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The chronic disease burden associated with physical inactivity may disproportionately affect socially disadvantaged populations. Racial and ethnic minority populations are consistently shown to be less physically active during leisure time compared with whites (1). In 2000, the prevalence of having no physical activity during leisure time was 54% among Hispanics, 52% among blacks, and 35% among whites (1). Numerous population surveys have similarly reported a positive association between leisure-time physical activity and measures of social class (8,17,22). Approximately 72% of adults with less than a ninth-grade education do not regularly participate in leisure-time physical activity, compared with 25% of college graduates (1). The methodological challenges associated with valid measurement of physical activity using self-report measures (14,16) may be magnified in studies involving lower-income populations. Few self-report measures are designed to assess activity accumulated through nonleisure sources (e.g., domestic, occupational, transportation), which may be more common and account for a larger proportion of total physical activity among lower-income populations. Individuals in lower-income populations are overrepresented in physically active occupations (i.e., construction, maintenance, housekeeping, factory work). Particularly in urban settings, individuals of lower income may have a higher likelihood of engaging in ambulatory activity for transportation purposes (e.g., walking to work, school, or a bus stop). This is a key concern, because it is largely unclear whether the recommended guidelines for daily physical activity (18) are met or exceeded by those in lower-income populations through these often unmeasured activity sources. For example, in two large, randomized intervention studies conducted among more than 4000 lower-income, multiethnic adults, our group recently found much higher, accelerometer-validated, rates of self-reported physical activity than would be expected based on the available literature (10,21). Results of these and other (5) studies highlight the need to assess total accumulated physical activity in these groups, using reliable and externally valid measurement strategies. A variety of motion sensor technologies (i.e., pedometers, accelerometers) have been developed to overcome the compromised validity associated with many self-report physical activity indexes (28). Pedometers capture the vertical accelerations associated with normal ambulation and demonstrate excellent concordance with accelerometer-derived physical activity (median correlation of 0.86), and can objectively detect gradations in walking behavior (4,11,28). Walking is the most frequently adopted type of regular physical activity (16,28), particularly among some racial and ethnic minority groups, (16) yet it is among the least reliably recalled activity types (16,28). Given their accuracy, low unit cost ($10–20), and ease of use, pending continued rigorous validation, pedometers hold great promise as measures of total physical activity among lower-income, multiethnic populations. Emerging data provide expected reference values for daily steps by a variety of sociodemographic characteristics (20,27,29). Higher daily steps are generally found among men (24,29), those of younger age (20,27,30), and the employed (7,30). Some evidence suggests that pedometer-determined daily steps are inversely associated with measures of socioeconomic position and are generally higher among whites (27). Few studies, however, have measured physical activity using pedometers in well-characterized, population-based samples that include individuals from lower-income and racial and ethnic minority groups. Given the limitations of the current literature, the primary aimof the present study was to discern patterns of pedometer-determined physical activity by a range of sociodemographic characteristics in a predominately racial and ethnic minority population of low-income housing residents.

Determinants of physical activity in minority populations remain under-explored. Acculturation is one proposed mechanism for the disparities that exist between racial and ethnic groups in health outcomes.This cross-sectional study evaluated the relation of language acculturation and generation in the US since migration with leisure-time and occupational activity. A low-income, multiethnic urban population was recruited from Massachusetts small businesses (SB) (n=1,725) and health centers (HC) (n=2,205). Baseline data were collected between May 2000 and February 2002.Individuals with low acculturation reported leisure-time activity 3-5 MET hours/week lower than those who were highly acculturated (P0.05). Generation predicted leisure-time activity only in SB participants. In the HC, least acculturated participants reported occupational activity 10-12 MET hours/week higher than highly acculturated participants. In SB men, acculturation was inversely associated with occupational activity; in SB women, language acculturation was positively associated with occupational activity. Generation was not predictive of occupational activity.Language acculturation and generation were positively associated with leisure-time activity. Language acculturation is also associated with occupational activity. Acculturation is important to consider when designing public health interventions.

Individuals of lower socioeconomic position smoke at higher rates than those of higher socioeconomic position. Because of this disparity, the National Cancer Institute has called for studies of targeted tobacco marketing to clarify mechanisms contributing to higher tobacco use among low-income Americans and other high-risk populations.We observed tobacco industry marketing in six Boston area communities (two of high socioeconomic position and four of low position; total of 41 observations) and in selected print publications that circulated in those communities during a 22-month period in 2000-2002.On average, there were fewer tobacco advertisements in the higher socioeconomic communities, compared to the lower socioeconomic communities (P0.001). In the low socioeconomic communities, there were more than three times as many brand advertisements as youth access signs (P = 0.0012). Although brand advertisements outnumbered smoke-free signs, on average, there was no difference in the ratio of brand advertisements to smoke-free signs in low and high socioeconomic communities (P = 0.06).The tobacco industry is actively present in community settings, particularly in communities with a low socioeconomic profile (SEP). Tobacco control researchers and advocates need to continue to monitor the tobacco industry's behavior at the community level and develop strategies to counter this behavior.

