The Role of US Adult Cancer Risk Perceptions and Knowledge on Nutritional Behaviors and Alcohol Intake

Abstract

Background: This study on US adult cancer risk perceptions aims to explore the relationship between an individual’s perceived risk of developing cancer and the extent to which they engage in preventative behaviors, such as nutrition and physical activity. Methods: Data were obtained from the 2025 Health Information National Trends Survey 7 (HINTS 7). Descriptive statistics were generated to explore participants’ sociodemographic characteristics and cancer risk perceptions. Multinomial regression analysis was used to examine associations between cancer beliefs and consumption of alcohol, fruit, and vegetables. Results: Using multinomial logistic regression, significant associations (p < 0.001) were reported across all cancer beliefs and daily intake of 1–5 drinks per day, as well as ≥6 drinks per day. Significant associations (p < 0.001) were also reported across all cancer beliefs and daily intake of fruits and vegetables, which was further broken down into <½ cup per day to 1 cup, 1 to <2 cups, 2 to <4 cups, and greater than 4 cups. Conclusions: Our findings support the need for greater cancer knowledge dissemination and awareness in communities.

1. Introduction

Cancer is one of the top causes of death globally and the second leading cause of death in the US [1,2]. Specific lifestyle behaviors that are known to be associated with cancer are nutrition (i.e., fruit and vegetable consumption), physical activity, current tobacco use, alcohol use, and sun protection [1]. Therefore, it is essential to adopt health-protective behaviors to reduce longitudinal risk for developing cancer and enhance the adoption of a series of health-protective behaviors for a comprehensive approach to overall well-being. Research suggests that health-protective behaviors such as regular physical activity, not smoking, and moderate (non-heavy) alcohol consumption are associated with better health-related quality of life (HRQL)—looking at general health, physical health, mental health, and activity limitation—for US adults [3]. Despite mixed findings regarding the association of alcohol status and HRQL, studies found that alcohol status (i.e., heavy alcohol drinking) was associated with worse mental health and activity limitation. This study also stresses the importance of adopting different health-protective behaviors together to increasingly improve quality of life in terms of general, physical, and mental health and well-being [3]. Based on self-reports of cancer survivors, increased healthy lifestyle behaviors of moderate physical activity, better sleep quality, and vegetable consumption have been associated with better psychological health, whereas such a correlation was not found for behaviors of strength training, sedentary lifestyle, sleep duration, and fruit consumption [4,5]. Furthermore, despite the fact that almost 90% of Americans recognize tobacco as a risk for cancer, there is less awareness about alcohol being a risk factor for cancer, despite alcohol being a Group 1 carcinogen (highest risk level) and accounting for 5.5% cancer cases globally every year [6]. Hence, more research is needed on the role of cancer risk perceptions in motivating at-risk US adults in the adoption of healthier behaviors and lifestyle choices.

Although cancer-related information has been widely accessible, cancer fatalism—defined as the belief that death is inevitable when cancer is present—persists among many US adults, often leading to disengagement from preventative health behaviors such as physical activity, healthy eating, and alcohol moderation [7,8]. One limitation is that fatalism is often misunderstood as a purely cultural trait rather than a reaction to systemic barriers like information overload or low health literacy, which can mimic fatalistic attitudes [9]. Evidence-based educational interventions have attempted to counteract these beliefs through strategies such as health literacy campaigns and physician counseling, yet these programs often do not fully penetrate underserved populations or correct misinformation effectively [10]. Educational campaigns delivered through social media have been shown to penetrate further and reduce such attitudes [11]. While existing interventions, such as health information campaigns and clinician counseling, attempt to address misinformation, they often fall short in reaching low-income and culturally diverse communities [12]. For rural populations, structural barriers such as poverty, lack of insurance, and geographic isolation reduce the efficacy of even well-designed interventions if they are not accompanied by broader systemic reforms [13]. Moreover, many Americans remain unaware of how negative nutritional behaviors, such as high alcohol consumption, low fruit and vegetable intake, and sedentary lifestyles significantly, elevate cancer risk [14].

