Rural residents 18 years and older of Granville and Vance counties (n=30) will be recruited to participate.

The program will consist of 4 in person sessions that are based on empirically supported Positive Psychosocial Well-Being PPWB components including Optimism, Mindfulness, Positive Reprisal as well as Strengths-based Cognitive Behavioral Therapy (SBCBT) to improve behavioral self-regulation towards health-related goals. Research staff will conduct face-to-face surveys with participants at baseline and at end of program. Finally, we will conduct a phone-based survey 30 days after program completion to assess sustainability of intervention effects.

DeStress for Health Program

Devon Noonan, Ph.D

The purpose of this research study is to determine whether a positive psychology intervention paired with a health behavior intervention is successful in decreasing perceived stress and increasing positive affect in residents of Vance and Granville County. Participants will attend 4 classes that occur once a week. The first class will focus on nutrition, the second class will focus on exercise, the 3rd class will focus on tobacco use, and the 4th class that will review the previous 3 classes and help participants incorporate the strategies taught in the Destress for Health Program into their everyday lives. The duration of each class is 1 hour and the classes will be held once a week for a total of 4 weeks. Participants in this research study will be asked to complete 2 surveys. The first survey will occur during class 1, and will ask participants about their demographic information, health behaviors, stress levels, emotions, and behaviors. The second survey will be conducted over the phone and will occur 30-days after the final class and will ask participants about their health behaviors, stress levels, emotions, behaviors and also about whether or not they felt the classes they attended were useful to them. Total study duration is about 2 months.

DeStress for Health: Partnering With Granville and Vance Counties to Reduce Stress and Cancer Risk

Measured on a scale from 1-5 with 1 being "Not Useful at All" and 5 being "Extremely Useful".

Measured on a scale from 1-5 with 1 being "Not at All" and 5 being "Extremely".

Duke University

Participants having previously attended at least once in previous years the "World Cancer Day Walk" will be considered as the group exposed to the health education intervention (returning).

The control/non-exposed group will be the participants who are attending the "World Cancer Day Walk" for the first time in 2020 (first timers) and have not yet received health education information.

Healthy lifestyle information (education) is distributed to participants during the "World Cancer Day Walk" via brochure, lectures, and professional counseling.

Healthy Lifestyle Education

Leigh Leibel, MSc

Cancer awareness is a critical element of cancer prevention and control. Creating public awareness on risk factors, preventative strategies, and the importance of early screening is the foundation upon which a cancer control program must be constructed. The purpose of this study is to describe the sociodemographic and risk factor distribution of the Abuja, Nigeria "World Cancer Day Walk" participants according to their motive for participating in the event (free cancer screening versus fun/activities), and secondarily, to investigate the impact of the event on educating attendees from the general population about cancer prevention and screening, in particular the importance of being physically active and maintaining a healthy body weight. Obesity is a known risk factor contributing to the development of cancer and NCD's.

Cancer awareness is a critical element of cancer prevention and control. Creating public awareness on risk factors, preventative strategies, and the importance of early screening is the foundation upon which a cancer control program must be constructed. Ideally, efforts should include knowledge of the problem and its solutions, a group of people who respect and care for the populations they want to serve, and importantly, resources.

Nigeria is the most populous black nation in the world with a population of over 196 million, more than 500 ethnic groups, 380 languages, and a diverse range of cultural, traditional and religious beliefs. Nigeria constitutes approximately 20% of the population of Africa and slightly more than 50% of the West African population. Cancer is a critical public health problem in this population. Nigeria is a major contributor to the overall cancer burden on the continent with 72,000 cancer deaths in 2012 and 115,950 new cases of cancer and 70,327 cancer deaths in 2018. Nigerians also have one of the world's poorest 5-year cancer survival rates.

