{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:26:57Z","timestamp":1786688817425,"version":"build-2736575974"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low adherence to primary and secondary prevention strategies for gastric cancer remains a major public health challenge. Understanding knowledge, beliefs, perceived barriers, and previous upper gastrointestinal endoscopy (UGE) use may help identify modifiable targets for prevention programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study aimed to describe knowledge, beliefs, perceived barriers, and previous UGE use related to\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      infection and gastric cancer prevention among community residents in Henan Province, China, and to examine their associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A descriptive cross-sectional knowledge-attitude-practice survey was conducted among 1,911 community residents in Henan Province, China. Multivariable logistic regression was used to estimate adjusted odds ratios for previous UGE use. Bayesian path analysis was performed to explore indirect associations among knowledge, beliefs, perceived barriers, and previous UGE use. All results were interpreted as associations rather than causal effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 25.1% (480\/1,911) of participants reported previous UGE use, and 15.3% reported a history of\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection. Previous UGE use was more common among participants with self-reported\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection (adjusted odds ratio [aOR] 2.29, 95% CI 1.70\u20133.08), a first-degree family history of gastric cancer (aOR 4.65, 95% CI 3.14\u20136.89), and gastrointestinal symptoms (aOR 1.67, 95% CI 1.32\u20132.10). Higher belief scores were associated with lower odds of previous UGE use (aOR 0.29, 95% CI 0.16\u20130.51). In Bayesian path analysis, knowledge was positively associated with beliefs (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.502,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and previous UGE use (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.126, p\u202f&amp;lt;\u202f0.001), whereas perceived barriers were negatively associated with previous UGE use (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.220).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Previous UGE use remained suboptimal despite generally favorable awareness and beliefs. These findings suggest an important gap between cognitive readiness and preventive action. Public health strategies should combine targeted health education with barrier reduction, risk-based referral, physician recommendation, and integration of\n                      <jats:italic>H. pylori<\/jats:italic>\n                      screen and treat strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1912334","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:31:59Z","timestamp":1786685519000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, beliefs, perceived barriers, and previous upper gastrointestinal endoscopy use regarding Helicobacter pylori and gastric cancer prevention among community residents: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Huiying","family":"An","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, Henan, China"]},{"name":"Department of Gastroenterology, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, Henan, China"]},{"name":"Department of Gastroenterology, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, Henan, China"]},{"name":"Department of Gastroenterology, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, Henan, China"]},{"name":"Department of Gastroenterology, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e70090","DOI":"10.3322\/caac.70090","article-title":"Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide for 34 cancers in 186 countries","volume":"76","author":"Sung","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in China, 2022","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"ref3","year":"2023"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1053\/j.gastro.2016.01.028","article-title":"Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis","volume":"150","author":"Lee","year":"2016","journal-title":"Gastroenterology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"3250","DOI":"10.1038\/s41591-024-03153-w","article-title":"Gastric cancer prevention by community eradication of Helicobacter pylori: a cluster-randomized controlled trial","volume":"30","author":"Pan","year":"2024","journal-title":"Nat Med"},{"key":"ref6","volume-title":"Population-Based","author":"Park","year":"2025"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1056\/NEJMsb2515372","article-title":"Helicobacter pylori screen-and-treat programs for gastric cancer prevention - IARC working group report","volume":"394","author":"Park","year":"2026","journal-title":"N Engl J Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1053\/j.gastro.2018.04.026","article-title":"Endoscopic screening in Asian countries is associated with reduced gastric cancer mortality: a meta-analysis and systematic review","volume":"155","author":"Zhang","year":"2018","journal-title":"Gastroenterology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1053\/j.gastro.2024.11.025","article-title":"Effect of an endoscopy screening on upper gastrointestinal cancer mortality: a community-based multicenter cluster randomized clinical trial","volume":"168","author":"Xia","year":"2025","journal-title":"Gastroenterology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"100741","DOI":"10.1016\/j.lanwpc.2023.100741","article-title":"Radiographic and endoscopic screening to reduce gastric cancer mortality: a systematic review and meta-analysis","volume":"35","author":"Hibino","year":"2023","journal-title":"Lancet Reg Health West Pac."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1055\/a-2529-5025","article-title":"Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) guideline update 2025","volume":"57","author":"Dinis-Ribeiro","year":"2025","journal-title":"Endoscopy"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1053\/j.gastro.2024.11.001","article-title":"AGA clinical practice update on screening and surveillance in individuals at increased risk for gastric cancer in the United States: expert review","volume":"168","author":"Shah","year":"2025","journal-title":"Gastroenterology"},{"key":"ref13","volume-title":"Gastric cancer screening and early 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prevention","volume":"16","author":"Kang","year":"2024","journal-title":"Cureus"},{"key":"ref20","volume-title":"StatPearls [Internet]","author":"Alyafei","year":"2026"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1007\/s12029-021-00652-8","article-title":"The barriers and facilitators of gastric cancer screening: a systematic review","volume":"52","author":"Hatamian","year":"2021","journal-title":"J Gastrointest Cancer"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1177\/0013164413495237","article-title":"Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety","volume":"76","author":"Wolf","year":"2013","journal-title":"Educ Psychol Meas"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3099","DOI":"10.1186\/s12889-024-20558-x","article-title":"Knowledge and practice of early gastric cancer screening among adults aged >=45 years in China: a cross-sectional 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