cancer-related beliefs and behaviour in low-, middle- and high-income countries
DESCRIPTION
Cancer-related beliefs and behaviour in low-, middle- and high-income countries. Overview. Survey development and methodology Participating countries Risk factor behaviour Screening and diagnosis Cancer prevention beliefs Risk factors and prevention beliefs. Why do a population survey?. - PowerPoint PPT PresentationTRANSCRIPT
Cancer-related beliefs and behaviourin low-, middle- and high-income countries
Overview
Survey development and methodology
Participating countries
Risk factor behaviour
Screening and diagnosis
Cancer prevention beliefs
Risk factors and prevention beliefs
Why do a population survey?
Beliefs influence lifestyle choices, participation in screening and treatment decisions
Cancer prevention programmes need to be informed by local population data to design programmes and evaluate progress
Aims: Enhance collection of comparable population survey data about
cancer beliefs and behaviours across countries where there are UICC member organizations
Develop capacity in UICC member organizations to use such survey data to develop population-based cancer control programmes and policies and evaluate their impact
Survey development
The UICC partnered with Roy Morgan Research Company and Gallup International
Technical advisory group to advise on survey development and reporting: Dr Melanie Wakefield, Australia
Dr Sharon Campbell, Canada
Dr Michael Stefanek, USA
Dr Jane Wardle, Britain
Dr Hein de Vries, Netherlands
Survey methodology
Data collection commenced in October 2007
The same survey questions were asked, regardless of administration method, in the language/s spoken by the majority of each country’s population
Randomly selected population sample
Administered face to face or by phone, depending on the country’s infrastructure
Often as part of Gallup affiliate omnibus survey to defray costs
For the information presented in the subsequent slides, the margin of error is ± 1.32%
Standard set of questions
Personal characteristics (age, sex, employment status, occupation, religion, personal cancer experience, family cancer experience)
Risk factor behaviour (smoking, alcohol use, physical activity, sun protection, body mass index)
Screening participation
Beliefs about treatment
Beliefs about risk factors for cancer
First 29 countries participating in survey
Australia (1272) Austria (920) Bolivia (1296) Canada (1070) China (1000) Czech Republic (500) Dominican Republic (500) Georgia (1000) Greece (500) Guatemala (500) Indonesia (1081) Israel (992) Kenya (500)
Lebanon (500) Mexico (518) New Zealand (858) Nigeria (5021) Panama (502) Peru (1206) Philippines (1000) Romania (947) Serbia (1004) Spain (1000) Turkey (2019) Ukraine (1137) United Kingdom (691) United States of America
(855) Uruguay (500) Venezuela (1036)
Categorization of these countries:
World Bank income groupsCategory Included countries
Low income
(N=5521)
Kenya Nigeria
Middle income
(N=15746)
BoliviaChinaDominican RepublicGeorgiaGuatemalaIndonesia
Lebanon MexicoPanamaPeruPhilippinesRomania
UkraineSerbiaTurkeyVenezuelaUruguay
High income
(N=8658)
AustraliaAustriaCanadaCzech Republic
GreeceIsraelNew Zealand
SpainUKUSA
12 additional countries (awaiting data)
Albania
Algeria
Belgium
Ethiopia
Finland
Germany
Ghana
India
Italy
Ivory Coast
Pakistan
Switzerland
Categorization of all 41 countries:
World Bank income groupsCategory Included countries Additional countries
Low income
(N=5521)
Kenya Nigeria
EthiopiaGhanaIndia
Ivory CoastPakistan
Middle income
(N=15746)
BoliviaChinaDominican Rep.GeorgiaGuatemalaIndonesiaLebanon MexicoPanama
PeruPhilippinesRomaniaUkraineSerbiaTurkeyVenezuelaUruguay
AlbaniaAlgeria
High income
(N=8658)
AustraliaAustriaCanadaCzech RepublicGreece
IsraelNew ZealandSpainUKUSA
BelgiumFinlandGermany
ItalySwitzerland
Risk factor behaviour
Smoking status
Alcohol consumption
Level of physical activity
Weight
Sun exposure
Prevalence of tobacco use
