Sleep is a major determinant of health, serving as a restorative function.1 Yet, approximately on... more Sleep is a major determinant of health, serving as a restorative function.1 Yet, approximately one-third of all Americans report suboptimal sleeping habits.2 Suboptimal sleep durations are associated with adverse health outcomes, such as an increased for mortality.3,4 Both longer and shorter sleep duration was associated with a higher risk for all-cause, cancer, and CVD-related mortality.3,4 Both short (≤5 h) and long (≥10 h) sleep duration increased the risk for all-cause mortality among cancer survivors when compared to those who reported sleeping an average of 7 h per night.5 What remains to be determined is whether the relationship between sleep duration and mortality differ by cancer sites. Our study examined the association between sleep duration and all-cause, cancer, and CVD mortality by different cancer sites.
Journal of health disparities research and practice, 2018
Background: No studies have compared the lifestyle behaviors between Puerto Rico, Guam, and the U... more Background: No studies have compared the lifestyle behaviors between Puerto Rico, Guam, and the U.S. Virgin Islands to that of the United States mainland. Documenting and addressing health disparities between these geographically and culturally distinct areas are important public health objectives. Differences in health status between and among the United States mainland and territories merit systematic and careful analyses. Methods: Four key healthy lifestyle characteristics include tobacco use, body mass index, physical activity, and fruit/vegetable consumption. Data from the 2009 Behavioral Risk Factor Surveillance System (N=420,481) were used to examine United States mainland and territorial differences among the four key healthy lifestyle behaviors. Descriptive statistics were summarized with chi-square tests for independence and multiple adjusted logistic regression models were used to examine differences in health compliance rates while controlling for age, gender, income, an...
Medicine & Science in Sports & Exercise, 2018
PURPOSE: To examine the racial and ethnic differences among various types of sedentary behavior (... more PURPOSE: To examine the racial and ethnic differences among various types of sedentary behavior (SB) in a sample of sedentary office workers. METHODS: Study participants were recruited from five worksites in a large metropolitan city in the United States (N = 149, 67% minority, 83% female) All participants sat for at least 5-hours during a typical workday. SB was measured using a 7-item modified version of the Sedentary Behavior Questionnaire (SBQ) and the two-item sedentary behavior questions assessed in the International Physical Activity Questionnaire. Racial differences were examined with descriptive statistics as regression models. Statistical significance was determined at p < 0.05 with a two-sided test. RESULTS: Sedentary behavior ranged from a median of 0 minutes/day for viewing movies or videos to 60 min/ day for watching television and riding in or driving a vehicle. Total median time spent sitting during the weekday was 480 min/day, whereas total time spent sitting during the weekend was 270 min/day. Our adjusted models indicated statistically significant racial and ethnic differences for sitting while talking on the phone (p < 0.001), watching television (p = 0.042), riding in or driving a vehicle (p = 0.027), total sitting time during the weekdays (p = 0.008), and weekend (p = 0.012). Median scores were higher among Blacks than Whites for both sitting and talking on the phone and while watching television (Blacks = 73 and 131, Whites = 26 and 86 min/day). Total time spent sitting on the weekend was higher among Blacks than both Hispanics and Whites (Blacks = 541, Whites = 346, Hispanics = 306 min/day). However, both Blacks and Whites had higher median minutes spent in total sedentary time during the weekday than Hispanics. CONCLUSION: According to these data, racial and ethnic differences exist between various types of SB. Healthcare professionals should consider these differences when designing culturally tailored interventions designed to curve sedentary behavior. Supported by NIH Grants K01CA158000, R03NR010291, and CA016672
Purpose: Despite convincing evidence that prolonged periods of sitting may influence critical bio... more Purpose: Despite convincing evidence that prolonged periods of sitting may influence critical biological mediators of cancer development, few studies assessed the relationship between time spent sitting and cancer-related biomarkers. Methods: This cross-sectional study included 825 postmenopausal women who were enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. Plasma levels of biomarkers were measured at the third annual visit. The time spent sitting per day was categorized as quartiles (Qs) and analysis of covariance was used to assess the relationships between sedentary time and cancer biomarkers. Results: No clear linear patterns were observed between the time spent sitting and levels of biomarkers; however, these relationships were modified by race, physical activity level, and exogenous estrogen use. Insulin-like growth factor-I (IGF-I) levels among black women were higher than those of white women acros...
