kjan Korean Journal of Adult Nursing Korean J Adult Nurs 1225-4886 2288-338X Korean Society of Adult Nursing 10.7469/kjan.2014.26.4.455 kjan-26-455 Original Article Factors Affecting on Cancer Prevention Behaviors in Adult Women KimII Ok 1 YeomGye Jeong 2 ShinSun Hwa 3 Department of Nursing, Sahmyook University, Seoul Graduate School of Health Science & Social Welfare, Sahmyook University, Seoul Graduate School, Ewha Womans University, Seoul, Korea Corresponding author: Shin, Sun Hwa Department of Nursing, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 139-742, Korea. Tel: +82-2-3399-1593, Fax: +82-2-3399-1594, E-mail: ffssh@hanmail.net 08 2014 08 2014 26 4 455 465 18062014 28072014 04082014 Copyright © 2014 Korean Society of Adult Nursing 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

This study was to identify relationships between the levels of perceived stress, cancer-related knowledge, attitude and prevention behaviors, and to explore factors influencing cancer prevention behaviors of adult women in Korea.

 Methods

This study was a descriptive research, using a cross-sectional survey. A convenience sample of 314 women aged 20 to 64 was selected. A self-administered questionnaire was used to measure perceived stress, cancer-related knowledge, cancer-related attitude, and cancer prevention behaviors. The data were analyzed with the SPSS/WIN 21.0 program.

 Results

Cancer-related knowledge significantly differed according to age, marital status, education level, and occupation. While correlations between cancer-related knowledge, cancer-related attitude, and cancer prevention behaviors were positive, correlations between perceived stress and cancer prevention behaviors were negative. The hierarchical regression analyses revealed significant positive relations between cancer prevention behaviors and age (β=.18, p=.003), perceived health status (β=.22, p<.001), periodic checkup (β=.21, p=.002), and cancer-related attitude (β=.25, p<.001). Perceived stress on the other hand was negatively related to cancer prevention behaviors (β=-.23, p<.001).

 Conclusion

Interventions targeting women, especially young adults should focus on enhancing cancer-related attitude in order to improve cancer prevention behaviors. Thus, there continues to be a need to reduce perceived stress in adult women.

