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Breast Cancer Knowledge Among College Students: Influencing Factors and

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Breast Cancer Knowledge Among College

Students: Influencing Factors and Resultant
Behaviors

Mary F. Justice, Keith A. King, Rebecca A. Vidourek & Ashley L. Merianos

To cite this article: Mary F. Justice, Keith A. King, Rebecca A. Vidourek & Ashley L.
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and Resultant Behaviors, American Journal of Health Education, 49:2, 86-93, DOI:
10.1080/19325037.2017.1414645

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AMERICAN JOURNAL OF HEALTH EDUCATION
2018, VOL. 49, NO. 2, 86–93
https://doi.org/10.1080/19325037.2017.1414645

Breast Cancer Knowledge Among College Students: Influencing Factors and

Resultant Behaviors
Mary F. Justice , Keith A. King, Rebecca A. Vidourek, and Ashley L. Merianos
University of Cincinnati

ABSTRACT ARTICLE HISTORY

Background: Many misconceptions about breast cancer exist. College students have the opportunity Received 20 July 2017
to perform breast cancer risk-reducing behaviors. Purpose: The purpose of this study was to assess Accepted 3 October 2017
breast cancer knowledge among university students and examine the influence of breast cancer
knowledge on health behaviors for breast cancer prevention. Methods: Data were collected via
survey in which students were asked about health behaviors and 20 true/false statements about
breast cancer. Results: College students were unable to accurately identify all truths and myths about
breast cancer. The overall mean knowledge score for the sample was 10.59 (SD = 2.865), based on a
potential range of 0–20 correct answers. Breast cancer knowledge was significantly influenced by race.
Results of Pearson correlation coefficients indicated an inverse correlation between breast cancer
knowledge and health behaviors. Discussion: Lack of accurate breast cancer knowledge is consistent
with current literature. Health communication alone may not be enough to effect behavior change.
Translation to Health Education Practice: This study provides valuable insights into knowledge
about breast cancer and associated behaviors among college students. Knowledge, as well as other
determinants of behavior, should be examined for their effects on breast cancer prevention. Sources
of knowledge available to college students should contain valid information.

Background address risks related to controllable factors, such as obesity

Although information about breast cancer is widely avail-
able, many misconceptions exist.1 These misconceptions
may negatively impact the empowerment felt by women
who seek information about breast cancer.2 Though breast
cancer occurs mainly in women, both men and women are
affected. Approximately 1% of breast cancers occur in
men.3 Additionally, men who have had a friend or family
member with breast cancer are closely impacted by the
disease.
Information about breast cancer comes from many
sources, with media being a major source.4 College-aged
women use the Internet for information seeking about
breast cancer prevention.5 Awareness efforts, such as the
NFL’s A Crucial Catch,6 are widely visible to men and
women. Breast cancer knowledge in college-aged women
may be influenced by perceptions in their teenage years.
Teen girls overestimate the incidence of breast cancer, as
well as their own personal breast cancer risk.7 Adult
women may also overestimate their risk as a result of
inaccurate information about breast cancer risk in
women’s consumer magazines.8 In fact, fewer than 1 in
10 women have an accurate understanding of their breast
cancer risk.9 One reason may be that media sources seldom
and harmful chemicals in the environment.10 Little is
known about breast cancer knowledge and risk reduction
behaviors in college-aged men. Breast cancer screening is
another topic that is often misunderstood.11 Early detec-
tion is a significant message promoted in many breast
cancer awareness campaigns. As such, many have the mis-
taken belief that mammograms prevent breast cancer or
reduce its risk.12 Indeed, many breast cancer survivors
wonder how they got the disease, when they got their
mammograms at the recommended times. In fact, mam-
mography increases the detection of early-stage breast can-
cer, but it does not prevent it.13 In 2009, the U.S. Preventive
Services Task Force recommended new screening guide-
lines for mammography, increasing the age of routine
screening and reducing the frequency of screening.14 In a
study by Kiviniemi and Hay,15 more than half of partici-
pants were not aware of the new screening guidelines.
Myths associated with the treatment of breast cancer
are also common.1 Misconceptions include the belief
that breast cancer can be cured by removing the entire
breast immediately and receiving chemotherapy and
radiation. In fact, early-stage breast cancer patients
who undergo breast conserving surgery, in which only
the cancerous part of the breast is removed, have a