Tobacco use was determined by asking “In the last 12 months have you used any tobacco products…”
If respondents indicated that they had used cigarettes, roll your own tobacco, pipe, cigars, chewing tobacco, snuff or bidis they were classified as a tobacco user
If respondents replied “no, none” they were classified as not being a tobacco user
As illustrated in the next figure, there was a large difference in the prevalence of tobacco users in low-income countries in comparison to tobacco users in middle- and high-income countries
Prevalence of tobacco use
6
3733
0
10
20
30
40
50
60
Low Middle High
World Bank income category
Tobacco user
Tobacco use was determined by asking “In the last 12 months have you used any tobacco products…”
If respondents indicated that they had used cigarettes, roll-your-own tobacco, pipe, cigars, chewing tobacco, snuff or bidis they were classified as a tobacco user
If respondents replied “no, none” they were classified as not using tobacco
As illustrated in the next figure, across income categories, tobacco use is more prevalent amongst males than females
This gender difference is most pronounced in the low-income category, where males are 11 times more likely than females to use tobacco
Prevalence of tobacco use
Prevalence of tobacco use
11
61
38
1
12
28
0
10
20
30
40
50
60
70
80
Low Middle High
World Bank income category
Male Female
Prevalence of tobacco use
Alcohol consumption
Alcohol consumption was determined by asking “In the last 12 months have you had an alcoholic drink of any kind? If yes, about how often do you have an alcoholic drink?”
If respondents replied “most days” or “5 or 6 days a week” they were classified as a frequent consumer
If they replied “3 or 4 days a week” or “once a week” they were classified as a moderate consumer
If respondents replied “2 or 3 times a month” “once a month” “less often” or “rarely” they were classified as an occasional consumer
Individuals who responded “no, never, or don’t drink” were classified as never consuming alcohol. The majority of respondents in low-income countries do not drink alcohol
Respondents in high-income countries were nearly three times more likely to identify that they were frequent alcohol consumers
Alcohol consumption
Alcohol consumption
4 411
7 10
28
12
40 37
77
46
24
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Frequent Moderate Occasional Never
Vigorous physical activity
Physical activity was assessed by asking “How often do you do hard physical or vigorous activity…” in three contexts: work; home; or at a gym, sports place or somewhere else
Based on National Physical Activity Guidelines for Australians, a recommended level of physical activity was engaging in activity “most days”, “5 or 6 days a week”
Less than recommended was engaging in physical activity “3 or 4 days a week” “once a week”, “2 or 3 times a month”, “once a month”, “less often”, “rarely” or “never”
In low- and high-income countries, more physical activity was occurring at home than at work or at a gym
Those in high-income countries appear to engage in higher overall physical activity than others
Vigorous physical activity
Vigorous physical activity on most days
8
1718
11
16
23
4 3
7
0
5
10
15
20
25
30
35
40
Low Middle High
World Bank income category
Work Home Gym
Body mass index
Estimates of height and weight were used to calculate BMI
Respondents were then classified as being either of an acceptable/healthy weight or as overweight/obese based on WHO weight recommendations
Those in middle-income countries were the only group where the majority of respondents were of a healthy weight
Note: Question not asked of respondents in Austria and Israel
Body mass index
Body mass index
58
27
59
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Overweight or Obese
Sun exposure
Sun exposure was determined by asking, “In the last 12 months have you been sunburnt? By sunburnt I mean any reddening of the skin after being outside in the sun?”
