Nativity and Healthy Lifestyle Index in a Pooled Cohort of Female Breast Cancer Survivors from Northern California Available to Purchase

In the United States, breast cancer is common in Asian, Hispanic, and non-Hispanic White (NHW) women, many of whom are immigrants. A healthy lifestyle is vital to survival, but it is unknown how lifestyle varies by nativity among survivors.

The study included 4,754 racially diverse, female breast cancer survivors from the Northern California, Exploring Networks in a Cohort of Latina and Asian Emigrants, Lifestyle, and Vital Status (ENCLAVE) study. We generated a healthy lifestyle index (HLI) based on World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations. Log-binomial regression models, controlling for sociodemographics, were used to evaluate associations between nativity and the highest tertile of HLI, as well as the optimal category of each HLI component.

Foreign-born (vs. US-born) women were more likely to have a high HLI [prevalence ratio (PR) = 1.44; 95% confidence interval (CI), 1.31–1.59]. In stratified models, we observed stronger associations among Hispanic (PR = 1.76; 95% CI, 1.39–2.24) and Asian (PR = 1.60; 95% CI, 1.32–1.94) versus non-Hispanic White (PR = 1.26; 95% CI, 1.08–1.47) women (P-interaction = 0.02). Foreign-born (vs. US-born) women were more likely to have a waist circumference <31.5 inches (PR = 1.19; 95% CI, 1.03–1.37); be normal weight (PR = 1.23; 95% CI, 1.11–1.37); never smoke (PR = 1.11; 95% CI, 1.06–1.17); and consume no sweets (PR = 1.44; 95% CI, 1.21–1.70), low red meat (PR = 1.46; 95% CI, 1.33–1.60), and high fruits and vegetables (PR = 1.46; 95% CI, 1.32–1.62).

Among women diagnosed with breast cancer, foreign-born women had a healthier lifestyle than US-born women.

Lifestyle differences by nativity in breast cancer survivors may help clarify prognostic differences by nativity.