Racial and Ethnic Differences in Health Behaviors Among Cancer Survivors Pratibha Nayak, PhD, Raheem J. Paxton, PhD, Holly Holmes, MD, Hoang Thanh Nguyen, PhD, Linda S. Elting, DrPH Introduction: Previous studies of health behaviors of adult cancer survivors have not adequately examined racial and ethnic differences because of small sample sizes. A national data set was used to examine differences in health behaviors between cancer survivors and controls and between racial and ethnic groups among survivors. Methods: The study analyzed 2009 Behavioral Risk Factor Surveillance System survey data in 2012–2014. Descriptive statistics were used to examine differences in health behaviors between cancer survivors and controls aged 20–64 years. Multivariable analysis was conducted to examine associations between race/ethnicity (white, African American, Hispanic, Asian, or Native American) and health behaviors (BMI, fruit and vegetable consumption, physical activity, and smoking status) while adjusting for demographic and medical characteristics. Significance was set at po0.01. Results: Compared with controls (n¼245,283), cancer survivors (n¼17,158) had higher prevalence rates for overweight/obese status (67% vs 65%); not meeting physical activity recommendations (53% vs 49%); and current smoking status (22% vs 20%). In the multivariable model, diet and smoking behavior differed across cancer status. African American (AOR¼1.95) and Hispanic (AOR¼2.06) survivors were more likely to have higher BMI than white survivors. African American survivors (AOR¼1.6) were less likely to meet physical activity guidelines. Native American (AOR¼3.08) and multiracial (AOR¼1.74) survivors were more likely to be current smokers than non-Hispanic white survivors. Conclusions: This study suggests that racial and ethnic differences exist in the adoption of recommended health behaviors; future research should identify factors to reduce these differences. (Am J Prev Med 2015;48(6):729–736) & 2015 American Journal of Preventive Medicine Introduction C ancer survivors (CS) face an increased risk of developing comorbid conditions such as cardio- vascular disease, diabetes, and second cancers, leading to premature mortality and morbidity compared with age- and sex-matched controls. 1,2 This burden is higher for Hispanic and African American survivors than for non-Hispanic white survivors. 3 Engaging in recom- mended health behaviors (e.g., recommended diet and physical activity [PA]) may prevent adverse cancer sequelae. 4–6 However, limited data exist on engagement of CS in these behaviors. 7,8 This study used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine racial and ethnic differences that may exist for these health behaviors. The findings of this study suggest opportunities for improving adherence to health behaviors and reducing racial and ethnic disparities among CS and the general population. Methods Study Sample The BRFSS 9 is an annual, random-digit-dial telephone survey that estimates the health behaviors of non-institutionalized U.S. residents aged 20–64 years. 10 Respondents reporting a history of cancer were selected as CS (n¼17,158), and respondents with no history of cancer served as controls (n¼245,283). Those diagnosed with cancer o1 year prior and those diagnosed with non- melanoma skin cancer were excluded. From the Department of General Internal Medicine (Nayak, Holmes), Department of Health Services Research (Nguyen, Elting); University of Texas MD Anderson Cancer Center; Health Promotion and Behavioral Sciences (Nayak), University of Texas Health Science Center, Houston; and the Department of Behavioral and Community Health (Paxton), University of North Texas Health Science Center, Fort Worth, Texas Address correspondence to: Pratibha Nayak, PhD, Department of General Internal Medicine, Unit 1465, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: pnayak@mdanderson.org. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2014.12.015 & 2015 American Journal of Preventive Medicine  Published by Elsevier Inc. Am J Prev Med 2015;48(6):729–736 729