As illustrated in the figure, the majority of respondents did not report being sunburnt in the last 12 months. However, a greater percentage of those in high-income countries reported being sunburnt than others
Sun exposure
Sunburn in the last 12 months
12
2935
7667 64
13
4 10
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes No Don't Know
Screening and diagnosis
Cancer screening
Individual and immediate family cancer diagnosis
Beliefs about a cure for cancer following diagnosis
Expectations about medical treatment decision-making
Cancer screening
Individuals were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes, they were asked, “Which, if any, of the following cancer tests have you had? Bowel or colon cancer check; Skin cancer check; Lung cancer check; (if female) pap test or pap smear; (if female) mammogram or breast x-ray; (if male) prostate check; other check”
In low- and middle-income countries, over 80% of respondents reported not being screened for cancer
Those in high-income countries were 4.9 times more likely (and middle-income respondents were 1.7 times more likely) to report being screened for cancer than those in low-income countries
Cancer screening
Previous screening for cancer
11
19
54
0
10
20
30
40
50
60
Low Middle High
World Bank income category
Yes
Previous cancer screening
Individuals were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes they were asked “Which, if any, of the following cancer tests have you had? Bowel or colon cancer check; Skin cancer check; Lung cancer check; (if female) pap test or pap smear; (if female) mammogram or breast x-ray; (if male) prostate check; other check”
In low-income countries, screening experience did not vary by age, but it increased with age in other countries
In high-income countries, 65% of respondents aged 40+ reported previous screening for cancer, compared with 30% and 11% respectively of those in middle- and low-income countries
Previous cancer screening
Previous screening for cancer by age group
11 11
29
1117
48
10
26
55
12
28
67
11
37
72
0
10
20
30
40
50
60
70
80
Low Middle High
World Bank income category
18-29 30-39 40-49 50-59 60+
Previous cancer screening
Males were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes, they were asked, “Which, if any, of the following cancer tests have you had?Bowel or colon cancer check; Skin cancer check; Lung cancer check; prostate check; other check”
Within low- and middle-income countries, over 85% of males reported not being previously screened for cancer
In high-income countries, 56% of males had not been previously screened
Previous cancer screening
Previous screening for cancer: men
1014
44
0
10
20
30
40
50
Low Middle High
World Bank income category
Yes
Previous cancer screening
Males were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes they were asked, “Which, if any, of the following cancer tests have you had? Bowel or colon cancer check; Skin cancer check; Lung cancer check; prostate check; other check”
In the middle-income category, over one third of men aged 60+ reported screening, compared with over two-thirds of men aged 60+ in high income countries
Screening increased with age in both middle- and high-income countries, but not in low-income countries
Previous screening for cancer: men by age group
10 9
23
10 10
35
8
19
40
10
21
57
11
34
68
0
10
20
30
40
50
60
70
80
Low Middle High
World Bank income category
18-29 30-39 40-49 50-59 60+
Previous cancer screening
Females were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes they were asked “Which, if any, of the following cancer tests have you had?
Bowel or colon cancer check; Skin cancer check; Lung cancer check; pap test or pap smear; mammogram or breast x-ray; other check”
Only within the high-income category did the majority of females report being previously screened for cancer
Previous cancer screening
Previous cancer screening
Previous screening for cancer: women
12
25
64
0
10
20
30
40
50
60
70
Low Middle High
World Bank income category
Yes
Females were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes they were asked “Which, if any, of the following cancer tests have you had? Bowel or colon cancer check; Skin cancer check; Lung cancer check; pap test or pap smear; mammogram or breast x-ray; other check”
Screening gradually increases with age in middle-income countries but not in low-income countries
In high-income countries, screening rates doubled between the age categories of 18-29 years and 40-49 years
Previous cancer screening
Previous screening for cancer: women by age group
12 13
35
11
26
61
13
32
70
13
36
76
11
41
75
0
10
20
30
40
50
60
70
80
Low Middle High
World Bank income category
18-29 30-39 40-49 50-59 60+
Previous cancer screening
Females were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes they were asked if they had previously had a pap test or pap smear
In high-income countries, 48% of women reported having a pap smear, compared with 16% and 3% respectively in middle- and low-income countries
Women in high-income countries are 16 times more likely (and women in middle-income countries are 5.3 times more likely) to report having had a pap test than women in low-income countries
Previous cancer screening
Previous screening: pap test
3
16
48
0
10
20
30
40
50
60
Low Middle High
World Bank income category
Yes
Previous cancer screening
Females were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes, they were asked if they had previously had a pap test or pap smear
Less than 5% of each age group of women in the low-income countries reported having had a pap test
In high-income countries, there was a sharp increase in the number of women reporting a previous pap test after the age of 30, in comparison to women aged 18-29
This trend was less marked, but still apparent, in middle-income countries
Previous cancer screening
Previous pap test: women by age group
36
28
4
21
49
3
18
55
4
29
56
1
27
55
0
10
20
30
40
50
60
Low Middle High
World Bank income category
18-29 30-39 40-49 50-59 60+
Previous cancer screening
Females were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes, they were asked if they had previously had a mammogram or breast x-ray
Women from high-income countries were 8.8 times more likely than women from low-income countries to have reported having a mammogram
Additionally, women in middle-income countries were twice as likely to have had a mammogram than women in low-income countries
Previous cancer screening
Previous screening: mammogram
5
10
44
0
5
10
15
20
25
30
35
40
45
50
Low Middle High
World Bank income category
Yes
Previous cancer screening
Females were asked “Have you ever had a cancer screening test, blood test, or some other test for cancer?”