CONTACT Mary F. Justice mary.justice@uc.edu Nursing Program, University of Cincinnati, Blue Ash College, 9555 Plainfield Rd., Blue Ash, OH 45236.
© 2018 SHAPE America

higher rate of survival.16 Furthermore, all breast cancers
do not require surgery, chemotherapy, and radiation.
Treatment depends on many factors, including the
complex nature of cancer cells for each individual.17
Receiving more treatment than is necessary for a parti-
cular type of cancer, or overtreatment, has become a
significant issue.18
Though breast cancer awareness may increase
knowledge about the disease, it may also contribute to
misconceptions about the disease. Factors influencing
breast cancer knowledge and subsequent breast
cancer–related behavior in college students have not
been examined by research. Because of this research gap,
and to improve breast health education, it is important to
identify the misconceptions that exist about breast cancer.
By examining the influence of various factors on breast
cancer knowledge and identifying how breast cancer
knowledge influences health behavior, better outcomes
may be achieved. College-aged students can adopt healthy
behaviors that may lower their future risk of breast
cancer.
Purpose
The purpose of this study was to examine general breast
cancer knowledge among college students. This study
identified how breast cancer knowledge correlates with
the independent variables of sex, grade level, race,
personal breast cancer experience of self or first-degree
relative, personal breast cancer experience of an extended
family member, and personal breast cancer experience of
a friend. Finally, this study examined how breast cancer
knowledge correlates with personal health behavior and
behavior impacting the problem of breast cancer. For this
study, breast cancer messages refers to any information
conveyed to the general public about breast cancer.
Messages may be associated with slogans, pink ribbons,
awareness events, fundraising events, videos, social
media, print media, Internet, TV/radio ads, billboards,
and pink products. Behaviors refers to 2 types of actions:
those impacting (1) personal health, such as performing
breast self-exam and talking to a doctor, and (2) the
overall problem of breast cancer, such as participating
in a fundraiser and becoming politically active. The fol-
lowing research questions will be addressed.
Research questions
● How knowledgeable are college students regarding
breast cancer causes, breast cancer risk factors,
breast cancer treatment effectiveness, and breast
cancer prevention?
BREAST CANCER KNOWLEDGE AMONG COLLEGE STUDENTS 87
● How does breast cancer knowledge correlate with the
independent variables of sex, grade level, personal
breast cancer experience of self or first-degree relative,
personal breast cancer experience of an extended
family member, and personal breast cancer experi-
ence of a friend?
● How does breast cancer knowledge correlate with
personal health behavior?
● How does breast cancer knowledge correlate with
behavior impacting the problem of breast cancer?
Methods
Participants
Participants consisted of a convenience sample of college
students (N = 284) at the University of Cincinnati (UC).
Total enrollment at UC consists of 44 251 students.19
Fifty-four percent are female and 46% are male. The
average age is 24.3 years. Whites comprise 85.6% of the
student population, and non-whites comprise 14.4%. Of
non-white students at UC, 8.4% are African American,
3.1% are Asian, and 2.9% are Hispanic.19 Participation in
the study was voluntary. Approval was granted by the
Institutional Review Board (IRB). A total of 284 students
participated in the study.
Instrumentation
The instrument was a 3-page survey developed to elicit
college students’ experiences with breast cancer mes-
sages. The survey contained 4 main items: Breast
Cancer Messages, Breast Cancer Awareness, Health
Behaviors, and About You. These items had either
yes/no or checklist options for responses. The present
study was focused on health behaviors and the Breast
Cancer Awareness section. The Breast Cancer Messages
section consisted of a 16-item behavior scale, which
contained a subscale of 11 behaviors categorized as
impacting personal health and a subscale of 5 behaviors
categorized as impacting the problem of breast cancer.
Behaviors impacting personal health were the follow-
ing: talk to a doctor; research the Internet; perform
breast self-exam; decide to abstain from alcohol or
drink in moderation; decide to eat a low-fat diet; decide
to exercise regularly; decide to maintain a healthy
weight; decide to abstain from smoking; decide to
investigate ingredients in personal care items; decide
to change use of personal care items; and talk to a
friend or family member about breast cancer.
Behaviors impacting the problem of breast cancer
were the following: participate in a breast cancer
88 M. F. JUSTICE ET AL.
event; purchase a pink product for breast cancer;
donate money toward breast cancer; become involved
in political action; and wear pink clothing or ribbon.
