{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:05:13Z","timestamp":1780923913869,"version":"3.54.1"},"reference-count":49,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"UNITE Research Priority Area and Markey Cancer Center grant mechanism at the University of Kentucky"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Adolescent and Young Adult Oncology"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Empirical evidence examining the impact of health insurance literacy (HIL) on cancer-related financial toxicity (FT) among adolescent and young adults (AYAs) is limited. AYA cancer survivors experience greater levels of financial hardship due to sociodemographic and developmentally related factors. The purpose of this study was to examine the relationship between HIL and FT in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used a cross-sectional design to survey 246 AYA cancer survivors (diagnosed between ages 15\u201339) through the Kentucky Cancer Registry (KCR). Survey data were collected on FT and HIL using the Health Insurance Literacy Scale (HILS) and Health Insurance Literacy Measure (HILM) subscales on behaviors related to choosing and using health insurance plans. Record-level KCR data included county of residence and race\/ethnicity among other sociodemographic variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Two-thirds (67%) of participants indicated experiencing problems with understanding health insurance or medical bills. When adjusting for sociodemographic variables, those with inadequate HILS scores reporting higher (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002) FT scores than those with adequate HILS (\n                      <jats:italic toggle=\"yes\">b<\/jats:italic>\n                      = 0.05, SE = 0.02). An inverse relationship (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.042) was found between behaviors related to choosing health insurance plans and FT (\n                      <jats:italic toggle=\"yes\">b<\/jats:italic>\n                      = \u22120.003, SE = 0.002). A significantly (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.028) lower proportion of rural participants had adequate HILS scores (55%), compared to their urban counterparts (71%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our findings highlight the need for integrating HIL education and resources in FT interventions tailored to address the unique needs of geographically diverse AYA cancer survivors across the cancer continuum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21565333261451816","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:19:18Z","timestamp":1779095958000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Health Insurance Literacy and Financial Toxicity in Adolescent and Young Adult Cancer Survivors"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9184-1048","authenticated-orcid":false,"given":"Jean","family":"Edward","sequence":"first","affiliation":[{"name":"College of Nursing, University of Kentucky, Lexington, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Wiggins","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Kentucky, Lexington, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Caldwell","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Kentucky, Lexington, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Baser","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Kentucky, Lexington, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly D.","family":"Northrip","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"D\u2019Orazio","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA."},{"name":"Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children\u2019s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-19-1534"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70211-5"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2023.2254649"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0279"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2020.21.2.289"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2014.001542"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.33.3179"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.6620"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.63.2232"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27660"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2013.0035"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27512"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/10732748251339251"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.23.1183"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.7197"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djv370"},{"key":"e_1_3_3_18_1","volume-title":"Measuring health insurance literacy: A call to action","author":"L Q","year":"2012","unstructured":"17.L Q. Measuring health insurance literacy: A call to action. Washington, DC; 2012."},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2014.936568"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/fcsr.12034"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/28322134.2025.2455706"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2214.2011.01282.x"},{"key":"e_1_3_3_23_1","unstructured":"22.Service USDoAER. Rural-urban continuum codes. 2024."},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.50844"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw205"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkae025"},{"key":"e_1_3_3_27_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP.22.00665"},{"issue":"4","key":"e_1_3_3_28_1","first-page":"413","article-title":"Prevalence of low cost-related health literacy among colorectal cancer survivors: Findings from the Kentucky cancer registry","volume":"26","author":"Edward JS","year":"2022","unstructured":"27.Edward JS, , Rayens MK, , Vanderpool RC. Prevalence of low cost-related health literacy among colorectal cancer survivors: Findings from the Kentucky cancer registry. Clin J Oncol Nurs 2022;26(4):413\u2013420.","journal-title":"Clin J Oncol Nurs"},{"key":"e_1_3_3_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28814"},{"key":"e_1_3_3_30_1","doi-asserted-by":"publisher","DOI":"10.1188\/22.CJON.E14-E25"},{"key":"e_1_3_3_31_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.0468"},{"key":"e_1_3_3_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06036-9"},{"key":"e_1_3_3_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-7-21"},{"key":"e_1_3_3_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X15578635"},{"issue":"4","key":"e_1_3_3_35_1","first-page":"e250","article-title":"Significant disparities exist in consumer health insurance literacy: Implications for health care reform","volume":"3","author":"Edward J","year":"2019","unstructured":"34.Edward J, , Wiggins A, , Young MH, , Rayens MK. Significant disparities exist in consumer health insurance literacy: Implications for health care reform. Health Lit Res Pract 2019;3(4):e250\u2013e258.","journal-title":"Health Lit Res Pract"},{"key":"e_1_3_3_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06819-0"},{"key":"e_1_3_3_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.4796"},{"key":"e_1_3_3_38_1","volume-title":"Foundation THJKF","author":"Mira Norton LH","year":"2014","unstructured":"37.Mira Norton LH, , Brodie M. Assessing Americans\u2019 Familiarity With Health Insurance Terms and Concepts. In: Foundation THJKF, editor. 2014."},{"key":"e_1_3_3_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-016-3396-7"},{"key":"e_1_3_3_40_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP-25-00389"},{"key":"e_1_3_3_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.conctc.2025.101523"},{"key":"e_1_3_3_42_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2020.7581"},{"key":"e_1_3_3_43_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP.23.00171"},{"key":"e_1_3_3_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/21565333261425502"},{"key":"e_1_3_3_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13187-020-01915-x"},{"key":"e_1_3_3_46_1","unstructured":"45.2030 HP. Health Literacy in Healthy People 2030: U.S. Department of Health and Human Services. Available from: https:\/\/odphp.health.gov\/healthypeople\/priority-areas\/health-literacy-healthy-people-2030"},{"issue":"1","key":"e_1_3_3_47_1","first-page":"e47","article-title":"Social disparities in health literacy in the United States","volume":"3","author":"Fleary SA","year":"2019","unstructured":"46.Fleary SA, , Ettienne R. Social disparities in health literacy in the United States. Health Lit Res Pract 2019;3(1):e47\u2013e52.","journal-title":"Health Lit Res Pract"},{"key":"e_1_3_3_48_1","unstructured":"47.Long S G D. Health reform monitoring survey. 2014."},{"issue":"1","key":"e_1_3_3_49_1","first-page":"3061","article-title":"Health literacy, social determinants of health, and disease prevention and control","volume":"6","author":"Coughlin SS","year":"2020","unstructured":"48.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_3_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27931"}],"container-title":["Journal of Adolescent and Young Adult Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21565333261451816","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21565333261451816","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21565333261451816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:32:58Z","timestamp":1780921978000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21565333261451816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":49,"alternative-id":["10.1177\/21565333261451816"],"URL":"https:\/\/doi.org\/10.1177\/21565333261451816","relation":{},"ISSN":["2156-5333","2156-535X"],"issn-type":[{"value":"2156-5333","type":"print"},{"value":"2156-535X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"article-number":"21565333261451816"}}