If respondents replied yes, they were asked if they had previously had a mammogram or breast x-ray
In high-income countries, two-thirds of women aged 50+ report having had a mammogram, as do half of those aged 40-49 years
Mammograms are infrequent in low-income countries, whereas in middle-income countries, just under one-quarter of those aged 50+ report having had one
Previous cancer screening
Previous mammogram: women by age group
6 4
12
58
26
6
12
51
5
23
65
6
22
64
0
10
20
30
40
50
60
70
Low Middle High
World Bank income category
18-29 30-39 40-49 50-59 60+
Previous cancer screening
Cancer diagnosis
Individuals were asked “Have you ever been diagnosed with cancer?” and responded either “Yes”, “No”, “Don’t know” or “Refused” (to respond)
In high-income countries, 10% had been diagnosed with cancer, in comparison to 1% of other respondents
A further 7% of respondents in low-income countries did not know if they had been diagnosed with cancer
Diagnosed with cancer: individual
1 1
10
0
5
10
15
20
25
Low Middle High
World Bank income category
Yes
Cancer diagnosis
Individuals were asked “Has anyone in your immediate family ever been diagnosed with cancer?” and responded either “Yes”, “No”, “Don’t know” or “Refused” (to respond)
In low- and middle-income countries, the majority did not report a diagnosis in their immediate family
In contrast, half of high-income respondents indicated that an immediate family member had been diagnosed with cancer
Cancer diagnosis
Diagnosed with cancer: immediate family member
2
24
50
11
31
0
10
20
30
40
50
60
Low Middle High
World Bank income category
Yes Don't Know
Cancer diagnosis
Beliefs about a cancer cure
To assess beliefs about a cure for cancer, individuals were asked, “Some people believe once a person has cancer not much can be done to cure it - do you agree or disagree with that?”
Individuals then indicated agreement, disagreement or whether they were undecided
Items were reverse scored for reporting
More of those in high-income countries believed much could be done to cure cancer than those in middle- and low-income countries
When they become available, cancer screening programmes in low- and middle-income countries will need to overcome these low expectations of the success of cancer treatment, which serve as a barrier to screening participation
Beliefs about a cure for cancer following diagnosis
52
61
83
2631
11
22
8 6
0
10
20
30
40
50
60
70
80
90
Low Middle High
World Bank income category
Cure No Cure Undecided
Beliefs about a cancer cure
Medical treatmentdecision expectations
Respondents were asked “When making a decision about what medical treatment to have, what is your preference?”
Response categories were: “The doctor should make the decisions using all that is known about
treatment”
“The doctor should make the decisions but strongly consider your needs and priorities”
“The doctor and you should make the decisions together on an equal basis”
“You should make the decisions, but would strongly consider the doctor’s opinion”
“You should make the decisions using all you know or learn about the treatments”
“Can’t say”
Respondents were asked “When making a decision about what medical treatment to have, what is your preference?”