BackgroundIn the United States, patients who have breast cancer experience significant economic b... more BackgroundIn the United States, patients who have breast cancer experience significant economic burden compared with those who have other types of cancers. Cancer‐related economic burden is exacerbated by adverse treatment effects. Strategies to resolve the economic burden caused by breast cancer and its adverse treatment effects have stemmed from the perspectives of health care providers, oncology navigators, and other subject‐matter experts. For the current study, patient‐driven recommendations were elicited to reduce economic burden after 1) breast cancer and 2) breast cancer‐related lymphedema, which is a common, persistent adverse effect of breast cancer.MethodsQualitative interviews were conducted with 40 long‐term breast cancer survivors who were residents of Pennsylvania or New Jersey in 2015 and were enrolled in a 6‐month observational study. Purposive sampling ensured equal representation by age, socioeconomic position, and lymphedema diagnosis. Semistructured interviews a...
... Psychometric theory. New York: McGraw-Hill. Oman, R., Vesely, S., McLeroy, K., Harris-Wyatt, ... more ... Psychometric theory. New York: McGraw-Hill. Oman, R., Vesely, S., McLeroy, K., Harris-Wyatt, V., Aspy C., Rodine, S., et al. (2002). ... Raheem J Paxton, MS, PhD is a Postdoctoral Fellow in the Cancer Research Center of Hawaii at the University of Hawaii-Manoa. ...
Cancer Epidemiology, Biomarkers & Prevention, 2010
Background: Evidence linking lifestyle factors and risk for prostate cancer is neither clear or c... more Background: Evidence linking lifestyle factors and risk for prostate cancer is neither clear or consistent and novel analytic techniques may help clarify the complex associations between lifestyle characteristics and risk for prostate cancer. Methods: This prospective study utilized data from 12216 (Median age = 63 years) African American men from the Multiethnic Cohort, a large cohort study over-sampled for ethnic minorities in Hawaii and Los Angeles that began in 1993. Adjusted latent class analysis was used to create homogenous groups of African Americans based on 21 indicators including dietary intake and other lifestyle behaviors such as physical activity, body mass index, and sedentary behavior. Results: Four lifestyle patterns were identified that differed by demographic and lifestyle characteristics indicating that the clustering algorithm converged properly. Adjusted Cox regression analyses stratified by smoking status indicated that among former smokers in a cluster charac...
Background Few studies have examined the real-time and dynamic relationship between lifestyle beh... more Background Few studies have examined the real-time and dynamic relationship between lifestyle behaviors and treatment-related symptoms. Objective The aim of this study was to examine the associations of daily physical activity and sedentary behavior with symptom burden, pain interference, and fatigue among patients who were undergoing active cancer treatment. Methods A total of 22 (mean age = 57 years; 73% women; 55% Black) cancer patients were recruited from a local hospital and reported a daily diary of physical activity, sedentary behavior, symptom burden, pain interference, and fatigue over 10 days. Adjusted mixed-effects models were used to examine all associations. Results Body mass index moderated the relationship between physical activity and symptom burden (γ = 0.06, P < .01) and physical activity and fatigue (γ = 0.09, P < .05). On days where physical activity was higher than average, symptom burden and fatigue scores were lower among patients who had lower body mass index values. Also, age moderated the relationship between sedentary behavior and symptom burden (γ = −0.04, P < .05); on days where patients sat more, symptom burden was lower among patients who were younger than the average age. Conclusions Overall, these data indicate that treatment-related symptoms vary daily within cancer patients and that physical activity may alleviate treatment-related symptoms for leaner patients. Larger samples and objective assessments of physical activity and sedentary behavior are needed to validate our results. Implications for Practice Oncology nurses may be in the best position to promote physical activity during treatment as a strategy to manage symptom burden.
