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Hudson L, Burus T, Park L, Huang B, Hull PC, Vanderford NL. Cancer disparities in Appalachian Kentucky. J Rural Health 2024; 40:87-95. [PMID: 37095596 PMCID: PMC10593907 DOI: 10.1111/jrh.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky). METHODS The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky. FINDINGS Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking. CONCLUSIONS Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity.
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Affiliation(s)
- Lauren Hudson
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Lee Park
- Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Pamela C. Hull
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Martin C, Estes J, Ickes M. Engaging Appalachian Youth: Lessons Learned From a Virtual Tobacco Prevention and Advocacy Training. Health Promot Pract 2023:15248399231196858. [PMID: 37724531 DOI: 10.1177/15248399231196858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Engaging youth is recommended as a key component of comprehensive tobacco control to bring voice to youth perspective and to connect to community impact. Yet, limited research exists to showcase practical lessons learned in supporting skill development and engagement of youth. This practice note describes how a tailored prevention and advocacy virtual training can serve to engage and empower rural Appalachian high school students to participate in tobacco control efforts. Specifically, we describe the implementation and practical lessons learned from a two-session virtual tobacco prevention and advocacy training led by college facilitators. Participating high school students (N = 20) strongly agreed that tobacco use was a major problem facing their community and that addressing tobacco use should be prioritized. After participating in the training, students' interpersonal confidence improved and participation in self-reported advocacy increased. Students also liked the virtual platform, interaction with college students, and the opportunity to apply information learned. Youth-focused tailored training promotes skill-building and enhances self-efficacy to engage in tobacco control. Youth engagement should be integral to supporting community health initiatives, including tobacco prevention.
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Miller CC, Xiao M, Lay DJ, Miley SN, Vanderford NL, Ickes MJ. The Impact of a Virtual Tobacco Prevention and Advocacy Training Among Youth in Appalachian Kentucky Communities. Tob Use Insights 2023; 16:1179173X221150747. [PMID: 36844175 PMCID: PMC9944190 DOI: 10.1177/1179173x221150747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/19/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Engaging youth is an important component of comprehensive tobacco control programs. PURPOSE This paper describes the impact of a virtual tobacco prevention training program to encourage and prepare youth in Appalachia to support tobacco prevention policies, to strengthen interpersonal confidence to address tobacco use within their communities and enhance advocacy self-efficacy for tobacco control. METHODS A two-part evidence-informed peer-led tobacco prevention and advocacy training was implemented among 16 high school students from Appalachian counties in Kentucky. The initial training (January 2021) included an overview of the e-cigarette landscape, advocacy skills related to policy change, developing messages to decision makers, and media advocacy. A follow-up session (March 2021) included a breakdown of advocacy skills and overcoming barriers. RESULTS Overall, participants held strong beliefs that tobacco use is an issue that needs to be addressed in their community. There was a statistically significant average difference in student interpersonal confidence between baseline and post-surveys (t = 2.016, P = .062 < .1). Students who participated in at least 1 of the provided advocacy events indicated higher self-reported advocacy. CONCLUSION Youth in Appalachia expressed an interest to advocate for stronger tobacco policy in their communities. Youth who participated in the tobacco advocacy policy trainings reported improvements in attitudes, interpersonal confidence, advocacy self-efficacy, and self-reported advocacy. Youth engagement in tobacco policy advocacy is promising and needs to be further supported.
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Affiliation(s)
- Claire C Miller
- Department of Kinesiology and
Health Promotion, University of
Kentucky, Lexington, KY, USA.
College of Education, University of
Kentucky, Lexington, KY, USA.
Department of Toxicology and Cancer Biology, College of
Medicine, University
of Kentucky, Lexington, KY, USA
| | - Min Xiao
- Department of Kinesiology and
Health Promotion, University of
Kentucky, Lexington, KY, USA.
College of Education, University of
Kentucky, Lexington, KY, USA.
Department of Toxicology and Cancer Biology, College of
Medicine, University
of Kentucky, Lexington, KY, USA
| | - Dillon J Lay
- Department of Kinesiology and
Health Promotion, University of
Kentucky, Lexington, KY, USA.
College of Education, University of
Kentucky, Lexington, KY, USA.
Department of Toxicology and Cancer Biology, College of
Medicine, University
of Kentucky, Lexington, KY, USA
| | - Sierrah N Miley
- Department of Kinesiology and
Health Promotion, University of
Kentucky, Lexington, KY, USA.
College of Education, University of
Kentucky, Lexington, KY, USA.
Department of Toxicology and Cancer Biology, College of
Medicine, University
of Kentucky, Lexington, KY, USA
| | - Nathan L Vanderford
- Department of Kinesiology and
Health Promotion, University of
Kentucky, Lexington, KY, USA.
College of Education, University of
Kentucky, Lexington, KY, USA.
Department of Toxicology and Cancer Biology, College of
Medicine, University
of Kentucky, Lexington, KY, USA
| | - Melinda J Ickes
- Department of Kinesiology and
Health Promotion, University of
Kentucky, Lexington, KY, USA.
College of Education, University of
Kentucky, Lexington, KY, USA.