The two “You should make…” categories were combined for scoring and reporting
Most respondents in low-income countries preferred the doctor to make the decisions based on treatment knowledge
Those in middle-income countries had a more even spread of views about the relative responsibilities of the doctor or the patient in treatment decisions
However, for respondents in high-income countries, decision-making that allows for more self-determination was preferred
Medical treatmentdecision expectations
Medical treatment decision expectations
75
25
11
0
30
16
8
28
43
915
29
0
10
20
30
40
50
60
70
80
Low Middle High
World Bank income category
The doctor should make the decisions using all that is known about treatmentThe doctor should make the decisions but strongly consider your needs and prioritiesThe doctor and you should make the decisions together on an equal basisYou should make the decisions
Medical treatmentdecision expectations
Cancer prevention beliefs
Most important health issues
Perceptions of cancer causes and risks: Drinking tap water from this area
Chewing tobacco
Drinking alcohol
Not eating vegetables
Not eating fruit
A lack of cereals or wholegrains
Eating fatty foods
Eating red meat
Being stressed
Smoking cigarettes
A lack of exercise
Being overweight
Using mobile/cell phones
Exposing your skin to the sun
Exposure to air pollution
Infection with viruses/bacteria
Important health issues
Respondents were asked “Which three health issues do you consider most important?”
The majority of those in middle- and high-income countries identified cancer as an important health issue
In low-income countries, AIDS was the most frequently cited important health issue
Thirty seven percent of those in high-income countries also identified heart disease as an important health issue
Important health issues
Important health issues
36
47
62
78
2821
9
26
37
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Cancer AIDS Heart disease
Perceived cancer risk
Respondents were asked to indicate if they believed drinking tap water from their area increases a person’s risk of cancer or not
The majority of respondents in all countries believed that drinking tap water was not a risk
28% of low-income respondents indicated that they “cannot say” if drinking tap water in their area increases a person’s risk of cancer or not
Perceived cancer risk
Perceived cancer risk of drinking tap water from this area
1721
13
55
67
79
28
11 8
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Respondents were asked to indicate if they believed smoking cigarettes increases a person’s risk of cancer or not
Ninety percent of those in middle-income and 94% of those in high-income countries believed that smoking cigarettes increased the risk of cancer
In low-income countries, 69% believed that smoking cigarettes increased the risk of cancer, but nearly one-quarter could not say, suggesting that public education appears needed in low-income countries
Perceived cancer risk
Perceived cancer risk of smoking cigarettes
69
9094
8 84
23
2 2
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Perceived cancer risk
Respondents were asked to indicate if they believed chewing tobacco increases a person’s risk of cancer or not
The majority of respondents believed that chewing tobacco increases the risk of cancer
However, 31% of those in middle-income countries did not believe that chewing tobacco increases the risk of cancer
Further, 27% of those in low-income countries could not say if chewing tobacco increases the risk of cancer.
Perceived cancer risk of chewing tobacco
63 60
87
10
31
7
27
8 7
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed drinking alcohol increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that alcohol did not elevate cancer risk
Perceived cancer risk
Perceived cancer risk of drinking alcohol
56
71
51
15
26
42
29
38
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed not eating vegetables increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that not eating vegetables elevated cancer risk
Perceived cancer risk
Perceived cancer risk of not eating vegetables
17
40
59
4651
3337
9 8
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Perceived cancer risk
Respondents were asked to indicate if they believed not eating fruit increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that not eating fruit elevated cancer risk
Perceived cancer risk of not eating fruit
15
36
59
47
55
3438
9 8
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed a lack of cereals and wholegrains increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that a lack of cereals and grains elevated cancer risk
Perceived cancer risk
Perceived cancer risk of a lack of cereals and wholegrains
12
30
53
44
58
3844
12 9
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed eating fatty foods increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that eating fatty foods elevated cancer risk