The Breast Cancer Awareness section contained a
knowledge subscale in which participants were given
20 true–false statements about breast cancer.
Demographic information was included in the survey.
It included whether the participant had ever been diag-
nosed with breast cancer and whether a close family
member or friend had been diagnosed with breast
cancer. Confidentiality and consent were explained in
the directions and on an information sheet. The survey
took approximately 5–10 minutes to complete.
Approval for the study was granted by the University
of Cincinnati IRB. Following IRB approval, reliability
testing of the survey instrument was conducted by the
principal investigator (PI). For reliability testing, 17 par-
ticipants were recruited from an undergraduate nursing
class, fall semester 2016. Surveys were distributed to the
class on 2 separate occasions, one week apart. The PI
administered and collected the presurveys and postsur-
veys. Students were informed of the purpose of the study,
voluntary nature of the study, and anonymity of
responses. Students were given a research information
sheet that explained the study and voluntary nature of
participation and they were instructed to contact the PI if
they had questions or concerns. Stability reliability was
established with Pearson correlation coefficients greater
than 0.80. Face and content validity was established by
distributing the survey to a panel of experts in breast
cancer and survey research.
Procedures
For the research study, surveys were administered in
collaboration with professors and graduate assistants in
the UC College of Education, Criminal Justice, and
Human Services. Surveys were administered to students
in university classes during regularly scheduled class
times, during fall semester 2016. Students were informed
of the general purpose of the survey, confidentiality and
anonymity measures, and the time required to complete
the survey. They were informed that participation is
voluntary and that by completing the survey, they were
giving permission to participate in the research study.
Students were given a research information sheet, along
with the survey. The research information sheet included
the PI’s contact information for the students. Students
were instructed to contact the PI if they had questions or
concerns. Returned surveys were given to the PI, who
locked them in her office. Upon completion of the
study, the surveys were shredded.
For reliability testing, survey data were entered into the
Statistical Package for the Social Sciences, Version 23.0.
For parametric items, Pearson correlation coefficients
were computed. To determine test–retest reliability for
nonparametric items, Kendall’s tau-b correlation coeffi-
cients were calculated. Results indicated that correlation
coefficients were greater than 0.80.
Data analysis
Data were analyzed using the Statistical Package for the
Social Sciences. Descriptive statistics were used to
describe the sample population. Characteristics examined
included sex, age, grade level, race, personal breast cancer
diagnosis, breast cancer diagnosis of a first-degree rela-
tive, and breast cancer diagnosis of a friend or extended
family member.
Regarding research question 1, descriptive statistics
were used to describe knowledge of college students.
The survey asked participants 20 myths/facts about
breast cancer related to breast cancer causes, breast
cancer risk factors, breast cancer treatment effective-
ness, and breast cancer prevention. Correct responses
were given 1 point and summed, resulting in an overall
score ranging from 0 to 20 for each participant. A mean
overall knowledge score, based on a range of 0–20, was
then calculated for the entire sample.
For research question 2, a series of independent
sample t tests was performed to examine the extent to
which breast cancer knowledge differed, based on the
independent variables of sex, grade level, race, personal
breast cancer diagnosis, breast cancer diagnosis of a
first-degree relative, breast cancer diagnosis of an
extended family member, and breast cancer diagnosis
of a friend. Independent variables were dichotomized
for the analysis. An alpha level of .05 was utilized to
avoid committing a type I error.
Regarding research questions 3 and 4, correlation
was used to examine the relationship between breast
cancer knowledge and behaviors. Health behaviors
were analyzed using the part of the survey that asked
participants about health behaviors they performed in
the past year. Each checked response was given 1 point
and summed for each of the 2 behavior categories. As a
result, each participant was given a score for behaviors
impacting personal health and a score for behaviors
impacting the problem of breast cancer. Mean scores
for the 2 behavior categories were then calculated for
the entire sample. Pearson correlation coefficients were
calculated to determine whether knowledge scores were
significantly correlated with behaviors impacting per-
sonal health and behaviors impacting the problem of
 BREAST CANCER KNOWLEDGE AMONG COLLEGE STUDENTS 89