 Women Cancer Attitude Stress Behaviors REFERENCES Beak N. S. 2001 Correct lifestyle for cancer prevention: Stress is the origin of all diseases The Science & Technology 34 12 88–89 Cho S. Y. 2011 Predicting women's cervical cancer prevention behaviors extending health belief model Journal of Korean Society for Advertising Education 91 348–377 Cohen S. Kamarck T. & Mermelstein R. 1983 A global measure of perceived stress Journal of Health and Social Behavior 244 385–396 Hyun K. S. Kang J. M. & Park Y. M. 2008 Relationship between health promoting lifestyle and general characteristics of the person undergoing health checkups in cancer prevention center Journal of East-West Nursing Research 14 1 14–23 Jun E. M. & Cho D. S. 2005 The relationship of symptoms of stress, cancer prevention behavior and the quality of life in women Korean Journal of Women Health Nursing 112 156–162 Kasl S. V. & Cobb S. 1966 Health behavior, illness behavior, and sick role behavior. I. Health and illness behavior Archives of Environmental Health: An International Journal 122 246–266 http://dx.doi.org/10.1080/00039896.1966.10664365 Kim E. J. & Moon I. O. 1987 A study on middle aged people's compliance for preventive health behavior of cancer Korean Journal of Health Education and Promotion 42 9–31 Kim I. J. & Kim S. H. 2012 Relationships between knowledge, attitude and preventive health behavior about cancer in university students Asian Oncology Nursing 121 44–51 http://dx.doi.org/10.5388/aon.2012.12.1.44 Kim N. S. & Lee K. E. 2014 Factors affecting cancer preventive behavior in middle-aged people Journal of Korean Academy Fundamentals of Nursing 211 29–38 http://dx.doi.org/10.7739/jkafn.2014.21.1.29 Kim S. K. & Lee B. S. 2006 Knowledge, attitude, and preventive health behavior of high school students on the six most common cancers in Korea Keimyung Journal of Nursing Science 101 135–148 Kim Y. S. 2012 Health behavior for cancer prevention and influencing factors in university students Journal of Korean Society for School Health Education 132 45–58 Koh H. J. Kim C. N. Park K. M. Park J. S. Park Y. S. & Kwak H. W. 2011 Cancer-related knowledge, attitude, and preventive health behavior of middle-aged women in Korea Keimyung Journal of Nursing Science 151 41–55 Korea National Statistics Office 2014 2012 Birth ․ mortality statistics Retrieved June 26, 2014, from http://kostat.go.kr/portal/korea/kor_nw/3/index.board?bmode=read&bSeq=&aSeq=327935&pageNo=1&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt= Lee E. H. Um T. H. Chi H. S. Hong Y. J. & Cha Y. J. 2012 Prevalence and distribution of human papilloma virus in-fection in Korean women as determined by restriction fragment mass polymorphism assay Journal of Korean Medical Science 279 1091–1097 http://dx.doi.org/10.3346/jkms.2012.27.9.1091 Lim J. J. 2001 Stress and preventive behavior of cancer among middle-aged women in rural area Unpublished master's thesis, Chonnam National University, Gwangju. Mahon S. M. 2000 Principles of cancer prevention and early detection Clinical Journal of Oncology Nursing 44 169–176 Maunsell E. Brisson J. Mondeor M. Verreault R. & Deschc-nes L. 2001 Stressful life events and survival after breast cancer Psychosomatic Medicine 632 306–315 Ministry of Health and Welfare 2006 Development of Indicators for National Cancer Control Program Seoul: Retrieved 2014. 5. 30. from http://www.mw.go.kr Ministry of Health and Welfare 2013 2013 National cancer screening program guidelines Seoul: Retrieved 2014. 5. 30. from http://www.mw.go.kr Park E. H. Cho Y. H. & Kim Y. J. 2009 Influence of health beliefs on preventive health behaviors for cancer among middle-aged women Korean Journal of Mental Health and Social Work 11 17–42 Park H. S. & Kwon S. J. 2012 The differences in the knowledge of cancer causes, and preventive health behaviors of college students Korean Journal of Society Safety 81 85–104 Park J. O. & Seo Y. S. 2010 Validation of the perceived stress scale (PSS) on samples of Korean university students Korean Journal of Psychology: General 293 611–629 Park S. Y. Park C. J. & Park J. S. 2001 The effects of cancer prevention and early detection education on cancer-related knowledge, attitudes, and preventive health behavior of middle-aged women in Korea Korean Academic Society of Adult Nursing 133 441–450 Schulmeister L. & Lifsey D. S. 1999 Cervical cancer screening knowledge, behaviors and beliefs of Vietnamese women Oncology Nursing Forum 265 879–887 Sharma R. Bhasin S. K. Agrawal S. & Tewari R. 2013 Cancer related knowledge and behavior among women across various socio-economic strata: A study from Delhi, India South Asian Journal of Cancer 22 66–69 http://dx.doi.org/10.4103/2278-330X.110489 Sim S. Y. 2012 A study on behaviors, nutrition intakes and stress, depression of married women in their 30-50's in Seoul Unpublished master's thesis, Dongguk University, Seoul. So H. S. Seo N. S. & Noh Y. H. 2000 Investigating the level of knowledge, attitude and practice of health behavior about five major cancer in Korea Chonnam Journal of Nursing Science 51 119–133 Statistics Korea 2012 Statistics about causes of mortality Seoul: Retrieved 2014. 5. 30. from http://www.kosis.kr Suh S. R. Jung B. Y. So H. S. & Tae Y. S. 1998 A study to advance the development of educational programs for the early detection and prevention of the five major cancer in Korea Journal of Korean Academic Adult Nursing 102 268–280 Figures and Tables

General Characteristics of the Study Participants (N=314)

Characteristics Categories n(%)
Age (year) 20~29 50 (15.9)
30~39 124 (39.5)
40~49 92 (29.3)
≥50 48 (15.3)
Marital status Unmarried 62 (19.8)
Married 252 (80.3)
Religion Yes 189 (60.2)
No 125 (39.8)
Education level ≤High school 67 (21.3)
University 226 (72.0)
≥Graduate school 21 (6.7)
Occupation Yes 274 (87.3)
No 40 (12.7)
Economic status Lower 104 (33.1)
Middle 172 (54.8)
Upper 38 (12.1)
Perceived health status Lower 39 (12.4)
Middle 146 (46.5)
Upper 129 (41.1)
Current disease Yes 18 (5.7)
No 296 (94.3)
Family history of cancer Yes 100 (31.9)
No 214 (68.2)
Periodic checkup No 64 (20.4)
Once a year 155 (49.4)
Once in two years 77 (24.5)
Once in three years 18 (5.8)

