Cancer-related lifestyle risk, knowledge, risk perception, and intention to screen in a socio-economically diverse urban population in South Africa

Abstract

Cancer prevention through lifestyle modification is a cost-effective approach to reducing rising cancer incidence in South Africa. This study aimed to investigate adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations and the association with socio-economic status (SES) and other health-related factors in a Black African urban population from Soweto, South Africa. A cross-sectional household survey was conducted using a proportionate stratified systematic random sample of 407 men and women. Anthropometric measurements were conducted, and structured questionnaires were used to collect data on socio-demographic characteristics, SES, dietary intake, and other lifestyle factors. To assess adherence to recommendations, a seven-point adherence score was developed, using WCRF/AICR cut-offs and adherence score categories for scoring each recommendation (0, 0·5 and 1) with zero indicating the lowest adherence to the recommendations. Bivariate and multivariate linear regression analyses, with estimated coefficients and 95% CI, were used to assess correlates of adherence. Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations was low, with a mean score of 3.0 (±SD = 0.86). Lower adherence was associated with younger age (p=0.010), high school education (vs no schooling or primary level) (p = 0.018) and high food security (p = 0.044). Higher adherence was associated with believing cancer is controllable if detected early (p = 0.017) and having been screened for prostate cancer (p = 0.018). In the multivariate model, lower adherence was associated with the 20-29 year agegroup versus the 30-39 (β = 0.27, 95% CI = 0.00, 0.54) and 50-55 (β = 0.44, 95% CI = 0.13, 0.76) year age groups, high school education (β = -0.29, 95% CI = -0.53, -0.05), current employment (β = -0.36, 95% CI = -0.66, -0.06), living in moderate-affluence area versus lowaffluence area (β = 0.42, 95% CI = 0.08, 0.76), and, for males only, high food security versus moderate food security (β = 0.52, 95% CI = 0.08, 0.95). Higher adherence was associated with having been screened for cancer for both males (β = 0.56, 95% CI = 0.08, 1.04) and females (β = 0.24, 95% CI = 0.00, 0.48). Low adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations is associated with younger age, higher SES, low risk perception, and poor cancer screening behaviour, with patterns differing with sex. Targeted public health efforts that account for sub-group differences are required to improve lifestyle health.