title: Prevalence and correlates of healthy lifestyle behaviors among early cancer survivors.
abstract: BACKGROUND
  Healthy lifestyle behaviors have been demonstrated to be beneficial for positive health outcomes and the quality of life in cancer survivors. However, adherence to recommendations is low. More insight is needed in factors that may explain engagement in lifestyle behaviors to develop effective cancer aftercare interventions. This study assessed different factors, namely socio-demographic, cancer-related, psychological, social cognitive factors (attitude, social support, self-efficacy) and intention, in relationship to five lifestyle behaviors (smoking, physical activity, alcohol, and fruit and vegetable consumption).
  
  
  METHODS
  Early survivors of various types of cancer were recruited from eighteen Dutch Hospitals (n = 255). Distal factors (socio-demographic, cancer related, psychological), proximal factors (social cognitive), intention and five lifestyle behaviors (smoking, physical activity, alcohol, fruit and vegetable consumption) were assessed through a self-reported questionnaire. Cross-sectional analyses (correlations and regression analyses) were conducted.
  
  
  RESULTS
  The lifestyle of a small group (11%) of the cancer survivors was coherent with all five health recommendations, the majority (>80%) adhered to two, three of four recommendations, and only few (<7%) adhered to one or none recommendation. The highest prevalence in followed recommendations have been detected in physical activity (87.4%), refrain from smoking (82%), and alcohol consumption (75.4%). There was low adherence to the fruit recommendation (54.8%) and to the vegetable recommendation (27.4%). Only weak associations were found between the different behaviors. Each separate lifestyle behavior was influenced by different patterns of correlates. Self-efficacy, attitude, and intention were the strongest correlates in all examined behaviors, although with various contributions, while socio-demographic, cancer-related and psychological factors provided a much smaller contribution.
  
  
  CONCLUSIONS
  Outcomes of engagement in healthy lifestyle behaviors were more positive in this study compared to other research in cancer survivors; however, there is room for improvements in adherence to all five lifestyle behaviors. Especially fruit consumption was poor and vegetable consumption even worse. Our findings emphasized that all examined lifestyle behaviors need to be encouraged, with taken into account that each lifestyle behavior may be influenced by a specific set of mainly social cognitive factors or intention.
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401, DL, Heerlen, The Netherlands. iris.kanera@ou.nl.
authors.forename: Iris M
authors.initials: IM
authors.lastname: Kanera
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401, DL, Heerlen, The Netherlands. catherine.bolman@ou.nl.
authors.forename: Catherine A W
authors.initials: CA
authors.lastname: Bolman
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands. ilse.mesters@maastrichtuniversity.nl.
authors.forename: Ilse
authors.initials: I
authors.lastname: Mesters
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401, DL, Heerlen, The Netherlands. roy.willems@ou.nl.
authors.forename: Roy A
authors.initials: RA
authors.lastname: Willems
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401, DL, Heerlen, The Netherlands. audrey.beaulen@ou.nl.
authors.forename: Audrey A J M
authors.initials: AA
authors.lastname: Beaulen
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P. O. Box 2960, 6401, DL, Heerlen, The Netherlands. lilian.lechner@ou.nl.
authors.forename: Lilian
authors.initials: L
authors.lastname: Lechner
mesh_terms: D000368:Aged; D004032:Diet; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D011788:Quality of Life; D012907:Smoking; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*