{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T03:27:38Z","timestamp":1793244458321,"version":"4.5.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007316","name":"NIH\/NCI","doi-asserted-by":"publisher","award":["#R01 CA140151"],"award-info":[{"award-number":["#R01 CA140151"]}],"id":[{"id":"10.13039\/100007316","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Health Promot"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To identify primary sociodemographic factors contributing to cancer health literacy disparities in cancer and non-cancer samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Cancer and primary care clinics, healthcare events, community centers, and churches in the Mid-Atlantic region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects<\/jats:title>\n                    <jats:p>We recruited U.S. adults with confirmed cancer diagnosis (n = 1306) and adults without cancer (n = 512).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>The Cancer Health Literacy Test\u201330 and a demographic questionnaire were administered using touchscreen tablets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Analysis<\/jats:title>\n                    <jats:p>One-factor model and measurement invariance were tested. Structural equation modeling was used in univariate and multivariable prediction models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One-factor and scalar invariance models were uniformly supported. Race\/ethnicity, education, and income were the strongest predictors of cancer health literacy. Age effect was non-significant in univariate analysis, but it was significant with a small effect size in multivariable analysis. A significant but small marital status effect in univariate analysis became non-significant after adjustment, similar to sex effect in non-cancer sample. A significant but small sex effect in cancer sample became non-significant after adjustment. Multivariable models explained 57%-59% variability in cancer health literacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Race\/ethnicity, educational attainment, and income are the primary drivers of disparities in cancer health literacy. Health promotion activities should target cancer health literacy in subpopulations self-identified as Non-Hispanic Black, low income, and low education, and adopt practical health promotion strategies to improve the health outcomes and wellbeing targeting these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08901171251390650","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T11:27:02Z","timestamp":1760441222000},"page":"471-478","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Disparities in Cancer Health Literacy by Race\/Ethnicity, Education, Income, Age, Sex, and Marital Status"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0702-9511","authenticated-orcid":false,"given":"Levent","family":"Dumenci","sequence":"first","affiliation":[{"name":"Temple University"},{"name":"Cancer Prevention and Control Program, Fox Chase Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danial L.","family":"Riddle","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-090419-102529"},{"key":"e_1_3_6_3_2","volume-title":"Health Literacy: A Prescription to End Confusion","author":"Kindig DA","year":"2004","unstructured":"Kindig DA, Panzer AM, Nielsen-Bohlman L, eds. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004."},{"key":"e_1_3_6_4_2","first-page":"764","volume-title":"International Handbook of Health Literacy: Research, Practice and Policy Across the Lifespan","author":"Okan O","year":"2019","unstructured":"Okan O, Bauer U, Levin-Zamir D, Pinheiro P, S\u00f8rensen K. International Handbook of Health Literacy: Research, Practice and Policy Across the Lifespan. Bristol: Policy Press; 2019:764."},{"key":"e_1_3_6_5_2","first-page":"1","volume-title":"Health Literacy: A Critical Concept for Public Health","author":"Van den Broucke S","year":"2014","unstructured":"Van den Broucke S. Health Literacy: A Critical Concept for Public Health, 72. London: Arch Pub Health; 2014:1-2."},{"key":"e_1_3_6_6_2","volume-title":"Talking Points About Health Literacy","author":"Centers for Disease Control and Prevention","year":"2021","unstructured":"Centers for Disease Control and Prevention. Talking Points About Health Literacy. Atlanta, GA: Centers for Disease Control and Prevention; 2021."},{"key":"e_1_3_6_7_2","volume-title":"Low Health Literacy: Implications for National Health Policy","author":"Vernon JA","year":"2007","unstructured":"Vernon JA, Trujillo A, Rosenbaum SJ, DeBuono B. Low Health Literacy: Implications for National Health Policy, 20. Bengaluru: Health Sciences Research Commons; 2007."