Objective. To explore the associations among ethnicity, educational attainment, and cortisol secretion. Design. Participants included 63 white (n=31) and African-American (n=32) adult men and women. Subjects provided salivary cortisol samples immediately upon awakening and again, 30 minutes later. Results. Analyses adjusted for relevant covariates revealed a steeper awakening response among whites with higher education compared to other groups. Cortisol levels were significantly lower among African-American participants with lower levels of education. All effects were independent of perceived stress. Conclusions. These preliminary findings demonstrate significant ethnic and education-related differences in awakening cortisol secretion responses. Our data highlight the importance of considering ethnicity and the moderating effects of social class when examining the associations among social contextual factors and cortisol secretion.

Supplemental digital content is available in the text., Introduction Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS), including nocturia, are extremely common among middle- and older-age American men. Although studies on physical activity (PA) and prevalent BPH-related outcomes suggest that PA may protect against the development of this common condition, only a few studies have examined the relation between PA and incident BPH-related outcomes and LUTS with mixed findings. In addition, although nocturia is the most commonly reported and most bothersome LUTS in men with or without evidence of BPH, few studies have examined the association of PA and nocturia independent of BPH. The purpose of this analysis was to examine the association of PA with BPH-related outcomes and nocturia in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial. Methods We examined this association with both prevalent (n = 28,404) and incident (n = 4710) BPH-related outcomes (measured by self-report of physician diagnosis, BPH surgery, finasteride use, and clinical indicators) and nocturia. Poisson regression with robust variance was used to calculate prevalence ratios and relative risks. Results PA was weakly positively associated with several prevalent BPH-related outcomes and was strongly inversely associated with prevalent nocturia. In incident analyses, PA was only associated with nocturia. Men who were active ≥1 h·wk−1 were 13% less likely (95% confidence interval, 2%–22%) to report nocturia and 34% less likely (95% confidence interval, 15%–49%) to report severe nocturia as compared with men who reported no PA. The associations were similar for men with and without additional BPH-related outcomes, except for prevalent nocturia, where the association was stronger for men without other BPH-related outcomes. Conclusions Combined with other management strategies, PA may provide a strategy for the management of BPH-related outcomes, particularly nocturia.

We investigated racial disparities in healthy behaviors and cancer screening in a large sample from the US population.This analysis used the data from 2005 National Health Interview Survey and included women at age ≥ 40 years who completed the cancer questionnaires (2,427,075 breast cancer survivors and 57,978,043 women without cancer). Self-reported information on cancer history, healthy behaviors (body mass index, smoking, alcohol use, physical activity, fruit/vegetable consumption, sunscreen use) was collected. We compared distributions of each factor among Caucasian, African American, and Hispanic women with and without breast cancer history.Caucasian breast cancer survivors as compared to their cancer-free counterparts were less likely to be current smokers (8.3 vs. 16.9 %, p0.001) and to have regular mammograms (51.5 vs. 36.9 %, p0.05). Differences in associations between cancer survivors and respondents without cancer among African American and Hispanic women did not reach statistical significance.Certain breast cancer survivor groups can benefit from tailored preventive services that would address concerns related to selected healthy behaviors and screening practices. However, most of the differences are suggestive and do not differ by race.

Purpose: Changes in cancer therapy, in addition to changes in obesity prevalence, suggest the need for a current assessment of weight gain patterns following breast cancer diagnosis. The aim of this study was to evaluate factors associated with weight gain among breast cancer survivors prior to enrolling into a behavioral weight loss intervention. Methods: Anthropometric measures and data on weight-related factors were collected at baseline on 665 breast cancer survivors. Postdiagnosis weight gain was determined between entry into the trial and previous diagnosis up to 5 years. Multivariate logistic regression analyses were used to evaluate the association between weight gain and influencing factors. Results: The mean weight gain was 4.5 % body weight (standard deviation = 10.6); 44 % of women experienced ≥5 % body weight gain. The risk of weight gain was inversely associated with age (adjusted odds ratio (ORadj) = 0.97, 95 % confidence interval (95 % CI) 0.95-0.99), Hispanic ethnicity (ORadj = 0.30, 95 % CI 0.13-0.68), and overweight (ORadj = 0.11, 95 % CI 0.05-0.23) or obese (ORadj = 0.03, 95 % CI 0.02-0.07) status at diagnosis and positively associated with time elapsed since diagnosis (ORadj = 1.19/year, 95 % CI 1.04-1.36). Women prescribed aromatase inhibitors were 46 % less likely to gain weight compared to women prescribed selective estrogen-receptor modulators (ORadj = 0.54, 95 % CI 0.31-0.93). The risk of weight gain was positively associated with smoking at diagnosis (ORadj = 2.69, 95 % CI 1.12-6.49) although this was attributable to women who subsequently quit smoking. Conclusions: Postdiagnosis weight gain is common and complex and influenced by age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. Implications for cancer survivors: Weight gain continues to be a concern following a diagnosis of breast cancer. Factors influencing this weight gain include age, ethnicity, weight, smoking status, time elapsed since diagnosis, and endocrine-modulating therapy. Effective weight management strategies are needed for this population of women. © 2014 Springer Science+Business Media New York.

