Kisha I. Coa

Health Behaviors and All-Cause Mortality in African American Men:

Because of the excess burden of preventable chronic diseases and premature death among African American men, identifying health behaviors to enhance longevity is needed. We used data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) and the NHANES III Linked Mortality Public-use File to determine the association between health behaviors and all-cause mortality and if these behaviors varied by age in 2029 African American men. Health behaviors included smoking, drinking, physical inactivity, obesity, and a healthy eating index score. Age was categorized as 25-44 years (n = 1,045), 45-64 years (n = 544), and 65 years and older (n = 440). Cox regression analyses were used to estimate the relationship between health behaviors and mortality within each age-group. All models were adjusted for marital status, education, poverty-to-income ratio, insurance status, and number of health conditions. Being a current smoker was associated with an increased risk of mortality in the 25- to 44-year age-group, whereas being physically inactive was associated with an increased risk of mortality in the 45- to 64-year age-group. For the 65 years and older age-group, being overweight or obese was associated with decreased mortality risk. Efforts to improve longevity should focus on developing age-tailored health promoting strategies and interventions aimed at smoking cessation and increasing physical activity in young and middle-aged African American men.

Association between Race, Place, and Preventive Health Screenings among Men: Findings from the Exploring Health Disparities in Integrated Communities Study

African American men consistently report poorer health and have lower participation rates in preventive screening tests than White men. This finding is generally attributed to race differences in access to care, which may be a consequence of the different health care markets in which African American and White men typically live. This proposition is tested by assessing race differences in use of preventive screenings among African American and White men residing within the same health care marketplace. Logistic regression was used to examine the association between race and physical, dental, eye and foot examinations, blood pressure and cholesterol checks, and colon and prostate cancer screenings in men in the Exploring Health Disparities in Integrated Communities in Southwest Baltimore Study. After adjusting for covariates, African American men had greater odds of having had a physical, dental, and eye examination; having had their blood pressure and cholesterol checked; and having been screened for colon and prostate cancer than White men. No race differences in having a foot examination were observed. Contrary to most findings, African American men had a higher participation rate in preventive screenings than White men. This underscores the importance of accounting for social context in public health campaigns targeting preventive screenings in men.

The Impact of Cancer Treatment on the Diets and Food Preferences of Patients Receiving Outpatient Treatment

Patients undergoing cancer treatment experience a multitude of symptoms that can influence their ability to complete treatment as well as their quality of life during and after treatment. This cross-sectional study sought to describe the dietary changes experienced by cancer patients and to identify associations between these changes and common treatment symptoms. A convenience sample of 1199 cancer patients aged 18 yr and older undergoing active treatment were recruited from 7 cancer centers to complete a self-administered paper-and-pencil survey. Descriptive analyses were conducted to estimate prevalence of dietary changes and chi-squared tests were used to examine associations between dietary changes and health outcomes. Approximately 40% of patients reported a decreased appetite since beginning treatment, and 67.2% of patients reported at least 1 chemosensory alteration. Increased taste sensitivities were more common than decreased taste sensitivities, with increased sensitivity to metallic being the most common taste sensitivity (18.6%). Patients also had increased sensitivities to certain smells including cleaning solutions (23.4%), perfume (22.4%), and food cooking (11.4%). Patients reported a wide range of food preferences and aversions. Patients who had less energy or lost weight since beginning treatment were more likely than others to report treatment-related dietary changes.

Key considerations in designing a patient navigation program for colorectal cancer screening.

Colorectal cancer is the second leading cause of cancer mortality among those cancers affecting both men and women. Screening is known to reduce mortality by detecting cancer early and through colonoscopy, removing precancerous polyps. Only 58.6% of adults are currently up-to-date with colorectal cancer screening by any method. Patient navigation shows promise in increasing adherence to colorectal cancer screening and reducing health disparities; however, it is a complex intervention that is operationalized differently across institutions. This article describes 10 key considerations in designing a patient navigation intervention for colorectal cancer screening based on a literature review and environmental scan. Factors include (1) identifying a theoretical framework and setting program goals, (2) specifying community characteristics, (3) establishing the point(s) of intervention within the cancer continuum, (4) determining the setting in which navigation services are provided, (5) identifying the range of services offered and patient navigator responsibilities, (6) determining the background and qualifications of navigators, (7) selecting the method of communications between patients and navigators, (8) designing the navigator training, (9) defining oversight and supervision for the navigators, and (10) evaluating patient navigation. Public health practitioners can benefit from the practical perspective offered here for designing patient navigation programs.

Capitalizing on the “teachable moment” to promote healthy dietary changes among cancer survivors: the perspectives of health care providers

PurposeAlthough cancer is often thought of as a teachable moment, many cancer survivors do not adhere to behavioral recommendations that might improve their health. This study explored health care providers’ perspectives on the importance and feasibility of addressing behavior change, specifically healthy diet, with cancer survivors.MethodsIn-depth interviews were conducted with 33 health care providers who care for posttreatment survivors of breast cancer, prostate cancer, and non-Hodgkin’s lymphoma. Interviews were analyzed thematically.ResultsHealth care providers emphasized the strength of evidence linking diet/obesity to recurrence in their assessment of the importance of promoting dietary change among their survivor patients. Cancer specialists (e.g., oncologists, surgeons) generally brought up dietary change with patients if they considered the evidence to be strong. In contrast, primary care providers viewed health promotion as important for all patients and reported treating cancer survivor patients the same as others when it came to making dietary recommendations. There was a lack of consensus among providers on the best timing to bring up behavior change. Providers described specific subgroups of patients who they saw as more motivated to make behavior changes and patient barriers to making dietary changes.ConclusionsHealth care providers can play an important role in promoting healthy diet among cancer survivors. As the evidence base around diet and cancer recurrence/prognosis grows, it is important that this information is communicated to providers. Strategies such as incorporating behavior change messages into survivor care plans may help standardize recommendations to survivors.

