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Williams O, Ting T, Matthews L, Block G, Block T, Teresi J, Eimicke J, Kong J, Silver S, Ravenell J, Mallaiah J, Jammalamadaka S, Nelson LM, Karmally W, Hankerson S. Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial. Trials 2024; 25:283. [PMID: 38671470 PMCID: PMC11046862 DOI: 10.1186/s13063-024-08110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. DESIGN AND METHODS We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)-a cardiovascular disease (CVD) risk score-at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. DISCUSSION Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. TRIAL REGISTRATION NCT05174286; clinicaltrials.gov; August 31st, 2023.
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Affiliation(s)
- Olajide Williams
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Tina Ting
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Lisa Matthews
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Gladys Block
- NutritionQuest and Turnaround Health, Berkeley, CA, USA
| | - Torin Block
- NutritionQuest and Turnaround Health, Berkeley, CA, USA
| | - Jeanne Teresi
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Joseph Eimicke
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Jian Kong
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Stephanie Silver
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Joseph Ravenell
- New York University Grossman School of Medicine, Manhattan, NY, USA
| | - Janhavi Mallaiah
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Soujanya Jammalamadaka
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Laura Maudene Nelson
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Wahida Karmally
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
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Williams O, Ting T, Matthews L, Block G, Block T, Teresi J, Eimicke J, Kong J, Silver S, Ravenell J, Mallaiah J, Jammalamadaka S, Nelson LM, Karmally W, Hankerson S. Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial. RESEARCH SQUARE 2024:rs.3.rs-3797889. [PMID: 38659874 PMCID: PMC11042434 DOI: 10.21203/rs.3.rs-3797889/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. Design and Methods: We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-months follow up, and Life Simple7 (LS7) - a cardiovascular disease (CVD) risk score - at 6 months and 1-year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed- methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. Discussion: Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. Trial registration: NCT05174286.
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Johnson CM, Stubblefield E, Godinich BM, Walker M, Salcedo Price R, Allicock MA. A Scoping Review to Explore the Potential Benefits of Nutrition Interventions for Latino/a Adult Cancer Survivors in the US. Nutrients 2023; 15:4963. [PMID: 38068821 PMCID: PMC10708293 DOI: 10.3390/nu15234963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Despite evidence for the role of healthy diets in preventing cancer, little is known about how nutrition can support positive health outcomes after a cancer diagnosis for Latino/a cancer survivors in the United States (U.S.). The purpose of this scoping review is to understand the potential benefits of nutrition interventions in supporting healthy survivorship among Latino/a cancer survivors in the U.S. A team compiled, evaluated, and summarized the available evidence. Potentially relevant studies were identified from a comprehensive search of peer-reviewed databases and the gray literature. Eligible studies included Latino/a adult cancer survivors with a nutrition education, dietary change, or behavioral intervention; and a nutrition-related health outcome. Data were extracted and summarized using tables. The review included 10 randomized controlled trials, with samples or subsamples of Latino/a cancer survivors. Interventions mostly focused on breast cancer survivors. The results showed some evidence that dietary behaviors, like fruit and vegetable intake, were related to positive outcomes, like a decreased risk of cancer (through changes in DNA methylation), decreased risk breast cancer recurrence (through changes in inflammatory biomarkers), or improved perception of health status. The findings highlight a need for community-engaged and culturally relevant nutrition interventions for Latino/a adults, especially for rural communities; and innovative intervention approaches, including m/ehealth approaches with long-term follow-up.
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Affiliation(s)
- Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Emily Stubblefield
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Brandon M. Godinich
- Center for Health Promotion and Prevention Research and Center for Pediatric Population Health, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX 75207, USA; (B.M.G.); (M.A.A.)
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Ave, El Paso, TX 79905, USA
| | - Miranda Walker
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Ramona Salcedo Price
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA; (E.S.); (M.W.); (R.S.P.)
| | - Marlyn A. Allicock
- Center for Health Promotion and Prevention Research and Center for Pediatric Population Health, Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, 2777 North Stemmons Freeway, Dallas, TX 75207, USA; (B.M.G.); (M.A.A.)
