Health Behaviors of Cancer Survivors and Population Controls From the National Health Interview Survey (2005-2015)

Abstract

Background: Population-based data from the National Health Interview Survey were examined to provide estimates of a wide range of health behaviors in cancer survivors (ie, physical activity, sun protection, alcohol use, cigarette and e-cigarette use, sleep, and diet) and trends over time.

Methods: Data were collected from 92 257 participants across 3 waves of the National Health Interview Survey. A total of 8050 participants reported having had cancer (2428 in 2005, 2333 in 2010, 3289 in 2015). Weighted and adjusted odds ratios (OR) between cancer survivors and controls were calculated using logistic and multivariable regressions in SPSS, and trend analyses from 2005 to 2015 were conducted. All statistical tests are 2-sided.

Results: After adjusting for demographics (2005-2015), cancer survivors, compared with controls, were more likely to wear sunscreen (OR = 1.41, 95% confidence interval [CI] = 1.32 to 1.51) and protect their skin (P < .001) and were less likely to tan indoors (OR = 0.81, 95% CI = 0.69 to 0.95), but reported less sleep (OR = 0.91, 95% CI = 0.85 to 0.98). In adjusted models, no differences were found for physical activity, sunburns, alcohol use, smoking, e-cigarette use, and diet. Smoking rates for cancer survivors decreased from 2005 to 2015 (P < .001) and physical activity increased (P = .02), but physical activity was not statistically significant after adjusting for multiple comparisons. All other health behavior rates for cancer survivors were unchanged from 2005 to 2015 (P > .14).

Conclusion: After adjusting for covariates, cancer survivors exhibited healthier sun protection, but not sleep behaviors, compared with controls. Cancer survivors (and controls) exhibited decreased smoking rates over time. These results may inform interventions focused on improving cancer control and prevention of other chronic conditions among cancer survivors.

Figure 1.

Forest plot of adjusted odds ratios comparing cancer survivors to controls. All analyses were adjusted for demographic covariates (age, sex, race, education, income, health status, and overall functional limitations). Physical activity (PA) = dichotomous variable (Y/N) where meeting PA guidelines (yes) indicates meeting both aerobic and strengthening guidelines; sunscreen use = dichotomous variable (Y/N) where sunscreen use (yes) indicates using sunscreen at least most of the time; sunburn = dichotomous variable (Y/N) where a sunburn (yes) indicates 1 or more sunburns in previous 12 months; indoor tanning = dichotomous variable (Y/N) where “yes” indicates 1 or more reported uses of indoor tanning in previous 12 months; alcohol use = dichotomous variable (Y/N) where “yes” indicates current light, moderate, or heavy drinking; smoking = dichotomous variable (Y/N) where “yes” indicates reporting being a current smoker; e-cigarettes (2015 analysis only) = dichotomous variable (Y/N) where “yes” indicates having used an e-cigarette in previous 30 days; adequate sleep = dichotomous variable (Y/N) where “yes” indicates getting 7-9 hours of sleep per night. CI = confidence interval.

Figure 2.

Bar graphs comparing age groups within cancer survivors adjusting for covariates. The y-axis represents percentage rates (0%-100%) for individuals within each age group engaging in these behaviors after adjusting for covariates, with the exception of “sun health” and “dietary,” which are adjusted mean rates because these were continuous (not binary) variables. All analyses were adjusted for demographic covariates (age, sex, race, education, income, health status, and overall functional limitations). Functional limitations split by age among individuals with a history of cancer: 18-39 years (39.8%), 40-64 years (57.1%), 65+ years (71.5%). Functional limitations split by age among individuals without a history of cancer: 18-39 years (17.3%), 40-64 years (37.5%), 65+ years (63.7%). Physical activity (PA) = dichotomous variable (Y/N) where meeting PA guidelines (yes) indicates meeting both aerobic and strengthening guidelines; sunscreen use = dichotomous variable (Y/N) where sunscreen use (yes) indicates using sunscreen at least most of the time; sun-protective behavior = continuous variable index of shade seeking, protective clothing use, and hat-wearing behavior (higher scores indicate more sun protection); sunburn = dichotomous variable (Y/N) where a sunburn (yes) indicates one or more sunburns in previous 12 months; indoor tanning = dichotomous variable (Y/N) where “yes” indicates 1 or more reported uses of indoor tanning in previous 12 months; alcohol use = dichotomous variable (Y/N) where “yes” indicates current light, moderate, or heavy drinking; smoking = dichotomous variable (Y/N) where “yes” indicates reporting being a current smoker; adequate sleep = dichotomous variable (Y/N) where “yes” indicates getting 7-9 hours of sleep per night; dietary behavior = continuous variable composite of fruit and vegetable consumption.