Studies show a protective relationship between physical activity and breast cancer risk across the life course from menarche to postmenopausal years. Mammographic breast density is a known and strong breast cancer risk factor. Whether the association of physical activity with breast cancer risk is mediated through mammographic breast density is poorly understood. This systematic review summarizes published studies that investigated the association between physical activity and mammographic breast density and discusses the methodological issues that need to be addressed. We included in this review studies that were published before October 31, 2011 that were accessible in full-text format and were published in English. We identified 20 studies through the PubMed Central, BioMed Central, Embase, and Scopus and using the search terms “physical activity and breast density” and “exercise and breast density” as well as through manual searches of the bibliographies of the articles identified in electronic searches. We found no evidence of association between physical activity and breast density across the studies by grouping them first by the timing of physical activity assessment (in adolescence, current/recent, past, and lifetime) and then by women’s menopausal status (premenopausal and postmenopausal). Given the strength of the relationship between physical activity and breast cancer and the null findings of this review, it is unlikely that the effect of physical activity is mediated through an effect on breast density.

Recognition of the complex, multidimensional relationship between excess adiposity and cancer control outcomes has motivated the scientific community to seek new research models and paradigms.The National Cancer Institute developed an innovative concept to establish a center grant mechanism in nutrition, energetics, and physical activity, referred to as the Transdisciplinary Research on Energetics and Cancer (TREC) Initiative. This paper gives an overview of the 2011-2016 TREC Collaborative Network and the 15 research projects being conducted at the centers.Four academic institutions were awarded TREC center grants in 2011: Harvard University, University of California San Diego, University of Pennsylvania, and Washington University in St. Louis. The Fred Hutchinson Cancer Research Center is the Coordination Center. The TREC research portfolio includes three animal studies, three cohort studies, four randomized clinical trials, one cross-sectional study, and two modeling studies. Disciplines represented by TREC investigators include basic science, endocrinology, epidemiology, biostatistics, behavior, medicine, nutrition, physical activity, genetics, engineering, health economics, and computer science. Approximately 41,000 participants will be involved in these studies, including children, healthy adults, and breast and prostate cancer survivors. Outcomes include biomarkers of cancer risk, changes in weight and physical activity, persistent adverse treatment effects (e.g., lymphedema, urinary and sexual function), and breast and prostate cancer mortality.The NIH Science of Team Science group will evaluate the value added by this collaborative science. However, the most important outcome will be whether this transdisciplinary initiative improves the health of Americans at risk of cancer as well as cancer survivors.

More than half of the cancer occurring today is preventable by applying knowledge that we already have. Tobacco, obesity, and physical inactivity are the modifiable causes of cancer that generate the most disease. Cancer burden can be reduced by alterations in individual and population behaviors and by public health efforts as long as these changes are driven by sound scientific knowledge and social commitment to change. The obstacles to these efforts are societal and arise from the organization of institutions, including academia, and in the habits of daily life. To achieve maximal possible cancer prevention, we will need better ways to implement what we know and improved infrastructure that will better incentivize and support transdisciplinary, multilevel research and successful intervention.

Familial Adenomatous Polyposis (FAP) is a rare autosomal dominantly inherited colorectal cancer syndrome. Individuals with FAP often undergo colectomy and are recommended to follow several surveillance protocols. Biological relatives of persons with FAP may also be at risk and thus should undergo genetic counseling. Screening adherence, genetic testing, and other health behaviors among individuals with FAP and their relatives are not well characterized. We conducted a cross-sectional self-report survey with individuals who have FAP (n=35) and their biological relatives (n=15). Respondents were recruited through a cancer center registry for inherited colon cancers. Most relatives had undergone colon cancer screening; 40% had undergone genetic testing. One fifth of respondents with FAP had not undergone an upper endoscopy, contrary to usual recommendations. Cigarette smoking rates were above average and were higher among FAP respondents. Use of vitamin supplements was fairly common, more so among those with FAP. Although most people had been screened, there are areas for improvement, notably for upper endoscopy among individuals with FAP and genetic testing among family members. Several other health-risk behaviors and health concerns other than FAP were identified. Further research into factors contributing to screening rates and other health behaviors in this high-risk population is warranted.

Background Physical activity decreases risk of colon polyps and colon cancer and might reduce risk of colon cancer recurrence. Focusing on recent calls for translation of epidemiologic evidence into clinical care, our pilot study delivered an evidence-based physical activity intervention in adults with polyps, who are thus at elevated risk of developing colon cancer. The objective was to evaluate change in physical activity, measured by steps per day and minutes of moderate/vigorous physical activity. Methods Sixteen adults with adenomas detected and removed at screening colonoscopy were recruited to a 12-week physical activity intervention. Participants were randomized to receive a standard (30 minutes/day) or high (60 minutes/day) walking program. Physical activity was measured via blinded pedometer and accelerometer at baseline and follow-up. Intervention messages focused on self-monitoring using pedometers and overcoming barriers to engaging in physical activity. Results Participants in both arms significantly increased objectively measured minutes of moderate/vigorous physical activity over the course of the intervention. Both arms exceeded the intervention goal, but there was not a significant difference between arms at follow-up. Results were similar for pedometer measured physical activity, with a significant overall increase in steps/day from baseline to follow-up, but no between arm difference in change. Conclusion Simple interventions of minimal contact time focusing on walking can significantly increase physical activity in individuals at increased risk of developing colon cancer. Trial Registration ClinicalTrials.gov NCT01476631

In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life (QOL), and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice, and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community.