Perceived cancer risk
Perceived cancer risk of eating fatty foods
14
6065
43
3228
43
8 6
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed eating red meat increases a person’s risk of cancer or not
In comparison to those in low-income countries, a greater percentage of those in middle- and high-income countries thought eating red meat elevated cancer risk
A higher percentage in all countries thought eating red meat did not elevate cancer risk
Perceived cancer risk
Perceived cancer risk of eating red meat
13
38 3743
52 52
44
10 10
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed a lack of exercise increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that a lack of exercise elevated cancer risk
Perceived cancer risk
Perceived cancer risk of a lack of exercise
13
42
57
46 47
3841
116
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed being overweight increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that being overweight elevated cancer risk
Perceived cancer risk
Perceived cancer risk of being overweight
14
50
63
42 41
31
44
9 6
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed using a mobile phone increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that using mobile or cell phones did not elevate cancer risk
Perceived cancer risk
Perceived cancer risk of using mobile or cell phones
16
3628
4451
55
40
1216
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed exposing your skin to the sun increases a person’s risk of cancer or not
As the income status of countries increased, there was an increasing percentage of people who thought that exposing your skin to the sun elevated cancer risk
Perceived cancer risk
Perceived cancer risk of exposing your skin to the sun
22
62
91
3530
7
42
83
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed exposure to air pollution increases a person’s risk of cancer or not
Those in middle- and high-income countries were more likely than those in low-income countries to think that air pollution elevated cancer risk
Perceived cancer risk
Perceived cancer risk of exposure to air pollution
30
76 78
27
17 16
44
7 6
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed infection with viruses or bacteria increases a person’s risk of cancer or not
Those in middle- and high-income countries were more likely than those in low-income countries to think that infection with viruses or bacteria elevated cancer risk
Perceived cancer risk
Perceived cancer risk from infection with viruses or bacteria
39
70
57
22 23
3240
711
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Respondents were asked to indicate if they believed being stressed increases a person’s risk of cancer or not
Those in middle- and high-income countries were more likely than those in low-income countries to think that being stressed elevated cancer risk
Perceived cancer risk
Perceived cancer risk from being stressed
16
59 57
40
3035
44
117
0
10
20
30
40
50
60
70
80
90
100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Perceived cancer risk
Tobacco use and perceived cancer risk of smoking cigarettes
Tobacco use and perceived cancer risk of chewing tobacco
Alcohol consumption and perceived cancer risk of drinking alcohol
Sunburn in the last 12 months and perceived cancer risk of sun exposure
Body mass index and perceived cancer risk of being overweight
Level of physical activity and perceived cancer risk of a lack of exercise
Cancer risk factors and prevention beliefs
In all countries, a smaller percentage of tobacco users thought cigarettes elevated cancer risk, compared with those who did not consume tobacco
This relative difference narrowed between those who did and did not consume tobacco as the income level of countries increased
Cancer risk factors and prevention beliefs
Perceived cancer risk of smoking cigarettes according to tobacco use
57
70
8592 90
96
19
712
6 82
24 23
3 1 3 2
010
2030
405060
7080
90100
Tobacco user Do not consume Tobacco user Do not consume Tobacco user Do not consume
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Cancer risk factors and prevention beliefs
As income status increased, there was an increasing percentage of tobacco users who believed that smoking cigarettes increases cancer risk
Twenty-four percent of low-income country tobacco users could not say if smoking cigarettes increases the risk of cancer or not
Cancer risk factors and prevention beliefs
Tobacco users' perceptions of cancer risk of smoking cigarettes
57
8590
1912
8
24
3 3
010
2030
405060
7080
90100
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Cancer risk factors and prevention beliefs
In all countries, a smaller percentage of tobacco users thought chewing tobacco elevated cancer risk, compared with those who did not consume tobacco
Over one-third of middle-income tobacco users believed that chewing tobacco was not a cancer risk in comparison to 12% of tobacco users in high-income countries and 19% of tobacco users in low-income countries
