lifestyle (e.g., not smoking, eating a healthy diet, exercising, and wearing

sunscreen), public understanding of cancer prevention is critical to cancer

control. Examining how knowledge and beliefs about cancer prevention are

associated with lifestyle and behavior is of special concern to health

communication practitioners. Effective communication strategies can help

to correct misperceptions that may lead to lower participation in

behaviors that are known to protect against cancer.

Most respondents to the National Cancer Institute’s (NCI) Health

Information National Trends Survey (HINTS) realize that cancer is

preventable; however, there appears to be confusion about known risk

factors for the disease and about which recommendations to follow to

decrease individual cancer risk.

Fatalistic beliefs, characterized by pessimism, helplessness, and confusion

about ways to avoid getting cancer, are prevalent among U.S. adults.These

fatalistic beliefs often are spurred by ambiguity regarding the credibility

and reliability of health information in the public domain.

In this HINTS Brief, we summarize two recently published studies that

show how fatalistic beliefs and ambiguity about cancer prevention are

associated with a lower likelihood of participating in many behaviors that

are known to reduce the risk of cancer generally, and colon, skin, and lung

cancers specifically.

It Seems Like

Everything

Causes Cancer

2003 Estimated

U.S. Population Percentage 46.88% Agree

11.09% No opinion

41.57% Disagree

0.45% Don’t know/Refused

There’s Not Much

People Can Do

to Lower Their

Chances of

Getting Cancer

2003 Estimated

U.S. Population Percentage 26.86% Agree

8.03% No opinion

64.71% Disagree

0.4% Don’t know/Refused

There Are So Many

Recommendations

about Preventing

Cancer, It’s Hard

to Know Which

Ones to Follow

2003 Estimated

U.S. Population Percentage

7.45% No opinion

21% Disagree

71.26% Agree

0.29% Don’t know/Refused

Fatalism and Ambiguity Pred

Lower Adherence to Cancer

Prevention Recommendation

• “Fatalism” is defined as an outlook that all ev

inevitable and controlled by fate, and humans 

to influence them.

• “Ambiguity” is defined as uncertainty regardi

reliability, credibility, or adequacy of informatio

A recently published study using HINTS 2003 data found 

fatalistic beliefs about cancer are associated with a lower 

engaging in behaviors known to reduce cancer risk, includ

exercise, not smoking, and eating five or more servings of 

vegetables per day. The relationship between fatalistic beli

behaviors proved significant even as other predictors of b

considered, including age, gender, race/ethnicity, income, ed

ment status, martial status, health insurance, and family his

A similar study using HINTS 2005 data examined associat

ambiguity about cancer prevention recommendations and 

specific to preventing colon, skin, and lung cancers. Investig

that respondents who agreed with the statement,“There 

recommendations about preventing colon/skin/lung cance

know which ones to follow,” were less likely to engage in 

reduce their risk of those cancers. Specifically, they were l

respondents who were not confused about cancer preven

recommendations to have reported undergoing flexible si

or colonoscopy or using sunscreen, and more likely to rep

current smoker. Ambiguity had an independent effect whe

sociodemographic characteristics were considered.

– Avoid smoking

– Eat a diet rich in vegetables and fruits and low in 

– Get regular physical activity

– Obtain recommended cancer screening exams

• Most Americans know that it is possible for individu

action to lower their risk of getting cancer.

• Confusion about the causes of cancer and recomme

preventing cancer is associated with a lower likeliho

participating in many behaviors that protect against 

In this HINTS Brief, we explore factors associated with confusion about cancer preven
How Can This Inform Your Work?

Because fatalism and ambiguity are associated with not engaging in Promote the use of credible resources for cancer 

behaviors that are known to protect against cancer, and because these • The National Cancer Institute’s Cancer Informatio

beliefs are prevalent among Americans with low levels of education, – URL: http://cis.nci.nih.gov/ health communication practitioners have an opportunity to play a role – Telephone: 1-800-4-CANCER in alleviating confusion by targeting information and prevention

strategies appropriately. Cultivating accurate beliefs and knowledge • The American Cancer Society

about the causes of cancer and recommendations for cancer prevention – URL: http://www.cancer.org

is a necessary first step in efforts to promote cancer prevention. – Telephone: 1-800-ACS-2345

Target efforts aimed at promoting the preventability of cancer and • The Centers for Disease Control and Prevention

specific behavioral recommendations for cancer prevention toward – URL: http://www.cdc.gov/cancer/

Americans with low levels of education. Consider that health literacy – Telephone: 1-800-CDC-INFO

and information access may play a role.

About H

http://hints.c

The National Cancer Institute (NCI) fielded the first Health Information National Trends Survey (HINTS)

in 2002 and 2003, surveying 6,369 Americans.The second survey was fielded in 2005, surveying 5,586 Americans. HINTS was cre

monitor changes in the rapidly evolving field of health communication.The survey data can be used to understand

how adults 18 years and older use different communication channels to obtain health information for themselves and their loved 

to create more effective health communication strategies across populations.

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings.They introduce population-level estimates for speci

in the survey and summarize significant research findings that are a result of analyzing how sociodemographic variables influence 

outcomes.The Briefs are intended to highlight top-level findings derived from analyses reported in other venues, and are not me

comprehensive reports.

For More Information on Cancer

• Call the NCI Cancer Information Service at 1-800-4-CANCER

(1-800-422-6237)

• Visit http://cancer.gov 

• Order NCI publications at https://cissecure.nci.nih.gov/ncipubs/

References Used in This HINTS Br

Han PKJ, Moser RP, Klein WMP. Perceived ambiguity about canc

recommendations: associations with cancer-related perceptions 

in a U.S. population survey. Health Expect. 2007 Dec;10(4):321-3

Niederdeppe J, Gurmankin Levy A. Fatalistic beliefs about cance

three prevention behaviors. Cancer Epidemiol Biomarkers Prev. 20

January 2008