Abstract
This cross-sectional study explores changes in the level of trust in professional, governmental, and personal sources of cancer information among adults who participated in the 2018 to 2024 Health Information National Trends Survey.
Introduction
Trust in individuals and institutions is a key component of cancer health communication and a critical factor in whether someone follows through with the health information.1 Trust in the source of information shapes information-seeking behavior, perceived credibility, and eventual health actions among patients with cancer.2,3 Low trust in cancer information from physicians and health care systems has been associated with poor or nonadherence to cancer screening guidelines, while higher levels of trust has known associations with a greater uptake of genetic testing and cancer treatment concordance.4,5,6
During the COVID-19 pandemic, trust in traditional health authorities in the US was tested amid rapidly changing guidance, competing narratives, and widespread misinformation.7,8 To understand how trust in various sources of cancer information varied throughout the pandemic, we analyzed the National Cancer Institute’s Health Information National Trends Survey (HINTS) data collected between March 2020 and September 2024 and compared them to prepandemic (January 2018-February 2020) data.
Methods
The HINTS is a regularly administered, nationally representative survey of noninstitutionalized US adults. We included data from 4 survey cycles that assessed trust in cancer information sources: HINTS 5 Cycle 2 (2018), HINTS 5 Cycle 4 (2020), HINTS 6 (2022), and HINTS 7 (2024). Respondents were classified into prepandemic, early-pandemic, late-pandemic, or postpandemic groups according to survey completion date; March 11, 2020, was used to distinguish prepandemic from early-pandemic responses in HINTS 5 cycle 4. In accordance with 45 CFR §46.104, this repeated cross-sectional study was exempt from ethics review and informed consent requirement because it used deidentified, publicly available data. We followed the STROBE reporting guideline.
The primary outcomes were trust in cancer information from doctors (hereafter physicians), government health agencies, family or friends, or charitable organizations. Trust was defined as reporting “a lot” or “some” trust vs “a little” or “not at all.” We estimated weighted prevalences using replicate weights and adjusted prevalence ratios (APR) with 95% CIs using survey-weighted logistic regression with average marginal predictions, adjusting for sex, age, race and ethnicity, educational level, urbanicity, and cancer history. Only complete cases were included in the primary analysis. Sensitivity analysis was performed using hot-deck imputation for missing covariates. The eMethods in Supplement 1 provides additional information. Analyses were performed with R 4.4.1 (R Project for Statistical Computing).
Results
Among 20 899 HINTS respondents, 17 252 (mean [SD] age, 47.9 [0.2] years; 51.0% [weighted] females) had complete data and were included in the analytic sample (4063 in prepandemic, 1952 early-pandemic, 5190 late-pandemic, and 6047 postpandemic periods). Across periods, weighted demographic distributions were similar, with 14.8% to 18.5% of respondents reporting Hispanic ethnicity, 4.8% to 5.7% non-Hispanic Asian race, 9.7% to 11.9% non-Hispanic Black race, 61.7% to 67.0% non-Hispanic White (hereafter White) race, and 2.5% to 5.2% non-Hispanic other race. Additionally, 87.0% to 88.7% of respondents lived in metropolitan counties, and 7.7% to 9.9% reported a previous cancer diagnosis (Table 1).
Table 1. Sample Characteristics of 2018-2024 HINTS Respondents by Pandemic Period .
