{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:06:30Z","timestamp":1788977190036,"version":"build-2803163510"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cancer Surviv"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Cancer caregivers experience heightened psychological distress, yet the cumulative impact of modifiable health behaviors on mental distress remains understudied. We evaluated the association between individual and cumulative protective factors and frequent mental distress (FMD) among U.S. cancer and non-cancer caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional analysis was conducted using data from the 2022 BRFSS data. Adult caregivers were identified and classified according to whether the individual provided care to an individual with cancer. FMD was defined as\u2009\u2265\u200914\u00a0days of poor mental health in the past 30\u00a0days. Protective factors included sufficient sleep, regular physical activity, non-smoking status, and adequate emotional support. A Cumulative Protective Factor Score (range, 0\u20134) was constructed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 10,923 caregivers, 1,483 (13.6%) were cancer caregivers. FMD was more prevalent in cancer caregivers than non-cancer caregivers (314 [21.6%] vs 1,227 [13.0%],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), who also reported fewer protective factors. Each individual protective factor was associated with lower odds of FMD (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), although these associations were attenuated among cancer caregivers for sleep, physical activity, and emotional support. Predicted probabilities of FMD declined progressively with increasing cumulative protective factor scores in both cohorts. At the highest score (4), predicted FMD was similar in cancer and non-cancer caregivers (10% vs 7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.12). Among cancer caregivers, females exhibited higher predicted FMD than males across all cumulative protective factor levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cancer caregivers experience disproportionately high mental distress, particularly when protective resources are limited. However, the co-occurrence of multiple health-promoting behaviors and emotional support may offset this burden. Sex-based disparities persisted, underscoring the need for tailored, caregiver-centered support strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Cancer Survivors<\/jats:title>\n                    <jats:p>Supporting caregivers of cancer survivors through interventions that promote healthy behaviors and emotional support may reduce mental distress and improve survivorship care outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11764-026-02120-3","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:11:07Z","timestamp":1788973867000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Buffering the burden: health behaviors, mental distress, and sex disparities in U.S. cancer caregivers"],"prefix":"10.1007","author":[{"given":"Areesh","family":"Mevawalla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azza","family":"Sarfraz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qaidar","family":"Alizai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meher","family":"Angez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Bega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Qasim","family":"Chaudhry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajia","family":"Ashraf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Elemosho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odysseas P.","family":"Chatzipanagiotou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"2120_CR1","unstructured":"CDC. Dementia Caregiving as a Public Health Strategy. Caregiving. January 31, 2025. Accessed December 19, 2025. https:\/\/www.cdc.gov\/caregiving\/php\/public-health-strategy\/index.html."},{"issue":"4","key":"2120_CR2","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1001\/jama.2012.29","volume":"307","author":"M Bevans","year":"2012","unstructured":"Bevans M, Sternberg EM. Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA. 2012;307(4):398\u2013403. https:\/\/doi.org\/10.1001\/jama.2012.29.","journal-title":"JAMA"},{"key":"2120_CR3","unstructured":"Centers for Disease Control and Prevention. Caregiving for family and friends-a public health issue.