breast cancer. An alpha level of .05 was utilized to avoid Breast cancer knowledge
committing a type I error.
Knowledge about breast cancer was calculated using
responses to survey questions that asked participants
to identify 20 statements as myths or facts. Statements
Results included topics about breast cancer causes, breast can-
cer risk factors, breast cancer treatment effectiveness,
Demographics
and breast cancer prevention. Correct responses were
A total of 284 college students completed the survey given 1 point and summed, resulting in an overall score
(Table 1); 42.8% were male (n = 121) and 57.2% were for each participant. A mean overall knowledge score
female (n = 162). Regarding grade level, 54% were was then calculated for the entire sample. The overall
freshmen/sophomores (n = 153) and 46% were mean knowledge score for the sample was 10.59
juniors/seniors/graduate students (n = 130). (SD = 2.865), based on a potential range of 0–20 correct
Regarding race, 70% were white (n = 198) and answers.
30.1% were non-white (n = 85). Racial/ethnic groups
included in the study were American Indian, African
American, Asian, Hawaiian/Pacific Islander, Correlation between breast cancer knowledge and
Hispanic/Latino, and multiracial. The percentage of independent variables
non-white participants in the study was 30.1%, com- Independent sample t tests were computed to examine
pared to 14.4% of UC students as a whole. Study the variables affecting breast cancer knowledge
participants included 9.2% African American, 13.1% (Table 2). A mean knowledge score was calculated for
Asian, and 2.5% Hispanic. each of the dichotomized, independent variables of sex,
A total of 2.1% respondents indicated that they have grade level, race, breast cancer of self, breast cancer of a
had breast cancer (n = 6), 7.8% had a first-degree relative first-degree relative, breast cancer of an extended family
who has had breast cancer (n = 22), 42.3% had an member, and breast cancer of a friend. The results
extended family member who has had breast cancer indicated a significant difference in knowledge scores
(n = 120), and 33.7% had a friend who has had breast between whites and non-whites in the study. Whites
cancer (n = 95). had a significantly higher mean knowledge score
(M = 10.99, SD = 2.594) than non-whites (M = 9.59,
SD = 3.182); t (281) = −3.884, P = .000. The results
Table 1. Demographics and background of participants.a indicated that the variables of sex, grade level, breast
Demographic variable n %
cancer of self, breast cancer of a first-degree relative,
Sex
Male 121 42.8
Female 162 57.2 Table 2. Breast cancer knowledge based on sex, grade, race,
Grade and breast cancer experience.a
Freshman 96 33.9
M
Sophomore 57 20.1
Junior 48 17.0 Independent variables (SD) t df P
Senior 75 26.5 Sex
Graduate student 7 2.5 Male 10.32 −1.258 281 .209
Race/ethnicity Female 10.75
American Indian 2 0.7 Grade
African American 26 9.2 Freshman/sophomore 10.63 0.369 281 .712
Asian 37 13.1 Junior/senior/graduate student 10.51
Hawaiian/Pacific Islander 0 0 Race/ethnicity
Hispanic/Latino 7 2.5 Non-white 9.59 −3.884 281 .000
White 198 70.0 White 10.99
Multiracial 12 4.2 Ever had breast cancer
Other 1 0.4 No 10.57 −0.643 282 .520
Ever had breast cancer Yes 11.33
No 278 97.9 Have a first-degree relative who has had
Yes 6 2.1 breast cancer
Have a first-degree relative who has had breast cancer No 10.57 −0.388 281 .699
No 261 92.2 Yes 10.81
Yes 22 7.8 Have an extended family member who has
Have an extended family member who has had breast cancer had breast cancer
No 164 57.7 No 10.60 0.065 282 .948
Yes 120 42.3 Yes 10.58
Has a friend who has had breast cancer Has a friend who has had breast cancer
No 187 66.3 No 10.51 −0.809 280 .902
a
N = 284; percentages refer to valid percentages; missing values are Yes 10.80
a
excluded. N = 284; means based on potential range of 0–20.
90 M. F. JUSTICE ET AL.
breast cancer of an extended family member, and breast
cancer of a friend did not significantly affect breast
cancer knowledge.
Correlation between breast cancer knowledge and
behaviors impacting personal health
The survey contained a subscale of 11 behaviors
impacting personal health, and participants indicated
which ones they performed. Each checked response was
given 1 point and summed for a total score. A mean
score was then given for the entire sample. The sample
mean score for behaviors impacting personal health
was 2.52 (SD = 2.682) based on a potential range of
