Skip to main content

Facilitators of behavior change and weight loss in an intervention for African American Breast Cancer Survivors

Cancer Causes & Control volume 31, pages 737–747 (2020)Cite this article

Abstract

Purpose

The purpose of this study was to examine facilitators of behavior change and weight loss among African-American women who participated in the Moving Forward Efficacy trial.

Methods

Linear mixed models were used to examine the role of self-efficacy, social support, and perceived access to healthy eating, exercise, and neighborhood safety on weight, physical activity, and diet. We also examined the mediation of self-efficacy, social support, and perceived access to healthy eating, exercise, and neighborhood safety on weight loss, physical activity, and diet using the Freedman Schatzkin statistic.

Results

We found no evidence to suggest mediation, but some direct associations of self-efficacy, certain types of social support and perceived access to exercise on weight loss, and behavior change.

Conclusion

We determined that self-efficacy, social support, and perceived access to exercise played a role in weight loss, increased MVPA, and better diet. The role of self-efficacy and perceived access to exercise were more consistent than social support.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. DeSantis CE, Siegel RL, Sauer AG, Miller KD, Fedewa SA, Alcaraz KI, Jemal A (2016) Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA: Cancer J Clin 66(4):290–308. https://doi.org/10.3322/caac.21340

    Article  Google Scholar 

  2. Coughlin SS, Yoo W, Whitehead MS, Smith SA (2015) Advancing breast cancer survivorship among African-American women. Breast Cancer Res Treat 153(2):253–261. https://doi.org/10.1007/s10549-015-3548-3

    PubMed  PubMed Central  Article  Google Scholar 

  3. Williams DR, Mohammed SA, Shields AE (2016) Understanding and effectively addressing breast cancer in African American women: unpacking the social context. Cancer. https://doi.org/10.1002/cncr.29935

    PubMed  PubMed Central  Article  Google Scholar 

  4. Chan DSM, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, Navarro Rosenblatt D, Thune I, Vieira R, Norat T (2014) Body mass index and survival in women with breast cancer—systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol 25(10):1901–1914. https://doi.org/10.1093/annonc/mdu042

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  5. Greenlee HA, Crew KD, Mata JM, McKinley PS, Rundle AG, Zhang W, Liao Y, Tsai WY, Hershman DL (2013) A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Obesity 21(1):65–76

    CAS  PubMed  Article  Google Scholar 

  6. Greenlee H, Shi Z, Molmenti CLS, Rundle A, Tsai WY (2016) Trends in obesity prevalence in adults with a history of cancer: results from the US National Health Interview Survey, 1997 to 2014. J Clin Oncol 34(26):3133

    PubMed  PubMed Central  Article  Google Scholar 

  7. Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, Fabian CJ, Gucalp A, Hershman DL, Hudson MM (2014) American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol 32(31):3568–3574

    PubMed  PubMed Central  Article  Google Scholar 

  8. Paxton RJ, Garner W, Logan G, Dean LT, Allen-Watts K (2019) Health behaviors and lifestyle interventions in African American breast cancer survivors: a systematic review. Front Oncol 9:3

    PubMed  PubMed Central  Article  Google Scholar 

  9. Stolley M, Sheean P, Gerber B, Arroyo C, Schiffer L, Banerjee A, Visotcky A, Fantuzzi G, Strahan D, Matthews L, Dakers R, Carridine-Andrews C, Seligman K, Springfield S, Odoms-Young A, Hong S, Hoskins K, Kaklamani V, Sharp L (2017) Efficacy of a weight loss intervention for African American breast cancer survivors. J Clin Oncol 35(24):2820–2828. https://doi.org/10.1200/JCO.2016.71.9856

    PubMed  PubMed Central  Article  Google Scholar 

  10. Stolley MR, Sharp LK, Oh A, Schiffer L (2009) A weight loss intervention for African American breast cancer survivors, 2006. Prev Chronic Dis 6(1):A22

