Of the 1,520 surveys, 52% were completed by men with 48% by women. As shown in Table 1, the median age of respondents was 53 years, 70% were White, 46.3% had attended some college or completed college, 76.5% were currently employed, and 87.6% were married or living with a partner. Forty-five percent of respondents owned their own home, 60% were born in the U.S. and 80.9% spoke all or mostly English. While 78% reported an annual household income ranging from $35,000-$74,999, 47% indicated that they were finding it difficult or very difficult to get by on their present income. Eighty percent of respondents resided in an urban area. Figure 1 shows the statewide distribution of completed surveys.
With regards to cancer-related beliefs and cancer prevention behaviors, most respondents (59%) believed they were unlikely to get cancer in their lifetime while 34% were extremely or somewhat worried about getting cancer (Table 2). Most respondents held fatalistic beliefs about cancer, with 56% agreeing with the statement ‘when I think about cancer, I think about death’. The majority also agreed that ‘it seems like everything causes cancer’ (55%), ‘it’s hard to know what cancer prevention recommendations to follow’ (61%), ‘there’s not much you can do to lower your chances of getting cancer’ (53%), and ‘I’d rather not know about my chances of getting cancer’ (54%).
We explored overall rates of cancer prevention/risk reduction behaviors and then examined differences between groups based on their country of birth, area of residence (urban vs. rural), income, and education levels. Overall, 35.6% of eligible participants reported receiving a human papilloma virus (HPV) vaccine and only 72.6% received all three shots. The average days respondents engaged in moderate exercise was 3.55 (s.d=1.42). Current smoking was reported among 37.6% of our participants and the percentage of respondents who reported never drinking was 11.8%.
When cancer prevention behaviors were stratified by country of birth, significant differences were observed on all but two questions (number of HPV shots and alcoholic drink frequency) (See Table 3). Significant differences were observed by country of birth on HPV vaccination rates (p < 0.001), number of days of moderate exercise per week (p < 0.001), and smoking rates (p = 0.003). Specifically, respondents from Puerto Rico and the rest of the United States had significantly higher HPV vaccination rates than respondents from Mexico, Cuba, or other Latin American countries. Further, respondents born in Mexico and Cuba reported the highest average days of moderate exercise per week while those from the USA had the highest smoking rates. No significant differences were observed in any of these 5 cancer prevention behaviors by area of residence (Table 3).
Several significant differences were observed in behaviors by levels of income and education (see Table 4). Generally, significant differences were found across income levels in the number of HPV shots received (p = 0.009), the number who currently smoke cigarettes (p = 0.018), the frequency of drinking alcohol (p < 0.001), and the number of days engaging in moderate physical activity per week (p < 0.001). Individuals in the lowest income group were found to drink and smoke significantly less than those with higher incomes. Conversely, respondents with low incomes were more likely to report they received the full course of 3 HPV shots than individuals with higher incomes. Similar differences were observed across education levels.
When we examined pairwise comparisons in these measures across education levels the patterns were more complex. Participants who had completed college or higher had received the fewest number of HPV shots, and exercised the fewest number of days on average. Those who completed high school or had some college had the highest percentage of people who smoked cigarettes. Finally, the frequency of drinking alcohol was similar across education levels except for those who completed high school; this group had the lowest percentage who never drank alcohol (see Table 4).
To clarify these relationships, we examined predictors cancer prevention/risk reduction behaviors using multivariate regression models. Our first model examined the probability of participants having received the HPV vaccine based on a variety of sociodemographic, and cancer belief variables. From this model, we saw that individuals who were less worried about getting cancer (p < 0.001), males (p < 0.001), higher income earners (p = 0.018), those born outside of the USA (p < 0.001), and those employed less than full-time (p < 0.001) were less likely to have received the HPV vaccine. Conversely, we saw that individuals who reported higher levels of financial adequacy (p < 0.001), and white individuals (p = 0.022) were more likely to have received the HPV vaccine (Table 5).
We then constructed a linear regression model to examine predictors of the number of days of moderate physical activity per week, a continuous outcome (Table 6). From this model we saw that the average number of days of physical activity per week across the entire sample was 2.07 and that individuals who were less worried about getting cancer or assessed their risk of getting cancer as unlikely reported more days of moderate physical activity (p < 0.001). Similarly, we saw that males (p < 0.001), higher income earners (p < 0.001), individuals from Mexico (p = 0.02), and those not employed or employed less than full-time (p < 0.001) had more days of moderate physical activity per week. Interestingly, while higher income levels were associated with more days of physical activity generally, greater financial adequacy predicted a lower number of days of physical activity per week (p < 0.001). This suggested that the financial adequacy variable is capturing some variation not directly related to household income (Table 6).
Table 7 shows our multivariate linear regression model predicting current smoking status where males were 9.5 times more likely to currently smoke than females (p < 0.001), and part-time workers and unemployed individuals also were more likely to smoke cigarettes than full-time workers (p = 0.038). Conversely, individuals who were not exclusively English speakers were significantly less likely to currently smoke (p = 0.002) as were individuals who were born in Puerto Rico and South and Central American countries (p = 0.016).
Finally, to examine predictors of frequency of alcohol consumption, we constructed a multivariate, multinomial logistic regression model (Table 8). Frequency of alcohol consumption had 4 response options ranging from: never drink alcohol (never) to drink < once per month (rarely), 2-4 times per month (occasionally), or ≥ 2 times per week (frequently). In addition to the other significant effects reported in this table, we want to highlight that this model showed that, for every year of increasing age, participants were more likely to drink rarely as compared to never drinking (p = 0.003), the reference level for the outcome. Those who completed high school were more likely to drink both occasionally and frequently compared to individuals who did not complete high school, while participants who completed college were more likely to drink occasionally compared to those who did not complete high school (p = 0.015).
Men were more likely than women to drink rarely, occasionally, and frequently rather than never (p < 0.001). Finally, there was a strong effect of household income (p < 0.001) where individuals earning $35,000 to $49,999 and $75,000+ per year were less likely than individuals earning < $35,000 per year to drink rarely as opposed to never drink. Conversely, participants who earned $50,000 to $74,999 per year were 2.6 times more likely than those with lower incomes to drink frequently (≥ 2 times per week) as opposed to never drinking. Regarding associations between alcohol consumption and health beliefs, participants who rated their chance of getting cancer as “neither likely nor unlikely” compared to those who thought they were “likely” to get cancer were more likely to drink rarely, as opposed to never drinking. Participants who disagreed with the statement that “everything causes cancer” were more likely to drink rarely, occasionally, and frequently rather than never drink compared to those who agreed that “everything causes cancer” (p = 0.025).