0–11 behaviors. The sample mean score for knowledge
was 10.59 (SD = 2.865) based on a potential range of
0–20 correct answers. Pearson correlation coefficients
were calculated to determine whether knowledge scores
were significantly correlated with behaviors impacting
personal health. Results indicated a significant inverse
correlation between scores for breast cancer knowledge
and scores for behaviors impacting personal health, r
(237) = −0.172, P = .008.
Correlation between breast cancer knowledge and
behaviors impacting the problem of breast cancer
The survey contained a subscale of 5 behaviors impact-
ing the problem of breast cancer, and participants indi-
cated which ones they performed. Each checked
response was given 1 point and summed for a total
score. A mean score was then given for the entire sample.
The sample mean score for behaviors impacting the
problem of breast cancer was 1.51 (SD = 1.548), based
on a potential range of 0 to 5 behaviors. The sample
mean score for knowledge was 10.59 (SD = 2.865) out of
a possible score of 20 correct answers. Pearson correla-
tion coefficients were calculated to determine whether
knowledge scores were significantly correlated with
behaviors impacting the problem of breast cancer.
Results indicated a significant inverse correlation
between scores for breast cancer knowledge and scores
for behaviors impacting the problem of breast cancer, r
(233) = −0.189, P = .004.
Discussion
The present study found that college students have some
accurate knowledge about breast cancer causes, risk factors,
treatment effectiveness, and prevention. Additionally, stu-
dents performed some behaviors that had the potential to
impact their own personal health, as well as some behaviors
that had the potential to impact the overall problem of
breast cancer. The study also identified that there are some
gaps in knowledge about breast cancer. Specifically, stu-
dents were unable to accurately identify all of the truths
and myths about breast cancer causes, risk factors, treat-
ment effectiveness, and prevention. Moreover, there were
gaps in the number of healthy behaviors performed, which
included behaviors impacting personal health and beha-
viors impacting the problem of breast cancer. Though
students performed some of these behaviors, there was
the potential to perform a greater number of behaviors,
thus having a greater impact on personal health and the
overall problem of breast cancer.
Breast cancer knowledge
The overall mean knowledge score for the study sample
was 10.59 (SD = 2.865) based on a potential range of
0–20 correct answers about breast cancer causes, risk
factors, treatment effectiveness, and prevention.
Though some accurate knowledge was confirmed by
the present study, the potential exists for a greater
number of correct answers and thus greater knowledge
about breast cancer causes, risk factors, treatment effec-
tiveness, and prevention.
The fact that there are gaps in accurate knowledge
about breast cancer is consistent with current literature
and the public culture of breast cancer awareness.
Regarding breast cancer causes, there are major gaps
in scientific literature about what causes breast cancer
to develop. In fact, research studies have not produced
any solid evidence about how breast cancer risk factors
cause cells to become cancerous.20 Yet, much public
awareness is focused on possible causes of breast can-
cer, and this emphasis may be contributing to an over-
all public misperception about causes for the disease.
Moreover, breast cancer is often portrayed as a highly
curable disease.21 Many breast cancer awareness cam-
paigns contain “for the cure” or “for the cause” taglines,
implying that research is moving toward a cure for
breast cancer.1 Widespread awareness campaigns that
contain these messages may be contributing to gaps in
knowledge. In fact, most oncology clinicians resist the
idea of a cure, and they do not tell their patients that
they are cured.22 The findings of the present study
suggest a need for improved knowledge regarding the
causes for breast cancer and a need for improved public
knowledge about the status of research into a cure for
breast cancer.
The current study identified a gap in knowledge
regarding college students’ knowledge of breast cancer,
including breast cancer risk factors. The gap in knowl-
edge about risk factors is consistent with current litera-
ture assessing risk factor knowledge. Among teen girls,