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Pichardo MS, Sanft T, Ferrucci LM, Romero-Ramos YM, Cartmel B, Harrigan M, Velazquez AI, Fayanju OM, Winer EP, Irwin ML. Diet and physical activity interventions in Black and Latina women with breast cancer: A scoping review. Front Oncol 2023; 13:1079293. [PMID: 36994212 PMCID: PMC10040823 DOI: 10.3389/fonc.2023.1079293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundA growing number of lifestyle interventions are being developed to promote weight loss and adoption of a healthful lifestyles among breast cancer survivors; yet Black and Latina women remain underrepresented.PurposeWe performed a scoping review of the available peer-reviewed literature to describe and compare the content, design, methods, and primary outcomes of current diet and/or physical activity (PA) interventions after a breast cancer diagnosis among Black and Latina women.MethodsWe queried PubMed, EMBASE, CINAHL, MEDLINE, and Clinicaltrials.gov up to October 1, 2022, to identify all randomized controlled trials of diet and/or PA after diagnosis of breast cancer with a majority (>50%) of Black or Latina participants.ResultsTwenty-two randomized controlled trials were included in this review (five efficacy, twelve pilot, five on-going). Nine trials were among Latinas (two diet, four PA, and three diet/PA), six among Blacks (one PA and five diet/PA) and seven included both populations (five PA and two diet/PA), all of which examined different endpoints. Two of the five efficacy studies achieved their a priori outcome (one diet trial improved short term dietary intake; one PA trial achieved clinically significant improvements in metabolic syndrome score), both in Latinas. Eight pilot trials intervened on both diet and PA and three of them found favorable behavioral changes. Three (two for Latinas and one for Blacks) out of the nine diet and PA trials and three (all for Latinas) efficacy trials incorporated a culturally focused approach (i.e., traditional foods, music, Spanish content, bicultural health coaches, spirituality). Overall, four trials, including one efficacy trial, had one-year follow-up data, with three finding sustained behavior change. Electronic/mobile components were incorporated in five trials and one involved informal care givers. Most of the trials were geographically limited to the Northeast USA (n=8, NY, NC, DC, NJ) and Texas (n=4).ConclusionsMost of the trials we identified were pilot or feasibility studies and of short duration, demonstrating the need for large randomized controlled efficacy lifestyle interventions among Black and Latina breast cancer survivors. Culturally tailored programing was limited but is an important component to incorporate in future trials in these populations.
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Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Margaret S. Pichardo,
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, United States
- Deparment of Medical Oncology, Yale School of Medicine, New Haven, CT, United States
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | | | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
| | | | - Ana I. Velazquez
- Department of Medicine, Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | | | - Eric P. Winer
- Yale Cancer Center, New Haven, CT, United States
- Deparment of Medical Oncology, Yale School of Medicine, New Haven, CT, United States
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Cancer Center, New Haven, CT, United States
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Rodríguez-Torres J, Calvache-Mateo A, Ortiz-Rubio A, Muñoz-Vigueras N, López-López L, Valenza MC. Uso de eSalud para promover la actividad física en los supervivientes de neoplasias torácicas: revisión sistemática y metaanálisis. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Williams VA, Brown NI, Johnson R, Ainsworth MC, Farrell D, Barnes M, Perumean-Chaney S, Fontaine K, Martin MY, Pekmezi D, Demark-Wahnefried W. A Web-based Lifestyle Intervention for Cancer Survivors: Feasibility and Acceptability of SurvivorSHINE. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1773-1781. [PMID: 34061334 PMCID: PMC8633161 DOI: 10.1007/s13187-021-02026-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 05/05/2023]
Abstract
Assess the feasibility, acceptability, and preliminary efficacy of a healthy lifestyle website, SurvivorSHINE ( www.survivorshine.org ), for cancer survivors using a mixed-methods approach. Formative research included a comprehensive literature review and four focus groups on website preferences with diagnosis-diverse cancer survivors (N = 17). Their feedback informed a web adaptation of a telephone counseling and mailed-print lifestyle intervention previously found effective for cancer survivors. The resulting web-based intervention was examined in a 3-week, single-arm trial among 41 cancer survivors. Assessments of physical activity, diet, body weight, and knowledge related to exercise and diet guidelines for cancer survivors occurred at baseline and 3 weeks later, along with exit interviews. Themes from focus groups indicated cancer survivors' desire for easy-to-use, interactive web-based platforms to access credible diet and exercise information. The study sample was recruited within 12 months, and study retention was high (85.4%). Participants showed significant pre- to post-test improvements in diet and exercise knowledge (t = 5.31, p < .0001) and physical activity (t = 2.40, p = .02). Improvements in body weight and some dietary components (red meat, alcohol) were observed, but did not reach statistical significance. Results support the feasibility and acceptability of SurvivorSHINE. The significant increases in healthy lifestyle knowledge and physical activity found in the current study are promising, but a larger, randomized-controlled trial is needed to determine efficacy.