Other influential factors contributing to formulation of adult cancer risk perceptions are complex and multifactorial, but social determinants of health (SDoH), genetic risks, and psychosocial factors are all significant players to explore, as understanding patterns between perceptions and health-protective behaviors can lead to more effective messaging and communication to more effectively inspire and encourage development and implementation of health-protective behaviors [15]. One study exploring perceptions of cancer risk among ovarian and/or breast cancer survivors and unaffected female relatives found a positive family history of cancer, higher income, great cancer worries, and being Caucasian predicted increased cancer risk perception Increased risk perception in first-degree relatives of patients with familial gastric cancer has also emphasized the fact that a positive family history is associated with heightened risk perception of cancer [16]. Race and culture also seem to play a role, whereby White people have been found to have generally higher cancer risk perceptions compared to Asian, Black, and Hispanic populations in the US [17]. Another study exploring perceived cancer risk among American Indian adults demonstrated that positive family history, higher education, greater knowledge of cancer risk factors, and higher BMI were associated with higher perceived cancer risk [18]. Psychosocial factors such as increased anxiety and worry, belief that the condition is less preventable or out of one’s control, increased awareness of family history and hereditary risk are also associated with increased cancer risk perception [19,20]. However, the relationship between risk perception and the adoption of lifestyle modifications such as exercise and improved nutrition behaviors in the literature is less consistent [21,22,23].

This retrospective cross-sectional study aims to examine the influence of cancer risk perceptions on nutritional and physical activity health-protective behaviors in a national sample of US adults. Findings will inform future efforts to improve the adoption of health behaviors and increase awareness and perceptions of cancer risks in early adulthood.

2. Methods

For the purpose of this study, the data were obtained from the 2025 Health Information National Trends Survey 7 (HINTS 7), a nationally representative survey routinely conducted by the National Cancer Institute (NCI) since 2003 [24]. HINTS targets civilian, non-institutionalized adults aged 18 or older living in the United States (US) and aims to assess public access to and use of information about cancer, particularly information about etiology, cancer prevention, early detection, diagnosis, treatment, and survivorship [24]. HINTS 7, the most recent administration of the program, was conducted from 25 March to 16 September 2024. It utilized a mailed, self-administered paper survey offered in English or Spanish with a push-to-web option, resulting in 7279 completed surveys [24].

A two-stage sampling design was used. First, a stratified sample of residential addresses was selected. Then, one adult was selected from each sampled household. Addresses were divided into four strata based on whether they were high-minority or low-minority areas and whether they were rural or urban. This was done to ensure higher sampling rates in high minority and rural areas, increasing the precision of estimates for those subpopulations. To encourage response rates, a standard $2 pre-incentive was included for all households and displayed in the envelope window rather than being hidden from view. However, response rates were still unexpectedly low for the first three mailings, so HINTS 7 employed an additional fourth mailing with an increased incentive of $30 for a subsample of non-respondents [24].

The data collection also included two embedded experiments to evaluate effects on response data and overall data quality. Every HINTS survey includes a standard set of questions, such as those assessing health communication constructs and demographics, along with topic-specific questions reflecting the developments in the public information environment during that period. For HINTS 7, the topics of special interest, particularly those pertaining to the focus of our paper, included issues with health information, specifically misinformation and digital literacy, conflicting information, and health literacy. It also assessed social issues, specifically healthcare discrimination experiences, social determinants of health, and social isolation, as well as the environment and health [24].

3. Results

3.1. Demographic Characteristics of Participants

Descriptive statistics were used to summarize the weighted frequencies and percentages of the participants’ sociodemographic characteristics (

Table 1. Sample participants’ demographic characteristics.

