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Objectives This study examined demographic and health-related factors associated with risk behaviors that have been linked to cancer including smoking, high BMI, and low physical activity. Design and Sample A secondary analysis was conducted using data from Rural Families Speak about Health, a multi-state, epidemiologic study of rural American women and their families (N=444). Measurement Validated measures for various demographic and health related items including tobacco use, BMI, physical activity, and depression were used. Results Of the total sample with complete data (n=399) the mean age was 32 years and the majority were white (64%), married (67%), had a high school education or higher (73%), and had an annual household income of less than $40,000 (90%). Regarding cancer risk behaviors, 36% of the sample were smokers, 39% reported low levels of physical activity, and 45% had a calculated BMI over 30. Thirty-five percent of participants reported engaging in two or more risk behaviors. There were significant differences in income, perceived health status, and depression depending on the number of risk behaviors reported. Conclusions Understanding combinations of risk behaviors can assist nurses and other health professionals in tailoring multiple health behavior change interventions to prevent cancer among rural women.

Using structural equation modeling, this study examined interactions among factors traditionally associated with health outcomes within a sample of rural low-income mothers. Prior research has established that education, employment, income, marital status, and health insurance coverage independently predict health outcomes. However, no studies have examined the simultaneous influence of these factors as conceptualized from an ecological systems perspective. Results indicate that when the multiple factors are considered simultaneously, different effects emerge. Implications are that the context in which these women live and the interactions between and among key influencing factors must be considered when addressing health challenges in rural areas.

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