There are many barriers that may prevent individuals from being physically active, including cost and access to fitness facilities, lack of green spaces, and family obligations (176). These barriers are exacerbated in racial and ethnic minorities and other medically underserved populations. Based on recent data, physical inactivity is higher in Hispanics (31.7 percent) and non-Hispanic Blacks (30.3 percent), compared to nonHispanic Whites (23.4 percent) (177). There are also geographic disparities, with only 16 percent of people in suburban and rural areas meeting the recommended physical activity guidelines, compared to 27.8 percent of those living in urban areas (170). Developing widespread campaigns to increase physical activity in the U.S. population is vital if we are to change the current trends. As one example, The Active People, Healthy Nation initiative aims to help 27 million people become more physically active by 2027 by designing activity-friendly communities, encouraging physical activity at school, and engaging community leaders to implement relevant programs to encourage physical activity. Poor diet, consisting of processed foods and lacking fresh fruits or vegetables, is responsible for the development of about five percent of all cancers, with several studies demonstrating a link between consumption of highly processed foods and cancer incidence (179). It is therefore concerning that U.S. adults consumed about seven percent more highly processed foods in 2017-2018 than they did in 2001-2002 (180). Highly processed foods lack fiber and include high amounts of added sugar, salt, fats, preservatives, and additives in their ingredients (see Sidebar 12, p. 45). Research has shown that high consumption of ultra-processed foods is associated with an increased risk of colorectal cancer (181). On the other hand, a diet rich in fresh fruits and vegetables, nuts, whole grains, and fish can help lower the risk of developing certain cancers and many other chronic conditions. For instance, one study of nearly 80,000 men from diverse backgrounds showed that adherence to a healthy diet lowered risk for certain types of colorectal cancers (182). There is growing appreciation of following healthy and balanced dietary patterns rather than eating more of a specific nutrient. For instance, a Mediterranean Diet emphasizes consumption of plant-based foods and healthy fats, which allows individuals to customize their diet to fit their tastes and preferences. The widespread availability and low cost of fast food—food that can be prepared quickly and easily and is sold in restaurants and snack bars as a quick meal or to be taken out—led to 37 percent of U.S. adults (ages 40 to 59) and 45 percent of U.S. young adults (ages 20 to 39) consuming these on any given day during 20132016 (184). Unfortunately, fast foods are highly processed, calorie dense, high in salt content, and low in fiber, making them of poor nutritional value. It is also concerning that fast food consumption is higher among racial or ethnic minorities with 43 percent of non-Hispanic Black adults versus 36 percent of non-Hispanic White adults consuming fast food between 2013 and 2016, the most recent timeframe for which these data are available (184). Disparities in diet quality among different segments of the U.S. population can be attributed to socioeconomic and geographic factors, which contribute to food insecurity. Food insecurity is defined by the United States Department of Agriculture (USDA) as the lack of access by all people in a household at all times to enough food for an active, healthy life. Studies show that food insecurity is higher among racial or ethnic minorities and those who live in poverty. These communities are often located in neighborhoods that are considered “food deserts,” which are areas that have low availability of healthy foods like fresh fruit and vegetables and an abundance of fast-food options. Community-driven initiatives administered through key partners, such as faith-based organizations, schools, and local food retailers, are one mechanism to promote healthy eating. Sugar-sweetened beverages are a major contributor to caloric intake among U.S. youth and adults, and there are emerging data indicating that consumption of sugar-sweetened beverages may be associated with an increased risk of cancer (4). In certain rural areas, for example the Appalachia region, local interventions have led to a reduction in consumption of sugar-sweetened beverages, and increased consumption of vegetables (185). The Philadelphia Beverage Tax on sugar-sweetened beverages, implemented in 2017, increased the cost of sodas and juices that contain sugar by 1.5 cents per ounce. The tax led to demonstrated reductions in the consumption of sugar-sweetened beverages (186), with one study indicating as much as a 42 percent drop in the sale of these types of beverages after two years (187). The tax revenue generated is used to fund early-education programs (including free universal pre-K), healthy messaging, and upgrades to playground equipment (188). Pilot initiatives like these need to be closely examined to determine their long-term health effects and impact on diet, obesity, and cancer burden. Reduce Risk of Diabetes Diabetes affects 11.3 percent of the U.S. population, equating to 37.3 million people (189). Evidence shows that having type 1 or type 2 diabetes increases the risk of developing liver, pancreatic, endometrial, colorectal, breast, and bladder cancers. Type 2 diabetes, a condition in which the body cannot regulate sugar properly, can be attributed to genetic factors as well as modifiable risk factors, some of which are also risk factors for cancer, such as obesity, poor diet, physical inactivity, and smoking. Recent studies have shown that many health conditions that are common among those with diabetes, including high Researchers found that the use of lowcost activity trackers led users to walk 40 additional minutes per day (178). 89 19:25 AACR Cancer Progress Report 2023 Reducing the Risk of Cancer Development 44
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