title: Risk-reduction opportunities in breast cancer survivors: capitalizing on teachable moments.
abstract: OBJECTIVE
  With advancements in detection and treatment, the number of breast cancer survivors is growing. To reduce mortality among survivors, tailored health-promotion programs are needed to combat comorbidities. However, the demand for such programs exceed that which is available for a vastly diverse population of survivors. The goal of the present study was to describe the prevalence of comorbidities in a group of breast cancer survivors and to examine associations between biological proximal factors of and the more distal individual-level factors on the number and types of comorbidities.
  
  
  METHODS
  In addition to medical chart reviews, breast cancer survivors (N = 369) from hospitals in two urban locations completed self-report measures. Bivariate analyses examined the relationship between distal and proximal predictors and the outcomes: number of comorbidities and comorbidity types.
  
  
  RESULTS
  Both proximal and distal factors were associated with comorbidities. African American, women with lower education attainment, and older women were more likely to be obese and have more comorbidities than their counterparts. In particular, they were more at risk for cardiovascular disease. Those who initiated hormonal therapy, chemotherapy, and radiation therapy were more likely to have comorbidities. Several psychosocial variables were related to proximal psychosocial factors.
  
  
  CONCLUSIONS
  The present findings highlight the need for targeted health-promotion treatments for breast cancer survivors, particularly for African Americans, those with lower education attainment, those who are obese, and those who may be older. Given the relationships between specific comorbidities and proximal psychosocial factors, future interventions may benefit from tailored approaches.
  
  
  CONCLUSIONS
  Tailored interventions for survivors may be more effective when accounting for factors associated with health-promotion engagement.
authors.affiliation: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA, kristahighland@gmail.com.
authors.forename: Krista Beth
authors.initials: KB
authors.lastname: Highland
authors.forename: Alejandra
authors.initials: A
authors.lastname: Hurtado-de-Mendoza
authors.forename: Cassandra A
authors.initials: CA
authors.lastname: Stanton
authors.forename: Chiranjeev
authors.initials: C
authors.lastname: Dash
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012306:Risk; D040242:Risk Reduction Behavior; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D016387:Women's Health