},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2005.40245.x"},{"issue":"1","key":"e_1_3_6_9_2","first-page":"3061","article-title":"Health literacy, social determinants of health, and disease prevention and control","volume":"6","author":"Coughlin SS","year":"2020","unstructured":"Coughlin SS, Vernon M, Hatzigeorgiou C, George V. Health literacy, social determinants of health, and disease prevention and control. J Environ Health Sci. 2020;6(1):3061.","journal-title":"J Environ Health Sci"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00005"},{"key":"e_1_3_6_11_2","volume-title":"NCES 2006-483","author":"Kutner M","year":"2006","unstructured":"Kutner M, Greenburg E, Jin Y, Paulsen C. The health literacy of America's adults: results from the 2003 national assessment of adult literacy. In: NCES 2006-483. Washington, DC: National Center for education statistics; 2006."},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0145455"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2010.09.016"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-020-06407-8"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2018.09.028"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006416-200701000-00014"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7381-1"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/day062"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2006.053967"},{"issue":"3","key":"e_1_3_6_20_2","first-page":"493","article-title":"A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability","volume":"46","author":"Clouston SA","year":"2017","unstructured":"Clouston SA, Manganello JA, Richards M. A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability. Age Ageing. 2017;46(3):493-499.","journal-title":"Age Ageing"},{"issue":"1","key":"e_1_3_6_21_2","first-page":"e47","article-title":"Social disparities in health literacy in the United States","volume":"3","author":"Fleary SA","year":"2019","unstructured":"Fleary SA, Ettienne R. Social disparities in health literacy in the United States. Health Lit Res Pract. 2019;3(1):e47-e52.","journal-title":"Health Lit Res Pract"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-1105-7"},{"issue":"3","key":"e_1_3_6_23_2","first-page":"144","article-title":"Health literacy-a new concept for general practice?","volume":"38","author":"Stocks NP","year":"2009","unstructured":"Stocks NP, Hill CL, Gravier S, et al. Health literacy-a new concept for general practice? Aust Fam Physician. 2009;38(3):144-146.","journal-title":"Aust Fam Physician"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckad160.1465"},{"issue":"10","key":"e_1_3_6_25_2","first-page":"1105","article-title":"The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior","volume":"99","author":"Peterson NB","year":"2007","unstructured":"Peterson NB, Dwyer KA, Mulvaney SA, Dietrich MS, Rothman RL. The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior. J Natl Med Assoc. 2007;99(10):1105-1112.","journal-title":"J Natl Med Assoc"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2015.02.013"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2014.943377"},{"issue":"2","key":"e_1_3_6_28_2","first-page":"e58","article-title":"Validation of the cancer health literacy test-30 for populations without cancer","volume":"2","author":"Dumenci L","year":"2018","unstructured":"Dumenci L, Matsuyama RK, Riddle DL, Cartwright L, Siminoff LA. Validation of the cancer health literacy test-30 for populations without cancer. Health Lit Res Pract. 2018;2(2):e58-e66.","journal-title":"Health Lit Res Pract"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13187-020-01915-x"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2021.09.012"},{"key":"e_1_3_6_31_2","doi-asserted-by":"publisher","DOI":"10.1080\/10705519909540118"},{"key":"e_1_3_6_32_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2010.02.070278"},{"issue":"3","key":"e_1_3_6_33_2","first-page":"493","article-title":"A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability","volume":"46","author":"Clouston SAP","year":"2017","unstructured":"Clouston SAP, Manganello JA, Richards M. A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability. Age Ageing. 2017;46(3):493-499.","journal-title":"Age Ageing"},{"key":"e_1_3_6_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/08901171231222073"},{"key":"e_1_3_6_35_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.87.5.728"},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19106237"},{"key":"e_1_3_6_37_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15102091"}],"container-title":["American Journal of Health Promotion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08901171251390650","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08901171251390650","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08901171251390650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:03:56Z","timestamp":1777367036000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08901171251390650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/08901171251390650"],"URL":"https:\/\/doi.org\/10.1177\/08901171251390650","relation":{},"ISSN":["0890-1171","2168-6602"],"issn-type":[{"value":"0890-1171","type":"print"},{"value":"2168-6602","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]}}}