Education in cancer prevention and control calls for training that spans disciplines to bring a broad range of skills together to develop future leaders who can speed research and delivery of effective prevention and control programs. We review the history of the Harvard Cancer Prevention Education Program as one example and summarize approaches to transdisciplinary training from the early 1990s onwards. From backgrounds in traditional public health disciplines (epidemiology, behavioral science, health policy, decision sciences, biostatistics, and environmental health) and clinical training, we encouraged common vocabulary, teamwork, and application of knowledge to the prevention of cancer with a population health perspective. While the evaluation of training programs is necessarily tied to the career trajectories of trainees, spanning decades, we present some early evidence of broad applications of training across research and delivery in government and not for profit sectors.

Research over the past 40 years has convincingly shown that lifestyle factors play a huge role in cancer incidence and mortality. The public, though, can often discount the preventability of cancer. That health information on the Internet is a vast and often scientifically suspect commodity makes promoting important and sound cancer prevention messages to the public even more difficult. To help address these issues and improve the public’s knowledge of, and attitudes toward, cancer prevention, there need to be concerted efforts to create evidence-based, user-friendly information about behaviors that could greatly reduce overall cancer risk. Toward this end, we condensed the current scientific evidence on the topic into eight key behaviors. While not an end in themselves, “Eight Ways to Stay Healthy and Prevent Cancer” forms an evidence-based and targeted framework that supports broader cancer prevention efforts.

As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations.This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final.In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisure-time physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final.These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations.

Background Weight misperception might preclude the adoption of healthful weight-related attitudes and behaviors among overweight and obese individuals, yet limited research exists in this area. We examined associations between weight misperception and several weight-related attitudes and behaviors among a nationally representative sample of overweight and obese US adults. Methods Data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) were used. Analyses included non-pregnant, overweight and obese (measured body mass index ≥ 25) adults aged 20 and older. Weight misperception was identified among those who reported themselves as "underweight" or "about the right weight". Outcome variables and sample sizes were: weight-loss attitudes/behaviors (wanting to weigh less and having tried to lose weight; n = 4,784); dietary intake (total energy intake; n = 4,894); and physical activity (meets 2008 US physical activity recommendations, insufficiently active, and sedentary; n = 5,401). Multivariable regression models were stratified by gender and race/ethnicity. Analyses were conducted in 2009-2010. Results These overweight/obese men and women who misperceived their weight were 71% (RR 0.29, 95% CI 0.25-0.34) and 65% (RR 0.35, 95% CI 0.29-0.42) less likely to report that they want to lose weight and 60% (RR 0.40, 95% CI 0.30-0.52) and 56% (RR 0.44, 95% CI 0.32-0.59) less likely to have tried to lose weight within the past year, respectively, compared to those who accurately perceived themselves as overweight. Blacks were particularly less likely to have tried to lose weight. Weight misperception was not a significant predictor of total energy intake among most subgroups, but was associated with lower total energy intake among Hispanic women (change -252.72, 95% CI -433.25, -72.18). Men who misperceived their weight were less likely (RR 0.68, 95% CI 0.52-0.89) to be insufficiently active (the strongest results were among Black men) and women who misperceived their weight were less likely (RR 0.74, 95% CI 0.54, 1.00, p = 0.047) to meet activity recommendations compared to being sedentary. Conclusion Overall, weight misperception among overweight and obese adults was associated with less likelihood of interest in or attempts at weight loss and less physical activity. These associations varied by gender and race/ethnicity. This study highlights the importance of focusing on inaccurate weight perceptions in targeted weight loss efforts.

Objectives. We sought to examine the association between structural, functional, and normative social factors and physical activity among urban, low-income, racially/ethnically diverse adults. Methods. We conducted a baseline cross-sectional survey among residents of 12 low-income housing communities in metropolitan Boston, Massachusetts. Participants were also asked to wear a pedometer for 5 days. We analyzed complete data from 1112 residents (weighted n = 1635). Results. Residents with smaller social networks were significantly less physically active than were residents with larger social networks (b = −1503.7; P = .01) and residents with conflicting demands were more active than were residents with none (b = 601.6; P = .01), when we controlled for employment status, gender, poverty level, current health status, age, and perceived safety. Social networks were most strongly associated with physical activity among Hispanics and younger residents (aged 18–35 years). Conclusions. These findings indicate that social factors, including social networks and role-related conflicting demands, may be important drivers of physical activity among low-income populations. Researchers and practitioners should consider social factors in developing multilevel physical activity interventions for this population.

Colorectal cancer is the third most common cancer globally and is a leading cause of cancer death. Gastric cancer contributes significantly to the global cancer burden, particularly in low- and middle-income countries. We reviewed the literature for studies on physical activity or exercise and colon, rectal, and gastric cancers as well as colonic adenomatous polyps. We identified 52 studies of colon cancer, 31 studies of rectal cancer, 23 studies of colon polyps, and 16 studies of gastric cancer. Of the 52 studies of physical activity and colon cancer, 37 found a statistically significant association between increased levels of physical activity and decreased colon cancer risk in at least one comparison. Accumulated evidence suggests that physical activity is associated with a 25% reduction in colon cancer risk. In line with previous reports, we found no indication that the association was more pronounced for occupational versus recreational physical activity, with both resulting in a risk reduction of about 22%. Evidence for other domains of physical activity (i.e., transportation or household physical activity) is limited. Evidence is emerging that individuals who are consistently active across the lifetime may obtain greater risk reductions than those who are only active in recent years. Despite consistent associations with colon cancer, evidence is more limited though suggestive that physical activity reduces risk of colon adenomas or adenoma recurrence. There is clear evidence that physical activity is not associated with rectal or gastric cancers.