Demographic Characteristics	Weighted Frequency	Weighted Percentage
Age Group
18–39	1551	23.27%
40–64	2612	39.19%
65+	2502	37.54%
Gender
Male	2629	39.77%
Female	3981	60.23%
Occupation Status
Employed	3068	47.04%
Homemaker/Student/Retired/Disabled	2580	39.56%
Unemployed	196	3.00%
Multiple Occupation Statuses	678	10.40%
Marital Status
Married/Living as Married or Living with Partner	3327	51.29%
Divorced/Widowed/Separated	1755	27.05%
Single	1405	21.66%
Educational Level
Less than High School	129	1.99%
High School/Post-High School	1823	28.19%
Some College	1399	21.63%
College Graduate/Post-Graduate	3116	48.18%
Hispanic Origin
No	5161	79.60%
Yes	1323	20.40%
Race
White	4434	70.89%
Black	1036	16.56%
Asian	364	5.82%
Multiple races	304	4.86%
Pacific Islander	64	1.02%
American Indian or Alaska Native	53	0.85%
Income Level
0–$49,999	2564	41.50%
$50,000–$74,999	1012	16.38%
$75,000–$99,999	765	12.38%
$100,000–$199,999	1287	20.83%
Greater than or equal to $200,000	551	8.92%

).

A total of 6665 survey participants were included after adjusting for missing data. The largest proportion of participants (39.19%, n = 2612) fell in the age group of 40–64 years old, followed by 37.54% (n = 2502) over the age of 65, and 23.27% (n = 1551) in the 18–39 years old range. A slight majority were female (60.23%, n = 3981), employed (47.04%, n = 3068), and married or living as married with a romantic partner (51.29%, n = 3327). Approximately 70% of the participants had either some college experience or had graduated from college and were White (70.89%, n = 4434) and non-Hispanic (79.60%, n = 5161). Almost two-fifths of participants reported an annual income of less than $50,000 (41.50%, n = 2564), with only 8.92% (n = 551) reporting an annual income greater than or equal to $200,000.

3.2. Cancer Risk Perceptions

As depicted in

Table 2. Adult cancer risk perceptions measured using the HINTS 7 2025 survey.

It Seems Like Everything Causes Cancer
Agree	4362 (68.05%)
Disagree	2048 (31.95%)
There’s not much you can do to lower your chances of getting cancer.
Agree	1921 (30.07%)
Disagree	4467 (69.93%)
There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow.
Agree	4699 (73.36%)
Disagree	1706 (26.64%)
When I think about cancer, I automatically think about death.
Agree	3754 (58.63%)
Disagree	2649 (41.37%)
Have you heard of “chemo brain,” “chemo fog,” or “cancer-related cognitive impairment?”
Yes	2740 (42.58%)
No	3695 (57.42%)
As far as you know, who has a greater chance of getting cancer—a person with a 1 in 1000 chance, or a person with 1 in 100?
1/100 is greater	4295 (66.75%)
1/1000 is greater	308 (4.79%)
Do not know	1831 (28.46%)

, the majority of respondents responded “Yes” to survey items surrounding cancer-related fatalism and perceptions of cancer risk. 68% (n = 4362) agreed that “It seems like everything causes cancer”, while 30% (n = 1921) believed that “There’s not much you can do to lower your chances of getting cancer.” Regarding recommendations and protective measures, 73.36% (n = 4699) felt that “There are so many recommendations about preventing cancer, it’s hard to know which ones to follow.” In terms of perceptions of cancer outcomes, 58.63% (n = 3754) endorsed “automatically thinking about death” when they think about cancer, while a slight majority (57.42%, n = 3695) denied knowledge of “chemo brain,” “chemo fog,” or “cancer-related cognitive impairment.” When tested on their statistical understanding of cancer risk, 66.75% (n = 4295) correctly identified that a 1/100 chance of cancer risk was greater than a 1/1000 chance, while 4.79% of participants (n = 308) wrongly perceived a 1/1000 risk as greater, and 1831 (28.46%) did not know who is at higher risk of having the disease in their lifetime.

3.3. Multinomial Regression Analysis on the Influential Role of Cancer Beliefs on Daily Alcohol, Fruit, and Vegetable Intake

A series of multinomial regression analyses was carried out to explore associations between US adult cancer beliefs and the daily intake of alcohol, fruits, and vegetables. All sociodemographic variables listed in Table 1 were controlled for as covariates (

Table 3. Multinomial regression of the association between cancer beliefs and drinks per day.