| Characteristic | HINTS respondents, No. (%) | |||
|---|---|---|---|---|
| Prepandemica | Early pandemica | Late pandemica | Postpandemica | |
| Total No. | 4063 | 1952 | 5190 | 6047 |
| Sex | ||||
| Female | 2385 (49.9) | 1140 (52.0) | 3111 (51.1) | 2432 (51.4) |
| Male | 1678 (50.1) | 812 (48.0) | 2079 (48.9) | 3615 (48.6) |
| Missing data, No. | 91 | 65 | 410 | 615 |
| Age group, y | ||||
| 18-34 | 532 (24.3) | 311 (31.5) | 799 (25.2) | 1030 (25.9) |
| 35-49 | 797 (26.9) | 452 (28.5) | 1093 (26.5) | 1297 (26.9) |
| 50-64 | 1336 (30.7) | 596 (24.2) | 1516 (28.0) | 1589 (26.6) |
| 65-74 | 881 (11.2) | 409 (10.0) | 1145 (12.7) | 1282 (12.5) |
| ≥75 | 517 (6.9) | 184 (5.7) | 637 (7.6) | 849 (8.1) |
| Missing data, No. | 130 | 84 | 98 | 613 |
| Race and ethnicityb | ||||
| Hispanic | 554 (14.8) | 354 (18.5) | 880 (16.3) | 1171 (16.6) |
| Non-Hispanic Asian | 166 (4.8) | 95 (5.0) | 270 (5.7) | 321 (5.5) |
| Non-Hispanic Black | 491 (9.7) | 287 (11.9) | 816 (10.8) | 901 (10.9) |
| Non-Hispanic White | 2688 (67.0) | 1153 (62.1) | 3050 (62.6) | 3419 (61.7) |
| Non-Hispanic otherc | 164 (3.7) | 63 (2.5) | 174 (4.7) | 235 (5.2) |
| Missing data, No. | 481 | 247 | 687 | 840 |
| Educational level | ||||
| No college | 912 (27.9) | 452 (28.8) | 1149 (26.7) | 1290 (26.5) |
| Some college | 1215 (40.2) | 570 (40.5) | 1496 (39.3) | 1747 (38.6) |
| College graduate | 1936 (31.8) | 930 (30.7) | 2545 (34.1) | 3010 (35.0) |
| Missing data, No. | 89 | 105 | 404 | 583 |
| Urbanicity | ||||
| Metro | 3529 (87.0) | 1765 (88.7) | 4520 (87.5) | 5209 (87.0) |
| Nonmetro | 534 (13.0) | 187 (11.3) | 670 (12.5) | 838 (13.0) |
| Missing data, No. | 0 | 0 | 0 | 0 |
| Cancer history | ||||
| No | 3369 (90.5) | 1676 (92.3) | 4420 (90.1) | 5110 (90.7) |
| Yes | 694 (9.5) | 276 (7.7) | 770 (9.9) | 937 (9.3) |
| Missing data, No. | 41 | 43 | 370 | 532 |
Abbreviation: HINTS, Health Information National Trends Survey.
Prepandemic period includes HINTS 5 cycle 2 (2018) and HINTS 5 cycle 4 (February 1 to March 11, 2020). Early pandemic period includes HINTS 5 cycle 4 (March 12 to June 30, 2020). Late pandemic period includes HINTS 6 (2022). Postpandemic period includes HINTS 7 (2024).
Race and ethnicity were self-reported. These data were included in the study to assess whether racial or ethnic differences were present in trust in cancer information sources.
Other included American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and 2 or more non-Hispanic races.
The prevalence of trust in physicians as a source of cancer information was 95.7% in the prepandemic period, with no significant change in trust during subsequent periods (Table 2). Trust in government health agencies as a source (75.9% before the pandemic) was significantly lower in the late-pandemic (71.3%; APR, 0.93 [95% CI, 0.90-0.97]) and postpandemic periods (71.7%; APR, 0.94 [95% CI, 0.90-0.97]). Changes from prepandemic trust levels for other information sources were more isolated, with lower trust in charitable organizations during the late-pandemic period (51.8% to 47.9%; APR, 0.92 [95% CI, 0.85-0.99]), and lower trust in family or friends during the postpandemic period (58.2% to 52.6%; APR, 0.91 [95% CI, 0.85-0.97]). Results were similar under sensitivity analysis.