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Affiliation(s)
- Victoria A Williams
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
| | - Nashira I Brown
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Roman Johnson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M Cole Ainsworth
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | | | | | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, UAB, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
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Rodríguez-Torres J, Calvache-Mateo A, Ortiz-Rubio A, Muñoz-Vigueras N, López-López L, Valenza MC. The use of eHealth to promote physical activity in thoracic malignancies survivors: A systematic review and meta-analysis. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 33:123-136. [PMID: 36400165 DOI: 10.1016/j.enfcle.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it. OBJECTIVE To explore the effects of eHealth in the promotion of PA among thoracic malignancies. METHODS Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings. RESULTS In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes. CONCLUSION Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.
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Affiliation(s)
- Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Andrés Calvache-Mateo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Natalia Muñoz-Vigueras
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie C Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
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Seven M, Marie Moraitis A. Community-based interventions designed to optimize health behaviors among cancer survivors: an integrative systematic review. Support Care Cancer 2022; 30:8405-8415. [PMID: 35524870 DOI: 10.1007/s00520-022-07097-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/27/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this review was to synthesize the evidence on community-based health behavior optimization interventions (physical activity, nutrition, weight management) with a focus on cancer survivors at risk for poor health outcomes. METHODS This integrative review followed the methods and protocol outlined by the Joanna Briggs Institute Methods Manual for systematic reviews and was reported using PRISMA-Scr. Four databases, namely, PubMed, CINAHL, Web of Science, SportDiscus, were searched in March 2021 to identify articles addressing health behaviors among cancer survivors. RESULTS The review included 43 articles describing unique interventions developed through community-based participatory research (CBPR). The majority of community-based interventions were designed to optimize exercise/physical activity (76.7%) exclusively or in combination with nutrition. Non-Hispanic White persons constituted most participants. Most interventions took place as a part of an established community program and recruited from existing community programs to evaluate intervention effects on specific health outcomes. Of the interventions, 88.3% improved at least one outcome measurement. CONCLUSION The current studies have built on the strengths and resources of the community using existing programs. There was a lack of diversity in socioeconomic status and racial/ethnic background among participants of most interventions and inputs from partners such as cancer survivors, community, and healthcare organizations. Multiple health behavior interventions with longitudinal studies are needed for racial/ethnic minoritized cancer survivors. Future research should focus on achieving mutual benefits through iterative processes to develop sustainable community/research partnerships, ensuring long-term commitment, and disseminating knowledge gained from CBPR to and by all involved partners to improve health behaviors.
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Affiliation(s)
- Memnun Seven
- University of Massachusetts Amherst, Elaine Marieb College of Nursing, Amherst, MA, USA.