Breast cancer is the most frequently diagnosed cancer in Nigerian women and the leading cause of cancer death in Nigeria, with an estimated 26,310 new cases and 11,564 deaths in 2018 (44% death rate). Breast cancer incidence in this population historically has been low but is now increasing. By comparison, in the United States (population 329 million) there were 30,700 new breast cancer cases and 6,310 deaths in 2016. Another female cancer - cervical, is 99% preventable, however, it is the second leading cause of cancer death in Nigeria with over 26 deaths every day. By comparison, in the United States between 2013-2017, the average annual death rate of cervical cancer was 2.3% per 100,000 (age adjusted to the 2000 US standard population). Prostate cancer is the leading cause of cancer deaths in Nigerian men with 13,078 new cases (which is 29.1%) and 5,806 deaths in 2018. The age-standardized incidence rates (ASR) for prostate cancer was 32.8 new cases per 100,000 men and mortality rate was about 16.3 per 100,000 men in 2018. On a daily basis, at least 15 men die of prostate cancer in Nigeria. By comparison, in the United States prostate cancer death rates in men declined 52% from 1993 to 2017.

Strategies for prevention and early detection are imperative in the reduction of cancer death rates globally; awareness campaigns (such as the annual "World Cancer Day Walk" in Abuja) are critical to educate the general population on cancer risk factors, the benefits of screening and early detection, and to offer free cancer screening to all populations.

This study "Step up to Health, Nigeria! Impact of World Cancer Day Walk on Health Behaviors Among Nigerians" will describe the sociodemographic and risk factor distribution of the Abuja, Nigeria "World Cancer Day Walk" participants according to their motive for participation, and secondarily, to investigate the impact of the event on educating attendees from the general population about cancer prevention and screening, in particular the importance of being physically active and maintaining a healthy body weight. Obesity is a known risk factor contributing to the development of cancer and NCD's.

The study will take place in Abuja, Nigeria on Feb 1, 2020 during the 6th Annual "World Cancer Day Walk" sponsored by Project PINK BLUE, a registered Nigerian nonprofit cancer organization, viz. Health \& Psychological Trust Centre (CAC/IT/NO 73960).

The purpose of the "World Cancer Day Walk" is to create awareness and advocate for better cancer care for Nigerians. The event offers free breast, cervical, and prostate cancer screenings; heath education and information about cancer risk reduction; and group physical activities that include a 5km Walk, 10km Race, 20km Ride, 5km Skate, 50km Cycle, and Marathon.

On the day of the event, the in-field research team will distribute a voluntary, one-page questionnaire to the anticipated 3,000 event participants to ascertain demographic information, cancer risk factors, motivations for attending the event, and lifestyle behaviors. Subjects will be recruited voluntarily onsite during the event following inclusion and exclusion criteria. Informed consent will be taken.

The questionnaire is 27 questions. Part one (eight questions) captures basic demographic information. Part two (six questions) captures personal and family history of cancer and cancer screening. Part three (six questions) captures information about the motivation for attending the event (free screening vs. fun/activities) and preferred ways to receive healthy lifestyle and cancer risk reduction / prevention information. Part four (five questions) captures lifestyle behaviors. Part five is the validated seven question International Physical Activity Questionnaire (IPAQ) instrument that measures physical activity and reduced sedentary behavior over the last seven days.

Step up to Health, Nigeria! Impact of World Cancer Day Walk on Health Behaviors Among Nigerians

The brief survey instrument captures participant sociodemographic characteristics. Participants are asked to provide known risk factors for cancer and to indicate if they are attending for "free cancer screening" or "fun/activities".

The International Physical Activity Questionnaire (IPAQ) measures self-reported time spent per week doing vigorous and moderate activity in the last 7 days; time spent walking in the last 7 days, and time spent sitting down in the last 7 days. It is a "fill in the blank" survey instrument.

Project PINKBLUE, Health and Psychological Trust Centre

University Of Nigeria Teaching Hospital

Vaughn A. Lewis Institute for Research and Innovation

Columbia University

AshtaYoga, LLC

Behaviors and Mental Disorders

All Conditions

Quality of Life

Participants will be enrolled in a 15 week program to assess quality of life and general health outcomes

Participants will be asked to complete a series of questionnaires assessing quality of life and other general health outcomes

Questionnaires

Dianne Shumay, PhD

Margaret Chesney, PhD

Interdisciplinary psychological interventions targeting survivorship are not only understudied but face several implementation challenges. For this project, the study team is proposing to analyze these data to report on preliminary pilot outcomes, as well as acceptability and feasibility of the implementation of the Survivorship Wellness Group Program, an interdisciplinary wellness and health-behavior change program for survivors of cancer, who have completed treatment at University of California, San Francisco and are currently without evidence of active disease.

