title: Long-term outcomes of the FRESH START trial: exploring the role of self-efficacy in cancer survivors' maintenance of dietary practices and physical activity.
abstract: BACKGROUND
  This study examined whether changes in self-efficacy explain the effects of a mailed print intervention on long-term dietary practices of breast and prostate cancer survivors. The relationship between change in self-efficacy and long-term physical activity (PA) also was examined.
  
  
  METHODS
  Breast and prostate cancer survivors (N = 543) from 39 US states and two Canadian provinces participated in the FRESH START intervention trial. Participants were randomly assigned to receive a 10-month program of mailed print materials on diet and PA available in the public domain or a 10-month program of tailored materials designed to increase fruit and vegetable (F&V) intake, decrease fat intake, and/or increase PA. Changes in self-efficacy for F&V intake and fat restriction were analyzed as potential mediators of the intervention's effects on diet at 2-year follow-up. Because we previously found that change in self-efficacy for PA did not vary by group assignment, the relationship between change in self-efficacy and PA at 2-year follow-up was examined across study conditions.
  
  
  RESULTS
  Results suggest that change in self-efficacy for fat restriction partially explained the intervention's effect on fat intake (mean indirect effect = -0.28), and change in self-efficacy for F&V consumption partially explained the intervention's effect on daily F&V intake (mean indirect effect = .11). Change in self-efficacy for fat restriction partially accounted for the intervention's impact on overall diet quality among men only (mean indirect effect = 0.60). Finally, change in self-efficacy for PA predicted PA at 2-year follow-up.
  
  
  CONCLUSIONS
  Findings suggest that self-efficacy may influence long-term maintenance of healthy lifestyle practices among cancer survivors.
authors.affiliation: Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA. cemosher@iupui.edu
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Mosher
authors.forename: Isaac
authors.initials: I
authors.lastname: Lipkus
authors.forename: Richard
authors.initials: R
authors.lastname: Sloane
authors.forename: Denise C
authors.initials: DC
authors.lastname: Snyder
authors.forename: David F
authors.initials: DF
authors.lastname: Lobach
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology*; D002170:Canada; D004032:Diet / Q000523:psychology*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000523:psychology*; D011788:Quality of Life; D012044:Regression Analysis; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States