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Williams V, Brown N, Moore JX, Farrell D, Perumean-Chaney S, Schleicher E, Fontaine K, Demark-Wahnefried W, Pekmezi D. Web-Based Lifestyle Interventions for Survivors of Cancer: Usability Study. JMIR Form Res 2022; 6:e30974. [PMID: 35188468 PMCID: PMC8902653 DOI: 10.2196/30974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to survivors of cancer. However, little is known about website use in this population or its association with healthy lifestyle changes. OBJECTIVE The aim of this study is to describe lifestyle intervention website use (log-ins, time on website, and page views) among survivors of cancer and patterns of use by participant characteristics. In addition, associations were explored between website use and changes in healthy lifestyle knowledge and practice. METHODS A total of 35 survivors of cancer were recruited between August 2017 and 2018 to participate in a 2-week, single-arm pilot test of the SurvivorSHINE lifestyle intervention website. Knowledge and practices related to healthy diet and physical activity behaviors were measured at baseline and follow-up. Website use (eg, time spent on the website, frequency of log-ins, and page views) were collected from the SurvivorSHINE administrative site during the intervention period. Patterns of use were examined by participants' gender and race. Correlations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Mann-Whitney U tests were used to compare demographic factors on website use. RESULTS Participants logged into the SurvivorSHINE intervention website an average of 3.2 (SD 2) times over the 2-week period and spent a total average of 94 (SD 56) minutes viewing the website during the intervention. Examining website activity, 1905 page views were logged. The User Profile (344 page views) and Home sections (301 page views) were the most frequently visited components. No associations were observed between the frequency of log-ins or the total time on the website, improvements in knowledge related to healthy lifestyles, or changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r=0.74; P=.02) and self-reported physical activity (r=0.35; P=.04). CONCLUSIONS Survivors of cancer demonstrated clear interest in a diet and exercise intervention website, as evidenced by their frequency of log-ins, page views on numerous features, and total viewing time. Moreover, increased website use was correlated with improvements in physical activity.
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Affiliation(s)
- Victoria Williams
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nashira Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Justin Xavier Moore
- Department of Population Health Sciences, Augusta University, Augusta, GA, United States
| | | | - Suzanne Perumean-Chaney
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erica Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
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Johansson JF, Lam N, Ozer S, Hall J, Morton S, English C, Fitzsimons CF, Lawton R, Forster A, Clarke D. Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults. BMJ Open 2022; 12:e053945. [PMID: 35105631 PMCID: PMC8804646 DOI: 10.1136/bmjopen-2021-053945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To systematically review and synthesise findings from process evaluations of interventions in trials which measured sedentary behaviour as an outcome in adults to explore: (1) how intervention content, implementation, mechanisms of impact and context influence outcomes and (2) how these interventions are experienced from different perspectives (participants, carers, staff). DESIGN Systematic review and narrative synthesis underpinned by the Medical Research Council process evaluation framework. DATA SOURCES Databases searches were conducted in March 2019 then updated in May 2020 and October 2021 in: CINAHL, SPORTDiscus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, AMED; EMBASE, PsycINFO, MEDLINE, Web of Science and ProQuest Dissertations & Theses. ELIGIBILITY CRITERIA We included: Process evaluations of trials including interventions where sedentary behaviour was measured as an outcome in adults aged 16 or over from clinical or non-clinical populations. We excluded studies if interventions were delivered in educational or workplace settings, or if they were laboratory studies focused on immediate effects of breaking sitting. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted and coded data into a framework and assessed the quality of studies using the Mixed Methods Appraisal Tool. We synthesised findings using a narrative approach. RESULTS 17 process evaluations were included. Five interventions focused on reducing sedentary behaviour or sitting time, 12 aimed to increase physical activity or promote healthier lifestyles. Process evaluations indicated changes in sedentary behaviour outcomes were shaped by numerous factors including: barriers (eg, staffing difficulties and scheduling problems) and facilitators (eg, allowing for flexibility) to intervention delivery; contextual factors (eg, usual lifestyle and religious events) and individual factors (eg, pain, tiredness, illness, age and individual preferences). DISCUSSION Intervention requires careful consideration of different factors that could influence changes in sedentary behaviour outcomes to ensure that interventions can be tailored to suit different individuals and groups. PROSPERO REGISTRATION NUMBER CRD42018087403.
