Proper Diet and Lifestyle as Cancer Prevention Strategies - Research Proposal Example

Research Proposal: Proper Diet and Lifestyle as Cancer Prevention Strategies Specific Aims According to the World Health Organization (WHO) (2014), cancer is one of the leading causes of morbidity and mortality for many countries, with around 14 million new cases and 8.2 million dying from it in 2012. Cancer can have genetic causes, but environmental factors are also highly influential variables that could increase cancer risks (Mahabir, 2013). The WHO (2014) asserted that around 30% of people dying from cancer do so because of these five behavioral and dietary risks: “high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, [and] alcohol use.” These risks are external factors that can be managed, which underline the importance of diet and physical activity to reducing cancer risks. Though results for the past few decades are mixed, an increasing number of studies suggested that having the proper diet and lifestyle can prevent, or even cure, a number of chronic diseases, including different types of cancer (Giovannucci et al., 2002; Norat et al., 2005; Wallace et al., 2009). “Proper diet” refers to lower fat and red meat intake and higher vegetable and fruit consumption (Heidemann et al., 2008). Western diet, on the opposite, has been regarded as an unhealthy diet because it is usually high in animal product, sugar, and fat consumption and low in dietary fiber, due to the prevalence of fast food and processed food consumption (Key et al., 2002; Stoll et al., 1998). This Western diet has been correlated to higher cancer risks, including colon and breast cancers (Key et al., 2002; Mahabir, 2013; Stoll et al., 1998). Moreover, by “lifestyle,” this study pertains to the way that people live, including management of alcohol consumption and smoking practices, as well as physical activity levels, life satisfaction with interpersonal relationships, and sleeping habits. This research intends to know if there is a “proper” diet and lifestyle that may reduce cancer risks. It proposes that holistic healthy living can prevent cancer risks, especially for those who have high cancer risks due to their family history and genetic profiles. Holistic healthy living refers to a lifestyle that responds to various needs: nutrition, physical activity, sleep, and social relations. Moreover, by cancer, this proposal covers several cancers, although it recognizes that certain diets and lifestyles may be more effective for some kinds of cancers, and that physical, genetic, and psychological variables can also impact, not only the successful (i.e. consistent and disciplined) adoption of healthy lifestyles and diets, but also the effectiveness of a healthy living approach. The target goals of the proposed research are the following: (1) To determine if a particular diet can reduce cancer risks; (2) To identify if moderate physical activity can decrease cancer risks; (3) To understand the relationship between enough sleep and cancer risks; and (4) To determine the relationship between quality interpersonal relations and cancer risks. Essentially, this study aims to solve a specific problem which is cancer, by examining the role of a holistic lifestyle approach to cancer prevention, and to suggest an alternative approach to preventing cancer that is not centered on drinking medicine, but on changing people’s thinking about their diets and living practices. Proper diet for this paper refers to decreasing or increasing certain food types. It consists of high consumption of vegetables and fruits, low consumption of sugar and fatty food, and low intake of processed food and dairy products. Proper lifestyle refers to zero to low consumption of alcohol, not smoking, physical activity of at least 30 minutes of moderate exercise, or physical activity that reaches the same calories burnt as moderate exercise, and sleeping at least six hours each day, as well as the perception of having positive interpersonal relationships. Research Strategy Significance The importance of this study is connected to the global problem of rising cancer risks (WHO, 2014), especially when many developing countries are embracing and following an unhealthy Western diet that is high on sugar, fats, and calories and low in dietary fiber, through the adoption of eating more fast food and processed food as socioeconomic status improves, or due to misconceptions that these foods are convenient and signs of higher social status (Popkin et al., 2012). Rising cancer risks must be stemmed because of cancer-related morbidity and mortality, with millions getting hospitalized and dying from cancer (WHO, 2014). In other words, to stop cancer by reducing the risks of developing it is to save lives. Furthermore, cancer is an expensive chronic disease due to hospitalization expenses and the costs of associated long-term medical services. The National Institutes of Health (NIH) approximated that, in 2009, the total yearly costs of cancer were $216.6 billion (American Cancer Society, 2014). The Journal of the National Cancer Institute computed the potential health care costs for treating cancer among the