Several studies have examined the relationship between smoking and mortality in cancer survivors.... more Several studies have examined the relationship between smoking and mortality in cancer survivors. However, few have reported the relationships in several cancer sites (i.e., bladder, non-melanoma skin, uterine, melanoma, and lymphoma), and limited data exist on the dose-response relationship between number of cigarettes smoked per day or duration of smoking cessation and mortality. Cancer survivors (N = 35,093, 61% female, mean age = 47 years old) from the National Health Interview Survey with linked data retrieved from the National Death Index served as our study participants. Cox proportional-hazards models were used to assess associations between smoking status, all-cause, and disease-specific mortality. After a median follow-up of 13 years, 11,066 deaths occurred. Survivors who reported smoking at study entry had a 73%, 75%, 85% higher risk for cardiovascular disease, cancer, and all-cause mortality, respectively when compared to nonsmokers. Former smokers had a 31% and 37% higher risk of all-cause and cancer mortality, respectively when compared to nonsmokers. The observed relationships appeared to differ by the number of cigarettes smoked (i.e., ≥ 10 per day), especially for breast, cervix, lung, prostate, uterine and non-melanoma skin cancer survivors. Those who continued smoking post diagnosis were at greatest risk of all-cause and cancer mortality, but the associations varied substantially by cancer site. These data provide sufficient evidence of the health hazards associated with smoking for cancer survivors and provide further support for public health strategies designed to curb smoking in this vulnerable population.
Background: The study of physical activity in cancer survivors has been limited to one cause, one... more Background: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine multiple correlates that influence physical activity compliance rates in cancer survivors. Methods: African American breast cancer survivors (N = 267, Mean age = 54 years) participated in an online survey that examined correlates of physical activity. Recursive partitioning (RP) was used to examine complex and nonlinear associations between sociodemographic, medical, cancer-related, theoretical, and quality of life indicators. Results: Recursive partitioning revealed five distinct groups. Compliance with physical activity guidelines was highest (82% met guidelines) among survivors who reported higher mean action planning scores (P < 0.001) and lower mean barriers to physical activity (P = 0.035). Compliance with physical activity guidelines was lowest (9% met guidelines) among survivors who reported lower mean action and coping (P = 0.002) planning scores. Similarly, lower mean action planning scores and poor advanced lower functioning (P = 0.034), even in the context of higher coping planning scores, resulted in low physical activity compliance rates (13% met guidelines). Subsequent analyses revealed that body mass index (P = 0.019) and number of comorbidities (P = 0.003) were lowest in those with the highest compliance rates. Conclusion: Our findings support the notion that multiple factors determine physical activity compliance rates in African American breast cancer survivors. Interventions that encourage action and coping planning and reduce barriers in the context of addressing function limitations may increase physical activity compliance rates.
Sleep is a major determinant of health, serving as a restorative function.1 Yet, approximately on... more Sleep is a major determinant of health, serving as a restorative function.1 Yet, approximately one-third of all Americans report suboptimal sleeping habits.2 Suboptimal sleep durations are associated with adverse health outcomes, such as an increased for mortality.3,4 Both longer and shorter sleep duration was associated with a higher risk for all-cause, cancer, and CVD-related mortality.3,4 Both short (≤5 h) and long (≥10 h) sleep duration increased the risk for all-cause mortality among cancer survivors when compared to those who reported sleeping an average of 7 h per night.5 What remains to be determined is whether the relationship between sleep duration and mortality differ by cancer sites. Our study examined the association between sleep duration and all-cause, cancer, and CVD mortality by different cancer sites.
Journal of health disparities research and practice, 2018
Background: No studies have compared the lifestyle behaviors between Puerto Rico, Guam, and the U... more Background: No studies have compared the lifestyle behaviors between Puerto Rico, Guam, and the U.S. Virgin Islands to that of the United States mainland. Documenting and addressing health disparities between these geographically and culturally distinct areas are important public health objectives. Differences in health status between and among the United States mainland and territories merit systematic and careful analyses. Methods: Four key healthy lifestyle characteristics include tobacco use, body mass index, physical activity, and fruit/vegetable consumption. Data from the 2009 Behavioral Risk Factor Surveillance System (N=420,481) were used to examine United States mainland and territorial differences among the four key healthy lifestyle behaviors. Descriptive statistics were summarized with chi-square tests for independence and multiple adjusted logistic regression models were used to examine differences in health compliance rates while controlling for age, gender, income, an...