STUDY OBJECTIVES:

1. To examine the feasibility and acceptability of implementing an interdisciplinary goal-setting clinical group program focused on domains of physical, psychological, and spiritual wellness for survivors of cancer at University of California, San Francisco.
2. To determine preliminary efficacy of the Survivorship Wellness intervention in regards to:

   1. Increasing knowledge of and perceived confidence in execution of health behavior changes in domains of physical, emotional, and spiritual wellness for survivors of cancer
   2. Increasing quality of life
   3. Reducing symptoms of depression and anxiety
   4. Increasing physical activity

Evaluation of Survivorship Wellness Group Program for Patients Treated at University of California, San Francisco (UCSF)

Evaluation of the Survivorship Wellness Group Program: An Interdisciplinary Goal-Setting Clinical Group Program for Survivors of Cancer at UCSF

The PROMIS Depression Short form consists of 4 items addressing patient depression with item response scores ranging from 1 (never) to 5 (Always). Raw scores are converted to scaled T-scores with higher scores indicating a greater level of depression.

The PROMIS Anxiety Short form consists of 2 items addressing patient anxiety with item response scores ranging from 1 (never) to 5 (Always). Raw scores are converted to scaled T-scores with higher scores indicating a greater level of anxiety.

The FACT-G is a 27-item questionnaire designed to measure four domains of health related quality of life (HRQOL) in cancer patients with 4 domains of interest: Physical, social, emotional, and functional well-being. Each tem response score ranges from 0 (not at all) to 5 (very much). The total score is a sum of the subscale scores, with a range from 0 - 108. The higher the score, the better the HRQOL.

Program satisfaction is measured by the participant's response to the following item: "How satisfied were you, overall, with this program?". Responses ranged from Not at all satisfied, Somewhat satisfied, Mostly satisfied, and Extremely satisfied. Responses will be counted and reported by category.

The 16 item cancer survivorship wellness survey assesses each participant for their level of importance in learning about various wellness topics of cancer survivorship and their current knowledge of these topics. Each item addressing importance is rated by the participant in terms of how important it is to learn about topics specific to cancer survivorship. Items are rated according to 5 categories "Not at all important", "Somewhat important", "Moderately important", "Very important", and "Extremely important".

The 16 item cancer survivorship wellness survey assesses each participant for their level of importance in learning about various wellness topics of cancer survivorship and their current knowledge of these topics. Each item addressing knowledge is rated by the participant in terms of how knowledgeable the participants are regarding topics specific to cancer survivorship. Items are rated according to 5 categories "Not at all knowledgeable", "Somewhat knowledgeable", "Moderately knowledgeable", "Very knowledgeable", and "Extremely knowledgeable".

The frequency of current exercise for participants was measured by a single item "How frequently do you exercise currently"? Responses are comprised of 5 categories: "Every day", "Several times per week", "Once per week", "Less than once per week", "Several times per month", "Once per month", and "Less than once per month"

The intensity of current exercise for participants was measured by a single item "How would you rate the intensity of your current exercise regimen?". Responses are comprised of 5 categories: "Very low intensity", "Light intensity", "Moderate intensity", and "High intensity".

University of California, San Francisco

Before the targeted health dialogue, the participants fill in a questionnaire about health behaviors, background characteristics and self-rated health. Samples for blood glucose and total cholesterol are taken. BMI, waist-to-hip ratio and blood pressure are measured. The results are summoned in a "health curve", which is discussed with specially trained healthcare personnel in a Targeted heath dialogue. In a sub-group, blood samples are collected for molecular analyses.