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Affiliation(s)
- Jessica Faye Johansson
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Jennifer Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
- Faculty of Life Sciences and Health Studies, University of Bradford, Bradford, UK
| | - Sarah Morton
- Geriatric Medicine, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Coralie English
- Faculty of Health and Medicine, The University of Newcastle School of Health Sciences, Callaghan, New South Wales, Australia
| | - Claire F Fitzsimons
- Institute of Sport, Physical Education and Health Sciences, University of Edinburgh Physical Activity for Health Research Centre, Edinburgh, UK
| | - Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
- Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
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11
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Ester M, Eisele M, Wurz A, McDonough MH, McNeely M, Culos-Reed SN. Current Evidence and Directions for Future Research in eHealth Physical Activity Interventions for Adults Affected by Cancer: Systematic Review. JMIR Cancer 2021; 7:e28852. [PMID: 34542415 PMCID: PMC8491123 DOI: 10.2196/28852] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/29/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Physical activity (PA) interventions can increase PA and improve well-being among adults affected by cancer; however, most adults do not meet cancer-specific PA recommendations. Lack of time, facility access, and travel distances are barriers to participation in PA interventions. eHealth technologies may address some of these barriers, serving as a viable way to promote PA behavior change in this population. However, no review from July 2018 has synthesized available evidence across eHealth and cancer types or examined the use of behavioral theory and behavior change techniques (BCTs), leaving important gaps in knowledge. Objective This review aims to provide a comprehensive, updated overview of evidence on eHealth PA interventions for adults with cancer by describing the current state of the literature, exploring associations between intervention characteristics and effectiveness, and identifying future research needs. Methods MEDLINE, Embase, CINAHL, SportDiscus, Scopus, and CENTRAL were searched for eHealth PA interventions for adults affected by cancer. Study selection and data extraction were performed in duplicate, with consultation from the senior author (NCR). BCT coding, risk of bias, and completeness of reporting were performed using standardized tools. Results were summarized via narrative synthesis and harvest plots. Weight analyses were conducted to explore the associations between intervention characteristics and effectiveness. Results A total of 71 articles (67 studies) involving 6655 participants (mean age 56.7 years, SD 8.2) were included. Nearly 50% (32/67) of the articles were published after July 2018. Significant postintervention PA increases were noted in 52% (35/67) of the studies, and PA maintenance was noted in 41% (5/12) of the studies that included a follow-up. Study duration, primary objectives, and eHealth modality (eg, websites, activity trackers, and SMS text messaging) varied widely. Social cognitive theory (23/67, 34%) was the most used theory. The mean number of BCTs used across the studies was 13.5 (SD 5.5), with self-monitoring, credible sources, and goal setting being used in >90% of studies. Weight analyses showed the greatest associations between increased PA levels and PA as a primary outcome (0.621), interventions using websites (0.656) or mobile apps (0.563), interventions integrating multiple behavioral theories (0.750), and interventions using BCTs of problem solving (0.657) and action planning (0.645). All studies had concerns with high risk of bias, mostly because of the risk of confounding, measurement bias, and incomplete reporting. Conclusions A range of eHealth PA interventions may increase PA levels among adults affected by cancer, and specific components (eg, websites, use of theory, and action planning) may be linked to greater effectiveness. However, more work is needed to ascertain and optimize effectiveness, measure long-term effects, and address concerns with bias and incomplete reporting. This evidence is required to support arguments for integrating eHealth within PA promotion in oncology.
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Affiliation(s)
- Manuel Ester
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Margaret McNeely
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.,Department of Oncology, University of Alberta, Edmonton, AB, Canada.,Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care - Alberta Health Services, Calgary, AB, Canada
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12
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Sotirova MB, McCaughan EM, Ramsey L, Flannagan C, Kerr DP, O'Connor SR, Blackburn NE, Wilson IM. Acceptability of online exercise-based interventions after breast cancer surgery: systematic review and narrative synthesis. J Cancer Surviv 2021; 15:281-310. [PMID: 32930924 PMCID: PMC7966228 DOI: 10.1007/s11764-020-00931-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE eHealth and mHealth approaches are increasingly used to support cancer survivors. This review aimed to examine adherence, acceptability and satisfaction with Internet-based self-management programmes for post-surgical cancer rehabilitation and to identify common components of such interventions. METHODS Nine electronic databases were searched from inception up to February 15, 2020, for relevant quantitative and qualitative studies evaluating Internet-based cancer rehabilitation interventions. Studies were required to include an exercise or physical activity-based self-management intervention and a measure of adherence, acceptability or user satisfaction with the programme. Two independent reviewers performed all data extraction and quality assessment procedures. Data were synthesized using a narrative approach. RESULTS Six hundred ninety-six potential papers were identified and screened. Eleven met the inclusion criteria. Interventions had wide variations in levels of adherence, but the majority were reported as being acceptable to the users. Increased acceptability and user satisfaction were associated with interventions which were seen as time and cost-efficient, requiring acquisition of minimal or no new skills, which used coherent language, or which provided tailored information. The majority contained behaviour change components such as goal setting. CONCLUSIONS Despite high levels of heterogeneity between studies, Internet-based approaches may be an acceptable method for the delivery of self-management interventions in post-surgical cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS There is a need for further studies exploring factors associated with increased user engagement and usage of digital interventions in cancer rehabilitation settings. These findings should be used to help develop interventions prior to testing their effectiveness in adequately powered randomized controlled trials.
