Cancer literacy and attitudes among school-going adolescents in a rural district of Tamil Nadu, India: A Cross-sectional study.

Background: Cancer remains a leading cause of global mortality, with a substantial disease burden in India across all age groups. While prevention strategies have proven to be effective, adolescence offers a crucial window for establishing lifelong health behaviors and cancer awareness. This developmental period is vital for building health literacy and understanding cancer prevention as habits formed during these years often persist in adulthood. This study was conducted to assess the cancer literacy and attitudes among school-going adolescents in Perambalur district, Tamil Nadu, South India, as well as identifying their independent predictors of inadequate literacy and attitudes.

Materials and methods: A cross-sectional study was conducted among 764 school-going adolescents (grades 8-12) in four randomly selected schools in Perambalur district, Tamil Nadu. Data were collected using a pretested semistructured questionnaire administered through the interviewer method. The questionnaire assessed cancer-related knowledge (11 items, maximum score 33) and attitudes (9 items, maximum score 27) using a three-point Likert scale. Data analysis was performed using SPSS v26, [IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp] employing descriptive statistics, Chi-square test, independent t-test, and one-way ANOVA and multivariable linear regression with P < 0.05 considered significant.

Results: Among 764 participants (56.9% males), the mean age was 14.13 ± 1.20 years. The mean knowledge and attitude scores were 25.9 ± 2.76 and 21.04 ± 2.36, respectively. While 61.8% knew the correct definition of cancer and 67.7% believed early detectable cancer is curable, only 34.9% were aware of cancer-preventive vaccines. Female students showed higher knowledge scores (26.39 ± 2.50) compared to males (25.67 ± 2.90, P = 0.002). Parental education significantly influenced knowledge scores, with children of graduate/postgraduate parents showing higher scores (P < 0.001). Urban residents demonstrated higher knowledge scores (26.46 ± 2.94) than rural residents (25.67 ± 2.59, P = 0.04). Age positively correlated with attitude scores (r = 0.23, P < 0.001). Multivariable analysis showed male gender (B = 0.70, 95% CI: 0.32-1.09) and maternal graduate education (B = 1.12, 95% CI: 1.03-2.27) as statistically significant predictors of knowledge scores (Adjusted R² =62%), while age (B = 0.42, 95% CI: 0.28-0.56) predicted attitude scores (Adjusted R² =48%).

Conclusion: While adolescents demonstrated moderate cancer literacy and positive attitudes, significant gaps exist in knowledge about preventive vaccines, risk factors, and common cancers. Educational interventions targeting these gaps, particularly focusing on sociodemographic disparities in cancer literacy, are essential for enhancing cancer prevention literacy among adolescents.