Belief about Cancer	Categories	1–5 Drinks		p-Value	95% CI		≥6 Drinks		p-Value	95% CI		0 Drinks
		N (%)	OR		Lower Bound	Upper Bound	N (%)	OR		Lower Bound	Upper Bound
Everything causes cancer	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Base Outcome
	Disagree	6588 (90.5%)	0.628		0.626	0.629	364 (5.0%)	0.591		0.589	0.593
Prevention is not possible	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	6588 (90.5%)	0.865		0.864	0.867	356 (4.9%)	0.591		0.590	0.593
Too many recommendations to follow	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	6582 (90.4%)	0.460		0.458	0.461	364 (5%)	0.722		0.719	0.724
Cancer is a fatal disease	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	6582 (90.4%)	0.747		0.745	0.748	357 (4.9%)	0.379		0.377	0.380

* significance set at p < 0.05.

).

Significant associations (p < 0.001) were reported across all cancer beliefs and daily intake of 1–5 drinks per day, as well as ≥6 drinks per day, compared to the base outcome of no daily drinks. Significant associations (p < 0.001) were also reported across all cancer beliefs and daily intake of fruits, which was further broken down into <½ cup per day to 1 cup, 1 to <2 cups, 2 to <4 cups, and greater than 4 cups. Likewise, our study showed significant associations (p < 0.001) across all cancer beliefs and daily intake of vegetables, which was similarly broken down into <½ cup per day to 1 cup, 1 to <2 cups, 2 to <4 cups, and greater than 4 cups.

When it comes to associations between cancer beliefs and number of drinks per day, compared to participants who selected “agree” on all four criteria of cancer beliefs, those who selected “disagree” had significantly lower odds of reporting 1–5 drinks and ≥6 drinks per day.

When it comes to associations between cancer beliefs and daily fruit intake, participants who disagreed with the statement that “everything causes cancer” had significantly lower odds of reporting <1/2 cup–1 cup/day (OR = 0.669, 95% CI (0.668–0.670), p < 0.001), 1–<2 cups/day (OR = 0.848, 95% CI (0.850–0.851), p < 0.001), and 2–<4 cups per day (OR = 0.968, 95% CI (0.967–0.970), p < 0.001), but higher odds of reporting 4+ cups per day (OR = 1.050, 95% CI (1.047–1.052), p < 0.001). Similarly, participants who disagreed with the statement that “prevention is not possible” had significantly lower odds of reporting <1/2–1 cup/day (OR = 0.676, 95% CI (0.675–0.677), p < 0.001), but higher odds of reporting 1–<2 cups/day (OR = 1.223, 95% CI (1.222–1.225), p < 0.001), 2–<4 cups/day (OR = 1.841, 95% CI (1.839–1.843), p < 0.001), and 4+ cups/day (OR = 1.050, 95% CI (1.047–1.052), p < 0.001). Moreover, participants who disagreed with the statement that “there are too many recommendations to follow” had significantly lower odds of reporting <1/2–1 cup/day (OR = 0.834, 95% CI (0.832–0.835), p < 0.001), but higher odds of reporting 1–<2 cups/day (OR = 0.893, 95% CI (0.893–0.896), p < 0.001), 2–<4 cups/day (OR = 1.239, 95% CI (1.237–1.241), p < 0.001), and >4 cups/day (OR = 1.490, 95% CI (1.492–1.502), p < 0.001). Furthermore, participants who disagreed with the statement that “cancer is a fatal disease” had significantly lower odds of reporting <1/2–1 cup/day (OR = 0.721, 95% CI (0.721–0.722), p < 0.001) and 1–<2 cups/day (OR = 0.855, 95% CI (0.855–0.858), p < 0.001), but higher odds of reporting 2–<4 cups/day (OR = 1.093, 95% CI (1.092–1.095), p < 0.001) and >4 cups/day (OR = 1.884, 95% CI (1.880–1.888), p < 0.001) (

Table 4. Multinomial regression of the association between cancer beliefs and daily fruit intake.