Department of Toxicology and Cancer Biology, College of
Medicine, University
of Kentucky, Lexington, KY, USA
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Hudson L, Prichard C, Weiss LT, Ickes MJ, Vanderford NL. Training Appalachian Kentucky Youth Cancer Advocates. South Med J 2021; 114:356-360. [PMID: 34075428 PMCID: PMC8274365 DOI: 10.14423/smj.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Kentucky has the highest cancer incidence and mortality rates in the United States, with the Appalachian region experiencing the highest of those rates. Cancer advocacy, which is defined as providing support to cancer patients and their communities, represents a means of decreasing the cancer cases in Appalachian Kentucky. This exploratory study examined the effects of advocacy training and experiential learning on Appalachian high school students' cancer advocacy attitudes and self-efficacy. METHODS The design of this study was a mixed-methods, one-group repeated measure with a group of participants from the Appalachian Career Training in Oncology (ACTION) Program (N = 9). The study assessed advocacy attitudes and self-efficacy before and after participants were provided advocacy training and participated in an advocacy event. RESULTS Participating students' attitudes and self-efficacy did not substantially change following the training and their participation in an advocacy event. Through their comments after the event, however, students seem eager to use their voices to influence the actions of state legislators. At the same time, they worry about the apathy of their community members to their cancer advocacy message. CONCLUSIONS Youth represent potentially powerful agents of advocacy that could help address the cancer burden in Kentucky. Participants in this study likely overestimated their advocacy abilities before learning more about advocacy and participating in the process. As such, additional trainings are likely necessary to increase students' self-efficacy, encourage them to share their stories, and help them overcome perceived barriers.
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Affiliation(s)
- Lauren Hudson
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - Chris Prichard
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - L. Todd Weiss
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
| | - Melinda J. Ickes
- Department of Kinesiology and Health Promotion, College of Education, University of Kentucky. Lexington, KY, USA
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky. Lexington, KY, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky. Lexington, KY, USA
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Cardarelli KM, Ickes M, Huntington-Moskos L, Wilmhoff C, Larck A, Pinney SM, Hahn EJ. Authentic Youth Engagement in Environmental Health Research and Advocacy. Int J Environ Res Public Health 2021; 18:2154. [PMID: 33672107 DOI: 10.3390/ijerph18042154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/24/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
Training in environmental health (EH) engages and inspires youth to tackle health promotion and policy change. Yet, there is little guidance on how to successfully nurture and sustain youth engagement. This paper compares four case studies of youth engagement to promote EH in rural and urban communities using the Youth Empowerment Solutions (YES!) framework. Of the case studies in rural (Central Appalachia) and urban (Cincinnati, Ohio) communities, two employ citizen science approaches using PhotoVoice and environmental sampling; one engages youth in a science communication camp; and one focuses on policy advocacy. We compare and contrast these case studies using the YES! Critical Components and Empowerment levels. The case studies were discussed at the 2020 Partnerships in Environmental Public Health Meeting, where participants identified challenges and possible solutions for promoting and maintaining authentic youth engagement in EH research and advocacy. Analysis of the case studies indicated that youth engagement activities focusing on the individual were more common than those targeting the organizational setting or the community. Youth demonstrate agency to impact EH issues in their communities by engaging in hands-on opportunities to practice citizen science and advocacy. Overcoming challenges to authentic young engagement is important to sustain this work.
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Hahn EJ, Wilmhoff C, Rayens MK, Conley NB, Morris E, Larck A, Allen T, Pinney SM. High School Students as Citizen Scientists to Decrease Radon Exposure. Int J Environ Res Public Health 2020; 17:ijerph17249178. [PMID: 33302585 PMCID: PMC7763282 DOI: 10.3390/ijerph17249178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Abstract
Residents in rural Kentucky (KY) and suburban Ohio (OH) expressed concerns about radon exposure and lung cancer. Although 85% of lung cancer cases are caused by tobacco smoke, radon exposure accounts for 10–15% of lung cancer cases. Academic and community members from the University of KY and the University of Cincinnati developed and pilot-tested a family-centered, youth-engaged home radon testing toolkit. The radon toolkit included radon information, and how to test, interpret, and report back findings. We educated youth as citizen scientists and their teachers in human subjects protection and home radon testing using the toolkit in the classroom. Youth citizen scientists explained the study to their parents and obtained informed consent. One hundred students were trained in human subjects protection, 27 had parental permission to be citizen scientists, and 18 homeowners completed surveys. Radon values ranged from < 14.8 Bq/m3 to 277.5 Bq/m3. Youth were interested and engaged in citizen science and this family-centered, school-based project provided a unique opportunity to further the healthy housing and quality education components of the Sustainable Development Goals for 2030. Further research is needed to test the impact of student-led, family-centered citizen science projects in environmental health as part of school curricula.
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Affiliation(s)
- Ellen J. Hahn
- UK-CARES and BREATHE, College of Nursing, University of Kentucky, Lexington, KY 40504 USA
- Correspondence: ; Tel.: +859-257-2358
| | - Craig Wilmhoff
- Perry County Central High School, Hazard, KY 41701, USA;
| | - Mary Kay Rayens
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY 40504 USA; (M.K.R.); (N.B.C.)
| | - Nicholas B. Conley
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY 40504 USA; (M.K.R.); (N.B.C.)
| | - Emily Morris
- Kentucky Geological Survey, University of Kentucky, Lexington, KY 40505, USA;
| | - Angela Larck
- Center for Environmental Genetics, University of Cincinnati, Cincinnati, OH 45267, USA; (A.L.); (S.M.P.)
| | - Trista Allen
- Fairfield Senior High School, Fairfield, OH 45014, USA;
| | - Susan M. Pinney
- Center for Environmental Genetics, University of Cincinnati, Cincinnati, OH 45267, USA; (A.L.); (S.M.P.)
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