Medicine & Science in Sports & Exercise, 2018
PURPOSE: To examine the racial and ethnic differences among various types of sedentary behavior (... more PURPOSE: To examine the racial and ethnic differences among various types of sedentary behavior (SB) in a sample of sedentary office workers. METHODS: Study participants were recruited from five worksites in a large metropolitan city in the United States (N = 149, 67% minority, 83% female) All participants sat for at least 5-hours during a typical workday. SB was measured using a 7-item modified version of the Sedentary Behavior Questionnaire (SBQ) and the two-item sedentary behavior questions assessed in the International Physical Activity Questionnaire. Racial differences were examined with descriptive statistics as regression models. Statistical significance was determined at p < 0.05 with a two-sided test. RESULTS: Sedentary behavior ranged from a median of 0 minutes/day for viewing movies or videos to 60 min/ day for watching television and riding in or driving a vehicle. Total median time spent sitting during the weekday was 480 min/day, whereas total time spent sitting during the weekend was 270 min/day. Our adjusted models indicated statistically significant racial and ethnic differences for sitting while talking on the phone (p < 0.001), watching television (p = 0.042), riding in or driving a vehicle (p = 0.027), total sitting time during the weekdays (p = 0.008), and weekend (p = 0.012). Median scores were higher among Blacks than Whites for both sitting and talking on the phone and while watching television (Blacks = 73 and 131, Whites = 26 and 86 min/day). Total time spent sitting on the weekend was higher among Blacks than both Hispanics and Whites (Blacks = 541, Whites = 346, Hispanics = 306 min/day). However, both Blacks and Whites had higher median minutes spent in total sedentary time during the weekday than Hispanics. CONCLUSION: According to these data, racial and ethnic differences exist between various types of SB. Healthcare professionals should consider these differences when designing culturally tailored interventions designed to curve sedentary behavior. Supported by NIH Grants K01CA158000, R03NR010291, and CA016672
Purpose: Despite convincing evidence that prolonged periods of sitting may influence critical bio... more Purpose: Despite convincing evidence that prolonged periods of sitting may influence critical biological mediators of cancer development, few studies assessed the relationship between time spent sitting and cancer-related biomarkers. Methods: This cross-sectional study included 825 postmenopausal women who were enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. Plasma levels of biomarkers were measured at the third annual visit. The time spent sitting per day was categorized as quartiles (Qs) and analysis of covariance was used to assess the relationships between sedentary time and cancer biomarkers. Results: No clear linear patterns were observed between the time spent sitting and levels of biomarkers; however, these relationships were modified by race, physical activity level, and exogenous estrogen use. Insulin-like growth factor-I (IGF-I) levels among black women were higher than those of white women acros...
BackgroundIn the United States, patients who have breast cancer experience significant economic b... more BackgroundIn the United States, patients who have breast cancer experience significant economic burden compared with those who have other types of cancers. Cancer‐related economic burden is exacerbated by adverse treatment effects. Strategies to resolve the economic burden caused by breast cancer and its adverse treatment effects have stemmed from the perspectives of health care providers, oncology navigators, and other subject‐matter experts. For the current study, patient‐driven recommendations were elicited to reduce economic burden after 1) breast cancer and 2) breast cancer‐related lymphedema, which is a common, persistent adverse effect of breast cancer.MethodsQualitative interviews were conducted with 40 long‐term breast cancer survivors who were residents of Pennsylvania or New Jersey in 2015 and were enrolled in a 6‐month observational study. Purposive sampling ensured equal representation by age, socioeconomic position, and lymphedema diagnosis. Semistructured interviews a...
... Psychometric theory. New York: McGraw-Hill. Oman, R., Vesely, S., McLeroy, K., Harris-Wyatt, ... more ... Psychometric theory. New York: McGraw-Hill. Oman, R., Vesely, S., McLeroy, K., Harris-Wyatt, V., Aspy C., Rodine, S., et al. (2002). ... Raheem J Paxton, MS, PhD is a Postdoctoral Fellow in the Cancer Research Center of Hawaii at the University of Hawaii-Manoa. ...
Cancer Epidemiology, Biomarkers & Prevention, 2010
Background: Evidence linking lifestyle factors and risk for prostate cancer is neither clear or c... more Background: Evidence linking lifestyle factors and risk for prostate cancer is neither clear or consistent and novel analytic techniques may help clarify the complex associations between lifestyle characteristics and risk for prostate cancer. Methods: This prospective study utilized data from 12216 (Median age = 63 years) African American men from the Multiethnic Cohort, a large cohort study over-sampled for ethnic minorities in Hawaii and Los Angeles that began in 1993. Adjusted latent class analysis was used to create homogenous groups of African Americans based on 21 indicators including dietary intake and other lifestyle behaviors such as physical activity, body mass index, and sedentary behavior. Results: Four lifestyle patterns were identified that differed by demographic and lifestyle characteristics indicating that the clustering algorithm converged properly. Adjusted Cox regression analyses stratified by smoking status indicated that among former smokers in a cluster charac...