    PubMed  Google Scholar 

  11. Spector D, Battaglini C, Groff D (2013) Perceived exercise barriers and facilitators among ethnically diverse breast cancer survivors. Oncol Nurs Forum 40(5):472–480. https://doi.org/10.1188/13.onf.472-480

    PubMed  Article  Google Scholar 

  12. Oyekanmi G, Paxton RJ (2014) Barriers to physical activity among African American breast cancer survivors. Psycho-Oncology 23(11):1314–1317. https://doi.org/10.1002/pon.3527

    PubMed  PubMed Central  Article  Google Scholar 

  13. Hong S, Bardwell WA, Natarajan L, Flatt SW, Rock CL, Newman VA, Madlensky L, Mills PJ, Dimsdale JE, Thomson CA, Hajek RA, Chilton JA, Pierce JP (2007) Correlates of physical activity level in breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study. Breast Cancer Res Treat 101(2):225–232. https://doi.org/10.1007/s10549-006-9284-y

    PubMed  Article  Google Scholar 

  14. Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice-Hall Inc, Englewood Cliffs, NJ

    Google Scholar 

  15. Heaney CA, Israel BA (2008) Social networks and social support. Health Behav Health Educ 4:189–210

    Google Scholar 

  16. Barber FD (2012) Social support and physical activity engagement by cancer survivors. Clin J Oncol Nurs. https://doi.org/10.1188/12.CJON.E84-E98

    PubMed  Article  Google Scholar 

  17. Hoedjes M, van Stralen MM, Joe STA, Rookus M, van Leeuwen F, Michie S, Seidell JC, Kampman E (2017) Toward the optimal strategy for sustained weight loss in overweight cancer survivors: a systematic review of the literature. J Cancer Surviv 11(3):360–385

    PubMed  PubMed Central  Article  Google Scholar 

  18. Sheppard VB, Hicks J, Makambi K, Hurtado-de-Mendoza A, Demark-Wahnefried W, Adams-Campbell L (2016) The feasibility and acceptability of a diet and exercise trial in overweight and obese black breast cancer survivors: the Stepping STONE study. Contemp Clin Trials 46:106–113. https://doi.org/10.1016/j.cct.2015.12.005

    PubMed  Article  Google Scholar 

  19. Djuric Z, Mirasolo J, Kimbrough L, Brown DR, Heilbrun LK, Canar L, Venkatranamamoorthy R, Simon MS (2009) A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. J Natl Med Assoc 101(6):552

    PubMed  PubMed Central  Article  Google Scholar 

  20. Jones A, Paxton RJ (2015) Neighborhood disadvantage, physical activity barriers, and physical activity among African American breast cancer survivors. Prev Med Rep 2:622–627. https://doi.org/10.1016/j.pmedr.2015.07.010

    PubMed  PubMed Central  Article  Google Scholar 

  21. Walcott-McQuigg JA, Prohaska TR (2001) Factors influencing participation of African American elders in exercise behavior. Public Health Nurs 18(3):194–203

    CAS  PubMed  Article  Google Scholar 

  22. Bronner Y, Boyington JE (2002) Developing weight loss interventions for African-American women: elements of successful models. J Natl Med Assoc 94(4):224–235

    PubMed  PubMed Central  Google Scholar 

  23. Wolfe WA (2004) A review: maximizing social support-A neglected strategy for improving weight management with African-American women. Ethn Dis 14(2):212–218

    PubMed  Google Scholar 

  24. Haughton CF, Silfee VJ, Wang ML, Lopez-Cepero AC, Estabrook DP, Frisard C, Rosal MC, Pagoto SL, Lemon SC (2018) Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: a systematic review. Prev Med Rep 9:131–137. https://doi.org/10.1016/j.pmedr.2018.01.012