Mean Score of Perceived Stress, Cancer related Knowledge, Cancer related Attitude, and Cancer Prevention Behaviors (N=314)

Variables Range M±SD Min Max
Perceived stress 0~40 18.54±5.01 5 34
Cancer related knowledge 0~30 19.61±4.37 6 28
   Stomach cancer 0~5 3.73±0.91 1 5
   Lung cancer 0~5 3.08±1.13 0 5
   Liver cancer 0~5 2.98±1.40 0 5
   Colorectal cancer 0~5 3.36±1.21 0 5
   Breast cancer 0~5 3.37±0.95 0 5
   Cervical cancer 0~5 3.09±1.40 0 5
Cancer related attitude 14~70 55.31±5.84 41 70
Cancer prevention behaviors 20~100 71.45±9.87 41 100

Cancer related Knowledge, Cancer related Attitude, and Cancer Prevention Behavior according to General Characteristics (N=314)

Characteristics Categories Stomach cancer Lung cancer Liver cancer Colorectal cancer Breast cancer
M±SD t or F (p) M±SD t or F (p) M±SD t t or F (p) M±SD t or F (p) M±SD t or F (p)
Age (year) 20~29a 3.18±0.98 8.54 2.94±1.08 0.35 2.46±1.42 4.28 2.98±1.15 2.23 3.28±0.88 1.09
30~39b 3.77±0.84 (＜.001) 3.09±1.17 (.790) 2.90±1.38 (.006) 3.36±1.30 (.084) 3.29±0.99 (.353)
40~49c 3.93±0.78 a＜b, c, d† 3.14±1.20   3.30±1.45   3.52±1.15   3.50±0.93  
≥50d 3.83±1.02   3.06±0.95   3.08±1.20   3.42±1.11   3.44±0.94  
Marital status Unmarried 3.24±0.92 -4.93 3.13±1.12 0.41 2.44±1.42 -3.46 2.98±1.19 -2.72 3.31±0.95 -0.61
Married 3.85±0.86 (＜.001) 3.06±1.13 (.683) 3.11±1.37 (.001) 3.45±1.20 (.007) 3.39±0.95 (.542)
Religion Yes 3.67±0.96 -1.46 3.12±1.14 0.87 3.06±1.39 1.34 3.43±1.21 1.39 3.33±0.87 -0.86
No 3.82±0.82 (.146) 3.01±1.11 (.384) 2.85±1.41 (.183) 3.24±1.21 (.167) 3.43±1.07 (.389)
Education level ≤High schoola 3.73±0.73 2.96 2.99±1.09 1.55 2.61±1.40 3.50 3.12±1.33 2.11 3.10±0.97 3.52
Universityb 3.69±0.96 (.053) 3.07±1.15 (.215) 3.05±1.42 (.032) 3.40±1.19 (.123) 3.44±0.95 (.031)
≥Graduate schoolc 4.19±0.68   3.48±0.93   3.38±0.92   3.67±1.02   3.52±0.75 a＜b†
Occupation Yes 3.73±0.93 -0.39 3.11±1.15 1.51 3.06±1.41 2.70 3.39±1.17 1.08 3.42±0.93 2.31
No 3.78±0.70 (.696) 2.83±0.96 (.132) 2.42±1.20 (.007) 3.13±1.49 (.285) 3.05±1.04 (.021)
Economic status Lowera 3.70±0.90 0.94 2.92±1.18 1.62 2.84±1.42 2.37 3.20±1.29 1.40 3.28±1.03 1.21
Middleb 3.71±0.93 (.393) 3.17±1.11 (.200) 3.13±1.38 (.095) 3.41±1.18 (.248) 3.39±0.92 (.298)
Upperc 3.92±0.82   3.05±1.06   2.68±1.38   3.53±1.16   3.55±0.86  
Perceived health status Lowera 3.69±0.95 0.09 3.13±1.08 0.18 2.82±1.48 0.58 3.26±1.21 0.16 3.36±1.04 0.03
Middleb 3.75±0.95 (.917) 3.10±1.20 (.832) 3.06±1.37 (.561) 3.36±1.24 (.854) 3.36±0.94 (.973)
Upperc 3.72±0.85   3.03±1.07   2.93±1.42   3.38±1.19   3.39±0.95  
Current disease Yes 3.89±0.83 0.75 3.11±1.02 0.13 2.94±1.43 -0.10 3.61±1.14 0.91 3.78±0.65 1.87
No 3.72±0.91 (.452) 3.07±1.14 (.894) 2.98±1.40 (.918) 3.34±1.22 (.361) 3.35±0.96 (.063)
Family history of cancer Yes 3.68±0.96 -0.70 3.01±1.07 -0.73 3.03±1.44 0.45 3.54±1.12 1.83 3.38±0.89 0.09
No 3.76±0.88 (.484) 3.11±1.16 (.465) 2.95±1.39 (.652) 3.27±1.25 (.068) 3.37±0.98 (.925)
Periodic checkup Noa 3.81±0.89 0.44 2.89±1.07 1.16 2.70±1.31 2.08 3.09±1.37 1.45 3.27±1.06 0.73
Once a yearb 3.71±0.97 (.726) 3.15±1.17 (.325) 2.98±1.46 (.103) 3.38±1.17 (.229) 3.41±0.96 (.535)
Once in two yearsc 3.75±0.81   3.13±1.06   3.26±1.22   3.51±1.08   3.43±0.86  
Once in three yearsd 3.56±0.86   2.83±1.25   2.72±1.81   3.44±1.46   3.17±0.86  