Race, social and environmental conditions, and health behaviors in men

Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand mens health disparities.

Exploring Important Influences on the Healthfulness of Prostate Cancer Survivors’ Diets

A cancer diagnosis is often conceptualized as a teachable moment when individuals might be motivated to make lifestyle changes. Many prostate cancer survivors, however, do not adhere to dietary guidelines. In this article, we explore how cancer affected prostate cancer survivors’ diets and identify important influences on diet. Twenty prostate cancer survivors completed three 24-hour dietary recalls and an in-depth dietary interview. We analyzed interviews using a constant comparison approach, and dietary recall data quantitatively to assess quality and qualitatively to identify food choice patterns. Most men reported not making dietary changes following their cancer diagnosis but did express an interest in healthy eating, primarily to facilitate weight loss. Men portrayed barriers to healthy eating that often outweighed their motivation to eat healthy. Public health programs should consider alternative ways of framing healthy eating programs for prostate cancer survivors that might be more effective than a cancer-specific focus.

Clinical Care Providers' Perspectives on Body Size and Weight Management Among Long-Term Cancer Survivors

Objective. To examine clinical care providers’ perspectives on cancer survivors’ body size and weight management. Study Design. In-depth, semi-structured, qualitative interviews. Methods. Interviews were conducted with 33 providers (eg. oncologists, surgeons, primary care providers, nurses, dietitians) across academic and community clinical settings. They were transcribed, coded, and analyzed thematically using constant comparative analysis. Results. Providers conceptualized weight in relation to acute treatment, cancer outcomes, or overall health/comorbidities. These patterns were reflected in their reported framing of weight discussions, although providers indicated that they counsel patients on weight to varying extents. Perspectives differed based on professional roles and patient populations. Providers reported that survivors are motivated to lose weight, particularly due to comorbidity concerns, but face numerous barriers to doing so. Conclusion. Providers described survivor-level and capacity-level factors influencing survivors’ weight management. Differences by provider type highlighted the role of provider knowledge, attitudes, and beliefs in clinical encounters. Opportunities for research and intervention include developing and disseminating evidence-based clinical resources for weight management among cancer survivors, addressing capacity barriers, and exploring communication strategies at interpersonal and population levels.

A qualitative study of dietary discussions as an emerging task for cancer clinicians

Objectives: Improvements in cancer detection and treatment create a need for care that prioritizes acute treatment and ongoing needs. There have been calls to include health promotion in cancer care, but little empirical consideration of the work involved in such an expansion of services. In this article, we adopt a constructionist position to explore clinicians’ perspectives on capacity for health promotion, specifically dietary counseling. Methods: Our data result from 33 semi-structured qualitative interviews with members of cancer care teams. All interviewees were affiliated with one of two contrasting medical systems located in Baltimore, MD, USA. Interviews focused on professional roles and responsibilities around health promotion for cancer survivors. We employed both purposive and snowball sampling. We conducted a thematic analysis informed by the sociology of professions literature of discussions of dietary change by provider type. Results: We discuss four emergent themes that relate to the work of providing dietary counseling: (1) prioritization of behavior change in survivorship care, (2) evidence base for dietary messaging, (3) available time and clinical priorities and (4) clinical expertise. Interviewees generally expressed support for the importance of diet for healthy cancer survivorship. However, while there was broad support for dietary change and health promotion, we found little evidence of an emerging consensus on how this work should be accomplished, nor an indication of any occupational group expanding their professional remit to prioritize health promotion tasks. Conclusions: Health promotion is the key to any efficient and effective model of cancer care. Careful attention to the impact of the task on key patient outcomes as well as system capacity for the provision of dietary counseling and its fit with a specific professional remit will be critical for successful integration of health promotion into routine cancer care.

“We’re Just Not Prepared for Eating Over Our Whole Life”: A Mixed Methods Approach to Understanding Dietary Behaviors Among Longer Term Cancer Survivors

Background: In many countries, there are growing numbers of persons living with a prior diagnosis of cancer, due to the aging population and more successful strategies for treatment. There is also growing evidence of the importance of healthful diet and weight management for survivorship, yet many long-term cancer survivors are not successfully following recommendations. Methods: We explored this issue in a mixed methods study with 53 adult survivors of 3 cancers (breast, prostate, and non-Hodgkin’s lymphoma), living in Maryland. Participants provided three 24-hour dietary recalls, and results were used to classify respondents on 2 metrics of healthful eating (the Healthy Eating Index 2010, and a 9-item index based on current dietary recommendations). Recalls were also used to guide in-depth qualitative discussions with participants regarding self-assessment of dietary behaviors, healthful eating, and diet’s importance in cancer prevention and survivorship. Results: Survivors following a more healthful diet were more likely to be female, have greater socioeconomic resources, more years since diagnosis, normal weight, and no smoking history. Qualitative discussions revealed a more nuanced understanding of dietary strategies among healthful eaters, as well as the importance of household members in dietary decision making. Discussion: Most survivors had received little nutrition counseling as part of their cancer care, highlighting the importance of holistic, household-oriented nutrition education for maintaining health among long-term cancer survivors.