    PubMed  PubMed Central  Article  Google Scholar 

  25. Schulz AJ (2011) Urban environments and health. In: Nriagu J (ed) Encyclopedia of environmental health. Elsevier, Burlington, MA, pp 549–555

    Chapter  Google Scholar 

  26. Shariff-Marco S, Yang J, John EM, Sangaramoorthy M, Hertz A, Koo J, Nelson DO, Schupp CW, Shema SJ, Cockburn M (2014) Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study. Cancer Epidemiol Biomark Prev. https://doi.org/10.1158/1055-9965

    Article  Google Scholar 

  27. Beyer KM, Zhou Y, Matthews K, Bemanian A, Laud PW, Nattinger AB (2016) New spatially continuous indices of redlining and racial bias in mortgage lending: links to survival after breast cancer diagnosis and implications for health disparities research. Health Place 40:34–43

    PubMed  Article  Google Scholar 

  28. Stolley MR, Sharp LK, Fantuzzi G, Arroyo C, Sheean P, Schiffer L, Campbell R, Gerber B (2015) Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors. BMC Cancer 15:1018. https://doi.org/10.1186/s12885-015-2004-4

    PubMed  PubMed Central  Article  Google Scholar 

  29. Kriska AM, Caspersen CJ (1997) Introduction to a collection of physical activity questionnaires. Med Sci Sports Exerc 29(6):5–9

    Article  Google Scholar 

  30. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard-Barbash R (2003) Physical activity levels before and after a diagnosis of breast carcinoma. Cancer 97(7):1746–1757

    PubMed  PubMed Central  Article  Google Scholar 

  31. Block G, Hartman AM, Naughton D (1990) A reduced dietary questionnaire: development and validation. Epidemiology 1:58–64

    CAS  PubMed  Article  Google Scholar 

  32. Block G, Wakimoto P (1998) A revision of the Block Dietary Questionnaire and database, based on NHANES III data. University of California at Berkeley, Berkeley

    Google Scholar 

  33. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, Kahle LL, Krebs-Smith SM (2013) Update of the healthy eating index: HEI-2010. J Acad Nutr Diet 113(4):569–580

    PubMed  Article  Google Scholar 

  34. Latimer L, Walker LO, Kim S, Pasch KE, Sterling BS (2011) Self-efficacy scale for weight loss among multi-ethnic women of lower income: a psychometric evaluation. J Nutr Educ Behav 43(4):279–283

    PubMed  PubMed Central  Article  Google Scholar 

  35. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR (1987) The development of scales to measure social support for diet and exercise behaviors. Prev Med 16(6):825–836

    CAS  PubMed  Article  Google Scholar 

  36. Bennett JA, Lyons KS, Winters-Stone K, Nail LM, Scherer J (2007) Motivational interviewing to increase physical activity in long-term cancer survivors: a randomized controlled trial. Nurs Res 56(1):18–27

    PubMed  Article  Google Scholar 

  37. Wang YJ, Boehmke M, Wu YW, Dickerson SS, Fisher N (2011) Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nurs 34(2):E1–13. https://doi.org/10.1097/NCC.0b013e3181e4588d

    PubMed  Article  Google Scholar 

  38. Mosher CE, Lipkus I, Sloane R, Snyder DC, Lobach DF, Demark-Wahnefried W (2013) Long-term outcomes of the FRESH START Trial: exploring the role of self-efficacy in cancer survivors’ maintenance of dietary practices and physical activity. Psycho-Oncology 22(4):876–885. https://doi.org/10.1002/pon.3089

    PubMed  Article  Google Scholar 

  39. Rieger E, Sellbom M, Murray K, Caterson I (2018) Measuring social support for healthy eating and physical activity in obesity. Br J Health Psychol 23(4):1021–1039

    PubMed  Article  Google Scholar 

  40. Kiernan M, Moore SD, Schoffman DE, Lee K, King AC, Taylor CB, Kiernan NE, Perri MG (2012) Social support for healthy behaviors: scale psychometrics and prediction of weight loss among women in a behavioral program. Obesity 20(4):756–764

