Personal cancer worry and Systemic Cancer Concern: Pathways to health behaviors via social media and emotional well-being

Cancer worry and concern are associated with how individuals engage with and interpret digital health environments, yet existing research has not distinguished between personal worry about individual risk and systemic concerns regarding institutional responses. This study examines how personal worry and systemic cancer concern relate to digital health behaviors through distinct affective and trust-related pathways. Drawing on an integrated theoretical framework, we analyze nationally representative U.S. data (HINTS 6; N = 6252) using structural equation modeling. Personal cancer worry is associated with increased social media engagement and reduced emotional well-being, with emotional vulnerability in particular aligning with greater involvement in harmful behaviors (e.g., smoking), whereas social media engagement shows more selective behavioral associations. In contrast, systemic cancer concern, marked by institutional distrust, corresponds to limited or passive digital engagement and diminished emotional well-being, patterns that relate to lower participation in positive health behaviors. Social media engagement is associated with perceiving less health misinformation, showing modest behavioral associations. Overall, the findings distinguish two forms of cancer-related psychological responses: a pattern of active but emotionally vulnerable engagement associated with personal worry, and a pattern of trust-sensitive, low-engagement interpretation associated with systemic concern. Findings inform psychologically responsive digital health design. Emotion-sensitive features may support users with heightened vulnerability, whereas credibility cues may address institutional distrust.