared with those without impairment. Having more than high school education (AOR, 1.66; 95% CI, 1.15-2.40), fewer comorbidities (AOR, 0.55; 95% CI, 0.33-0.91), and not being obese (OR, 0.53; 95% CI, 0.36-0.77) were associated with meeting physical activity guidelines compared with being sedentary. CONCLUSIONS: Gynecologic cancer survivors do not meet physical activity guidelines and experience functional impairment, which is associated with lower adherence to physical activity recommendations. Prospective studies are needed to better elucidate the relation between functional impairment and physical activity.

Racial and ethnic differences in health behaviors among cancer survivors.

INTRODUCTION: Previous studies of health behaviors of adult cancer survivors have not adequately examined racial and ethnic differences because of small sample sizes. A national data set was used to examine differences in health behaviors between cancer survivors and controls and between racial and ethnic groups among survivors. METHODS: The study analyzed 2009 Behavioral Risk Factor Surveillance System survey data in 2012-2014. Descriptive statistics were used to examine differences in health behaviors between cancer survivors and controls aged 20-64 years. Multivariable analysis was conducted to examine associations between race/ethnicity (white, African American, Hispanic, Asian, or Native American) and health behaviors (BMI, fruit and vegetable consumption, physical activity, and smoking status) while adjusting for demographic and medical characteristics. Significance was set at p<0.01. RESULTS: Compared with controls (n=245,283), cancer survivors (n=17,158) had higher prevalence rates for overweight/obese status (67% vs 65%); not meeting physical activity recommendations (53% vs 49%); and current smoking status (22% vs 20%). In the multivariable model, diet and smoking behavior differed across cancer status. African American (AOR=1.95) and Hispanic (AOR=2.06) survivors were more likely to have higher BMI than white survivors. African American survivors (AOR=1.6) were less likely to meet physical activity guidelines. Native American (AOR=3.08) and multiracial (AOR=1.74) survivors were more likely to be current smokers than non-Hispanic white survivors. CONCLUSIONS: This study suggests that racial and ethnic differences exist in the adoption of recommended health behaviors; future research should identify factors to reduce these differences.

Self-reported physical activity among middle-aged cancer survivors in the United States: Behavioral Risk Factor Surveillance System Survey, 2009.

INTRODUCTION: Regular physical activity (PA) can improve health outcomes in cancer survivors, but the rate of adherence to PA recommendations among middle-aged survivors is unclear. We examined adherence to PA recommendations among cancer survivors and controls. We sought to identify correlates of adherence to PA and to determine whether PA adherence is associated with health-related quality of life (HRQOL) among cancer survivors. METHODS: We examined PA adherence among 8,655 cancer survivors and 144,213 control subjects aged 45-64 years who were respondents to the 2009 Behavior Risk Factor Surveillance System survey. We used multinomial logistic regression to assess associations between PA adherence and demographic, psychosocial, and clinical factors, and multivariable linear regression to assess the relationship between PA adherence and HRQOL of cancer survivors. RESULTS: Cancer survivors and control subjects had similar rates of PA adherence. Of the survivors, 47% met the recommendations of 150 minutes of moderate-intensity PA or 120 minutes of vigorous-intensity PA per week, 41% were somewhat active, and 12% were sedentary. Compared with cancer survivors who were sedentary, survivors who were somewhat active were less likely to be obese (odds ratio [OR], 0.65; P < .007), and those who met PA recommendations were less likely to be overweight (OR, 0.61; P < .002) or obese (OR, 0.33, P < .001). Regression analysis indicated that PA adherence was positively correlated with HRQOL (P < .001). CONCLUSION: Most cancer survivors did not meet PA recommendations, but those who are active seem to have improved HRQOL. Therefore, targeted interventions to improve adherence to PA among cancer survivors are needed.

Chronic conditions and health status in older cancer survivors.

BACKGROUND: With the aging population and improved cancer care, the number of cancer survivors is steadily increasing. Planning for their care requires an understanding of the impact of cancer and chronic conditions on quality of life. We sought to determine chronic conditions and health status in older cancer survivors compared to controls. METHODS: In this retrospective cross-sectional study, we used survey data from 18,133 cancer survivors and 94,407 controls age 65 and older who participated in the Behavioral Risk Factor Surveillance System 2009 telephonic survey. Our main measures were chronic conditions (cardiovascular disease, hypertension, diabetes mellitus, high cholesterol, and arthritis) and poor health status (poor or fair self-rated health). RESULTS: Cancer survivors were older, more likely white, had higher education, and slightly more likely to have a healthcare provider and higher levels of emotional support. More survivors reported having 2 or more chronic conditions compared to controls (67.5% vs. 64.5%, respectively). Health status was lower for survivors, and was significantly different by racial/ethnic group. In a multivariable model for health status, having 2 or more chronic conditions was more strongly associated with poorer health status than cancer survivorship. CONCLUSIONS: Cancer survivors had slightly higher numbers of chronic conditions and poorer health status than controls. However, chronic conditions were more strongly associated with poor health status than cancer. Monitoring for recurrence and second cancers is important in cancer survivors, but chronic conditions also need to be given priority due to their substantial impact on health status.

African-American breast cancer survivors' preferences for various types of physical activity interventions: a Sisters Network Inc. web-based survey.

BACKGROUND: Needs assessments are essential to developing lifestyle interventions for minority populations. To our knowledge, no physical activity (PA) needs assessment studies have been conducted for African-American (AA) breast cancer survivors. The purpose of this study was to determine the PA intervention preferences of AA breast cancer survivors and determine whether these preferences differ according to medical and sociodemographic factors. METHODS: AA breast cancer survivors (n = 475, mean age = 54 years) were recruited using ads sent via email and social media sites. Preferences for the mode of intervention delivery were assessed via web-based questionnaires. Descriptive statistics were used to characterize their interests in PA interventions, and subgroup differences were assessed. RESULTS: About 49 % (142 out of 291) of the participants who completed the survey were obese and 54 % did not meet the recommended guidelines for PA. Most (90 %) participants reported that they could participate in PA, and many (67 %) indicated that they were interested in receiving program materials. Participants expressed the greatest interest in email (50 %)-, web (48 %)-, or mail-based (45 %) over group (39 %), and telephone (10 %). Women also expressed the greatest interest in participating in studies that promoted walking and resistance or strength training. Intervention preferences did not differ significantly (P > 0.05) across sociodemographic or medical factors. CONCLUSION: Most AA breast cancer survivors can participate in PA, and many are interested in interventions that promoted walking and resistance training and were delivered via the email or web. The development of culturally sensitive interventions that provide activities consistent with preferences can assist AA breast cancer survivors to adopt and maintain a healthy lifestyle. IMPLICATIONS FOR CANCER SURVIVORS: Despite evidence that AA breast cancer survivors are at increased risk for poor breast cancer-specific outcomes, they are underrepresented in clinical trials promoting positive health behaviors. In this study, we propose to assess their exercise preferences and receptivity to a culturally appropriate PA intervention developed in collaboration with the Sisters Network Inc. Health promotion programs developed in collaboration with a community-based organization may aid in the development of research tools and resources that AA breast cancer survivors are receptive to using.