Faculty Publications

Background: Regular physical activity may offer benefits to lung cancer survivors, many of whom experience quality-of-life (QOL) impairments. However, little is know about lung cancer survivors' engagement in physical activity across the cancer trajectory. The current study addressed this research gap and also examined the association between lung cancer survivors' physical activity and their QOL. Methods: The study participants were 175 individuals who completed surgical treatment for early-stage non-small cell lung cancer 1 to 6 years previously. Participants completed a one-time survey regarding their current QOL and their engagement in physical activities currently, during the 6 months after treatment, and during the 6 months before diagnosis. Results: Participants' reported engagement in both moderate and strenuous intensity activities was lower during the post-treatment period compared with before diagnosis and at the current time. Engagement in light intensity activities did not differ for the three time points. Almost two-thirds of participants did not engage in sufficient activity to meet national physical activity guidelines for any of the three time points. Lung cancer survivors who currently met physical activity guidelines reported better QOL in multiple domains than less active individuals. Conclusions: Engagement in physical activity among lung cancer survivors is particularly low during the early post-treatment period. Current engagement in physical activity is associated with better QOL. However, most lung cancer survivors do not meet physical activity guidelines and may benefit from interventions to promote engagement in regular physical activities. (Cancer Epidermiol Biomarkers Prev 2009;18(2):664-72)

BACKGROUND: Individuals with a sibling who has had colorectal cancer diagnosed before age 61 are at increased risk for colorectal cancer and may derive particular benefit from screening. Tailored interventions may increase participation in appropriate colorectal cancer screening. PURPOSE: This study evaluated the efficacy of two tailored interventions and a generic print intervention. METHODS: Participant siblings (N = 412) who were not up-to-date with colorectal cancer screening were randomly assigned to receive either a generic print pamphlet, a tailored print pamphlet, or a tailored print pamphlet and tailored counseling call. Colorectal cancer screening 6 months after the baseline interview was the outcome measure. RESULTS: Results indicated that colorectal cancer screening adherence increased among intermediate risk siblings enrolled in all three intervention groups. Participants in both tailored intervention groups reported having colorectal cancer screening at significantly higher rates than participants in the generic print group. The increase in colorectal cancer screening in the tailored print and counseling call group was not significantly higher than that achieved by the tailored print alone. Decisional balance partially mediated treatment effects. Tailored behavioral interventions are effective methods for increasing screening adherence but telephone counseling did not add significantly to treatment effects.

Purpose: Men with a family history of prostate cancer and black men are at higher risk for prostate cancer. Recruitment and retention of these men at high risk into early detection programs is challenging. We report a comprehensive analysis of recruitment methods, show rates and participant factors from the Prostate Cancer Risk Assessment Program, a prospective, longitudinal prostate cancer screening study. Materials and Methods: Men 35 to 69 years old were eligible for recruitment if they had a family history of prostate cancer, were black or had a BRCA1/2 mutation. Recruitment methods were analyzed using standard statistical methods with respect to participant demographics and presentation to the first program appointment. Results: Of 707 men recruited 64.9% presented to the initial program appointment. More men were recruited via radio than via referral or other methods (chi-square = 298.13, p<0.0001). Men recruited by radio were more likely to be black (p<01.001), less educated (p = 0.003) and not married or partnered (p = 0.007), and have no prostate cancer family history (p <0.001). Men recruited by referral had a higher income (p = 0.007) and were more likely to attend the initial program visit than those recruited by radio or other methods (chi-square = 27.08, p <0.0001). Conclusions: This comprehensive analysis shows that radio led to higher recruitment of black men with lower socioeconomic status. However, these men at high risk have a lower presentation rate for prostate cancer screening. Targeted motivational measures must be studied to improve the show rate for prostate cancer risk assessment in these men at high risk.