Table 2. Prevalence and Changes in Trust in Cancer Information Sources Among 2018-2024 Health Information National Trends Survey Respondents by Pandemic Perioda.
| Group | Trust in physicians | Trust in government health agencies | Trust in family or friends | Trust in charitable organizations | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WP, % | APR (95% CI)b | WP, % | APR (95% CI)b | WP, % | APR (95% CI)b | WP, % | APR (95% CI)b | |||||||||
| Pandemic periodc | Pre | Early | Late | Post | Pre | Early | Late | Post | Pre | Early | Late | Post | Pre | Early | Late | Post |
| Overall | 95.7 | 1.01 (0.99-1.03) | 0.99 (0.97-1.01) | 0.99 (0.97-1.01) | 75.9 | 1.04 (0.99-1.09) | 0.93 (0.90-0.97) | 0.94 (0.90-0.97) | 58.2 | 1.00 (0.93-1.08) | 0.95 (0.89-1.02) | 0.91 (0.85-0.97) | 51.8 | 0.98 (0.89-1.07) | 0.92 (0.85-0.99) | 0.97 (0.90-1.04) |
| Sex | ||||||||||||||||
| Female | 95.4 | 1.02 (0.99-1.04) | 1.00 (0.98-1.01) | 0.99 (0.97-1.01) | 76.6 | 1.01 (0.95-1.07) | 0.95 (0.91-1.00) | 0.95 (0.90-1.00) | 61.6 | 1.03 (0.93-1.13) | 0.95 (0.88-1.02) | 0.81 (0.75-0.89) | 53.7 | 0.98 (0.87-1.09) | 0.92 (0.84-1.00) | 0.95 (0.87-1.04) |
| Male | 96.1 | 1.00 (0.96-1.05) | 0.99 (0.95-1.02) | 0.98 (0.96-1.01) | 75.3 | 1.08 (1.01-1.16) | 0.91 (0.86-0.97) | 0.92 (0.87-0.98) | 54.8 | 0.98 (0.86-1.11) | 0.96 (0.85-1.07) | 1.02 (0.93-1.12) | 49.8 | 0.97 (0.84-1.13) | 0.92 (0.82-1.04) | 0.99 (0.89-1.11) |
| Age group, y | ||||||||||||||||
| 18-34 | 97.4 | 1.00 (0.94-1.05) | 0.97 (0.91-1.03) | 0.97 (0.93-1.01) | 82.3 | 1.04 (0.95-1.14) | 0.85 (0.76-0.95) | 0.89 (0.82-0.96) | 57.5 | 0.93 (0.78-1.11) | 0.87 (0.74-1.04) | 0.86 (0.73-1.02) | 58.0 | 0.93 (0.77-1.13) | 0.86 (0.73-1.02) | 0.97 (0.84-1.13) |
| 35-49 | 94.4 | 1.01 (0.96-1.06) | 0.99 (0.94-1.04) | 0.99 (0.94-1.04) | 76.1 | 0.99 (0.89-1.09) | 0.94 (0.86-1.01) | 0.96 (0.89-1.04) | 60.2 | 0.98 (0.86-1.12) | 0.95 (0.85-1.06) | 0.84 (0.75-0.94) | 51.4 | 1.01 (0.85-1.20) | 0.99 (0.86-1.14) | 0.99 (0.87-1.13) |
| 50-64 | 95.6 | 1.02 (0.99-1.05) | 1.00 (0.98-1.03) | 0.99 (0.96-1.02) | 73.2 | 1.07 (0.99-1.16) | 0.97 (0.92-1.03) | 0.96 (0.89-1.03) | 60.8 | 1.06 (0.93-1.20) | 0.98 (0.90-1.07) | 0.93 (0.85-1.03) | 49.9 | 1.03 (0.88-1.19) | 0.94 (0.84-1.05) | 0.96 (0.85-1.09) |
