What Children and Adolescents Know and Need to Learn about Cancer.

Despite cancer's devastating effects on health and longevity, and the critical role of health habits formed during childhood and adolescence in its prevention, children's knowledge of contributors to cancer is understudied. In this paper, the first developmental analysis of the literature, we outline relevant theoretical perspectives and three early emerging intuitions about illness evident among preschool children-contagion/germ, contamination, and unhealthy lifestyle theories-and then review research on elementary and secondary school students' awareness of risk factors for cancer in light of these early intuitive theories. Our analysis centers on the 16 studies we could locate, done in seven countries, that allowed calculating the percentages of children of different age groups who mentioned various risk factors in response to open-ended questions or endorsed them in response to structured questions. Awareness of primary known risk factors (led by smoking), lifestyle contributors, and personal factors (genetics and old age) increased with age, while contact myths decreased with age until adolescents began to show awareness of sexual contact as a contributor to certain cancers. In addition, the analysis revealed higher levels of awareness in response to structured questions than in response to open-ended questions; a glaring need for research asking young school-aged children about key risk factors and exploring not only their knowledge but their causal understanding; a need for attention to sociocultural influences; and connections between preschool children's intuitive theories of disease and older children's patterns of belief about cancer that can help guide school-based cancer education.