U.S. population five years from now. The Institute learned that, by 2020, these costs could reach $158 billion at the minimum (in 2010 dollars) (NIH, 2014). Moreover, as new tools for diagnosing, treating, following-up, and monitoring cancer become increasingly expensive, these medical costs may rocket up to $207 billion (NIH, 2014). Given past medical care costs and future expenses, to prevent cancer will reduce personal and national health care costs. Besides seeking to lessen the costs of cancer, this proposal intends to do research on diets and lifestyles that can improve people’s ability to fight cancer, instead of merely being reactive by focusing on advanced and expensive cancer treatment tools and options. This study will improve scientific knowledge by showing that certain ways of nutrition and living can effectively stave off cancer (Ruiz & Hernández, 2014). Some people may assert that it is common sense to state that proper nutrition and lifestyle can reduce, not only cancer risks, but also the risks for other illnesses, as well, but this thinking is not accepted and applied by many people, nor is there an emphasis in communities and health care organizations regarding a rigorous approach to preventing cancer development (Kenfield et al., 2014). The prevention of illness through systematic, scientifically-monitored education programs for at-risk groups are not widely funded and implemented across the country. This study wants to provide fresh insight about holistic living that is necessary for society to be progressively cancer-free, which can be used to justify and promote a government-funded program. Furthermore, this proposal can also enhance clinical practice in child health and human development, if doctors and related health care institutions or organizations can advance and inculcate a holistic health mindset in communities and schools that may reduce cancer risks, a mindset that should begin with parents and other adults. Many children, for instance, are spending too much time playing on their computers and cellular phones that they are not getting enough sleep. Inadequate sleep may be a trigger of cancer risks, as these kids get used to lack of sleep until their adulthood. Studies that can show some evidence that the right diet and lifestyle are effective in preventing cancer may help convince people that they should embrace proper diet and lifestyle, while they are young, or to do this with their children, to reduce cancer risks in the future (Mahabir et al., 2013). This study has significance in seeking to improve the quality of lives of future generations through preventing the development of high-mortality diseases like cancer. Aside from curbing cancer risks for children and adult populations, this study presents preventative strategies that can be followed even by the poorest, at-risk people, provided that they can also get access to needed health care education and economic resources. Fundamentally, this study wants to help reduce socioeconomic and health gaps by ensuring that the poor and at-risk people (who are prone to obesity, which may increase cancer risk) (Swinburn et al, 2011) can also easily follow cancer prevention strategies, since the proposed holistic living approach does not emphasize the consumption of expensive supplements, or the promotion of buying costly exercise equipment, but relies on indigenous vegetables and fruits and practical and doable lifestyle changes. This study wants to change how doctors advise at-risk patients by highlighting the role of specific food and lifestyle variables in cancer prevention. One of the main concepts of this study is to reject the thinking that the Western diet is part of a symbolic social status that should be aspired for- a kind of thinking that many people in developing countries tend to practice, as their socioeconomic status improves (Valeggia, Burke, & Fernandez-Duque, 2010). It advocates the thinking that a simpler diet and lifestyle that highlight healthy food (e.g. less processed food and fast food) and regular physical activity is actually better than the Western diet that the media shows in its advertisements as a representative of a good life, or, a “progressing” life. Being a regular or heavy consumer of “Big Food,” which pertains to “multinational food and beverage companies with huge and concentrated market power” (Stuckler & Nestle, 2012) is adverse to health and can increase cancer risks (Lucan et al., 2010). This proposal finds it essential to promote a mindset about food and lifestyle that endorses holistic healthy life choices to prevent practicing unhealthy eating and living attitudes and habits. Innovation This study challenges current research because past studies involved only certain aspects of diet or physical activity, or a combination of both, but not proper diet, physical activity, interpersonal relations, and sleep (Giovannucci et al., 2008). Kenfield et al. (2014), Boffetta et al. (2010), and Aune et al. (2011) concentrated on particular diets and their relationship to cancer risks, while Wallace et al. (2009) studied both exercise and dietary factors. The researcher if this proposal has not found a study that