Targeted health dialogues

Kristina Sundquist, PhD, MD

Emelie Stenman, PhD

The County Council of Region Skåne, Sweden, has recently initiated Targeted Health Dialogues in primary care. The prevention program includes health dialogues provided by specially trained personnel, collection of clinical and laboratory data as well as questionnaire data on, e.g., individual health and health behaviors. So far, it enrolls all 40-year old Swedish and foreign-born inhabitants in the county and it will also include all 50- and 60-year old persons within a near future. A research project will be integrated within the program where the collected data will be linked, on the individual level, to national and regional data on hospital admissions, clinical diagnoses from specialist clinics and primary care, causes of death, and prescriptions. The individual linkages will also include population data on sociodemographic characteristics, neighborhood of residence and family relations. Blood samples will be collected for analyses of molecular biomarkers. The research project will examine associations between potential predictors and future risk of cardiovascular diseases and other serious diseases, such as cancer, and also whether the effect of the prevention program is modified by these potential predictors. The effect of the intervention will be examined, and whether the protocol needs to be modified in order to develop more precise and personalized medicine.

The County Council of Region Skåne, the third most populous region in Sweden with 1.4 million inhabitants, has recently initiated Targeted Health Dialogues in primary care with the ultimate goal to improve cardiovascular health in the entire population in Skåne. Targeted health dialogues have previously been proven to improve health behaviors and risk factors and decrease the incidence of cardiovascular disease and mortality. The prevention program includes, in addition to the health dialogues provided by specially trained personnel, collection of clinical and laboratory data (e.g. blood pressure, BMI, waist hip ratio, lipids, fasting blood glucose) as well as detailed questionnaire data on, e.g., individual health and symptoms, family history, diet, physical activity, alcohol and smoking. So far, it enrolls all 40-year old Swedish and foreign-born inhabitants in the county and it will also include all 50- and 60-year old persons within a near future. The County Council and the Ethical Review Board have granted permission to integrate a research project within the program where collected data will be linked, at the individual level, to national and regional data on hospital admissions, clinical diagnoses from specialist clinics and primary care, causes of death, and prescriptions. The individual linkages will also include population data on sociodemographic characteristics, neighborhood of residence and family relations. In addition to the collection and linkages of these data, blood samples will be collected for analyses of molecular biomarkers. The research project will allow for examining associations between a number of potential predictors and future risk of cardiovascular disease and other serious diseases, such as cancer, and also whether the effect of the prevention program is modified by these potential predictors. The effect of the intervention will be examined and whether the protocol needs to be modified in order to develop more precise and personalized medicine.

Targeted Health Dialogues in Primary Care

Targeted Health Dialogues in Primary Care: Lifestyle Screening and Molecular Profiling for a Healthier Life

The short- and long-term effect of targeted health dialogues on incidence of CVD events, its comorbidity and CVD-related deaths in the participants compared to a general population cohort and historical controls.

The short- and long-term effect of targeted health dialogues on incidence of cancer and other serious diseases in the participants compared to a general population cohort and historical controls.

Modification of possible associations between targeted health dialogues and future CVD, cancer, other serious diseases and preterm death by individual characteristics (e.g., sociodemographic factors)

Associations between risk factors/combination of risk factors (lifestyle-related, metabolic, psychosocial and familial) at baseline and incidence of CVD, cancer, other serious diseases and preterm death.

The ability of biological aging, epigenetic changes and genetic and metabolomic profiles to predict CVD, cancer, other serious diseases and preterm death as well as the effect of targeted health dialogues.

Level of physical activity and sedentary behavior, intake of healthy/unhealthy food, alcohol consumption, smoking habits, stress, psychological well-being, blood glucose, cholesterol, BMI, waist-hip ratio. Comparisons between subgroups: age, sex, sociodemography, previous diagnoses.

Associations between dental health at baseline and incidence of CVD, cancer, other serious diseases and preterm death.

Validity and reliability of the questionnaire and targeted health dialogue method

Costs related to the targeted health dialogues versus individual and societal gains.

Which samples and tests were taken as a result of the targeted health dialogues?

Evaluation of new search patterns due to the targeted health dialogues.

What obstacles and motivators for physical activity do inactive people experience?