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Affiliation(s)
- Mariya B Sotirova
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK.
| | - Eilís M McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, Northern Ireland, UK
| | - Lucia Ramsey
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Coleraine, Northern Ireland, UK
| | - Daniel P Kerr
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicole E Blackburn
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Iseult M Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
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13
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Abstract
This narrative review of web-delivered weight management, diet quality, and physical activity interventions for cancer survivors relies on a systematic search of PubMed, Psych Info, and EBSCOhost which identified 19 unique web-delivered lifestyle interventions for cancer survivors. The sample sizes for these studies ranged from 11–492. Intervention duration ranged from 1–12 months; however, most interventions were 6–12 weeks in length. Ten studies were randomized controlled trials (RCTs), two were two-arm quasi RCTs, and seven employed a single-arm pre/post-test design. Many (N= 15) of the interventions were well-grounded in behavioral theory, which may have led to favorable behavior change. Most studies (15-of-19) targeted and reported increases in physical activity, while only a few targeted and reported improvements in diet quality (36.9% and 15.8%, respectively) and weight management (26.3% and 10.5%, respectively). A notable limitation was that most studies were conducted among populations that were primarily White and female. Future directions for Internet-based lifestyle interventions for cancer survivors include increasing: (a) focus on multiple behavior change, (b) representation of male and minority populations to improve generalizability of findings, (c) extended intervention duration and follow-up to evaluate long-term efficacy of web-based lifestyle interventions, and (d) sample size to allow for adequate statistical power.
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14
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Lynch BM, Nguyen NH, Moore MM, Reeves MM, Rosenberg DE, Boyle T, Vallance JK, Milton S, Friedenreich CM, English DR. A randomized controlled trial of a wearable technology-based intervention for increasing moderate to vigorous physical activity and reducing sedentary behavior in breast cancer survivors: The ACTIVATE Trial. Cancer 2019; 125:2846-2855. [PMID: 31012970 DOI: 10.1002/cncr.32143] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial examined the efficacy of an intervention (use of the Garmin Vivofit 2 activity monitor coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions) to increase moderate to vigorous physical activity (MVPA) and reduce sedentary behavior in breast cancer survivors. METHODS This randomized controlled trial recruited 83 inactive, postmenopausal women diagnosed with stage I-III breast cancer who had completed primary treatment. Participants were randomly assigned to the intervention group or to the control group, and the intervention was delivered over a 12-week period. MVPA and sedentary behavior were measured with Actigraph and activPAL accelerometers at baseline (T1) and at the end of the intervention (T2). RESULTS Retention in the trial was high, with 80 (96%) of participants completing T2 data collection. At T2, there was a significant between-group difference in MVPA (69 min/wk; 95% CI = 22-116) favoring the intervention group. The trial resulted in a statistically significant decrease in both total sitting time and prolonged bouts (≥20 min) of sitting, with between-group reductions of 37 min/d (95% CI = -72 to -2) and 42 min/d (95% CI = -83 to -2), respectively, favoring the intervention group. CONCLUSION Results from the ACTIVATE Trial suggest that the use of wearable technology presents an inexpensive and scalable opportunity to facilitate more active lifestyles for cancer survivors. Whether or not such wearable technology-based interventions can create sustainable behavioral change should be the subject of future research.
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Affiliation(s)
- Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nga H Nguyen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melissa M Moore
- Medical Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marina M Reeves
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Terry Boyle
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Shakira Milton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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