Belief About Cancer	Categories	<1/2 Cup–1 Cup		p-Value	95% CI		1–<2 Cups		p-Value	95% CI		2–<4 Cups		p-Value	95% CI		4+ Cups		p-Value	95% CI		0 Cups
		N (%)	OR		Lower Bound	Upper Bound	N (%)	OR		Lower Bound	Upper Bound	N%	OR		Lower bound	Upper bound	N (%)	OR		Lower Bound	Upper bound
Everything causes cancer	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Base Outcome
	Disagree	2926 (40.2%)	0.669		0.668	0.670	2089 (28.7%)	0.849		0.848	0.8501	1295 (17.8%)	0.968		0.967	0.970	160 (2.2%)	1.050		1.047	1.052
Prevention is not possible	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	2919 (40.1%)	1.002		1.001	1.003	2089 (28.7%)	1.223		1.222	1.225	1302 (17.9%)	1.841		1.839	1.843	160 (2.2%)	1.050		1.047	1.052
Too many recommendations to follow	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	2933 (40.3%)	0.834		0.832	0.835	2089 (28.7%)	0.895		0.893	0.896	1288 (17.7%)	1.239		1.237	1.241	160 (2.2%)	1.497		1.492	1.502
Cancer is a fatal disease	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	2926 (40.2%)	0.721		0.721	0.722	2089 (28.7%)	0.855		0.855	0.858	1295 (17.8%)	1.093		1.092	1.095	162 (2.2%)	1.884		1.880	1.888

* significance set at p < 0.05.

).

Regarding the associations between cancer beliefs and daily vegetable intake, participants who disagreed that “everything causes cancer” has significantly lower odds of reporting <1/2–1 cup/day (OR = 0.691, 95% CI (0.690–0.692), p < 0.001), 1–<2 cups/day (OR = 0.861, 95% CI (0.860–0.862), p < 0.001), and 2–<4 cups/day (OR = 0.862, 95% CI: 0.861–0.863, p < 0.001), but higher odds of reporting greater than 4 cups per day (OR = 1.022, 95% CI (1.020–1.024), p < 0.001). Participants who disagreed that “prevention is not possible” had significantly lower odds of reporting <1/2–1 cup/day (OR = 0.569, 95% CI (0.569–0.570), p < 0.001) and 1–<2 cups/day (OR = 0.747, 95% CI (0.747–0.748), p < 0.001), but higher odds of reporting 2–<4 cups (OR = 1.141, 95% CI (1.140–1.142), p < 0.001) and >4 cups/day (OR = 1.548, 95% CI (1.545–1.550), p < 0.001). Further, participants who disagreed that there are “too many recommendations to follow” had a significantly lower chance of reporting <1/2 to 1 cup/day (OR = 0.286, 95% CI (0.286–0.287), p < 0.001) and 1–<2 cups/day (OR = 0.596, 95% CI (0.595–0.597), p < 0.001), but higher chance of reporting 2–<4 cups/day (OR = 1.340, 95% CI (1.337–1.343), p < 0.001) and 4+ cups/day (OR = 1.808, 95% CI (1.805–1.812), p < 0.001). Finally, participants who disagreed with the statement that “cancer is a fatal disease” had significantly lower odds of reporting <1/2–1 cup/day (OR = 0.413, 95% CI (0.413–0.414), p < 0.001) and 1–<2 cups/day (OR = 0.720, 95% CI (0.719–0.721), p < 0.001), but higher odds of reporting 2–<4 cups/day (OR = 1.253, 95% CI (1.251–1.255), p < 0.001) and 4+ cups/day OR = 2.220, 95% CI (2.216–2.225), p < 0.001) (see

Table 5. Multinomial regression of the association between cancer beliefs and daily vegetable intake.

