All ETDs from UAB

Advisory Committee Chair

Wendy Demark-Wahnefried

Advisory Committee Members

Jose R Fernandez

Julie L Locher

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Health Professions


Background: Rural Americans have poorer overall health and physical functioning than their urban counterparts. A varied diet, rich in vegetable and fruit (V&F) consumption may improve health; however, little is known about rural-urban differences in V&F consumption, especially in older cancer survivors. Objective: To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type. Design: This was a cross-sectional secondary analysis. Participants/setting: Screening data from the Harvest for Health trial was obtained on 731 Medicare-eligible cancer survivors across Alabama. Main outcome measures: V&F consumption was measured by 2-items from the Eating at America’s Table NCI Dietary Screener. Rural and urban residence was coded at the zip-code level using the USDA’s Rural-Urban Commuting Area (RUCA) coding schema using five different classifications (A-E). Sex, race and cancer-type were dichotomized as male/female, Non-Hispanic White (NHW)/Non-Hispanic Black (NHB) and gastro-intestinal (GI) /other cancers, respectively. Statistical analyses: Kruskal Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α<0.05). Results: V&F consumption of cancer survivors living in isolated, small, rural towns was roughly half that consumed by survivors living elsewhere; thus, statistically significant rural-urban differences were found in models that accounted specifically for this subgroup, i.e., RUCA categorizations A and E, but not B-D. V&F consumption also was significantly lower in NHBs (1.32 ± 0.98 cups/day) than NHWs (1.51 ± 1.10 cups/day) (p=0.0456); however, no statistically significant differences were detected by sex and cancer type. Conclusion: Analyses that address the variability within “rural” designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, i.e., older cancer survivors living in isolated, small, rural towns, as well as among NHBs, to best target future interventions.