title: Adherence to cancer prevention guidelines in 18 African countries.
abstract: BACKGROUND
  Cancer rates in Africa are projected to double by 2030 due to aging and increased exposure to cancer risk factors, including modifiable risk factors. We assessed adherence to 5 modifiable cancer risk factors across 18 African countries.
  
  
  METHODS
  Data on adults 18 years and older were obtained from the 2002-2004 World Health Survey. Adherence to current World Cancer Research Fund guidelines on smoking, alcohol, body weight, physical activity, and nutrition was assessed. Adherence scores ranged from 0 (no guideline met) to 5 (all guidelines met). Determinants of adherence were assessed using multivariable linear regression adjusted for individual and country level characteristics.
  
  
  RESULTS
  Across all countries, adherence to the guidelines among adults was high for smoking (72%-99%) and alcohol (85%-100%), but low for body weight (1.8%-78%), physical activity (3.4%-84%) and nutrition (1.4%-61%). Overall adherence score ranged from 2.32 in Mali to 3.72 in Comoros. In multivariable models, residing in low versus high SES households was associated with reduced adherence by 0.24 and 0.21 points for men and women respectively after adjusting for age, gender, education, and marital status (p<0.001). Every % increase in GDP spent on health was associated with increased adherence by 0.03 in men and 0.09 in women (p<0.001).
  
  
  CONCLUSIONS
  The wide variation in adherence to cancer prevention guidelines observed across countries and between population sub-groups suggests the need for targeted public health efforts to improve behaviors related to body weight, physical activity and nutrition.
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Tomi F
authors.initials: TF
authors.lastname: Akinyemiju
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Jasmine A
authors.initials: JA
authors.lastname: McDonald
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tsui
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, United States of America; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: Heather
authors.initials: H
authors.lastname: Greenlee
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000428:Alcohol Drinking; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control*; D010349:Patient Compliance / Q000706:statistics & numerical data; D012307:Risk Factors; D012907:Smoking; D055815:Young Adult