    PubMed  Article  Google Scholar 

  41. Uchino BN (2004) Social support and physical health: understanding the health consequences of relationships. Yale University Press, New Haven

    Book  Google Scholar 

  42. Cohen S, Underwood LG, Gottlieb BH (2000) Social support measurement and intervention: a guide for health and social scientists. Oxford University Press, Oxford

    Book  Google Scholar 

  43. Kampshoff CS, Stacey F, Short CE, van Mechelen W, Chinapaw MJ, Brug J, Plotnikoff R, James EL, Buffart LM (2016) Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Support Care Cancer 24(8):3333–3342. https://doi.org/10.1007/s00520-016-3148-8

    PubMed  PubMed Central  Article  Google Scholar 

  44. Olson EA, Mullen SP, Rogers LQ, Courneya KS, Verhulst S, McAuley E (2014) Meeting physical activity guidelines in rural breast cancer survivors. Am J Health Behav 38(6):890–899

    PubMed  PubMed Central  Article  Google Scholar 

  45. Crookes DM, Shelton RC, Tehranifar P, Aycinena C, Gaffney AO, Koch P, Contento IR, Greenlee H (2016) Social networks and social support for healthy eating among Latina breast cancer survivors: implications for social and behavioral interventions. J Cancer Surviv 10(2):291–301. https://doi.org/10.1007/s11764-015-0475-6

    PubMed  Article  Google Scholar 

  46. Kong A, Tussing-Humphreys LM, Odoms-Young AM, Stolley MR, Fitzgibbon ML (2014) Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obes Rev 15(Suppl 4):62–92. https://doi.org/10.1111/obr.12203

    PubMed  PubMed Central  Article  Google Scholar 

  47. Dean LT, Gehlert S, Neuhouser ML, Oh A, Zanetti K, Goodman M, Thompson B, Visvanathan K, Schmitz KH (2018) Social factors matter in cancer risk and survivorship. Cancer Causes Control 29(7):611–618. https://doi.org/10.1007/s10552-018-1043-y

    PubMed  PubMed Central  Article  Google Scholar 

  48. Joseph RP, Ainsworth BE, Keller C, Dodgson JE (2015) Barriers to physical activity among African American women: an integrative review of the literature. Women Health 55(6):679–699. https://doi.org/10.1080/03630242.2015.1039184

    PubMed  PubMed Central  Article  Google Scholar 

  49. Schulz AJ, Israel BA, Mentz GB, Bernal C, Caver D, DeMajo R, Diaz G, Gamboa C, Gaines C, Hoston B, Opperman A, Reyes AG, Rowe Z, Sand SL, Woods S (2015) Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention. Health Educ Behav. https://doi.org/10.1177/1090198114560015

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Acknowledgments

We are grateful to all of the participants who devoted time and energy to this trial and to the Chicago Park District. A special thanks to Alexis Visotcky for advice on statistical analyses.

Funding

This funding was supported by National Cancer Institute [Grant No.CA154406] and Health Resources and Services Administration [Grant No. T32HP10030].

Author information

Affiliations

  1. Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    J. L. Kwarteng

  2. Division of Epidemiology, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    K. M. M. Beyer

  3. Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    A. Banerjee

  4. Division of Hematology and Oncology, Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    M. R. Stolley

Authors
  1. J. L. Kwarteng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. M. M. Beyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. R. Stolley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. L. Kwarteng.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kwarteng, J.L., Beyer, K.M.M., Banerjee, A. et al. Facilitators of behavior change and weight loss in an intervention for African American Breast Cancer Survivors. Cancer Causes Control 31, 737–747 (2020). https://doi.org/10.1007/s10552-020-01315-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-020-01315-y

Keywords

  • Weight loss
  • Breast cancer
  • African American breast cancer survivors