Awareness of lifestyle risk factors for cancer and heart disease among adults in the UK

Abstract

Objective

To examine and compare awareness of lifestyle risk factors for cancer and heart disease in a single UK representative sample.

Methods

Two open-ended questions about cancer and heart disease risk factors were included in a population-based survey of 1747 adults. Responses were coded for four lifestyles with established links to both diseases: smoking, eating an unhealthy diet, drinking excessive alcohol and physical inactivity.

Results

Awareness of lifestyle risk factors was low for both diseases, although higher for heart disease than cancer. The average number identified by respondents was 2.1 (heart disease) and 1.4 (cancer). The strongest predictor was education (both p < 0.001). Awareness that physical inactivity is a cancer risk factor was particularly low at 7%.

Conclusion

These findings suggest that public awareness of the impact of lifestyle on commonly feared diseases, especially cancer, is low.

Practice implications

Unhealthy lifestyles make a significant contribution to ill health and mortality. Increased public awareness of the links between lifestyles and commonly feared diseases might help people understand the potential health consequences of their actions and encourage them to make much-needed lifestyle changes. Efforts are needed to improve public health messages about how lifestyle risk factors impact on the chances of developing these important diseases.

Introduction

Unhealthy lifestyles such as tobacco smoking, unhealthy diet, excessive alcohol consumption and physical inactivity are having an unprecedented impact on the health of the public [1]. For example, over 50% of cancers and over 40% of circulatory diseases including heart disease are believed to be attributable to lifestyle factors. Cancer and heart disease are the leading causes of death in the UK [2], with 21% of premature deaths in men and 12% in women being from heart disease [3], and one in three people developing cancer in their lifetime [4]. In the US, smoking is estimated to account for around 30% of all cancers, obesity for 15%, poor diet for at least 10%, inactivity for 5%, and alcohol consumption for 4% [5]. Worldwide, approximately 31% of heart disease is believed to be attributable to poor diet (e.g. low intake of fruit and vegetables) and 22% to physical inactivity, and a further 22% is estimated to be attributable to smoking in industrialized countries [1]. In addition, the World Health Organization (WHO) recently stated that a number of cardiovascular disorders are adversely affected by excessive alcohol consumption [6]. In women, maintaining a desirable body weight, eating a healthy diet, exercising regularly, not smoking, and consuming a moderate amount of alcohol could result in an 84% lower heart disease risk, yet only 3% of women fall into that category [7].

Promoting healthy lifestyles to reduce cancer and heart disease, as well as other common conditions, is therefore a clear public health priority. However, predicting and promoting healthy lifestyles is complex. Social cognition models of health behaviour posit a range of factors that appear to influence behaviour, including perceived threat (e.g. perceived severity of and susceptibility to disease), perceived response-efficacy (e.g. confidence that engaging in a recommended behaviour will reduce the threat of disease), and perceived self-efficacy (i.e. confidence in personal ability to carry out the recommended behaviour) [8]. Because a prerequisite of a number of these cognitions is knowledge or awareness of the association between the disease and the behaviour, ensuring public awareness of the links between common disease and lifestyle is a necessary, albeit not alone sufficient, step towards helping people to understand the potential health consequences of their actions, and towards encouraging them to take risk-reducing action and make currently much-needed changes to their lifestyle [9].

Several surveys have shown high public awareness of the links between smoking and developing lung cancer, but considerably lower awareness of the impact that other lifestyles such as eating a healthy diet can have on cancer risk [10], [11], [12], [13]. Thus people may believe that there is nothing else they can do to reduce their chances of developing cancer other than not to smoke. Importantly, spontaneous awareness of risk factors may actually be even lower than reported, because all of these studies have asked people to endorse risk factors from a list, and this method has been shown to produce higher estimates of knowledge than open-ended questions [14].

We are not aware of any surveys exploring what people in the general population believe about the role of lifestyles in causing heart disease, the other major cause of mortality in the UK and other Western countries. Existing heart disease research has focused predominantly on patient groups and has been conducted largely in the context of rehabilitation programmes [15], [16], [17], [18]. This research has tended to show that even in these high risk populations awareness of the role of lifestyles in heart disease is higher than for population-levels for cancer, but still low. It is not clear to what extent these findings regarding heart disease can be extrapolated to the wider general public, nor is it clear to what extent the attitudes of these patient groups specifically represent people with high family history-based risk of disease outside of the clinic setting.

Finally, no studies have directly compared knowledge of the role of lifestyles in causing cancer and heart disease in a single sample. Doing so could shed light on how public perceptions of these two major causes of ill health and mortality differ, providing useful information for those engaged in developing patient education materials and public health messages about disease prevention.

The aims of the present study were: to assess levels of public awareness of lifestyle risk factors for cancer using open-ended questions; to identify demographic factors associated with awareness; to examine whether people with a family history of the disease were more aware of the importance of lifestyle in disease prevention than those with no family history; and to compare these levels of, and factors associated with, awareness of lifestyle risk factors for heart disease in the same population-based sample. Because the focus of this study was on awareness of modifiable lifestyle risk factors for these diseases, other risk factors such as occupational environment were not coded for in the present analyses. We predicted on the basis of previous research that awareness of risk factors for cancer would be higher amongst women and those with higher levels of education. In the absence of any prior comparative data on heart disease, we predicted that levels of awareness would be higher for heart disease than for cancer, but still low; that the same factors would be associated with awareness of heart disease risk factors as for cancer risk factors; and that, because it has greater personal relevance, people with a family history of each disease would be more aware of the links between lifestyle and that disease than those with no family history.