<b>The Role of Sociodemographic and Psychosocial Predictors in Cancer Risk Perception and Preventive Behaviors among Tertiary Students in Punjab, India: A Multigroup Analysis across Gender and Districts</b>

Background:Risk perception is a well-established predictor of health-promoting behavior, yet its influence may vary significantly across sociodemographic groups. In the context of rising cancer prevalence in Punjab, understanding how identity and context shape the relationship between perceived cancer risk and preventive actions is essential for designing effective public health interventions. Objectives:This study examined the moderating effects of gender, geographic district, and family history of cancer on the relationship between cancer risk perception and health-promoting behavior among tertiary students in six high-risk districts in Punjab, India. Methods:A cross-sectional study was conducted among 601 students selected through multistage sampling. Standardized tools were used to measure risk perception (TRIRISK), cancer stigma, and preventive behavior (HPLP-II). Data were analyzed using MANOVA, interaction regression, and multigroup structural equation modeling (SEM) to test for moderating effects across gender, district, and family history subgroups. Results:Risk perception significantly predicted health-promoting behavior (β = .37, p < .001), but this relationship was moderated by gender, district of residence, and family cancer history. Females showed a stronger association between perceived risk and preventive action (β = .39) than males (β = .24). Similarly, students from high-risk districts and those with a family history of cancer demonstrated heightened behavioral responses to perceived risk. Multigroup SEM confirmed significant moderation, and model fit indices indicated excellent structural validity (CFI = .958, RMSEA = .045). Conclusion:The influence of cancer risk perception on health behavior is not uniform and is significantly shaped by demographic and contextual factors. Tailored health interventions that account for gender, place, and personal cancer history are critical to improving cancer prevention strategies among young adults in high-risk regions. Keywords: Cancer risk perception, health behavior, moderation, multigroup SEM, gender differences, cancer prevention, tertiary students.