Patterns of cancer-related health behaviors among middle-aged and older adults: Individual- and area-level socioeconomic disparities

Multiple health behaviors could have greater impact on chronic diseases than single behaviors, but correlates of behavioral clusters are relatively understudied. Using data from NIH-AARP Diet and Health Study (initiated in 1995) for 324,522 participants from the U.S. (age 50-71), we conducted exploratory factor analysis to identify clusters of adherence to eight cancer prevention behaviors. Poisson regressions examined associations between cluster scores and neighborhood socioeconomic deprivation, measured with census block group (1) poverty and (2) low education. Four clusters emerged: Movement (adequate physical activity/less TV); Abstinence (never smoked/less alcohol); Weight control (healthy body mass index/high fruits and vegetables); and Other (adequate sleep/receiving cancer screenings). Scores on all clusters were lower for participants in neighborhoods with the highest poverty (most deprived quintile versus least deprived: relative risk [RR] = 0.95 (95% confidence interval [CI] = 0.94-0.96) for Movement, 0.98 (95% CI = 0.97-0.99) for Abstinence, 0.94 (95% CI = 0.92-0.95) for Weight control, and 0.94 (95% CI = 0.93-0.95) for Other; all p < 0.001). Scores on three clusters were lower for participants in neighborhoods with the lowest education (RR = 0.88 (95% CI = 0.87-0.89) for Movement, 0.89 (95% CI = 0.88-0.90) for Weight control, and 0.90 (95% CI = 0.89-0.91) for Other; all p < .001). Health behaviors among older adults demonstrated four clusters. Neighborhood deprivation was associated with lower scores on clusters, suggesting that interventions to reduce concentrated deprivation may be an efficient approach for improving multiple behaviors simultaneously.