| 65-74 | 95.3 | 1.02 (0.97-1.06) | 1.00 (0.96-1.04) | 1.02 (0.98-1.05) | 72.8 | 1.04 (0.95-1.15) | 0.99 (0.92-1.07) | 0.95 (0.87-1.04) | 49.9 | 1.11 (0.94-1.33) | 1.01 (0.89-1.14) | 1.08 (0.94-1.24) | 50.2 | 0.90 (0.76-1.07) | 0.87 (0.76-0.99) | 0.90 (0.77-1.04) |
| ≥75 | 96.3 | 1.03 (0.99-1.07) | 1.01 (0.97-1.05) | 1.00 (0.96-1.04) | 70.2 | 1.12 (0.97-1.29) | 0.96 (0.85-1.08) | 0.92 (0.80-1.05) | 55.0 | 0.94 (0.74-1.19) | 0.97 (0.83-1.14) | 0.95 (0.81-1.11) | 42.1 | 0.90 (0.65-1.26) | 0.88 (0.75-1.04) | 1.09 (0.91-1.31) |
| Race and ethnicity | ||||||||||||||||
| Hispanic | 91.4 | 1.06 (0.98-1.14) | 1.02 (0.95-1.10) | 1.00 (0.94-1.07) | 75.1 | 1.09 (0.97-1.23) | 0.94 (0.84-1.06) | 1.01 (0.92-1.10) | 54.6 | 0.87 (0.69-1.10) | 0.82 (0.69-0.98) | 0.86 (0.72-1.04) | 54.2 | 1.03 (0.84-1.27) | 0.94 (0.79-1.13) | 1.01 (0.85-1.20) |
| Non-Hispanic Asian | 96.9 | 1.02 (0.67-1.55) | 0.94 (0.69-1.27) | 1.01 (0.93-1.10) | 85.5 | 1.09 (0.96-1.24) | 0.95 (0.79-1.14) | 0.99 (0.83-1.17) | 57.5 | 1.20 (0.88-1.65) | 0.81 (0.58-1.14) | 1.13 (0.84-1.53) | 46.0 | 1.39 (0.96-2.00) | 0.94 (0.63-1.42) | 1.07 (0.73-1.57) |
| Non-Hispanic Black | 93.6 | 1.02 (0.96-1.09) | 1.02 (0.99-1.06) | 1.00 (0.96-1.04) | 81.0 | 0.98 (0.86-1.11) | 0.91 (0.82-1.01) | 0.94 (0.86-1.03) | 64.9 | 0.85 (0.67-1.06) | 0.92 (0.79-1.07) | 0.82 (0.69-0.96) | 61.2 | 1.07 (0.90-1.29) | 0.92 (0.80-1.07) | 0.93 (0.80-1.07) |
| Non-Hispanic White | 97.0 | 1.00 (0.97-1.02) | 0.99 (0.97-1.00) | 0.98 (0.96-1.00) | 75.4 | 1.03 (0.96-1.10) | 0.93 (0.89-0.97) | 0.91 (0.86-0.95) | 58.4 | 1.05 (0.95-1.15) | 0.99 (0.92-1.07) | 0.92 (0.85-1.00) | 51.2 | 0.89 (0.79-1.01) | 0.90 (0.82-0.99) | 0.95 (0.86-1.04) |
| Non-Hispanic Other | 95.1 | 1.04 (0.94-1.16) | 0.93 (0.84-1.03) | 0.99 (0.89-1.09) | 62.7 | 1.25 (0.87-1.80) | 1.05 (0.80-1.38) | 1.07 (0.80-1.43) | 52.7 | 0.90 (0.51-1.58) | 1.10 (0.83-1.47) | 0.83 (0.58-1.19) | 34.5 | 1.59 (0.85-2.98) | 1.29 (0.79-2.10) | 1.27 (0.77-2.09) |
| Educational level | ||||||||||||||||
| No college | 93.7 | 1.02 (0.95-1.09) | 0.99 (0.94-1.04) | 0.99 (0.94-1.03) | 68.3 | 1.05 (0.94-1.17) | 0.92 (0.84-1.01) | 0.96 (0.87-1.05) | 61.6 | 0.94 (0.79-1.11) | 0.93 (0.83-1.05) | 0.86 (0.76-0.97) | 47.1 | 0.84 (0.65-1.08) | 0.94 (0.81-1.10) | 0.97 (0.82-1.15) |