Do targeted health dialogues affect food-related metabolites in the blood?

Region Skane

Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Skin and Connective Tissue Diseases

Digestive System Diseases

Blood and Lymph Conditions

Immune System Diseases

Rare Diseases

Prostatic Neoplasms

Breast Neoplasms

Colorectal Neoplasms

Lymphoma

Endometrial Neoplasms

Hodgkin Disease

Neoplasms by Histologic Type

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Breast Diseases

Skin Diseases

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Genital Neoplasms, Male

Urogenital Neoplasms

Genital Diseases

Genital Diseases, Male

Urogenital Diseases

Prostatic Diseases

Male Urogenital Diseases

Uterine Neoplasms

Genital Neoplasms, Female

Uterine Diseases

Genital Diseases, Female

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Lymphosarcoma

Hodgkin Lymphoma

With assistance from the study team, the clinic will implement the AH-HA tool in the clinics' EPIC EHR. Providers at the intervention sites will be trained to use the tool during routine follow-up care with survivors. During a routine follow-up care appointment, the provider will use the AH-HA tool with enrolled patients.

Usual care practices will conduct routine follow-up care visits for enrolled survivors following typical clinic practice, without use of the AH-HA tool.

The Automated Heart-Health Assessment tool implemented in clinics' EPIC EHR will be used by providers during routine follow-up care appointments.

AH-HA Tool in the EPIC EHR

Kathryn Weaver, MD

The objective of this hybrid effectiveness-implementation study is to examine the effects of an EHR-based cardiovascular health assessment tool (AH-HA) among breast, prostate, colorectal, endometrial, and Hodgkin and non-Hodgkin lymphoma cancer survivors (N=600) receiving survivorship care in community oncology practices, using a group-randomized trial design (6 intervention practices and 6 usual care practices). Our central hypothesis is that the AH-HA tool will increase (1) cardiovascular health (CVH) discussions among survivors and oncology providers, (2) referrals and visits to primary care and cardiology (care coordination), and (3) cardiovascular (CV) risk reduction and health promotion activities compared to usual care.

In this hybrid effectiveness-implementation group-randomized clinical trial, 6 intervention practices will receive an EHR-based cardiovascular health assessment tool (Automated Heart Health Assessment for Survivors: AH-HA) and 6 practices will serve as usual care (control) practices without access to the AH-HA tool. AH-HA renders a visual, interactive display of CVH risk factors, automatically populated from the EHR. This tool was first implemented in primary care and now incorporates EHR data on receipt of cancer treatments with cardiotoxic potential. Providers at each intervention site will be trained to use the tool during routine follow-up care with survivors. Eligible survivors with breast, prostate, colorectal, endometrial, or Hodgkin and non-Hodgkin lymphoma cancer (n=600) will provide baseline data before and immediately after seeing their oncology provider and complete 6-month and 1-year study follow-up visits. The study team will compare changes in outcomes from baseline to 1-year in survivors at the intervention and usual care clinics using data from survivor self-reports and the EHR. The primary outcome is CVH discussions defined as the number of patient-reported discussions with their provider regarding up to seven non-ideal CVH conditions identified for that patient during oncology visits. Secondary outcomes include referrals to primary care and cardiology, provider efforts to manage CV risk, survivors' completed visits with primary care providers and cardiologists, and control of CVH factors and behaviors. Implementation metrics will be assessed using data from the EHR and semi-structured interviews with providers and administrators (n=24-30) at intervention clinics.

Assessing Effectiveness and Implementation of an EHR Tool to Assess Heart Health Among Survivors

Assessing Effectiveness and Implementation of an EHR Tool to Assess Heart Health Among Survivors (AH-HA)

Wake Forest NCORP Research Base is committed to following the NIH Statement on Sharing Research Data (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-03-032.html). As of July 2018, the WF NCORP RB signed an agreement with NCI to contribute de-identified data and data dictionaries from clinical trials conducted through our RB to the NCI NCTN/NCORP data archive within 6 months of primary and non-primary publications of phase II/III and phase III trials to https://nctn-data-archive.nci.nih.gov/. This will become the primary means for sharing raw data, and we will adhere to the guidelines spelled out in the NCTN/NCORP Data Archive Usage Guide. De-identified data from studies not covered by the agreement (e.g., phase II and observational studies) will be made available upon request. All data files will be de-identified. De-identification procedures will meet the HIPAA criteria as detailed in the Code of Federal Regulations, Part 45, Section 164.514.

