Research Project #2

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Quality of life problems and functional deficits after cancer diagnosis are particularly acute for low socioeconomic status (SES) and minority cancer survivors. Physical activity has been shown to remediate many problems experienced by survivors and has been shown to reduce fatigue and psychological distress and improve physical functioning and quality of life. Observational data indicate that survivors who are more physically active have lower cancer-related mortality. Yet most cancer survivors do not exercise at recommended levels, and little is known about how to increase physical activity among cancer survivors in persistent poverty areas. Considerable physical activity barriers exist in persistent poverty neighborhoods, such as lack of facilities for leisure-time physical activity, few/poor quality sidewalks and parks, and concerns about neighborhood safety. Active Living After Cancer (ALAC) is an evidence-based physical activity program, adapted for minority and medically underserved survivors, that teaches participants behavioral and cognitive skills to increase physical activity. However, it is focused primarily on individual behavior change. The proposed project will incorporate community-level interventions into the ALAC program before implementing it in Acres Homes, a historically Black, persistent poverty community in Houston, Texas. We propose to leverage Be Well Acres Homes, a place-based cancer prevention initiative, to develop a multi-level intervention using health promotion interweaving. The community resources and programs developed in Be Well Acres Homes will enable connection/navigation to resources as participants develop the skills for increasing their physical activity and will foster sustainable community supports beyond the completion of participation in the ALAC program. The adaptations in ALAC will interweave the intervention with the informational environment (through enhanced communication strategies to recruit potential participants and exposure to cancer prevention educational messages provided by Be Well Acres Homes), social/cultural/organizational environment (creating a network of cancer survivors in a single neighborhood, connecting survivors with other groups/programs, e.g., walking clubs, fitness classes, community gardens), and the physical environment (connecting survivors with environmental supports for activity, e.g., park improvements) of the Acres Homes community. Using a wait-list control design we will evaluate the effect of the adapted ALAC intervention on cancer survivors’ physical functioning, quality of life. Additionally, using outcome measures based on the RE-AIM framework we will evaluate the reach, effectiveness, and implementation of the ALAC program and investigate poverty-related moderators of program effectiveness and engagement to identify further program adaptations needed for survivors in persistent poverty communities.