Iris Kanera

7 157 General Discussion Prevalence of vegetable and fruit consumption Overall, prior (inter) national studies confirm the low prevalence (9% - 34%) of vegetable and fruit consumption among several cancer survivor populations (Blanchard et al., 2008; LeMasters et al., 2014; Winkels et al., 2016), despite differences in e.g., measurement, cancer type, and time from diagnosis. Increasing vegetable and fruit consumption should be promoted given the health benefits (e.g., reduction of fatigue, improvement of quality of life [QoL], reduced overall mortality; Emaus et al., 2016; Gong et al., 2017; Schwedhelm, Boeing, Hoffmann, Aleksandrova, & Schwingshackl, 2016; Zick et al., 2017). Adherence to the vegetable and fruit recommendation of our study population was among the middle ranking countries, which is not surprising considering the Dutch middle ranking position with regard to vegetable and fruit consumption in the general adult populations in Europe (European Food Information Council, 2012). Social cognitive correlates of vegetable and fruit consumption In our study, vegetable and fruit consumption were positively associated with intention only. During the social cognitive model-based statistical analysis, self-efficacy (for fruit consumption), and both self-efficacy and attitude (for vegetable consumption) contributed significantly before intention was added to the model, which is conform the Reasoned Action Approach and suggest that intention mediates the influence of attitude and self- efficacy on behavior (Fishbein & Ajzen, 2010). Our cancer survivor population did not express a need for dietary support, which created the suspicion of a potential vegetable intake misconception (Willems et al., 2016). Others studies revealed that individuals might have an unrealistic estimation (overestimation) of their personal vegetable intake (Bogers, Brug, van Assema, & Dagnelie, 2004a). To increase cancer survivors’ vegetable intake they need to be made aware of their real vegetable intake first, which requires specific supportive strategies. There is a scarcity in results concerning social cognitive correlates of adherence to vegetable and fruit recommendations among Dutch cancer survivors. Nevertheless, a systematic review of social cognitive theory-based dietary behavior interventions for cancer survivors revealed that self-efficacy was associated with positive dietary changes confirming our results (Stacey et al., 2015). Prevalence of smoking With regard to active smoking among cancer survivors, (inter) national smoking prevalence ranges from 5% to 46%; 18% being the prevalence in our study described in Chapter 2 (Bours et al., 2015; Coups & Ostroff, 2005; Del Valle et al., 2014; Mowls et al., 2016; Thong et al., 2016; Weaver et al., 2013b; Westmaas et al., 2014). Differences in registration and regional variations might account for this variation in smoking prevalence. Moreover, also differences in cancer type and age were due to variations in smoking prevalence (Coups &