The role of rurality and area-level disadvantage in lifestyle risk factors and psychological well-being among cancer survivors: findings from the 2021 NCI HINTS-SEER.

Anita M Kumar, Carrie A Miller, Reyna Han, D Jeremy Barsell, Joseph Boyle, Bernard F Fuemmeler

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Article in Cancer causes & control : CCC, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Anita M KumarDepartment of Social Behavioral Sciences, IRACDA Postdoctoral Research Fellow, Virginia Commonwealth University, 830 E. Main Street, Richmond, VA, 23286, USA. kumaram@vcu.edu.ORCID http://orcid.org/0000-0002-2976-996X

Carrie A MillerDepartment of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, VA, USA.ORCID http://orcid.org/0000-0002-8136-7618

Reyna HanVirginia Commonwealth University School of Medicine, Richmond, VA, USA.

D Jeremy BarsellDepartment of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, VA, USA.ORCID http://orcid.org/0000-0003-4641-9176

Joseph BoyleMassey Comprehensive Cancer Center, Richmond, VA, USA.ORCID http://orcid.org/0000-0002-1411-5584

Bernard F FuemmelerDepartment of Social Behavioral Sciences, IRACDA Postdoctoral Research Fellow, Virginia Commonwealth University, 830 E. Main Street, Richmond, VA, 23286, USA.ORCID http://orcid.org/0000-0002-3550-0107

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRural cancer survivors consistently experience poorer health outcomes than their urban counterparts, yet the interplay between rurality and area-level disadvantage remains understudied. This study examines how rural versus urban residence and neighborhood disadvantage relate to obesity, smoking, and psychological well-being among cancer survivors.

methodsData from 1,062 HINTS-SEER participants across three registries were analyzed. Logistic regression models estimated associations between area-level factors (Social Deprivation Index (SDI) and Areas of Persistent Poverty) and health outcomes, adjusting for individual sociodemographic factors. Analyses accounted for complex survey design using Taylor series linearization.

resultsUrban residents showed lower odds of obesity compared with their rural counterparts (OR: 0.69; 95% CI: 0.50-0.95). In stratified analyses, area-level social deprivation demonstrated smaller statistically significant associations. Higher deprivation was associated with increased odds of obesity among urban cancer survivors (OR: 1.01; 95% CI: 1.00-1.02) and increased depression/anxiety among rural survivors (OR: 1.02; 95% CI: 1.00-1.04). Across all models, individual-level socioeconomic factors (education, income) showed stronger, more consistent protective associations than area-level indicators. CONCLUSIONS AND IMPLICATIONS: Area-level disadvantage was a contributor to rural cancer survivors' psychological well-being. Individual socioeconomic status remains the dominant determinant of lifestyle and mental health outcomes. Cancer survivors residing in socioeconomically disadvantaged rural areas may benefit from targeted mental health intervention. Future longitudinal research incorporating census tract-level geographic measures and residential histories is needed to clarify the mechanisms linking the geographic and socioeconomic context to survivorship outcomes.

Indexed as

Cancer SurvivorsLife StyleNeoplasmsRural PopulationAdultAgedFemaleHumansMaleMiddle AgedObesityPsychological Well-BeingRisk FactorsSEER ProgramSocioeconomic Disparities in HealthUnited StatesArea-level disadvantageCancer survivorshipLifestyle health behaviorsPsychological well-beingRural–urban differences

Identifiers

PMID42423918

DOI10.1007/s10552-026-02212-6

PMCPMC13350146

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.