Inequalities in Cancer Prevention Literacy Across Six Latin American and Caribbean Countries
Paula Castro Prieto, Ariadna Feliu, Rubana Islam, Sergio Iván Galicia Pacheco, Carolina EspinaPURPOSE
Latin America and the Caribbean (LAC) is characterized by profound social inequalities that may shape cancer prevention literacy (CPL). However, CPL remains poorly studied across the region. Using the CPL Questionnaire developed within the LAC Code Against Cancer project, this study analyzed the associations between CPL-related constructs and sociodemographic factors (age, sex, education, occupation, and country), identifying patterns of inequality across six LAC countries.
METHODS
A cross-sectional telephone-based survey was conducted among adults aged ≥18 years without a prior cancer diagnosis in Brazil, Colombia, Costa Rica, Mexico, Peru, and the Dominican Republic (n = 2,431). Outcomes included beliefs about cancer prevention, risk perceptions, awareness and knowledge about cancer prevention, intention to change unhealthy behaviors and/or uptake prevention interventions, adherence to healthy behaviors, and awareness about the LAC Code Against Cancer. Multivariable linear, ordinal, and logistic regression models were fitted according to outcome type. Analyses were conducted using R version 4.6.0, applying survey weights.
RESULTS
In multivariable analyses, significant associations across countries and sociodemographic groups were observed for all CPL constructs. Using Brazil as the reference category, adults in Mexico and Peru showed higher odds of adherence to several healthy behaviours, particularly daily physical activity (OR: 7.61 and 8.08, respectively). Respondents in Colombia had lower odds of intention to have their children vaccinated against hepatitis B (OR: 0.49) and HPV (OR: 0.61), while those in Costa Rica had higher odds of intention to adopt a healthy diet (OR: 3.67). Adults in the Dominican Republic had lower odds of correctly identifying the proportion of preventable cancer cases (OR: 0.51). Other sociodemographic characteristics were also associated with CPL constructs. Higher educational attainment was associated with lower odds of negative cancer-related beliefs (OR: 0.46), higher cancer risk-factor awareness (OR: 1.70), and greater intentions to stop smoking or using tobacco products (OR: 2.87) and achieve or maintain a healthy weight (OR: 2.84). Small-town residence was associated with higher cancer risk-factor awareness (OR: 1.57), while women had higher odds of regular sun protection than men (OR: 1.50).
CONCLUSION
CPL-related outcomes varied across sociodemographic characteristics and countries, with education emerging as an important correlate across several constructs.