Discussion of non-ideal cardiovascular health (CVH) factors (yes or no). CVH discussions will be defined as patient-reported discussions with their provider for any of the seven non-ideal CVH conditions identified for that patient. Conditions include CVH factors (cholesterol, blood pressure, glucose/hemoglobin A1c) and CVH behaviors (body mass index, smoking, diet, and physical activity). Measured using survivor survey (discussions, diet, and primary care) and EHR for other CVH factors.

Medical chart abstraction of referrals and communication with providers regarding CVH at each survivor visit.

Medical chart abstraction; Patient survey as secondary, verification source. Measured using smoking status, BMI, physical activity, and healthy diet.

Medical chart abstraction; Patient survey as secondary, verification source. Measured using total cholesterol, blood pressure, and fasting plasma glucose/Alc.

Measured using structured survivor survey. Health knowledge questions were adapted from a survey assessing the relative risk of cancer and cardiovascular disease in United States populations.Minimum score is 0, maximum score is 3 and answer is the total number of questions where a patient responded agree or strongly agree.

We will capture the number of eligible patient visits during which the AH-HA tool was used in intervention clinics and the total number of eligible visits to calculate the proportion of patients where AH-HA was utilized.

In the Baseline: Post-Visit Survey, survivors will complete a Tool Assessment questionnaire assessing whether or not they recall seeing or discussing the AH-HA tool with their provider and five questions assessing: how much they liked the tool, how helpful it was, how easy it was to understand, how much it improved their understanding, and if they would like to use this tool in the future. Patients will respond to 5 questions on a scale from strongly agree to strongly disagree.

National Cancer Institute (NCI)

Washington University School of Medicine

University of Texas Southwestern Medical Center

Wake Forest University Health Sciences

The control/non-exposed group will be the participants who are attending the "World Cancer Day Walk" for the first time in 2022 (first timers) and have not yet received health education information.

Health literacy education (cancer prevention and healthy lifestyle) and free breast, prostate, cervical cancer screening

World Cancer Day Walk

Runcie CW Chidebe, MSc

Cancer awareness is a critical element of cancer prevention and control. Creating public awareness on risk factors, preventative strategies, and the importance of early screening is the foundation upon which a cancer control program must be constructed. Ideally, efforts should include knowledge of the problem and its solutions, a group of people who respect and care for the populations they want to serve, and importantly, resources.

Nigeria is the most populous black nation in the world with a population of over 196 million, more than 500 ethnic groups, 380 languages, and a diverse range of cultural, traditional and religious beliefs. Nigeria constitutes approximately 20% of the population of Africa and slightly more than 50% of the West African population. Cancer is a critical public health problem in this population. Nigeria is a major contributor to the overall cancer burden on the continent with 72,000 cancer deaths in 2012 and 115,950 new cases of cancer and 70,327 cancer deaths in 2018. Nigerians also have one of the world's poorest 5-year cancer survival rates.

Breast cancer is the most frequently diagnosed cancer in Nigerian women and the leading cause of cancer death in Nigeria, with an estimated 26,310 new cases and 11,564 deaths in 2018 (44% death rate). Breast cancer incidence in this population historically has been low but is now increasing. By comparison, in the United States (population 329 million) there were 30,700 new breast cancer cases and 6,310 deaths in 2016. Another female cancer - cervical, is 99% preventable, however, it is the second leading cause of cancer death in Nigeria with over 26 deaths every day. By comparison, in the United States between 2013-2017, the average annual death rate of cervical cancer was 2.3% per 100,000 (age adjusted to the 2000 US standard population). Prostate cancer is the leading cause of cancer deaths in Nigerian men with 13,078 new cases (which is 29.1%) and 5,806 deaths in 2018. The age-standardized incidence rates (ASR) for prostate cancer was 32.8 new cases per 100,000 men and mortality rate was about 16.3 per 100,000 men in 2018. On a daily basis, at least 15 men die of prostate cancer in Nigeria. By comparison, in the United States prostate cancer death rates in men declined 52% from 1993 to 2017.

