Sedentary Behavior Contexts Cluster In US Adults With And Without Cancer: Implications For Future Intervention Targets

The average U.S. adult spends most of the day engaging in sedentary behavior (SB), which is concerning considering the strong positive association between SB and chronic disease risk. Cancer survivors (CS) are particularly susceptible to the negative consequences of SB. One challenge to developing effective SB reduction interventions is that SB occurs in a variety of contexts, including occupational (O), transport (T), television viewing (TV), screen/computer (C), or other. PURPOSE: The objective of this study was to investigate SB context and clustering in adults with and without cancer. METHODS: We surveyed a convenience sample of 1,588 U.S. adults from 2020-2022. Participants self-reported cancer history and SB context for weekdays (WD-SB) and weekends (WE-SB). Z-scores were calculated. Cluster analysis was conducted using a two-step method: agglomerative hierarchical clustering with squared Euclidean distance and visual inspection of clusters followed by K-means clustering. Clusters were labeled via distinguishing SB contexts (high >0.5, low: <-0.5). Partial eta-squared (η2) measured effect size (small: 0.01, medium: 0.06, large: 0.14 respectively) and ANOVA was used to compare group by cluster. RESULTS: 233 CS (48 ± 19 yr., 52% female, 73% employed, 15+ cancer types) and 1,355 individuals without cancer (45 ± 18 yr., 64% female, 57% employed) completed the survey. CS engaged in 11.4 ± 6.3 WD-SB and 10.9 ± 5.6 WE-SB. Non-cancer individuals engaged in 10.6. ± 6.3 WD-SB and WE-SB. Cluster analysis identified 4 SB-context clusters with a small effect (η2: 0.01, p = 0.03). Cluster 1 (reference group) was characterized by the least amount of SB in all contexts (34% cancer). Cluster 2 included the most CS, exhibited high O, T, TV, C and moderate other for WD-SB and WE-SB (39% cancer, p = 0.03). Cluster 3 exhibited low O, moderate T, TV, C, and high other WD-SB/WE-SB (6% cancer, p = 0.03). Cluster 4 exhibited moderate O and TV and very low T, C, or other WD-SB/WE-SB (21% cancer, p = 0.01). CONCLUSIONS: The largest number of CS were in the highest SB cluster across all contexts (cluster 2). SB context did not vary from WD to WE and CS are highly sedentary amongst all contexts. Future interventions should potentially target SB contexts most amenable to change such as TV or C because these contexts have fewer barriers to change.