\u00a0https:\/\/stacks.cdc.gov\/view\/cdc\/85158. Accessed 19 Dec 2026."},{"key":"2120_CR4","unstructured":"CDC. Dementia Caregiving as a Public Health Strategy. Caregiving. January 31, 2025. Accessed December 19, 2025. https:\/\/www.cdc.gov\/caregiving\/php\/public-health-strategy\/index.html."},{"key":"2120_CR5","doi-asserted-by":"publisher","first-page":"1059605","DOI":"10.3389\/fpsyg.2023.1059605","volume":"14","author":"Z KarimiMoghaddam","year":"2023","unstructured":"KarimiMoghaddam Z, Rostami M, Zeraatchi A, MohammadiBytamar J, Saed O, Zenozian S. Caregiving burden, depression, and anxiety among family caregivers of patients with cancer: an investigation of patient and caregiver factors. Front Psychol. 2023;14:1059605. https:\/\/doi.org\/10.3389\/fpsyg.2023.1059605.","journal-title":"Front Psychol"},{"key":"2120_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2025.108165","author":"AR Medlin","year":"2025","unstructured":"Medlin AR, Abrams HR, Kent EE, Ogunjesa BA, Park S, Tan KR. Variations in mental distress among caregivers of individuals with chronic illnesses and comorbid cognitive impairment. Am J Prev Med. 2025. https:\/\/doi.org\/10.1016\/j.amepre.2025.108165. (Published online October 22).","journal-title":"Am J Prev Med"},{"issue":"7","key":"2120_CR7","doi-asserted-by":"publisher","first-page":"e7157","DOI":"10.1002\/cam4.7157","volume":"13","author":"EA Johnston","year":"2024","unstructured":"Johnston EA, Collins KE, Vicario JN, Sibthorpe C, Ireland MJ, Goodwin BC. Changes in rural caregivers\u2019 health behaviors while supporting someone with cancer: a qualitative study. Cancer Med. 2024;13(7):e7157. https:\/\/doi.org\/10.1002\/cam4.7157.","journal-title":"Cancer Med"},{"issue":"1","key":"2120_CR8","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1080\/21642850.2020.1838282","volume":"8","author":"H Tough","year":"2020","unstructured":"Tough H, Brinkhof MWG, Fekete C. Is informal caregiving at odds with optimal health behaviour? A cross-sectional analysis in the caregiving partners of persons with spinal cord injury. Health Psychol Behav Med. 2020;8(1):526\u201342. https:\/\/doi.org\/10.1080\/21642850.2020.1838282.","journal-title":"Health Psychol Behav Med"},{"key":"2120_CR9","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1186\/s12889-022-14127-3","volume":"22","author":"H Tough","year":"2022","unstructured":"Tough H, Brinkhof MWG, Fekete C. Untangling the role of social relationships in the association between caregiver burden and caregiver health: an observational study exploring three coping models of the stress process paradigm. BMC Public Health. 2022;22:1737. https:\/\/doi.org\/10.1186\/s12889-022-14127-3.","journal-title":"BMC Public Health"},{"key":"2120_CR10","unstructured":"Stress, Employment Changes, and Psychological Distress Among Caregivers of Patients With Head and Neck Cancer | Psychiatry and Behavioral Health | JAMA Otolaryngology\u2013Head & Neck Surgery | JAMA Network. Accessed December 19, 2025. https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2832490."},{"issue":"6","key":"2120_CR11","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1007\/s00038-020-01402-6","volume":"65","author":"S Gottschalk","year":"2020","unstructured":"Gottschalk S, K\u00f6nig HH, Brettschneider C. The association between informal caregiving and behavioral risk factors: a cross-sectional study. Int J Public Health. 2020;65(6):911\u201321. https:\/\/doi.org\/10.1007\/s00038-020-01402-6.","journal-title":"Int J Public Health"},{"key":"2120_CR12","doi-asserted-by":"publisher","unstructured":"Mevawalla A, Khalil M, Rashid Z, Altaf A, Sarfraz A, Pawlik TM. Cancer screening adherence among e-cigarette users in the United States. Tob Prev Cessat. 2025;11. https:\/\/doi.org\/10.18332\/tpc\/207098.","DOI":"10.18332\/tpc\/207098."},{"key":"2120_CR13","unstructured":"CDC. Life Satisfaction & Healthy Days. Mental Health. August 25, 2025. Accessed December 20, 2025. https:\/\/www.cdc.gov\/mental-health\/about-data\/life-satisfaction.html."