Background: Although data on the association of physical activity and colon cancer risk is convincing, little research has examined whether change in physical activity alters risk of cancer incidence and mortality. Methods: We examined the association of 10- and 15-year change in physical activity with risk of colon cancer incidence and mortality in the Cancer Prevention Study II. Endpoints were verified through medical record abstraction or registry or National Death Index linkage. Ten-year physical activity analysis included 1,863 incident and 826 fatal cases, whereas the longer-term exposure analysis included 1,386 incident and 602 fatal colon cancer cases. Age and multivariable-adjusted hazard ratios were estimated using Cox proportional hazards models. Results: Neither measure of physical activity change was associated with colon cancer incidence. Fifteen-year change was not associated with colon cancer mortality. However, consistently high physical activity over 10 years was associated with a decreased risk of colon cancer mortality as compared with those with consistently low activity. The association attenuated to borderline significance with adjustment for body mass index. Those consistently at or above sample median physical activity levels over 15 years had half the risk of colon cancer death as those consistently below the median. Conclusions: Regular long-term physical activity was associated with a lower risk of colon cancer mortality. Impact: This study suggests that long-term participation in physical activity provides the greatest reduction in risk of colon cancer death. Cancer Epidemiol Biomarkers Prev; 19(12); 3000–4. ©2010 AACR.

Background Physical activity self-report instruments in the US have largely been developed for and validated in White samples. Despite calls to validate existing instruments in more diverse samples, relatively few instruments have been validated in US Blacks. Emerging evidence suggests that these instruments may have differential validity in Black populations. Purpose This report reviews and evaluates the validity and reliability of self-reported measures of physical activity in Blacks and makes recommendations for future directions. Methods A systematic literature review was conducted to identify published reports with construct or criterion validity evaluated in samples that included Blacks. Studies that reported results separately for Blacks were examined. Results The review identified 10 instruments validated in nine manuscripts. Criterion validity correlations tended to be low to moderate. No study has compared the validity of multiple instruments in a single sample of Blacks. Conclusion There is a need for efforts validating self-report physical activity instruments in Blacks, particularly those evaluating the relative validity of instruments in a single sample.

Patients with cancer increasingly ask what they can do to change their lifestyles and improve outcomes. Risk factors for onset of cancer may differ substantially from those that modify survival with implications for counseling. This review focuses on recent data derived from population-based studies of causes of cancer and of patients with cancer to contrast risk factors for etiology with those that impact survival. For different cancer sites, the level of information to inform the timing of lifestyle exposures and risk of disease onset or progression after diagnosis is often limited. For breast cancer, timing of some exposures, such as radiation, is particularly important. For other exposures, such as physical activity, higher levels may prevent onset and also improve survival. For colon cancer, study of precursor polyps has provided additional insight to timing. Extensive data indicate that physical activity reduces risk of colon cancer, and more limited data suggest that exposure after diagnosis improves survival. Dietary factors including folate and calcium may also reduce risk of onset. More limited data on prostate cancer point to obesity increasing risk of aggressive or advanced disease. Timing of change in lifestyle for change in risk of onset and for survival is important but understudied among patients with cancer. Counseling patients with cancer to increase physical activity and avoid weight gain may improve outcomes. Advice to family members on lifestyle may become increasingly important for breast and other cancers where family history is a strong risk factor.

The article examines the importance of managing weight to reduce risk for developing cancer and for survival among cancer patients and presents a set of strategies that can be useful to guide clinical advice to patients for whom weight control is an important adjunct to risk management or to improve quality of life and disease-free survival after diagnosis., Weight, weight gain, and obesity account for approximately 20% of all cancer cases. Evidence on the relation of each to cancer is summarized, including esophageal, thyroid, colon, renal, liver, melanoma, multiple myeloma, rectum, gallbladder, leukemia, lymphoma, and prostate in men; and postmenopausal breast and endometrium in women. Different mechanisms drive etiologic pathways for these cancers. Weight loss, particularly among postmenopausal women, reduces risk for breast cancer. Among cancer patients, data are less robust, but we note a long history of poor outcomes after breast cancer among obese women. While evidence on obesity and outcomes for other cancers is mixed, growing evidence points to benefits of physical activity for breast and colon cancers. Dosing of chemotherapy and radiation therapy among obese patients is discussed and the impact on therapy-related toxicity is noted. Guidelines for counseling patients for weight loss and increased physical activity are presented and supported by strong evidence that increased physical activity leads to improved quality of life among cancer survivors. The “Five A's” model guides clinicians through a counseling session: assess, advise, agree, assist, arrange. The burden of obesity on society continues to increase and warrants closer attention by clinicians for both cancer prevention and improved outcomes after diagnosis.