PURPOSE: Men with a family history of prostate cancer and black men are at higher risk for prostate cancer. Recruitment and retention of these men at high risk into early detection programs is challenging. We report a comprehensive analysis of recruitment methods, show rates and participant factors from the Prostate Cancer Risk Assessment Program, a prospective, longitudinal prostate cancer screening study. MATERIALS AND METHODS: Men 35 to 69 years old were eligible for recruitment if they had a family history of prostate cancer, were black or had a BRCA1/2 mutation. Recruitment methods were analyzed using standard statistical methods with respect to participant demographics and presentation to the first program appointment. RESULTS: Of 707 men recruited 64.9% presented to the initial program appointment. More men were recruited via radio than via referral or other methods (chi-square = 298.13, p &lt;0.0001). Men recruited by radio were more likely to be black (p &lt;0.001), less educated (p = 0.003) and not married or partnered (p = 0.007), and have no prostate cancer family history (p &lt;0.001). Men recruited by referral had a higher income (p = 0.007) and were more likely to attend the initial program visit than those recruited by radio or other methods (chi-square = 27.08, p &lt;0.0001). CONCLUSIONS: This comprehensive analysis shows that radio led to higher recruitment of black men with lower socioeconomic status. However, these men at high risk have a lower presentation rate for prostate cancer screening. Targeted motivational measures must be studied to improve the show rate for prostate cancer risk assessment in these men at high risk.

OBJECTIVE: This study examined the prevalence and correlates of U.S. adults' awareness of the role that physical activity plays in preventing colon cancer. METHODS: Data were analyzed for 1932 respondents to the Health Information National Trends Survey who answered a question about factors that reduce the chances of getting colon cancer. Individuals who listed physical activity in response to this question were denoted as being aware of its role in colon cancer prevention. RESULTS: Few respondents (15.0%) listed physical activity as a means of reducing colon cancer risk. Awareness was especially low among individuals aged 50 years and over, those with lower levels of education, individuals who believe that physical activity recommendations are confusing, those reporting less exposure to information about physical activity and cancer, individuals who did not report looking for information about cancer, those with poorer knowledge of colon cancer symptoms, and less physically active individuals. CONCLUSIONS: There is poor awareness among U.S. adults of the role that physical activity plays in preventing colon cancer. PRACTICE IMPLICATIONS: Health care providers should routinely inform their patients that engaging in regular physical activity greatly reduces the risk of developing colon cancer.

Background: The incidence of all types of skin cancer has increased over the past 3 decades in the United States. Increased skin cancer risk is associated with exposure to ultraviolet radiation. This study examined the age-stratified prevalence and correlates of multiple skin cancer risk behaviors (infrequent use of sun-protective clothing, staying in the sun when outside on a sunny day, infrequent use of sunscreen, indoor tanning, and receiving a sunburn) among U.S. adults. Methods: 28,235 adults participating in the 2005 National Health Interview Survey (NHIS) answered questions regarding sun-protection behaviors, indoor tanning in the past year, and sunburns in the past year. Examined correlates included geographic location, demographics, healthcare access, BMI, physical activity, smoking, alcohol use, melanoma family history, perceived cancer risk, skin sensitivity to the sun, and receipt of a total skin exam. Results: The most commonly reported skin cancer risk behaviors were infrequent use of sun-protective clothing and infrequent use of sunscreen. The majority of individuals reported multiple skin cancer risk behaviors. Although significant correlates varied according to age, individuals reporting more risk behaviors were more likely younger, residing in the Midwest, male, non-Hispanic white, less-educated, smokers, risky drinkers, and had skin that was less sun-sensitive. Conclusions: The majority of the U.S. population engage in multiple skin cancer risk behaviors. A comprehensive approach to skin cancer prevention requires attention to multiple skin cancer risk behaviors that are common in the U.S. population.