considers more variables in its research design, specifically sleep and perception of quality of interpersonal relations. One of the additional factors that this study will consider is sleep deprivation. Wang et al. (in press) discovered that women who work night shifts have increased risks for breast cancer. This article suggests that having inadequate sleep can also be a determining factor in developing cancer. Not getting enough sleep may be an emotional and/or physiological trigger that can increase cancer risks. Another independent variable of this study will be the quality of interpersonal relationships that can help improve stress management and individual happiness (Zhu et al., 2013). Social support can reduce stress that comes from everyday life tribulations, and, since stress may lead to depression or psychological distress that can lead to cancer (Dalton et al., 2002), it is possible that healthy interpersonal relations can also decrease cancer risks. This study believes that social relations are also essential to reducing cancer risks because they can help manage stress and improve happiness. This proposal is also an innovation because it wants to focus on changing how people see food and their ways of life, so that they can make appropriate changes that can make them healthier and more physically capable of fighting cancer. It aims for health care staff working with children, most especially, to help educate children and parents about holistic lifestyle and proper diet as cancer prevention strategies. The novelty of this paper, thus, is in its approach in combining different environmental variables that may impact cancer prevention by enhancing education in support for healthy diet and lifestyles. Moreover, the proposed study is more descriptive than experimental because it will rely on self-reports than actual experimental data collection, but it will also be different from other studies because it recognizes the role of holism in battling cancer risks, as it strives to consider more independent variables in examining cancer risks. It does not want to analyze diets or exercise per se, but diet, exercise, sleep, and relationships altogether. More variables can make the study more complex, but this is precisely its innovation. It does not want to veer away from the possibility that battling cancer will take more than food and exercise, but also precious sleep and interpersonal relationships. Furthermore, this proposal will combine a survey method and self-recording monitoring method to improve the validity of self-report measures. It will use mobile/online application to track food consumed and physical activity. These methods are appropriate to the study because of the monitoring needed to measure the target variables, and because these tools can offer convenience and self-awareness that can enhance monitoring accuracy and, potentially, lower drop-outs. Moreover, survey and self-recording methods can reveal new habits that may be connected to reduced or higher cancer risks. These habits can say something specific about individuals and the groups they belong to, thereby enhancing the particularity of cancer prevention programs in the future. In addition, this study will have an advantage in terms of methodology because it will also improve the validity of questionnaires on diet and lifestyle by including more factors, predominantly, sleep and quality of interpersonal relations, and by using a data adjustment method. An innovation for this study that is not found in many other studies is the use of energy-adjusted variables, which Reedy et al. (2010) suggested. This adjustment is essential because of individual physical differences that can impact energy needs (e.g. body weight). Reedy et al. (2010) stressed that energy adjustment is important because “energy needs are determined by body size, age, physical activity, and other factors and also because diet quality is of greater interest rather than absolute intakes” (p. 486). Energy adjustment can also decrease measurement error that some studies suffered from, although future research would help understand the role of this method to data analysis better (Reedy et al., 2010, p. 486). In addition, an important innovation of this proposal is that it wants to decrease confounding variables to improve the analysis of the connection between dependent and independent variables. It assesses the role of sleep, interpersonal relations, and physical activity, independently, or altogether, in affecting cancer risks. Hence, this proposed study has innovations in its approach and instrumentation. Approach Data Collection: The research design of this proposed study is a prospective cohort study that measures absolute cancer risk. This research design is chosen because it has been used in similar past studies that also aim to determine the correlation between diet and lifestyle factors, on the one hand, and cancer risk, on the other hand (Aune et al., 2011; Boffetta et al., 2010). This design’s weaknesses are that self-reports can have truth or accuracy issues and that drop-out of participants can impact external validity. Despite these weaknesses, this design is a valid