| Some college | 96.0 | 1.01 (0.98-1.04) | 0.99 (0.96-1.02) | 0.98 (0.95-1.00) | 75.9 | 1.07 (0.98-1.17) | 0.91 (0.85-0.98) | 0.89 (0.83-0.96) | 57.1 | 1.05 (0.93-1.18) | 0.91 (0.81-1.01) | 0.89 (0.80-1.00) | 51.3 | 1.08 (0.91-1.28) | 0.86 (0.75-1.00) | 0.97 (0.85-1.10) |
| College graduate | 97.2 | 1.01 (0.99-1.02) | 1.00 (0.98-1.01) | 1.00 (0.99-1.02) | 82.6 | 1.01 (0.96-1.07) | 0.97 (0.93-1.02) | 0.98 (0.94-1.02) | 56.7 | 1.01 (0.89-1.14) | 1.02 (0.93-1.12) | 0.98 (0.89-1.07) | 56.5 | 0.97 (0.87-1.08) | 0.97 (0.90-1.04) | 0.98 (0.90-1.06) |
| Urbanicity | ||||||||||||||||
| Metro | 95.4 | 1.02 (0.99-1.04) | 1.00 (0.98-1.02) | 0.99 (0.97-1.01) | 76.4 | 1.04 (0.99-1.10) | 0.94 (0.90-0.98) | 0.95 (0.91-0.98) | 57.9 | 1.00 (0.92-1.08) | 0.95 (0.89-1.02) | 0.92 (0.86-0.99) | 51.9 | 1.00 (0.91-1.10) | 0.92 (0.85-1.00) | 0.99 (0.91-1.06) |
| Nonmetro | 97.8 | 0.96 (0.90-1.03) | 0.96 (0.92-1.00) | 0.95 (0.91-0.99) | 73.0 | 1.05 (0.90-1.22) | 0.91 (0.81-1.01) | 0.88 (0.78-1.00) | 60.0 | 1.05 (0.84-1.31) | 0.95 (0.83-1.10) | 0.84 (0.73-0.97) | 51.1 | 0.79 (0.58-1.09) | 0.89 (0.74-1.07) | 0.88 (0.72-1.07) |
| Cancer history | ||||||||||||||||
| No | 95.7 | 1.01 (0.99-1.03) | 0.99 (0.97-1.01) | 0.99 (0.97-1.01) | 76.4 | 1.03 (0.99-1.09) | 0.93 (0.89-0.97) | 0.93 (0.90-0.97) | 58.6 | 1.01 (0.93-1.09) | 0.95 (0.89-1.02) | 0.90 (0.84-0.97) | 52.5 | 0.97 (0.89-1.07) | 0.91 (0.84-0.99) | 0.96 (0.89-1.03) |
| Yes | 96.1 | 1.02 (0.98-1.05) | 1.01 (0.98-1.04) | 0.99 (0.96-1.04) | 71.3 | 1.11 (1.00-1.24) | 0.97 (0.88-1.07) | 0.95 (0.86-1.05) | 54.1 | 0.94 (0.78-1.14) | 0.95 (0.83-1.08) | 0.99 (0.85-1.14) | 44.5 | 0.96 (0.76-1.22) | 0.97 (0.80-1.17) | 1.13 (0.96-1.34) |
Abbreviations: APR, adjusted prevalence ratio; WP, weighted prevalence.
Change measured as APR using survey-weighted logistic regression with average marginal predictions, adjusting for sex, age, race and ethnicity, educational level, urbanicity, and cancer history. Estimates were weighted using complex sampling weights.
Reference: prepandemic period group.
Prepandemic period includes HINTS 5 cycle 2 (2018) and HINTS 5 cycle 4 (February 1 to March 11, 2020). Early pandemic period includes HINTS 5 cycle 4 (March 12 to June 30, 2020). Late pandemic period includes HINTS 6 (2022). Postpandemic period includes HINTS 7 (2024).