Characteristics Categories Cervical cancer Cancer related knowledge Cancer related attitude Cancer prevention behaviors
M±SD t or F (p) M±SD t or F (p) M±SD t or F (p) M±SD t or F (p)
Age (year) 20~29a 2.82±1.40 1.43 17.66±4.45 5.64 53.84±5.60 1.36 65.78±9.77 12.42
  30~39b 3.03±1.45 (.233) 19.44±4.49 (.001) 55.55±5.89 (.256) 70.27±9.68 (＜.001)
  40~49c 3.16±1.34   20.57±4.09 a＜c, d† 55.82±5.58   73.72±8.30 a＜b, c, d†
  ≥50d 3.38±1.39   20.21±3.88   55.25±6.38   76.06±10.08 b＜d†
Marital Unmarried 2.73±1.42 -2.29 17.82±4.50 -3.66 53.55±5.18 -2.67 66.45±8.59 -4.60
status Married 3.18±1.39 (.023) 20.04±4.23 (＜.001) 55.74±5.93 (.008) 72.68±9.79 (＜.001)
Religion Yes 3.06±1.31 -0.38 19.69±4.20 0.41 55.33±5.74 0.09 72.06±9.37 1.35
  No 3.13±1.54 (.701) 19.48±4.63 (.681) 55.27±6.03 (.928) 70.53±10.57 (.178)
Education ≤High schoola 2.87±1.58 1.19 18.42±4.66 4.79 55.69±6.24 0.47 69.55±9.89 1.87
level Universityb 3.14±1.37 (.306) 19.78±4.34 (.009) 55.12±5.86 (.625) 71.82±9.83 (.155)
  ≥Graduate schoolc 3.29±1.10   21.52±2.46 a＜c† 56.14±4.30   73.52±9.89  
Occupation Yes 3.11±1.37 0.55 19.81±4.25 2.23 55.31±5.83 -0.02 71.59±9.81 0.67
  No 2.98±1.64 (.583) 18.18±4.93 (.026) 55.33±6.00 (.985) 70.47±10.35 (.504)
Economic Lowera 3.03±1.42 1.04 18.97±4.58 1.70 55.18±5.91 0.19 69.41±10.43 5.88
status Middleb 3.06±1.40 (.356) 19.87±4.23 (.184) 55.27±6.03 (.831) 71.76±9.62 (.003)
  Upperc 3.39±1.41   20.13±4.29   55.84±4.82   75.63±7.98 a＜c†
Perceived Lowera 2.97±1.51 0.42 19.23±4.53 0.35 54.97±5.98 0.26 64.51±9.69 17.44
health Middleb 3.16±1.37 (.657) 19.81±4.48 (.708) 55.56±6.03 (.768) 70.71±9.60 (＜.001)
status Upperc 3.04±1.42   19.49±4.21   55.12±5.62   74.40±9.06 a＜b＜c†
Current Yes 3.33±1.37 0.76 20.67±3.18 1.06 57.22±6.80 1.43 74.06±10.11 1.15
disease No 3.07±1.41 (.448) 19.54±4.43 (.289) 55.19±5.77 (.153) 71.29±9.85 (.250)
Family history Yes 3.13±1.45 0.35 19.77±4.16 0.46 54.46±5.48 -1.77 71.15±9.13 -0.37
of cancer No 3.07±1.39 (.725) 19.53±4.47 (.648) 55.71±5.98 (.078) 71.59±10.22 (.711)
Periodic Noa 2.84±1.42 2.43 18.61±4.56 2.52 53.66±6.03 2.17 66.13±9.85 8.61
checkup Once a yearb 3.03±1.37 (.065) 19.66±4.39 (.058) 55.75±5.84 (.091) 73.19±9.69 (＜.001)
  Once in two yearsc 3.44±1.33   20.52±3.73   55.73±5.28   72.34±9.23 a＜b, c†
  Once in three yearsd d 3.00±1.75   18.72±5.39   55.56±6.90   71.61±8.16  

