JAMA Netw Open. 2025 Nov 3;8(11):e2542330. doi: 10.1001/jamanetworkopen.2025.42330.
ABSTRACT
IMPORTANCE: The American Cancer Society (ACS) Guideline Score captures collective adherence to health behavior recommendations, including a healthy diet, physical activity (PA), alcohol intake, and body mass index (BMI). Exploring the role of social determinants of health (SDoH) in health behavior engagement may present opportunities for improving health equity.
OBJECTIVE: To identify SDoH associated with co-occurring health behaviors captured by the ACS Guideline Score in a large US cohort.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included adults in the Cancer Prevention Study-3 who enrolled between 2006 and 2013 at ACS community events across 35 US states, the District of Columbia, and Puerto Rico using data from comprehensive follow-up surveys administered in 2015. Data were analyzed from June to September 2024.
EXPOSURES: Self-reported race and ethnicity, marital status, education, household income, secondhand smoke exposure, and work status were examined. Rural-Urban Commuting Area codes and food desert status were classified according to US Department of Agriculture definitions.
MAIN OUTCOMES AND MEASURES: Co-occurring health behaviors were measured using a 0-to-8-point score quantifying adherence to the 2020 ACS Guidelines for Diet and PA for Cancer Prevention on diet, alcohol, healthy BMI maintenance, and PA. Scores of 8 represent complete adherence. Ordinal logistic regression models were used to cross-sectionally assess SDoH factors associated with co-occurring health behaviors measured by ACS Guideline Scores.
RESULTS: Of 142 085 participants (mean [SD] age, 52.0 [9.6] years; 111 694 women [78.6%]), 2415 identified as Asian, Native Hawaiian, or Pacific Islander (1.7%), 3267 identified as Black (2.3%), 7814 identified as Latino (5.5%), 126 739 identified as non-Hispanic White (89.2%), and 1989 identified as another racial and/or ethnic group (1.4%). The mean (SD) ACS Guideline Score was 4.6 (1.7). Compared with White participants, Asian, Native Hawaiian, and Pacific Islander participants had increased odds of higher ACS Guideline Scores (odds ratio [OR], 1.99; 95% CI, 1.86-2.14). Holding a graduate degree was associated with a 33% higher likelihood of a higher ACS Guideline Score (OR, 1.33; 95% CI, 1.30-1.36) compared with college graduates. Compared with working full-time, working part-time (OR, 1.62; 95% CI, 1.57-1.66) or being retired (OR, 1.26; 95% CI, 1.22-1.30) was associated with a higher score.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study, multiple SDoH factors associated with co-occurring health behaviors for diet, PA, BMI, and alcohol consumption were identified. These findings may aid in identifying populations most vulnerable to poor health behaviors, guiding future approaches for advancing health equity.
PMID:41201801 | DOI:10.1001/jamanetworkopen.2025.42330