breast cancer incidence and risk are often
overestimated,7 and this misperception may remain
during young women’s college years. It has also been
shown that adult women may overestimate their breast
cancer risk as a result of inaccurate information about
breast cancer risk in women’s consumer magazines.8
Fewer than 1 in 10 women have an accurate under-
standing of their breast cancer risk.9 Moreover, media
sources seldom address risk factors that are related to
controllable factors, such as obesity and harmful che-
micals in the environment.10 These findings, combined
with the findings of the current study, suggest a need
for more accurate knowledge about breast cancer risk
factors among college students.
In addition to breast cancer risk factors, the present
study identified a gap in accurate knowledge about
breast cancer screening and prevention. This finding
is consistent with literature that has identified mis-
conceptions about breast cancer screening.11
Specifically, many in the general public have the mis-
taken belief that mammograms prevent breast cancer
or reduce its risk12 when, in fact, mammography only
aids in the detection of breast cancer.13 This misper-
ception may be driven by the major emphasis on
breast cancer screening associated with many breast
cancer awareness campaigns.23 Additionally, the 2009
screening guidelines for breast cancer14 conflict with
current practice, which may add to increased public
confusion about breast cancer screening. The findings
of the present study, along with misperceptions iden-
tified in the current literature, suggest a need for
improvement in general knowledge regarding breast
cancer screening.
The present study identified gaps in breast cancer
knowledge, which included misperceptions about treat-
ment effectiveness. This result is consistent with cur-
rent literature that has identified myths associated with
the treatment of breast cancer.1 One common public
misperception is the belief that breast cancer can be
cured by removing the entire breast immediately and
receiving chemotherapy and radiation. In fact, breast
conserving surgery, rather than more extensive surgery,
has a higher rate of survival for early stage breast
cancer.16 Misperceptions about treatment effectiveness
may be leading some women to seek more treatment
than necessary for their particular type of breast cancer,
resulting in harmful and long-lasting effects from the
treatment.17,18 The knowledge gap identified by the
present study and current literature suggests a need
for increased public awareness regarding breast cancer
treatment effectiveness.
BREAST CANCER KNOWLEDGE AMONG COLLEGE STUDENTS 91
Correlation between race and breast cancer
knowledge
The present study examined the correlation between
the variable race and breast cancer knowledge
(Table 2).
Race was dichotomized into whites and non-whites.
Results indicated that whites had a higher mean knowl-
edge score (M = 10.99, SD = 2.594) compared to non-
whites (M = 9.59, SD = 3.182). Independent sample t
tests indicated that the difference in mean knowledge
scores between whites and non-whites was significant, t
(281) = −3.884, P = .001. It should be noted that Asian
Americans represented the highest percentage of non-
white participants in the study (13.1%).
Racial/ethnic differences are documented for various
types of health knowledge, such as smoking24,25 and
heart disease.26 For minority women diagnosed with
breast cancer, knowledge of their specific tumor char-
acteristics is low.27 A possible explanation for the racial
differences in breast cancer knowledge is the fact that
whites are portrayed more often than non-whites in
health communication about breast cancer.28 More
research is needed to determine the influence of breast
cancer knowledge on non-white college students, spe-
cifically Asian Americans. Future studies are also
needed to determine knowledge sources of breast can-
cer information for non-white college students.
Correlation between breast cancer knowledge and
health behavior
Knowledge scores were examined for their correlation
with health behaviors. The results of the present study
indicated that knowledge had an inverse correlation
with health behavior. More specifically, the higher the
knowledge score, the lower the behavior score. This