approach in answering this proposal’s research questions because it is essential to know the internal consistency of diet and lifestyle habits across time, and because a prospective cohort study can help enhance the attainment of the former. Moreover, to enhance data collection, this study aims to improve convenience for target participants through conducting online/mail communication and data collection methods. Since many people use the Internet and have smartphones, these tools will be indispensable in capturing more accurate data than when documentation is done by hand or manually. The target sampling would be a specific community and college where the researcher resides and studies. The local health government will be contacted to ask for their permission to conduct this study, to get addresses, and to contact residents by e-mail and/or mail. All participants will be sent electronic and/or paper mail to inform them about the survey and how it intends to help reduce chronic illnesses in the neighborhood. They will also be ensured that the privacy and confidentiality of their information will be safeguarded through passwords for all data and files generated from this study. Cancer would not be specifically mentioned because it may result to unconscious or conscious awareness of this illness that may distort self-reported data. Those who respond and agree to participate in the study would be provided a small amount of compensation for their time, as the data collection will include self-monitoring diet and lifestyle practices for one year. The independent variables pertain to diet and lifestyle factors, while the dependent factor is cancer risk. It is expected that those who follow proper diet and lifestyle have lower cancer risks than those who do not. It is also expected that eating more processed food and dairy products can increase cancer risk. The cancer risks to be examined are breast cancer, colon cancer, and prostate cancer. They are chosen because two are gender-based and one can happen to both genders. At baseline, participants will receive a mailed general questionnaire that will have questions on demographics, chronic diseases, risk factors for chronic diseases, and number of hours of sleep for every 24 hours (Patel et al., 2004). The questionnaire will also ask if they are satisfied with their interpersonal relationships, particularly, family, friends, neighborhood, and community. Smoking habits will also be measured through answering a questionnaire, where people will be categorized into current, past, and never smoker, and parental history on having diabetes which includes none, one, or both parents (Sluijs et al., 2010, p. 44). Physical activity will be measured through the Cambridge Physical Activity Score. To measure food consumed, the self-administered food-frequency questionnaire (FFQ) will be used (Sluijs et al., 2010). Furthermore, since underreporting or overreporting of food consumption can produce higher extraneous variation, the researcher will adjust the dietary pattern scores through the residual method (Heidemann et al, 2008). To also decrease random within-person variation and to represent long-term diet, the cumulative averages of the dietary pattern scores will be calculated (Heidemann et al, 2008). In addition, to validate self-report measures, participants will be asked to log in their daily food intake, where they will send a picture of their food intake to the researcher’s e-mail every day. This will serve as a food diary record for twelve months. They will also log in their physical fitness activities and minutes consumed per activity using the mobile application Fit. The combination of FFQ and other self-monitoring tools can also decrease the potential inaccuracy of self-report measures. Finally, a secondary research will be done for data interpretation. Research for the past five years will be used to assess the correlation between dietary and lifestyle variables and cancer risks for different groups. It can provide information on how to interpret the data in terms of past concepts and theories regarding cancer development and nutrition. Secondary data will also help understand the weaknesses of this study and future directions. It can also improve the knowledge in alternative explanations and how moderating factors can be controlled and determined. Data Analysis: Analysis will be done through Cox regression. This is an appropriate method because it is commonly used in cohort studies. The proportional hazard assumption for red meat, fish, poultry intake, processed food, and dairy food variables will be done in relation to cancer risk through the likelihood ratio test, and the models will be compared with and without product terms for these variables (Heidemann et al, 2008). Data will also be stratified by center to control the differences in questionnaire design and other environmental effects (Heidemann et al, 2008). The researcher will also perform stratified analysis to determine if the relationship between dietary and lifestyle patterns and risk of mortality was influenced by age “(3.5 h/wk), smoking status (current smokers versus nonsmokers), or overweight status ( Read More