Abstract PR1: Financial strain and cancer risk factors among African American adults
Authors: Advani Pragati , Reitzel Lorraine , Nguyen Nga , Fisher Felicia , Savoy Elaine , Cuevas Adolfo , Wetter David , McNeill Lorna 
Published: May 2015

Background: Early screening and treatment advances have resulted in an overall decline in cancer death rates over the past two decades in the United States (US). However, considerable ethnic disparities still exist in terms of which groups most benefit from these trends. Cancer statistics (2013) suggest that overall cancer incidence and death rates are higher among African Americans as compared to Whites for several cancer sites. Modifiable risk behaviors (smoking, heavy alcohol use, insufficient physical activity, poor diet) and associated outcomes (overweight/obesity) have been causally linked to cancer incidence and related mortality among adults of all ethnicities. However, even after accounting for differences in risk behavior prevalence, African Americans tend to disproportionately suffer from the adverse consequences of behavior risk factors for cancer relative to other ethnic groups. Social determinants, including socioeconomic influences, have been cited as factors contributing to these disparities. There has been recent interest in how financial strain, or an unfavorable income to needs ratio, might uniquely contribute to engagement in modifiable behavioral risk factors for cancer over and above other socioeconomic indicators, but these relations have not been previously examined among African Americans. The current study addressed this gap.

Objectives: To examine associations between financial strain and multiple modifiable behavioral risk factors for cancer (smoking, heavy alcohol use, insufficient physical activity, insufficient fruit and vegetable intake, overweight/obesity, and multiple risk factors) among 1278 African American adults (age=46.5+12.6, 77% female), and explore potential mediators (stress and depressive symptoms) of those associations.

Methods: A series of regression models were used to examine associations between financial strain and cancer risk factors. All analyses were adjusted for age, sex, partner status, total annual household income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Statistical significance was set at p&lt;.008 due to multiple comparisons. Nonparametric bootstrapping procedures were used to assess mediation, using conventional significance levels.

Results: Greater financial strain was associated with greater odds of insufficient physical activity (p&lt;.003) and smoking (p=.005) and was positively associated with the total number of cancer risk factors (p&lt;.0001). Additionally, there was a significant indirect effect of both stress and depression on the association between financial strain and physical inactivity and on the association of financial strain and the total number of cancer risk factors. Greater financial strain was associated with greater perceived stress and more severe depressive symptoms, which were each associated with a higher likelihood of physical inactivity and more risk factors in covariate-adjusted analyses (ps&lt;.05).

Conclusions: Financial strain may contribute to higher cancer risk among African Americans through associations with insufficient physical activity, smoking, and multiple behavioral risk factors for cancer. Greater stress and depressive symptoms may lie along the causal pathway. Future interventions aimed at reducing cancer disparities need to focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms. Although additional studies with longitudinal designs are needed to confirm these results, potential theoretical, intervention, and policy implications are discussed.

This abstract is also presented as Poster B1.

Citation Format: Pragati Advani, Lorraine Reitzel, Nga Nguyen, Felicia Fisher, Elaine Savoy, Adolfo Cuevas, David Wetter, Lorna McNeill. Financial strain and cancer risk factors among African American adults. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr PR1. doi:10.1158/1538-7755.DISP13-PR1