Iris Kanera

48 Chapter 2 In the present study, the strongest correlates in vegetable and fruit consumption were positive intentions, while being women and having a higher education were found to be correlated to meeting vegetable and fruit recommendation in other research (Mayer et al., 2007). Furthermore, we identified that more excessive alcohol drinkers and smokers were less likely to adhere to the fruit recommendation. The latter might be explained by assuming that smokers possibly smoke at times when nonsmokers eat fruit (e.g., during break times at work). These results confirm prior findings that risk behaviors among adults tend to cluster (Spring, King, Pagoto, Van Horn, & Fisher, 2015). Moreover, it is shown that combinations or clustering of risk behaviors might be involved with additional health risks (Bradbury, Appleby, & Key, 2014). To disentangle separate determinants of vegetable and fruit consumption, more specific research is needed. In clinical practice, attention should be given to vegetable and fruit consumption to increase the intake in cancer survivors, preferably tailored to personal attitudes, self-efficiency expectations, and intentions. Adherence to recommendations In our study, the adherence to recommendations (Figure 2.1) was overall more positive in comparison with other studies (Blanchard et al., 2008; O’Neill et al., 2013; Schlesinger et al., 2014). Higher scores on attitude, self-efficacy, and intention of some of the lifestyle behaviors were the strongest correlates with adherence to an increasing number of recommendations (Table 2.6). The strong association between self-efficacy toward nonsmoking and adherence to recommendations could be explained by the presence of never-smokers (43.2%) in our sample. Not much is known about contributing factors in explaining adherence to an increasing number of lifestyle recommendations in cancer survivors, yet. We found that positive mental adjustment contributed ( p = .045), what could be in line with findings from other research, reporting that emotional benefit-finding related to cancer was positively associated with engagement in several health behaviors (Low et al., 2014). Although the two concepts are not the same, we could assume that cancer survivors who are able to cope more positively with their situation might be more likely to be involved in healthier lifestyle behaviors. However, a direction en causality of this association cannot be determined in this study. We emphasize again, that especially for cancer survivors it may be important to live as healthy as possible. Therefore, more insight is needed in the determinants of engagement in as much as possible healthy lifestyle behaviors, and, furthermore, cancer aftercare programs should aim to target multiple lifestyle behaviors.