finding was unexpected, because the hypothesis would
indicate that more knowledge would be associated with
a greater number of health behaviors. There was an
inverse correlation between scores for breast cancer
knowledge and scores for behaviors impacting personal
health, r (237) = −0.172, P = .008. There was also an
inverse correlation between scores for breast cancer
knowledge and scores for scores for behaviors impact-
ing the problem of breast cancer, r (233) = −0.189,
P = .004. It should be noted that the correlation for
both behaviors is small (−0.172 and −0.189). Though
knowledge and behaviors were significantly correlated
due to the sample size, they may not be practically
significant.
92 M. F. JUSTICE ET AL.
Despite lack of practical significance, the unexpected
significant result prompted a closer examination of the
survey. The behavior questions on the survey asked
participants whether they performed health behaviors
as a result of seeing or hearing a breast cancer message.
Therefore, a possible explanation for the result of an
inverse correlation between knowledge and behavior is
the fact that a breast cancer message may not have
motivated the more knowledgeable respondents to per-
form any certain health behavior. Knowledgeable
respondents may not have been hearing anything new
in the breast cancer message or they may have already
been performing the behavior. This explanation is con-
sistent with the findings of Burgess and Murray,29 who
concluded that there was no consistent relationship
between awareness of breast cancer health campaigns
and overall knowledge about breast cancer among col-
lege students.
More research into the effect of breast cancer knowl-
edge on health behavior is greatly needed. Future stu-
dies should focus on factors influencing breast cancer
knowledge and whether breast cancer health messages
convey the knowledge needed to motivate people to
perform healthy behaviors.
Limitations
There were limitations to the current study that should
be noted. The study involved a survey of self-reported
responses. Study participants may have had difficulty
recalling behaviors they performed during the previous
12 months. They may have also had difficulty identify-
ing the motivations for their behaviors. They may have
been confused by conflicting information regarding
breast cancer, which may have influenced responses to
knowledge questions. Additionally, college students
may have responded to the survey in a socially desirable
manner. The study participants were delimited to pre-
dominantly white college students at a large
Midwestern university. Therefore, the results cannot
be generalized to other populations. Finally, because
of the cross-sectional nature of the study, causal rela-
tionships could not be determined.
Translation to Health Education Practice
The results of this study could assist Health Educators
with health promotion and education interventions, such
as school breast health programs. Planning for such
programs should take into account the misinformation
that exists among teens and college-aged women. This
study found no significant difference in breast cancer
knowledge between college-aged men and women,
suggesting that teen girls may not be benefiting from
school breast health programs. Knowledge was not cor-
related with an increase in health behaviors, suggesting
that breast health programs should incorporate skills and
attitudes, along with knowledge content. The study sur-
vey, which incorporates behaviors, may be used as an
evaluation tool for breast health programs.
Health Educators identify and analyze factors that
influence health behavior.30 The present study found
that few health behaviors resulted from seeing or hear-
ing a breast cancer message. This information could
assist Health Educators to improve messages conveyed
in breast health programs. A large barrier to endorsing
breast cancer prevention behaviors is that there is no
direct cause-and-effect relationship between specific
behaviors and breast cancer prevention. However, over-
all healthy lifestyle modification has been solidly shown
to reduce one’s risk.31 Therefore, lifestyle modification
should be a major emphasis in breast health programs.
ORCID
Mary F. Justice http://orcid.org/0000-0003-1240-3547
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