BACKGROUND. Black men are at increased risk for prostate cancer (PCA), particularly with a family history (FH) of the disease. Previous reports have raised concern for suboptimal screening of black men with an FH of PCA. The extent of FH of PCA are reported from a prospective, longitudinal PCA screening program for high-risk men. METHODS. Black men ages 35 to 69 years are eligible for PCA screening through the Prostate Cancer Risk Assessment Program (PRAP) regardless of FH. Rates of self-reported FH of PCA, breast, and colon cancer at baseline were compared with an age-matched sample of black men from the 2005 National Health Interview Survey (NHIS) using standard statistical methods. RESULTS. As of January 2007, 332 black men with pedigree information were enrolled in PRAP and FH of PCA was compared with 838 black men from the 2005 NHIS. Black men in PRAP reported significantly more first-degree relatives with PCA compared with black men in the 2005 NHIS (34.3% [95% confidence interval (95% CI), 29.2-39.7] vs 5.7% [95% CI, 3.9-7.4]). Black men in PRAP also had more FH of breast cancer compared with those in the 2005 NHIS (11.5% [95% CI, 8.2-15.4] vs 6.3% [95% CI, 4.6-8.0]). CONCLUSIONS. FH of PCA appears to be a motivating factor for black men seeking PCA screening. Targeted recruitment and education among black families should improve PCA screening rates. Efforts to recruit black men without an FH of PCA are also needed. Cancer 2008;113:2559-64. (C) 2008 American Cancer Society.

BACKGROUND: Little is known about the prevalence of indoor tanning among the US general adult population. OBJECTIVES: This study sought to: (1) describe the prevalence of indoor tanning throughout adulthood; (2) identify demographic and psychosocial correlates of indoor tanning; and (3) determine whether these correlates vary by age group. METHODS: This study used data from the 2005 National Health Interview Survey, an annual health survey of the US adult population. RESULTS: Indoor tanning rates were higher among individuals who were young, white, and female. Rates of indoor tanning in the last year varied from 20.4% for those aged 18 to 29 years to 7.8% for those aged 65 years and older. A variety of demographic, health, and behavioral health risk factors correlated with indoor tanning. LIMITATIONS: The study design was cross-sectional and all data were self-reported. CONCLUSIONS: Health care providers should address indoor tanning as a health risk factor across the lifespan.

BACKGROUND: Individuals who are not adherent to colorectal cancer screening have a greater prevalence of several other behavioral risk factors for colorectal cancer than adherent individuals. However, previous relevant studies have typically not considered the co-occurrence of such behavioral risk factors at the individual level. In the current study, we examined the prevalence, patterns, and predictors of multiple behavioral risk factors for colorectal cancer according to colorectal cancer screening status (adherent versus not adherent). METHODS: The study sample consisted of 11,090 individuals ages 50 years and older who participated in the 2000 National Health Interview Survey. Based on responses to survey questions, individuals were categorized as being adherent or not adherent to colorectal cancer screening guidelines and were also denoted as having or not having each of seven behavioral risk factors for colorectal cancer (smoking, low physical activity, low fruit and vegetable intake, high caloric intake from fat, obesity, high alcohol intake, and low intake of multivitamins). RESULTS: Individuals who were not adherent to screening reported having a greater number of risk factors than adherent individuals. For each screening group, there was a high prevalence of having low physical activity, low fruit and vegetable intake, and low intake of multivitamins. Demographic and health-related correlates of behavioral risk factor prevalence were identified in both screening groups. CONCLUSIONS: In combination with efforts to promote colorectal cancer screening uptake and adherence, there is a need to develop interventions to modify the colorectal cancer behavioral risk factors that are common among screening-adherent and nonadherent individuals. (Cancer Epidemiol Biomarkers Prev 2007;16(3):510-6).

This study examines potential predictors of perceived risk for colon cancer in a U.S. sample of 2,949 individuals aged 45 and older with no colon cancer history. We examined perceived comparative risk for colon cancer as the outcome in ordinal regression analyses, and perceived absolute risk for colon cancer in linear regression analyses. Potential predictors included demographics, current risk behaviors, self-reported health, family and personal cancer history, emotion variables (colon cancer worry, general anxiety, and fear of positive screening findings), general cancer beliefs (causes, lack of preventability, information overload), and cancer information seeking. Those who had poorer self-reported health, a family cancer history, and increased colon cancer worry had higher perceived comparative and absolute colon cancer risk (all ps < .05). Those who were younger, interviewed in Spanish, had increased anxiety, and information overload had higher comparative risk; those with a personal history of cancer and fear that colon cancer screening would result in positive findings had higher absolute risk (all ps < .05). We determined that older individuals, those with risk factors, and those with good subjective health may not realize their colon cancer risk. Those distressed about colon cancer and who report cancer prevention information overload may require different messages.