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Rural–urban differences in health behaviors and implications for health status among US cancer survivors

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Abstract

Purpose

Rural US adults have increased risk of poor outcomes after cancer, including increased cancer mortality. Rural–urban differences in health behaviors have been identified in the general population and may contribute to cancer health disparities, but have not yet been examined among US survivors. We examined rural–urban differences in health behaviors among cancer survivors and associations with self-reported health and health-related unemployment.

Methods

We identified rural (n = 1,642) and urban (n = 6,162) survivors from the cross-sectional National Health Interview Survey (2006–2010) and calculated the prevalence of smoking, physical activity, overweight/obesity, and alcohol consumption. Multivariable models were used to examine the associations of fair/poor health and health-related unemployment with health behaviors and rural–urban residence.

Results

The prevalence of fair/poor health (rural 36.7 %, urban 26.6 %), health-related unemployment (rural 18.5 %, urban 10.6 %), smoking (rural 25.3 %, urban 15.8 %), and physical inactivity (rural 50.7 %, urban 38.7 %) was significantly higher in rural survivors (all p < .05); alcohol consumption was lower (rural 46.3 %, urban 58.6 %), and there were no significant differences in overweight/obesity (rural 65.4 %, urban 62.6 %). All health behaviors were significantly associated with fair/poor health and health-related unemployment in both univariate and multivariable models. After adjustment for behaviors, rural survivors remained more likely than urban survivors to report fair/poor health (OR = 1.21, 95 % CI 1.03–1.43) and health-related unemployment (OR = 1.49, 95 % CI 1.18–1.88).

Conclusions

Rural survivors may need tailored, accessible health promotion interventions to address health-compromising behaviors and improve outcomes after cancer.

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Acknowledgments

This work was supported by the National Cancer Institute at the National Institutes of Health (Grant number R03 CA156641-01). Dr. Palmer is supported by the NCI/NIH Grant number R25 CA122061. The authors thank Karen Potvin Klein, MA, ELS (Office of Research, Wake Forest School of Medicine) for her editorial comments on this manuscript.

Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Kathryn E. Weaver & Nynikka Palmer

  2. Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Lingyi Lu & L. Douglas Case

  3. Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Ann M. Geiger

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  1. Kathryn E. Weaver
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  2. Nynikka Palmer
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Correspondence to Kathryn E. Weaver.

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Weaver, K.E., Palmer, N., Lu, L. et al. Rural–urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control 24, 1481–1490 (2013). https://doi.org/10.1007/s10552-013-0225-x

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