Observational research has shown that the physical activity levels of survivors of hematological cancer are low, with deleterious health consequences. This review summarizes the research on exercise interventions in adult and pediatric hematological cancer survivors. We searched MEDLINE, SPORTDiscus, CINAHL, Embase, Cochrane and PEDro through September 2009 for exercise intervention studies in children and adults with any type of hematological cancer. In the 24 adult intervention studies reviewed, we found strong evidence (that is, > or =3 high-quality studies and > or =75% reporting a significant benefit) for a benefit on body composition. Weak, but promising, evidence (> or =3 high-quality studies, but

Colorectal cancer is the third most common cancer globally and is a leading cause of cancer death. Gastric cancer contributes significantly to the global cancer burden, particularly in low- and middle-income countries. We reviewed the literature for studies on physical activity or exercise and colon, rectal, and gastric cancers as well as colonic adenomatous polyps. We identified 52 studies of colon cancer, 31 studies of rectal cancer, 23 studies of colon polyps, and 16 studies of gastric cancer. Of the 52 studies of physical activity and colon cancer, 37 found a statistically significant association between increased levels of physical activity and decreased colon cancer risk in at least one comparison. Accumulated evidence suggests that physical activity is associated with a 25% reduction in colon cancer risk. In line with previous reports, we found no indication that the association was more pronounced for occupational versus recreational physical activity, with both resulting in a risk reduction of about 22%. Evidence for other domains of physical activity (i.e., transportation or household physical activity) is limited. Evidence is emerging that individuals who are consistently active across the lifetime may obtain greater risk reductions than those who are only active in recent years. Despite consistent associations with colon cancer, evidence is more limited though suggestive that physical activity reduces risk of colon adenomas or adenoma recurrence. There is clear evidence that physical activity is not associated with rectal or gastric cancers.

The purpose of this study was to evaluate the influence of the location (ankle, hip, wrist) where an activity monitor (AM) is worn and of the minimum bout duration (BD) on physical activity (PA) variables during free-living monitoring. Study 1 participants wore AMs at three locations for 1 day while wearing the Intelligent Device for Energy Expenditure and Activity (IDEEA) system. Study 2 participants wore AMs at the same locations for 3 days. Variables included time (T(MV), min/day) and AEE (AEE(MV) kcal/day) for each monitor location and BD above a moderate-vigorous (MV) intensity. T(MV) and AEE(MV) in Study 1 were similar across AMs to IDEEA values at BD = 10 min, as was T(MV) in Study 2. This suggests that ankle-, wrist- and hip-worn AMs can provide similar PA outcome values during free-living monitoring at 10-min BDs.

Although an inverse association between physical activity and risk of colon cancer is well established, a formal estimate of the magnitude of this risk reduction that includes recent studies is not available. This analysis examines the association by sex and study design, restricting analyses to studies where data for colon cancer alone were available. The authors reviewed published studies through June 2008 examining the association between physical activity and risk of colon cancer. Heterogeneity and publication bias were evaluated and random effects models used to estimate relative risks (RR). Differences by sex and study design were evaluated. A total of 52 studies were included. An inverse association between physical activity and colon cancer was found with an overall relative risk (RR) of 0.76 (95% confidence interval (CI): 0.72, 0.81). For men, the RR was 0.76 (95% CI: 0.71, 0.82); for women, this was little different, (RR=0.79, 95% CI: 0.71, 0.88). The findings from case–control studies were stronger (RR=0.69, 95% CI: 0.65, 0.74) than for cohort studies (RR=0.83, 95% CI: 0.78, 0.88). This study confirms previous studies reporting an inverse association between physical activity and colon cancer in both men and women, and provides quantitative estimates of the inverse association.

Background:The International Physical Activity Questionnaire-Short Form (IPAQ-S) has been evaluated against accelerometer-determined physical activity measures in small homogenous samples of adults in the United States. There is limited information about the validity of the IPAQ-S in diverse US samples.Methods:142 Blacks residing in low-income housing completed the IPAQ-S and wore an accelerometer for up to 6 days. Both 1- and 10-minute accelerometer bouts were used to define time spent in light, moderate, and vigorous physical activity.Results:We found fair agreement between the IPAQ-S and accelerometer-determined physical activity (r = .26 for 10-minute bout, r = .36 for 1-minute bout). Correlations were higher among men than women. When we classified participants as meeting physical activity recommendations, agreement was low (kappa = .04, 10-minute; kappa = .21, 1-minute); only 25% of individuals were classified the same by both instruments (10-minute bout).Conclusions:In one of the few studies to assess the validity of a self-reported physical activity measure among Blacks, we found moderate correlations with accelerometer data, though correlations were weaker for women. Correlations were smaller when IPAQ-S data were compared using a 10- versus a 1-minute bout definition. There was limited evidence for agreement between the instruments when classifying participants as meeting physical activity recommendations.

Blacks in the United States bear the greatest disease burden associated with cigarette smoking. Previous studies have shown that the rapidly increasing population of foreign-born Blacks has lower smoking rates compared to their native-born counterparts. However, less is known about whether cigarette smoking among Blacks varies by region of birth (US, Africa, or the Caribbean), generational status, or acculturation. We examined the association between nativity and cigarette smoking among 667 Black adult men and women enrolled in the Harvard Cancer Prevention Program project. In multi-variable analyses, US-born Blacks were more likely to be smokers compared to those born in the Caribbean (OR = 0.16, 95% CI 0.08, and 0.34) or in Africa (OR = 0.24, 95% CI 0.08, and 0.74). Language acculturation was positively associated with cigarette smoking (OR = 2.62, 95% CI 1.17, and 5.85). We found that US-born Blacks were more likely to be current cigarette smokers than those born in either Caribbean or African countries. Our findings highlight the importance of intervening early new Black immigrants to stem the uptake of cigarette smoking behaviors as individuals become acculturated.