Cancer risk factors and prevention beliefs
Perceived cancer risk of chewing tobacco according to tobacco use
5364
5464
8190
199
3827
124
27 27
8 8 8 6
0
20
40
60
80
100
Tobaccouser
Do notconsume
Tobaccouser
Do notconsume
Tobaccouser
Do notconsume
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Cancer risk factors and prevention beliefs
In high-income countries, tobacco users were more likely than low- or middle-income tobacco users to believe that chewing tobacco increases the risk of cancer
Over one quarter of tobacco users in low-income countries indicated that they “can’t say” whether chewing tobacco increases a person’s cancer risk
Cancer risk factors and prevention beliefs
Tobacco users' perceptions of the cancer risk of chewing tobacco
53 54
81
19
38
12
27
8 8
0
10
20
30
40
50
60
70
80
90
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Cancer risk factors and prevention beliefs
Within each income category, those who more often drank alcohol were less likely to perceive that alcohol increased cancer risk
Of note, 52% of frequent drinkers in high-income countries and 49% of frequent drinkers in middle-income countries believed there was no cancer risk associated with drinking alcohol
Cancer risk factors and prevention beliefs
Perceived cancer risk of drinking alcohol according to alcohol consumption
4451
5948
60 59
87
4149
61
25 2013 10
524545
28
3 3 2 3 7 8 8 8
47
28
43
314037
27
49
3129
0
20
40
60
80
100
Fre
quen
t
Mod
erat
e
Occ
asio
nal
Nev
er
Fre
quen
t
Mod
erat
e
Occ
asio
nal
Nev
er
Fre
quen
t
Mod
erat
e
Occ
asio
nal
Nev
er
Low Middle High
World Bank Income Category
Yes, increases cancer risk No risk Can't Say
Cancer risk factors and prevention beliefs
As income status increased, the percentage of frequent drinkers who believed that there was no cancer risk associated with drinking alcohol increased
In addition, in the low-income category 45% of frequent drinkers could not say whether drinking alcohol increases a person’s risk of cancer
Cancer risk factors and prevention beliefs
Frequent drinkers' perceptions of the cancer risk of drinking alcohol
28
4841
27
4952
45
37
0
10
20
30
40
50
60
70
Low Middle High
World Bank income category
Yes, increases risk No Risk Can't Say
Cancer risk factors and prevention beliefs
As the income status of countries increased, there was an increasing percentage of people who thought that exposing one’s skin to the sun elevated cancer risk
Cancer risk factors and prevention beliefs
Sun exposure in the last 12 months and perceived cancer risk of sun exposure
1724
63 62
93 90
01020304050
60708090
100
Sunburn No burn Sunburn No burn Sunburn No burn
Low Middle High
World Bank income category
Yes, increases risk
Cancer risk factors and prevention beliefs
In all countries, individuals who did and did not report being sunburnt had similar perceptions of the cancer risk associated with exposing one’s skin to the sun
Cancer risk factors and prevention beliefs
Perceived cancer risk of sun exposure by sunburn in the last 12 months
1724
63 62
93 90
4035
28 31
6 7
43 40
9 61 3
0102030405060708090
100
Sunburn No burn Sunburn No burn Sunburn No burn
Low Middle High
World Bank income category
Yes, Increases risk No risk Can't Say
Cancer risk factors and prevention beliefs
As income status increased, an increasing percentage of respondents believed that being overweight increases the risk of cancer
High- and middle-income overweight/obese respondents were over 3 times more likely to perceive being overweight as increasing the risk of cancer than overweight/obese individuals from low-income countries
Cancer risk factors and prevention beliefs
Perceived cancer risk of being overweight according to body mass index
15 17
47
5865 63
4743 46
33 30 31
39 40
8 95 5
0
10
20
30
40
50
60
70
Healthy Weight Overw eight Healthy Weight Overw eight Healthy Weight Overw eight
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Cancer risk factors and prevention beliefs
Overweight/obese respondents from high- and middle-income countries were over 3 times more likely to perceive being overweight as increasing the risk of cancer than overweight/obese individuals from low-income countries
Cancer risk factors and prevention beliefs
Cancer risk factors and prevention beliefs
Overweight or obese individuals' perceptions of cancer risk of being overweight
17
5863
43
33 31
40
95
0
10
20
30
40
50
60
70
Low Middle High
World Bank income category
Yes, increases cancer risk No risk Can't Say
Further enquiries?
Unit-record-level data is available for further data analysis by the UICC member organization, provided it is not sold on to any third party.
Visit www.cancervic.org.au/uicc for more detailed graphs on all the data items by World Bank income category or email [email protected]
Future analyses will be posted to this website in the coming months