},{"issue":"9","key":"2120_CR14","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1002\/da.22386","volume":"32","author":"L Zhai","year":"2015","unstructured":"Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32(9):664\u201370. https:\/\/doi.org\/10.1002\/da.22386.","journal-title":"Depress Anxiety"},{"issue":"4","key":"2120_CR15","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.amepre.2019.05.012","volume":"57","author":"CP McDowell","year":"2019","unstructured":"McDowell CP, Dishman RK, Gordon BR, Herring MP. Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies. Am J Prev Med. 2019;57(4):545\u201356. https:\/\/doi.org\/10.1016\/j.amepre.2019.05.012.","journal-title":"Am J Prev Med"},{"key":"2120_CR16","unstructured":"2022 BRFSS Questionnaire. Published online 2023."},{"key":"2120_CR17","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.jad.2022.01.095","volume":"302","author":"GE Kim","year":"2022","unstructured":"Kim GE, Kim MH, Lim WJ, Kim SI. The effects of smoking habit change on the risk of depression-analysis of data from the Korean National Health Insurance Service. J Affect Disord. 2022;302:293\u2013301. https:\/\/doi.org\/10.1016\/j.jad.2022.01.095.","journal-title":"J Affect Disord"},{"key":"2120_CR18","doi-asserted-by":"publisher","unstructured":"Bruss KV. Loneliness, lack of social and emotional support, and mental health issues \u2014 United States, 2022. MMWR Morb Mortal Wkly Rep. 2022. https:\/\/doi.org\/10.15585\/mmwr.mm7324a1. Accessed 19 Dec 2026.","DOI":"10.15585\/mmwr.mm7324a1"},{"issue":"6","key":"2120_CR19","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1177\/0193945913510211","volume":"36","author":"ML Longacre","year":"2014","unstructured":"Longacre ML, Ross EA, Fang CY. Caregiving choice and emotional stress among cancer caregivers. West J Nurs Res. 2014;36(6):806\u201324. https:\/\/doi.org\/10.1177\/0193945913510211.","journal-title":"West J Nurs Res"},{"issue":"3","key":"2120_CR20","doi-asserted-by":"publisher","first-page":"igae017","DOI":"10.1093\/geroni\/igae017","volume":"8","author":"J Cho","year":"2024","unstructured":"Cho J, Sands LP, Stevens AB, Allore HG, Horstman MJ. Profile of caregiving activities and association with physical health among dementia spousal caregivers. Innov Aging. 2024;8(3):igae017. https:\/\/doi.org\/10.1093\/geroni\/igae017.","journal-title":"Innov Aging"},{"issue":"6","key":"2120_CR21","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1001\/jamapsychiatry.2022.0609","volume":"79","author":"M Pearce","year":"2022","unstructured":"Pearce M, Garcia L, Abbas A, et al. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiat. 2022;79(6):550\u20139. https:\/\/doi.org\/10.1001\/jamapsychiatry.2022.0609.","journal-title":"JAMA Psychiat"},{"issue":"3","key":"2120_CR22","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1002\/wps.20773","volume":"19","author":"J Firth","year":"2020","unstructured":"Firth J, Solmi M, Wootton RE, et al. A meta\u2010review of \u201clifestyle psychiatry\u201d: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360\u201380. https:\/\/doi.org\/10.1002\/wps.20773.","journal-title":"World Psychiatry"},{"key":"2120_CR23","unstructured":"Multicomponent Intervention for Distressed Informal Caregivers of People With Dementia: A Randomized Clinical Trial | Geriatrics | JAMA Network Open | JAMA Network. Accessed December 20, 2025. https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2831650."},{"issue":"1","key":"2120_CR24","doi-asserted-by":"publisher","first-page":"e0189849","DOI":"10.1371\/journal.pone.0189849","volume":"13","author":"P Gellert","year":"2018","unstructured":"Gellert P, H\u00e4usler A, Suhr R, et al. Testing the stress-buffering hypothesis of social support in couples coping with early-stage dementia. PLoS One. 2018;13(1):e0189849. https:\/\/doi.org\/10.1371\/journal.pone.0189849.","journal-title":"PLoS One"},{"issue":"12","key":"2120_CR25","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.1097\/01.MLR.0000036408.76220.1F","volume":"40","author":"M Navaie-Waliser","year":"2002","unstructured":"Navaie-Waliser M, Spriggs A, Feldman PH. Informal caregiving: differential experiences by gender. Med Care. 2002;40(12):1249\u201359. https:\/\/doi.org\/10.1097\/01.MLR.0000036408.76220.1F.","journal-title":"Med Care"},{"issue":"1","key":"2120_CR26","doi-asserted-by":"publisher","first-page":"P33","DOI":"10.1093\/geronb\/61.1.P33","volume":"61","author":"M Pinquart","year":"2006","unstructured":"Pinquart M, S\u00f6rensen S. Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis. J Gerontol Ser B. 2006;61(1):P33\u201345. https:\/\/doi.org\/10.1093\/geronb\/61.1.P33.","journal-title":"J Gerontol Ser B"},{"key":"2120_CR27","unstructured":"Women and Caregiving: Facts and Figures. Accessed December 20, 2025. https:\/\/www.caregiver.org\/resource\/women-and-caregiving-facts-and-figures\/."},{"key":"2120_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-025-02565-5","volume":"24","author":"M del R\u00edo-Lozano","year":"2025","unstructured":"del R\u00edo-Lozano M, Mora DJ, Maroto-Navarro G, Oca\u00f1a-Riola R, Garc\u00eda-Calvente MdelM. Gender inequalities of caregiver mental health and burden in the three years post COVID-19 (CUIDAR-SE study). Int J Equity Health. 2025;24:282. https:\/\/doi.org\/10.1186\/s12939-025-02565-5.","journal-title":"Int J Equity Health"},{"issue":"2","key":"2120_CR29","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s00520-024-09095-w","volume":"33","author":"EYN Yuen","year":"2025","unstructured":"Yuen EYN, Toke S, Macpherson H, Wilson C. Factors which influence social connection among cancer caregivers: an exploratory, interview study. Support Care Cancer. 2025;33(2):92. https:\/\/doi.org\/10.1007\/s00520-024-09095-w.","journal-title":"Support Care Cancer"},{"issue":"17","key":"2120_CR30","doi-asserted-by":"publisher","first-page":"3212","DOI":"10.1002\/cncr.30759","volume":"123","author":"LS Porter","year":"2017","unstructured":"Porter LS, Dionne-Odom JN. Supporting cancer family caregivers: how can frontline oncology clinicians help? Cancer. 2017;123(17):3212\u20135. https:\/\/doi.org\/10.1002\/cncr.30759.","journal-title":"Cancer"},{"key":"2120_CR31","doi-asserted-by":"publisher","unstructured":"Caring for Caregivers: An Overdue Need for Effective Intervention. ASCO Connection. Accessed December 20, 2025. https:\/\/connection.asco.org\/do\/https:\/\/doi.org\/10.1200\/ACON.23.00091\/full\/.","DOI":"10.1200\/ACON.23.00091\/full"},{"key":"2120_CR32","unstructured":"CARE Act Legislation | Long-Term Services and Supports State Scorecard. January 31, 2024. Accessed December 20, 2025. https:\/\/ltsschoices.aarp.org\/scorecard-report\/2023\/dimensions-and-indicators\/care-act-legislation."},{"key":"2120_CR33","doi-asserted-by":"publisher","first-page":"S94","DOI":"10.1016\/j.pec.2010.08.022","volume":"81","author":"LL DuBenske","year":"2010","unstructured":"DuBenske LL, Chih MY, Gustafson DH, Dinauer S, Cleary JF. Caregivers\u2019 participation in the oncology clinic visit mediates the relationship between their information competence and their need fulfillment and clinic visit satisfaction. Patient Educ Couns. 2010;81:S94\u20139. https:\/\/doi.org\/10.1016\/j.pec.2010.08.022.","journal-title":"Patient Educ Couns"},{"key":"2120_CR34","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35303","author":"KM McConnell","year":"2024","unstructured":"McConnell KM. The need for multilevel supportive care infrastructure for cancer caregivers. Cancer. 2024. https:\/\/doi.org\/10.1002\/cncr.35303.","journal-title":"Cancer"},{"issue":"12","key":"2120_CR35","doi-asserted-by":"publisher","first-page":"1768","DOI":"10.2105\/ajph.83.12.1768","volume":"83","author":"AD Stein","year":"1993","unstructured":"Stein AD, Lederman RI, Shea S. The Behavioral Risk Factor Surveillance System questionnaire: its reliability in a statewide sample. Am J Public Health. 1993;83(12):1768\u201372. https:\/\/doi.org\/10.2105\/ajph.83.12.1768.","journal-title":"Am J Public Health"}],"container-title":["Journal of Cancer Survivorship"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11764-026-02120-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11764-026-02120-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11764-026-02120-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:11:10Z","timestamp":1788973870000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11764-026-02120-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":35,"alternative-id":["2120"],"URL":"https:\/\/doi.org\/10.1007\/s11764-026-02120-3","relation":{},"ISSN":["1932-2259","1932-2267"],"issn-type":[{"value":"1932-2259","type":"print"},{"value":"1932-2267","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"assertion":[{"value":"26 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}