To determine whether self-reported discretionary time was associated with physical activity and uptake of a physical activity promotion intervention in a multi-ethnic urban sample.We examined the association of self-reported discretionary time with hours/week of leisure-time physical activity at baseline and physical activity intervention uptake.Low levels of discretionary time were significantly (P0.01) associated with fewer hours/week (beta=-0.78, 95%CI=-1.34, -0.22) of physical activity at baseline. Discretionary time was not associated with physical activity intervention uptake.Lack of discretionary time may serve as barrier to physical activity, but its importance on intervention uptake is less clear.

Although physical activity has been consistently associated with lower risk of colon cancer, many details of the relationship remain unclear. We assessed the relation between physical activity and risk of colon cancer in 79,295 women aged 40–65 who were free of cancer, ulcerative colitis and Crohn’s disease and who reported their leisure-time physical activity in 1986; 547 cases were identified through 2002. Women who expended more than 21.5 metabolic equivalent hr/week of physical activity had a relative risk (RR) of colon cancer of 0.77 (95% CI 0.58–1.01), compared to women who expended 4 hr/week had a 40% lower risk of colon cancer than those exercising

Objective: Our objective was to examine the associations of nativity, immigrant generation, and language acculturation with obesity among lower income black adult men and women. Research Methods and Procedures: Data from 551 black adult men and women were collected from participants in the Healthy Directions-Health Centers Study. Race/ethnicity and nativity were self-reported. Language acculturation was defined using participants’ first language, preferred reading language, and language spoken at home. Mixed model logistic regression models were estimated to account for within-health center clustering. Results: Foreign-born blacks had a lower obesity risk, compared with all U.S.-born participants, in multivariable analyses [odds ratio (OR) = 0.57, 95% confidence interval (CI), 0.38, 0.84]. Among U.S.-born participants, those with foreign-born parents were significantly less likely to be obese than individuals with U.S.-born parents (OR = 0.54; 95% CI, 0.37, 0.80). Low-moderate language acculturation also decreased the odds of being obese (OR = 0.45; 95% CI, 0.23, 0.88). Discussion: Our findings suggest a protective effect of foreign-born status and low-moderate language acculturation on obesity risk among lower income black immigrants. These data highlight the importance of more frequently examining nativity in obesity-related research conducted among blacks.

Several studies have shown a positive association between acculturation and obesity in Hispanics. We sought to examine the association in a sample of urban Hispanic women. Using data collected in the Chicago Breast Health Project, we used logistic regression to examine the association of obesity (BMIor = 30 kg/m(2)) with language acculturation and years in the US in a sample of 388 Hispanic women. Women self-reported the number of years they had lived in the US (mean 17.6) as well as their preferred language across several domains, which was used to calculate a language acculturation score. Nearly all the women (98%) were born outside the US with the majority (65%) born in Mexico and the majority of women (69%) had low language acculturation, i.e., answered "only Spanish" in every domain. Over half of the women were obese (56%). In multivariable analysis, odds of obesity was twice as high among women living in the US for greater than 20 years compared to those in the US for 10 years or less (OR/year = 2.07, 95% CI 1.25-3.42). In contrast, low language acculturation was not associated with odds of obesity (OR = 1.14, 95% CI 0.70-1.86). While greater years in the US increased odds of obesity among Hispanic women, no association of obesity with language acculturation was found. These results suggest that mechanisms other than language contribute to the immigration effect.

Objective: The elevated prevalence of obesity among U.S. blacks has been attributed to low socioeconomic position (SEP), despite inconsistent empirical findings. It is unclear whether low SEP at various lifecourse stages differentially influences adulthood BMI and BMI change. Research Methods and Procedures: Among 1167 black adults in the Pitt County Study, we examined independent cross-sectional and longitudinal associations between SEP, measured in childhood and adulthood, and BMI and 13-year BMI change. Low vs. high childhood SEP was measured by parental occupation and childhood household deprivation; low vs. high adulthood SEP was assessed by employment status, education, and occupation. Using childhood and adulthood SEP, four lifecourse SEP categories were created: low-low, low-high, high-low, high-high. Results: We found no consistent associations between SEP and BMI or BMI change among men. Among women, we observed the expected inverse association between SEP and BMI at baseline. In multivariable-adjusted analyses, socioeconomically advantaged women demonstrated larger 13-year increases in BMI: skilled vs. unskilled parental occupation (6.1 vs. 4.8 kg/m2, p = 0.04); college-educated vs. < high school (6.2 vs. 4.5 kg/m2, p = 0.04); white-collar vs. blue-collar job (5.8 vs. 4.8 kg/m2, p = 0.05); and high-high vs. low-low lifecourse SEP (6.5 vs. 4.6 kg/m2, p = 0.02). Discussion: For women in this black cohort, lower SEP predicted earlier onset of obesity; however, low SEP was less predictive of BMI increases over time. Our findings demonstrate complex patterns of association between SEP and BMI change among black women.