Strategies for prevention and early detection are imperative in the reduction of cancer death rates globally; awareness campaigns (such as the annual "World Cancer Day Walk" in Abuja) are critical to educate the general population on cancer risk factors, the benefits of screening and early detection, and to offer free cancer screening to all populations.

This study "Step up to Health, Nigeria! Impact of the 2022 World Cancer Day Walk on Health Behaviors Among Nigerians" will describe the sociodemographic and risk factor distribution of the Abuja, Nigeria "World Cancer Day Walk" participants according to their motive for participation, and secondarily, to investigate the impact of the event on educating attendees from the general population about cancer prevention and screening, in particular the importance of being physically active and maintaining a healthy body weight. Obesity is a known risk factor contributing to the development of cancer and NCD's.

The study will take place in Abuja, Nigeria on Feb 5, 2022 during the 8th Annual "World Cancer Day Walk" sponsored by Project PINK BLUE, a registered Nigerian nonprofit cancer organization, viz. Health \& Psychological Trust Centre (CAC/IT/NO 73960).

The purpose of the "World Cancer Day Walk" is to create awareness and advocate for better cancer care for Nigerians. The event offers free breast, cervical, and prostate cancer screenings; heath education and information about cancer risk reduction; and group physical activities that include a 5km Walk, 10km Race, 20km Ride, 5km Skate, 50km Cycle, and Marathon.

On the day of the event, the in-field research team will distribute a voluntary, one-page questionnaire to the anticipated 5,000 event participants to ascertain demographic information, cancer risk factors, motivations for attending the event, and lifestyle behaviors. Subjects will be recruited voluntarily onsite during the event following inclusion and exclusion criteria. Informed consent will be taken.

The questionnaire is 27 questions. Part one (eight questions) captures basic demographic information. Part two (six questions) captures personal and family history of cancer and cancer screening. Part three (six questions) captures information about the motivation for attending the event (free screening vs. fun/activities) and preferred ways to receive healthy lifestyle and cancer risk reduction / prevention information. Part four (five questions) captures lifestyle behaviors. Part five is the validated seven question International Physical Activity Questionnaire (IPAQ) instrument that measures physical activity and reduced sedentary behavior over the last seven days.

Step up to Health, Nigeria! Impact of 2022 World Cancer Day Walk on Health Behaviors Among Nigerians

Step up to Health, Nigeria! Utilizing Information From Abuja's 2022 World Cancer Day Walk for Equity-based Cancer Prevention Interventions

Receiving Targeting the Teachable Moment Intervention materials (focusing on health behaviors and issues specific to breast cancer survivors) every other week for 4 months

Receiving Standardized Lifestyle Management materials (focusing mostly on health behaviors) every other week for 4 months

Receiving SLM materials at the end of the 7 months

TTMI material (every other week for 4 months)

Targeting the Teachable Moment

SLM material (every other week for 4 months)

Standardized Lifestyle Management

Crystal L. Park, Ph.D

1. The purpose of the study is to test the effectiveness of a new mail-based intervention for breast cancer survivors compared with standard lifestyle management and no-treatment.
2. This intervention addresses both lifestyle factors such as dietary and physical activities and psychological issues specific to breast cancer survivors to improve healthy behaviors.

Participants will be assigned randomly to one of three groups: 1) newly developed mail-based intervention (Targeting the Teachable Moment Intervention; TTMI), 2) standard Lifestyle Intervention (SLM), and 3) usual care. Both TTMI and SLM focus on health behaviors, however TTMI additionally addresses psychosocial issues specific to breast cancer survivors.

All participants will complete questionnaires at the time they start the study, the end of the 4 months, and 3 months later for a follow-up.

