Association between health literacy and cancer history with medical trust among adults in the United States

Introduction: Health literacy, or the ability to understand health information, shapes health-seeking behaviors. Among those with a history of cancer, low health literacy is associated with poor outcomes. In an era of disinformation, examining how health literacy and cancer history interact with trust in sources of health information can elucidate individuals' health decisions. Methods: We analyzed data from the Health Information National Trends Survey (HINTS), a nationally representative dataset, for the 2014, 2018, 2020, 2022, and 2024 cycles. Health literacy (Low: never, rarely, sometimes; High: always), personal cancer history (ever vs. never), and age (18-39, 40-64, 65+) were examined in relation to trust in doctors, family, and religious organizations for health information (Low: not at all, a little, some; High: a lot). All variables were self-reported. Survey-weighted logistic regression models accounted for complex sampling and replicate weights using the jackknife method in R. Models included health literacy, cancer history, age category, and survey cycle as predictors. Interactions between age and health literacy, and age and cancer history were tested using Rao-Scott likelihood ratio tests; significant interactions were explored with stratified odds ratios. Results: Higher health literacy was significantly associated with greater trust in doctors for health information (aOR 4.50, 95% CI 3.61-5.60). When stratified by age, the association varied (ages 18-39: aOR 4.78, 95% CI 2.89-7.91; ages 40-64: aOR 4.00, 95% CI 2.91-5.50; ages 65+: aOR 5.34, 95% CI 3.68-7.75). Cancer history was not associated with doctor trust (aOR 1.17, 95% CI 0.91-1.51), and trust did not vary meaningfully by cycle. For trust in family for health information, the association with health literacy differed by age (interaction p = 0.03). In stratified analyses, higher health literacy showed a trend towards greater trust among younger adults (ages 18-39: aOR 2.02, 95% CI 0.91-4.51), while associations were weaker for middle-aged (ages 40-64: aOR 0.71, 95% CI 0.43-1.16) and older adults (65+: aOR 1.02, 95% CI 0.56-1.87). Cancer history was not associated with family trust, but trust was lower in later cycles (2022 vs. 2017 aOR 0.58, 95% CI 0.42-0.81; 2024 vs. 2014 AOR 0.56, 95% CI 0.41-0.76), suggesting shifting trust in family after the COVID-19 pandemic. Trust in religious organizations for health information was higher in older adults (ages 40-64 vs. 18-39 aOR: 1.95, 95% CI 1.36-2.79; 65+ vs. 18-39 aOR: 1.55, 95% CI 1.13-2.15) and lower among cancer survivors (aOR 0.61, 95% CI 0.43-0.87). Health literacy was not associated with trust in religious organizations and trust remained stable across cycles. Conclusion: These findings emphasize the importance of targeted outreach for different patient and trust contexts to promote informed health decisions, especially for older adults and cancer survivors.