Subjective Financial Strain and Fatalistic Beliefs about Cancer Among U.S. Adults: A Cross-Sectional Study.

Abstract

Cancer fatalism-beliefs that cancer is inevitable, unpreventable, and closely associated with death-has been identified as a barrier to cancer prevention and early detection behaviors. Although socioeconomic disparities in cancer fatalism are well documented, most studies have relied on objective indicators of socioeconomic status, potentially overlooking the role of perceived financial circumstances. This study examined the association between subjective financial strain and cancer fatalistic beliefs among U.S. adults. Data were obtained from the 2024 Health Information National Trends Survey (HINTS 7), a nationally representative survey of U.S. adults (n = 5,824). Subjective financial strain was measured using respondents' perceived ability to live on their present income. Cancer fatalism was assessed using three widely used items reflecting beliefs that everything causes cancer, that cancer prevention is not possible, and that thinking about cancer automatically evokes thoughts of death. Survey-weighted ordinal logistic regression models were estimated for each outcome. Models were first estimated unadjusted and subsequently adjusted for age, sex, race/ethnicity, educational attainment, annual household income, family history of cancer, personal history of cancer, and health insurance status. Average marginal effects and predicted probabilities were calculated to facilitate interpretation. Fatalistic cancer beliefs were common among U.S. adults. Greater subjective financial strain was consistently associated with stronger endorsement of fatalistic beliefs. In fully adjusted models, compared with respondents living comfortably, those reporting greater financial difficulty had significantly higher odds of agreeing that everything causes cancer (OR = 1.53-3.11), that there is not much that can be done to lower cancer risk (OR = 1.21-1.41), and that thinking about cancer automatically evokes thoughts of death (OR = 1.54-2.43). Predicted probabilities showed a graded association, with stronger fatalistic beliefs observed among respondents reporting greater financial difficulty. Associations were most pronounced for beliefs concerning cancer ubiquity and cancer-related mortality. Subjective financial strain was independently associated with stronger cancer fatalistic beliefs among U.S. adults after accounting for objective socioeconomic status and other sociodemographic and health-related characteristics. These findings suggest that perceived financial circumstances may represent an important socioeconomic correlate of cancer fatalism and highlight the need for longitudinal research to clarify the temporal relationship between financial strain and cancer fatalistic beliefs.