Background Few studies have examined the real-time and dynamic relationship between lifestyle beh... more Background Few studies have examined the real-time and dynamic relationship between lifestyle behaviors and treatment-related symptoms. Objective The aim of this study was to examine the associations of daily physical activity and sedentary behavior with symptom burden, pain interference, and fatigue among patients who were undergoing active cancer treatment. Methods A total of 22 (mean age = 57 years; 73% women; 55% Black) cancer patients were recruited from a local hospital and reported a daily diary of physical activity, sedentary behavior, symptom burden, pain interference, and fatigue over 10 days. Adjusted mixed-effects models were used to examine all associations. Results Body mass index moderated the relationship between physical activity and symptom burden (γ = 0.06, P < .01) and physical activity and fatigue (γ = 0.09, P < .05). On days where physical activity was higher than average, symptom burden and fatigue scores were lower among patients who had lower body mass index values. Also, age moderated the relationship between sedentary behavior and symptom burden (γ = −0.04, P < .05); on days where patients sat more, symptom burden was lower among patients who were younger than the average age. Conclusions Overall, these data indicate that treatment-related symptoms vary daily within cancer patients and that physical activity may alleviate treatment-related symptoms for leaner patients. Larger samples and objective assessments of physical activity and sedentary behavior are needed to validate our results. Implications for Practice Oncology nurses may be in the best position to promote physical activity during treatment as a strategy to manage symptom burden.
Several studies have examined the relationship between smoking and mortality in cancer survivors.... more Several studies have examined the relationship between smoking and mortality in cancer survivors. However, few have reported the relationships in several cancer sites (i.e., bladder, non-melanoma skin, uterine, melanoma, and lymphoma), and limited data exist on the dose-response relationship between number of cigarettes smoked per day or duration of smoking cessation and mortality. Cancer survivors (N = 35,093, 61% female, mean age = 47 years old) from the National Health Interview Survey with linked data retrieved from the National Death Index served as our study participants. Cox proportional-hazards models were used to assess associations between smoking status, all-cause, and disease-specific mortality. After a median follow-up of 13 years, 11,066 deaths occurred. Survivors who reported smoking at study entry had a 73%, 75%, 85% higher risk for cardiovascular disease, cancer, and all-cause mortality, respectively when compared to nonsmokers. Former smokers had a 31% and 37% higher risk of all-cause and cancer mortality, respectively when compared to nonsmokers. The observed relationships appeared to differ by the number of cigarettes smoked (i.e., ≥ 10 per day), especially for breast, cervix, lung, prostate, uterine and non-melanoma skin cancer survivors. Those who continued smoking post diagnosis were at greatest risk of all-cause and cancer mortality, but the associations varied substantially by cancer site. These data provide sufficient evidence of the health hazards associated with smoking for cancer survivors and provide further support for public health strategies designed to curb smoking in this vulnerable population.
Background: The study of physical activity in cancer survivors has been limited to one cause, one... more Background: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine multiple correlates that influence physical activity compliance rates in cancer survivors. Methods: African American breast cancer survivors (N = 267, Mean age = 54 years) participated in an online survey that examined correlates of physical activity. Recursive partitioning (RP) was used to examine complex and nonlinear associations between sociodemographic, medical, cancer-related, theoretical, and quality of life indicators. Results: Recursive partitioning revealed five distinct groups. Compliance with physical activity guidelines was highest (82% met guidelines) among survivors who reported higher mean action planning scores (P < 0.001) and lower mean barriers to physical activity (P = 0.035). Compliance with physical activity guidelines was lowest (9% met guidelines) among survivors who reported lower mean action and coping (P = 0.002) planning scores. Similarly, lower mean action planning scores and poor advanced lower functioning (P = 0.034), even in the context of higher coping planning scores, resulted in low physical activity compliance rates (13% met guidelines). Subsequent analyses revealed that body mass index (P = 0.019) and number of comorbidities (P = 0.003) were lowest in those with the highest compliance rates. Conclusion: Our findings support the notion that multiple factors determine physical activity compliance rates in African American breast cancer survivors. Interventions that encourage action and coping planning and reduce barriers in the context of addressing function limitations may increase physical activity compliance rates.
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