Scheffé test.

Correlations of Perceived Stress, Cancer related Knowledge, Cancer related Attitude, and Cancer Prevention Behaviors (N=314)

Variables Perceived stress Cancer related knowledge Cancer related attitude
Cancer related knowledge -0.09 (.118)    
Cancer related attitude -0.08 (.138) 0.30 (＜.001)  
Cancer prevention behaviors -0.40 (＜.001) 0.15 (.006) 0.31 (＜.001)

Factors Influencing Cancer Prevention Behavior in Adult Women (N=314)

Variables (reference) Model 1 Model 2 Model 3 Model 4
b β p b β p b β p b β p VIF
(Constant) 42.23 0.19 .002 58.57 0.15 .013 54.95 0.15 .017 35.56 0.18 .003 1.64
Age 0.21 0.14 .019 0.16 0.12 .037 0.16 0.11 .064 0.19 0.08 .156 1.56
Marital status (Unmarried) 3.54 -0.03 .543 3.07 -0.03 .588 2.75 -0.03 .569 2.03 -0.03 .538 1.06
Religion (Yes) -0.63     -0.54     -0.57     -0.59      
Education (≤High school)
  University 1.42 0.06 .288 0.51 0.02 .699 0.25 0.01 .850 0.76 0.03 .549 1.57
  ≥Graduate school 0.09 0.01 .969 -1.01 -0.03 .658 -1.48 -0.04 .523 -1.02 -0.03 .646 1.48
Occupation (Yes) 0.87 0.03 .583 0.25 0.01 .869 0.47 0.02 .759 0.22 0.01 .881 1.17
Economic status (Lower)
  Middle 1.00 0.06 .248 0.01 0.01 .997 -0.08 0.01 .941 0.10 0.01 .926 1.35
  Upper -0.60 -0.03 .582 1.94 0.06 .248 1.91 0.06 .255 1.88 0.06 .243 1.33
Perceived health status (Lower)                          
  Middle 3.98 0.27 ＜.001 3.17 0.22 ＜.001 3.22 0.22 ＜.001 3.28 0.22 ＜.001 1.38
  Upper 0.70 0.04 .521 0.45 0.02 .671 0.42 0.02 .695 0.43 0.02 .670 1.24
Current disease (Yes) -0.40 -0.01 .856 -0.45 -0.01 .832 -0.44 -0.01 .835 0.23 0.01 .911 1.08
Family history of cancer (Yes) -0.16 -0.01 .884 -0.02 0.01 .985 0.02 0.01 .985 -0.51 -0.02 .616 1.07
Periodic checkup (No)
  Once a year 5.78 0.29 ＜.001 5.06 0.26 ＜.001 1.40 0.11 .068 4.09 0.21 .002 2.12
  Once in two years 3.69 0.16 .019 2.98 0.13 .051 3.63 0.18 .001 2.25 0.10 .127 1.92
  Once in three years 2.75 0.06 .249 2.64 0.06 .254 -1.47 -0.03 .572 1.73 0.04 .437 1.28
Perceived stress       -0.48 -0.24 ＜.001 -0.48 -0.24 ＜.001 -0.45 -0.23 ＜.001 1.22
Cancer related knowledge             0.15 0.07 .196 -0.02 -0.01 .861 1.25
Cancer related attitude                   0.43 0.25 ＜.001 1.17
R2 (ΔR2) .261 .311 (.050) .314 (.003) .369 (.055)
F (p) 7.02 (＜.001) 8.36 (＜.001) 7.99 (＜.001) 9.60 (＜.001)