Background Obesity is disproportionately prevalent among many racial/ethnic minority communities. The efficacy of weight control efforts in these groups may depend on individual's ability to accurately perceive their weight status. We examined whether racial/ethnic differences exist in weight status misperception among overweight adults. Methods Nationally-representative data from the National Health and Nutrition Examination Survey (NHANES) 1999–2002 were examined. Participants included overweight and obese adult men (n = 3115) and women (n = 3437). Weight status misperception was identified among respondents who self-reported being "about the right weight/underweight." Results Blacks (OR = 2.06, 95% CI: 1.71, 2.54) were twice as likely and Hispanics (OR = 1.70, 95%CI: 1.33, 2.17) were 70-percent more likely than Whites to misperceive their weight, in models adjusted for age, education, income, marital status, self-reported health, and self-reported medical diagnosis of overweight. Black overweight (OR = 2.03, 95% CI: 1.26, 3.26) and obese (OR = 3.56, 95% CI: 1.57, 8.11) women were considerably more likely to exhibit misperception compared to their White female counterparts. Odds of misperception were higher among overweight Black (OR = 2.20, 95%CI: 1.54, 3.15), Hispanic (OR = 1.89, 95% CI: 1.30, 2.75), and obese Black men (OR = 2.84, 95% CI: 1.54, 5.22), compared to White men. Conclusion Weight status misperceptions among the overweight are more common among Blacks, and Hispanic men. The persistence of racial/ethnic differences after adjustment for medical diagnosis of overweight may suggest some resistance to physician weight counseling. Identifying strategies to correct weight status misperceptions status may be necessary to ensure the efficacy of clinical and public health obesity interventions conducted among these groups.

Background: Racial/ethnic minorities report myriad barriers to regular leisure time physical activity (LTPA), including the stress and fatigue resulting from their occupational activities.Purpose: We sought to investigate whether an association exists between job strain and LTPA, and whether it is modified by race or ethnicity.Methods: Data were collected from 1,740 adults employed in 26 small manufacturing businesses in eastern Massachusetts. LTPA and job strain data were self-reported. Adjusted mean hours of LTPA per week are reported.Results: In age and gender adjusted analyses, reports of job strain were associated with LTPA. There was a significant interaction between job strain and race or ethnicity (p = .04). Whites experiencing job strain reported 1 less hr of LTPA per week compared to Whites not reporting job strain. Collectively, racial/ethnic minorities reporting job strain exhibited comparatively higher levels of LTPA compared to their counterparts with no job strain, although patterns for individual groups did not significantly differ.Conclusions: Job strain was associated with LTPA in a lower income, multiethnic population of healthy adult men and women. The association between job strain and LTPA was modified by race or ethnicity, highlighting the importance of investigating the differential effects of psychosocial occupational factors on LTPA levels by race or ethnicity.

To investigate Blacks'views regarding the connections among overweight, exercise, and health.A national randomized telephone survey of 986 US Blacks, conducted between 6 July 2004 and 15 July 2004.The majority (65%) of respondents reported their weight as average or underweight. Most participants also reported being regularly physically active in the last month (84.5%). The majority of participants reported believing that it is possible to be overweight and healthy. Most acknowledged the connection between exercise and health, and just over half of respondents identified the association between overweight and cancer risk. There was little sociodemographic variation in responses, although findings differed by self-reported overweight and physical activity.Some Blacks may underestimate the extent of their overweight, perhaps resulting from the high prevalence of the condition in the population. Gaps exist in Blacks' recognition of the connection between weight and health, although the importance of exercise for health promotion was widely acknowledged. These data may highlight an important target for intervention attention.

We examined the association between perceived racial/ethnic harassment and tobacco use in 2129 African American college students in North Carolina. Age-adjusted and multivariate analyses evaluated the effect of harassment on daily and less-than-daily tobacco use. Harassed participants were twice as likely to use tobacco daily (odds ratio = 2.01; 95% confidence interval=1.94, 2.08) compared with those with no reported harassment experiences. Experiences of racial/ethnic harassment may contribute to tobacco use behaviors among some African American young adults.

73 Background: Analysis from population-based cancer registry data has suggested that being married is associated with improved survival in men with prostate cancer. However, a limitation of such analysis is the inability to control for PSA or medical comorbidity which may differ by marital status. We investigated the association between marital status and both prostate cancer specific mortality (PCSM) and overall mortality (OM) in men treated with radical prostatectomy. Methods: The study population included 3596 men treated with radical prostatectomy at a single institution between 1994 and 2004 and followed for a median of 72 months. Disease specific factors (PSA, clinical stage, and biopsy Gleason grade), comorbidity (validated ACE-27 comorbidity index), ethnicity, age, and marital status at time of treatment were retrieved from an institutional cancer registry. Differences between marital status groups were evaluated by Chi square or ANOVA. Multivariable Cox proportional hazard regression models were used to estimate the hazard ratio (HR) of PCSM and OM by marital status. Results: 86.9% of men were married, 5.3% divorced, 2.4% widowed, and 5.5% never married. Marital status was associated with differences in PSA (p Conclusions: Never married men had an increased risk of PCSM and OM. Factors associated with social isolation or unhealthy behaviors may have a detrimental effect on survival after prostatectomy. [Table: see text]