In subgroup analyses, White respondents reported lower trust in government health agencies, from 75.4% in the prepandemic period to 70.2% in the late-pandemic (APR, 0.93; 95% CI, 0.89-0.97) and 68.7% in the postpandemic periods (APR, 0.91; 95% CI, 0.86-0.95). Similar reductions in trust in government health agencies were observed across the same periods among males (75.3% to 69.2% and 69.7%, respectively), adults aged 18 to 34 years (82.3% to 71.2% and 72.6%, respectively), metropolitan residents (76.4% to 72.2% and 72.7%, respectively), and respondents with no cancer history (76.4% to 71.4% and 72.0%, respectively). Aside from White respondents, only nonmetropolitan residents showed decreased trust in physicians, from 97.8% in the prepandemic period to 93.2% in the late-pandemic (APR, 0.96; 95% CI, 0.92-1.00) and 92.9% in the postpandemic periods (APR, 0.95; 95% CI, 0.91-0.99).
Discussion
In this study, trust in physicians as sources of cancer information remained high from 2018 to 2024, while trust in government health agencies decreased. These findings suggest changes in institutional trust during and after the COVID-19 pandemic, with shifts varying according to information source and population subgroups. The patterns we observed align with recent reports that cancer-related information and behavior may be increasingly shaped by nontraditional messengers.9 Coordinated cancer communication efforts may help reinforce evidence-based information through trusted clinical, public health, and community sources.10
Study limitations include potential biases from self-reports, nonresponse, or analytic choices. Additionally, the study design limited our ability to establish causality. Nevertheless, our use of nationally representative data and consistent measures over time highlights recent shifts in trust in cancer information sources in the US.
eMethods
eReferences
Data Sharing Statement
References
- 1.Weerakoon SM, Henson-Garcia M, Valerio-Shewmaker MA, Messiah SE, Knell G. Contributions of trustworthiness, health literacy, and self-efficacy in communicating with COVID-19 vaccine-hesitant audiences: web-based survey study. JMIR Form Res. 2022;6(8):e38076. doi: 10.2196/38076 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lee WC, Kim EM, Nemirovski EA, Kamprath S, Masel MC, Patel DI. Public trust in different sources of information: gaps in rural residents and cancer patients. Healthcare (Basel). 2025;13(6):640. doi: 10.3390/healthcare13060640 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hillen MA, de Haes HCJM, Smets EMA. Cancer patients’ trust in their physician-a review. Psychooncology. 2011;20(3):227-241. doi: 10.1002/pon.1745 [DOI] [PubMed] [Google Scholar]
- 4.Yang TC, Matthews SA, Hillemeier MM. Effect of health care system distrust on breast and cervical cancer screening in Philadelphia, Pennsylvania. Am J Public Health. 2011;101(7):1297-1305. doi: 10.2105/AJPH.2010.300061 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Roberts MC, Taber JM, Klein WM. Engagement with genetic information and uptake of genetic testing: the role of trust and personal cancer history. J Cancer Educ. 2018;33(4):893-900. doi: 10.1007/s13187-016-1160-9 [DOI] [PubMed] [Google Scholar]
- 6.Mouslim MC, Johnson RM, Dean LT. Healthcare system distrust and the breast cancer continuum of care. Breast Cancer Res Treat. 2020;180(1):33-44. doi: 10.1007/s10549-020-05538-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Sauer MA, Truelove S, Gerste AK, Limaye RJ. A failure to communicate? how public messaging has strained the COVID-19 response in the United States. Health Secur. 2021;19(1):65-74. doi: 10.1089/hs.2020.0190 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Kreps SE, Kriner DL. Model uncertainty, political contestation, and public trust in science: evidence from the COVID-19 pandemic. Sci Adv. 2020;6(43):eabd4563. doi: 10.1126/sciadv.abd4563 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Rockwell MS, Kahn KL, Fendrick AM, Vangala S, Mafi JN. Ivermectin-benzimidazole prescribing following celebrity endorsement. JAMA Netw Open. 2026;9(5):e2616780. doi: 10.1001/jamanetworkopen.2026.16780 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Viswanath K, Nagler RH, Bigman-Galimore CA, McCauley MP, Jung M, Ramanadhan S. The communications revolution and health inequalities in the 21st century: implications for cancer control. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1701-1708. doi: 10.1158/1055-9965.EPI-12-0852 [DOI] [PMC free article] [PubMed] [Google Scholar]
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Supplementary Materials
eMethods
eReferences
Data Sharing Statement