If participants are assigned to any of the intervention group, they will receive materials every other week for 4 months. If participants are assigned to the usual care group, they will receive the same materials as the standard lifestyle intervention et the end of the 7 months.

A Lifestyle Intervention for Breast Cancer Survivors

Targeting the Teachable Moment: A Lifestyle Intervention for Breast Cancer Survivors

usefulness of each module (e.g., whether each intervention is helpful or not) will be assessed at each mailing (for eight times) for 4 months.

Diet habits (amount of fat and fruit/vegetable uptake) will be assessed at 3 times: at baseline, at the end of the 4 months, and at the end of 7 months.

Frequency and amount of time for physical exercise will be measured at 3 times: at baseline, at the end of 4 months, and at the end of 7 months.

Coping strategies (e.g., problem-focused coping, emotional approach coping) will be assessed at 3 times: at baseline, at the end of the 4 months, and at the end of 7 months.

A general sense of perceived self-efficacy will be measured at 3 times: at the baseline, at the end of 4 months, and at the end of 7 months

Social support will be measured at 3 times: at baseline, at the end of 4 months, and at the end of 7 months

Presence of Meaning and Search for Meaning will be measured at 3 times: at baseline, at the end of 4 months, and at the end of 7 months.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
DeStress for Health: Partnering With Granville and Vance Counties to Reduce Stress and Cancer Risk	NCT03776890	Stress Reductio...	DeStress for He...	18 Years -	Duke University
Step up to Health, Nigeria! Impact of World Cancer Day Walk on Health Behaviors Among Nigerians	NCT04248881	Cancer Preventi...	Healthy Lifesty...	18 Years -	AshtaYoga, LLC
Step up to Health, Nigeria! Impact of World Cancer Day Walk on Health Behaviors Among Nigerians	NCT04248881	Cancer Preventi...	Healthy Lifesty...	18 Years -	AshtaYoga, LLC
Evaluation of Survivorship Wellness Group Program for Patients Treated at University of California, San Francisco (UCSF)	NCT04636905	Cancer	Questionnaires	18 Years -	University of California, San Francisco
Step up to Health, Nigeria! Impact of World Cancer Day Walk on Health Behaviors Among Nigerians	NCT04248881	Cancer Preventi...	Healthy Lifesty...	18 Years -	AshtaYoga, LLC
Targeted Health Dialogues in Primary Care	NCT04912739	Health Behavior... Risk Factors Cardiovascular ... Cancer Serious Disease...	Targeted health...	40 Years - 70 Years	Region Skane
Targeted Health Dialogues in Primary Care	NCT04912739	Health Behavior... Risk Factors Cardiovascular ... Cancer Serious Disease...	Targeted health...	40 Years - 70 Years	Region Skane
Evaluation of Survivorship Wellness Group Program for Patients Treated at University of California, San Francisco (UCSF)	NCT04636905	Cancer	Questionnaires	18 Years -	University of California, San Francisco
Assessing Effectiveness and Implementation of an EHR Tool to Assess Heart Health Among Survivors	NCT03935282	Breast Neoplasm Prostatic Neopl... Colorectal Neop... Endometrial Neo... Hodgkin Disease Non Hodgkin Lym...	AH-HA Tool in t...	18 Years -	Wake Forest University Health Sciences
Step up to Health, Nigeria! Impact of 2022 World Cancer Day Walk on Health Behaviors Among Nigerians	NCT05239325	Cancer Preventi...	World Cancer Da...	18 Years -	AshtaYoga, LLC
A Lifestyle Intervention for Breast Cancer Survivors	NCT01819324	Breast Cancer	Targeting the T... Standardized Li...	18 Years - 80 Years	Hartford Hospital
Step up to Health, Nigeria! Impact of World Cancer Day Walk on Health Behaviors Among Nigerians	NCT04248881	Cancer Preventi...	Healthy Lifesty...	18 Years -	AshtaYoga, LLC
DeStress for Health: Partnering With Granville and Vance Counties to Reduce Stress and Cancer Risk	NCT03776890	Stress Reductio...	DeStress for He...	18 Years -	Duke University

Spots Global Cancer Trial Database for health behaviors