Healthier Energy Balance Behaviors Most Important for Health-Related Quality of Life in Rural Cancer Survivors in Central Pennsylvania

Jenny L. Olson, Michael Robertson, Minxing Chen, David E. Conroy, Kathryn H. Schmitz, Scherezade K. Mama

Research output: Contribution to journalArticlepeer-review


Background: Rural cancer survivors face a greater number of health disparities, including poorer health-related quality of life (HRQoL), than urban cancer survivors. Engagement in healthy lifestyle behaviors also varies between rural and urban cancer survivors. Lifestyle behaviors can improve HRQoL; however, the combination of behaviors most important for HRQoL in rural survivors is unclear. This study examined clusters of lifestyle behaviors in rural cancer survivors, and differences in HRQoL between behavioral clusters. Methods: Rural cancer survivors in the United States (N = 219) completed a cross-sectional survey. Lifestyle behaviors were classified into unhealthy/healthy binary categories (inactive/active, longer/shorter sedentary time, excessive/acceptable fat intake, very low/higher fruit and vegetable intake, some/no alcohol consumption, and poor/good sleep quality). Behavioral clusters were identified by latent class analysis. HRQoL differences between behavioral clusters were assessed by ordinary least squares regression. Results: The 2-class model demonstrated the best fit and interpretability. The “mostly unhealthy behaviors” class (38.5% of sample) had higher probabilities of all unhealthy behaviors, except alcohol consumption. The “healthier energy balance” class (61.5% of sample) had higher probabilities of active, shorter sedentary, higher fruit and vegetable consumption, excessive fat intake, some alcohol consumption, and poor sleep categories, and reported better HRQoL. Conclusions: Healthier energy balance behaviors were particularly relevant for HRQoL in rural cancer survivors. Multiple behavior change interventions to improve HRQoL in rural cancer survivors should focus on supporting energy balance behaviors. Many rural cancer survivors may lead very unhealthy lifestyles, placing them at high risk of adverse outcomes. This subpopulation should be prioritized to help alleviate cancer health disparities.

Original languageEnglish (US)
Pages (from-to)752-759
Number of pages8
JournalJournal of Physical Activity and Health
Issue number8
StatePublished - Aug 2023


  • health behavior
  • health status disparities
  • lifestyle risk reduction
  • rural health

ASJC Scopus subject areas

  • Epidemiology
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Public Health, Environmental and Occupational Health


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