Health Literacy, Socioeconomic Status, and Health Behavior Adherence Among Young Adult Survivors With Cancer: A Cross-Sectional Study.

IntroductionYoung adults (YAs) with cancer are at elevated risk for chronic conditions and late effects, making adherence to healthy eating and physical activity guidelines a key survivorship priority. Health literacy is theorized to support guideline-concordant behaviors, yet its role in YA oncology remains unclear, particularly in the context of socioeconomic and environmental influences. This study aimed to characterize health literacy among YA cancer survivors and examine its association with adherence to healthy eating and physical activity guidelines, after accounting for sociodemographic/clinical factors.Methods273 YAs (18-39 years) receiving care at an NCI-designated cancer center completed an anonymous online survey. Measures included the BRIEF Health Literacy Tool, the Rapid Eating Assessment for Participants-Short Version, the Rapid Assessment of Physical Activity, the Social Support and Eating Habits and Exercise Surveys, and self-reported sociodemographic and clinical variables. Analyses included descriptive statistics, bivariate correlations, and multiple regression models controlling for variables of interest.ResultsMost participants demonstrated adequate health literacy, and health literacy was positively associated with education and household income. However, health literacy was not significantly associated with adherence to healthy eating or physical activity guidelines. Higher BMI was associated with lower adherence to healthy eating, whereas having a college degree or higher and family participation in exercise were associated with adherence to healthy eating. For physical activity, friends' discouragement of healthy eating and family participation in exercise were associated with better adherence.ConclusionsIn this relatively well-educated, higher-income YA oncology sample, health literacy was generally adequate and did not independently predict adherence to healthy eating or physical activity guidelines. These findings suggest that, in higher socioeconomic status settings, structural and social determinants may outweigh the influence of health literacy on lifestyle behaviors. Survivorship interventions should combine health literacy-sensitive communication with multilevel strategies targeting weight management, food/activity environments, and family/peer support.