Belief About Cancer	Categories	<1/2 Cup–1 Cup		p-Value	95% CI		1–<2 Cups		p-Value	95% CI		2–<4 Cups		p-Value	95% CI		4+ Cups		p-Value	95% CI		0 Cups
		N (%)	OR		Lower Bound	Upper Bound	N (%)	OR		Lower Bound	Upper Bound	N%	OR		Lower Bound	Upper Bound	N (%)	OR		Lower Bound	Upper Bound
Everything causes cancer	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Base Outcome
	Disagree	2525 (34.7%)	0.691		0.690	0.692	2104 (28.9%)	0.861		0.860	0.862	1791 (24.6%)	0.862		0.861	0.863	276 (3.8%)	1.022		1.020	1.024
Prevention is not possible	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	694 (34.8%)	0.569		0.569	0.570	577 (28.9%)	0.747		0.747	0.748	491 (24.6%)	1.141		1.140	1.142	74 (3.7%)	1.548		1.545	1.550
Too many recommendations to follow	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	2519 (34.6%)	0.286		0.286	0.287	2111 (29%)	0.596		0.595	0.597	1783 (24.5%)	0.654		0.653	0.655	269 (3.7%)	1.340		1.337	1.343
Cancer is a fatal disease	Agree	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref	Ref	Ref	<0.001 *	Ref	Ref
	Disagree	2524 (34.7%)	0.944		0.942	0.945	2111 (29.0%)	1.170		1.168	1.172	1791 (24.6%)	1.253		1.251	1.255	276 (3.8%)	2.22		2.216	2.225

* significance set at p < 0.05.

).

4. Discussion

Findings from our study highlighted how nutritional and health-promoting behaviors are influenced by cancer knowledge and cancer-risk perceptions in a sample of US adults, with the ultimate goal of informing future efforts to improve cancer awareness and prevention efforts in early adulthood.

Our multinomial regression analysis showed that when it comes to associations between cancer beliefs and number of drinks per day, those who selected “disagree” had significantly lower odds of reporting 1–5 drinks and ≥6 drinks per day compared to participants who agreed with fatalistic cancer beliefs on all four criteria. This is in line with previous literature that has found that, among adults without a history of cancer, each unit increase in a cancer fatalism score, measured as agreement with the cancer belief statements used in this study, was associated with 30.0% higher odds of risky health behaviors, including heavy alcohol drinking [25]. Other research has found that having fatalistic views of cancer was associated with lower health literacy and lower cancer information-seeking behaviors, and this lack of proactivity may limit necessary health behavior changes [26]. Conversely, optimistic views of the health benefits that come from avoiding risky behaviors, as well as higher cognitive ability, were linked to lower odds of heavy drinking and higher engagement in healthy behaviors [27]. This study also found that only 37.1% of participants correctly identified alcohol as a risk factor for cancer, which is in line with previous estimates of low alcohol–cancer association awareness among the US general public [28,29].

Results from the regression analysis also highlighted significant associations and lower odds of fruit and vegetable intake among those with fatalistic cancer beliefs. These results are in line with previous findings that fatalistic perceptions of cancer prevention were associated with less engagement in prevention behaviors, including weekly exercise, not smoking, and eating 5 or more fruits and vegetables daily [30]. A previous study using 2013 HINTS data had similar percentages of participants who consumed less than 1 cup of fruits and vegetables, showing an alarming lack of improvement in the diet of the American public for over a decade. The same study also found that belief in fatalistic cancer risk perceptions was negatively associated with fruit and vegetable consumption, even independently of health literacy levels [31]. Another study found that, while health fatalism did not have a significant effect on participants’ BMI or physical activity, it did serve as a significant predictor for diet quality in that higher degrees of fatalism were associated with poorer diet [32,33].

Having greater cancer knowledge, measured in this study by familiarity with chemotherapy side effects and statistical understanding of cancer risk, was positively associated with more accurate risk perception and greater policy support for measures relating to alcohol advertising and packaging. Previous research has found that fatalistic attitudes towards cancer were linked with low health literacy and lower levels of education, and these attitudes were in turn associated with engaging in health-risk behavior [27,31,32,34]. Other research has found that education level was tied to information-seeking and relying on several sources for health information, as well as more positive health behaviors, with college-educated participants more likely to meet physical activity recommendations and to engage in practices like taking multivitamins [29,35,36]. Similarly, higher education was also linked to lower cancer fatalism, and this decreased burden of pessimism and hopelessness in regard to cancer outcomes may encourage better health protective behaviors [35,36]. Poor health literacy (<9th grade) was associated with other negative health behaviors, such as limited knowledge and completion of cancer screenings, and while minority ethnicities were less likely to have adequate knowledge of cancer screenings, poor health literacy remained a better predictor of screening knowledge than both ethnicity and education level [37]. Previous studies have also highlighted the link between knowledge of the alcohol-cancer link and greater support of policies to address alcohol consumption, including advertising bans, warning labels, volumetric taxation, and banning sport sponsorship, as well as policies targeting tobacco use and banning social media ads for junk food [38,39,40].

