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Examining the mediating role of cancer‐related problems on spirituality and self‐rated health among African American cancer survivors: a report from the American Cancer Society's Studies of Cancer Survivors‐II
Author(s) -
Best Alicia L.,
Alcaraz Kassandra I.,
McQueen Amy,
Cooper Dexter L.,
Warren Rueben C.,
Stein Kevin
Publication year - 2015
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.3720
Subject(s) - spirituality , moderation , cancer , clinical psychology , ethnic group , medicine , path analysis (statistics) , distress , gerontology , psychology , social psychology , alternative medicine , pathology , statistics , mathematics , sociology , anthropology
Objective African American (AA) cancer survivors report poorer self‐rated health (SRH) compared to other racial/ethnic groups. Spirituality is often linked to positive health outcomes, with AAs reporting greater levels of spirituality. This study examined the potential mediating role of cancer‐related problems in the relationship between spirituality and SRH among AA cancer survivors compared to non‐African American (non‐AA) survivors. Methods We analyzed data on 9006 adult cancer survivors from the American Cancer Society's Study of Cancer Survivors‐II. Preliminary analyses compared characteristics of AAs and non‐AAs and identified significant covariates of SRH. We tested a path model using multi‐group structural equation modeling (SEM), and then examined race as a moderator. Results Of the three domains of spirituality assessed, AAs had higher levels of peace ( p < .001) and faith ( p < .001), but not meaning , compared to non‐AAs; and of four domains of cancer‐related problems assessed, AAs had greater physical distress ( p < .001), emotional distress ( p < .001), and employment / finance problems ( p < .001), but not fear of recurrence . In SEM analyses adjusting for number of comorbidities and income, race moderated the impact of spirituality and cancer‐related problems on SRH. Specifically, spirituality had significantly stronger associations with cancer‐related problems among AAs than non‐AAs. Spirituality was positively associated with all four domains of cancer‐related problems, but only physical distress was associated with SRH among AAs. Conclusions The negative effects of physical distress may attenuate the positive effects of spirituality on AA's SRH. Future studies should consider racial/ethnic differences in the determinants and conceptualization of SRH, which is a known predictor of survival. Copyright © 2014 John Wiley & Sons, Ltd.