Alcohol consumption, for instance, is a well-established carcinogen linked to a range of cancers, including breast, liver, and colorectal cancer, yet public understanding of alcohol’s cancer risks remains low, indicating a need for targeted education campaigns [41,42,43,44]. Similarly, poor dietary habits, such as low intake of fruits and vegetables and high consumption of processed foods, contribute significantly to cancer incidence through mechanisms such as oxidative stress, inflammation, and inadequate fiber intake, yet such risks are rarely emphasized in popular dietary messaging [41,45,46]. Research consistently demonstrates that higher levels of physical activity reduce the risk of various cancers, including breast and colon cancer [42,47,48]. However, many US adults, particularly those from lower-income and minority backgrounds, are either unaware of these links or lack the resources and structural support to modify their behavior [41]. Despite these well-documented findings of barriers, public health campaigns often fail to effectively communicate these risks, and many communities still perceive cancer as unrelated to lifestyle choices due to cultural beliefs or misinformation [30,40].

Public policy plays a critical role in correcting misinformation about alcohol’s link to cancer, especially through tools like warning labels and advertising restrictions. Health warning labels that explicitly state the cancer risks of alcohol in both text and images have been found to significantly reduce the likelihood of consumers choosing alcohol [47]. Several countries have introduced cancer-specific health warning labels on alcohol containers, with studies showing increased awareness and modest reductions in alcohol selection among consumers exposed to such warnings; despite this, industry pressure led to suspension of these initiatives in certain cases [49,50,51,52]. As of 2023, countries in the European Union are slowly moving toward mandatory cancer warnings on alcohol labels [53]. Despite the fact that alcohol is a Group 1 carcinogen on par with tobacco and asbestos, the US still does not mandate cancer warnings on alcohol labels, although implementing advertising bans, especially targeting youth and public spaces, has been proven to be successful in lowering tobacco consumption rates in the past [54]. Furthermore, alcohol industry-funded misinformation campaigns continue to sow doubt about alcohol’s health risks, using ambiguous language or diverting focus to moderation rather than risk elimination [55,56]. Ongoing gaps include the absence of uniform national legislation in the US, weak enforcement mechanisms, and minimal integration of these policies into broader cancer prevention initiatives [57].

Limitations

Various limitations were encountered in this study due to its cross-sectional design and data collection methods, particularly that it does not allow for the establishment of causality in associations that were found. The data collected was derived from the HINTS 7 database, which contains self-reported information. Self-reported data increase the possibility of encountering bias due to phenomena such as social desirability bias, recall bias, or simply reporting misinformation for various reasons. Furthermore, validated clinical data utilizable in this study were found to be limited because responses to data collection surveys were based on parental reports. As mentioned in the methods section, there was a lower-than-expected response rate for the surveys, which ultimately limits the generalizability of the results. Despite these limitations, this study successfully examined the influence of cancer risk perceptions on health-protective behaviors in US adults, providing valuable insights and possible applications for future interventions and further research.

5. Conclusions

This study provides important insight into how cancer risk perceptions shape the nutritional and physical activity behaviors of US adults. Our findings revealed that individuals endorsing more fatalistic views about cancer are significantly more likely to engage in unhealthy behaviors, including higher alcohol consumption, binge drinking, and lower fruit and vegetable intake, all of which are associated with increased cancer risk. This research emphasizes the need to address and reshape public perceptions of cancer to encourage proactive health behaviors. Given the well-established links between poor nutrition, alcohol abuse, physical inactivity, and increased cancer risk, raising awareness about the tangible impact of lifestyle choices on cancer development is a key step in furthering public health as a whole. Interventions that focus on educating young adults about the modifiable nature of cancer risks may promote healthier behaviors that could significantly lower the national cancer burden.