Performing Department
(N/A)
Non Technical Summary
Melanoma is the fastest growing cancer in the United States. Kentucky ranks seventh in rate of new melanomas (28.2 per 100,000), higher than that of the U.S. (22.9 per 100,000). Average mortality rate in Kentucky for the 2015-2019 period was 1,305 per 100,000 people. Depending on the severity of the disease, healthcare costs for skin cancer range from a total of $4,648.48 to $159,808. This poses a significant public health challenge not only in Kentucky, but also for the entire nation.Current evidence indicate that the rate of skin cancer is increasing in predominantly agricultural regions, and among small, limited-resource and minority farmers (SLRMF) who dominate Kentucky agriculture. Sun exposure is the main risk factor. However, very few studies have reported on farmers and farmworkers whose outdoor work exposes them to excessive amounts of sun. More so, adherence to sun protective behaviors (like the use of sunscreens and wearing of long sleeve shirts and wide-brim hats) have been suboptimal. Currently, there is no research and outreach program related to skin cancer among farmers in Kentucky. Consequently, research efforts to generate data relevant to Kentucky's SLRMF is essential in designing an intervention study. This project will evaluate skin cancer awareness, knowledge and prevalence, and identify sun exposure behaviors and beliefs that are barriers to adoption of prevention practices.A mixed method approach combining self-reported survey and focus group research will be used to develop effective strategies for adoption and implementation of protective behaviors aimed at reducing sun exposure. Four institutions, KSU, NKU, Berea College, and UK Extension, will partner to address this health issue of significance to Kentucky farming communities. The survey will be conducted in selected counties from each of Kentucky's 15 Area Development Districts.The project is expected to increase awareness and knowledge of sun protective measures, change attitudes and beliefs related to negative sun protection practices, increase the number of SLRMF adopting skin cancer prevention and early detection practices, promote health and safety of Kentucky's farming population, provide opportunities for STEM student mentorship, and strengthen cooperation among participating institutions. The project's long-term goal is the creation of a KSU Center for Community Health, and Wellness, and lead to the development of a database on skin cancer awareness, knowledge and prevention.This project directly addresses some of the most compelling priorities and recommendations of the U.S. DHSS (Healthy People 2030), the CDC's Cancer Prevention and Control strategy, the National Occupational Research Agenda (NORA), and the U.S. Preventive Services Task Force on the prevention of cancer in agricultural workers.
Animal Health Component
0%
Research Effort Categories
Basic
30%
Applied
50%
Developmental
20%
Goals / Objectives
PROJECT OBJECTIVES This study on the dermal health of Kentucky's small, limited-resource and minority farmers (SLRMF)will:1) Develop and validate, a relevant skin cancer survey instrument to be administered to SLRMF in Kentucky2) Estimate via survey, skin cancer prevalence and identify detection practices among 2,500 SLRMF in Kentucky3) Identify and understand sun exposure behaviors, beliefs and attitudes among 2,500 SLRMF in Kentucky using the Health Belief Model4) Conduct focus groups in an engagement with SLRMF drawn from 15 Area Development Districts in Kentucky
Project Methods
A mixed method approach combining survey and focus group research, and the Health Belief Model (HBM) will be used to investigate skin cancer prevalence, knowledge and health-seeking behaviors and to synthesize quantitative and qualitative resultsthat will guide the development of population-relevant interventions. The project director (PD) will lead the accomplishment of all project objectives.1. Establishment of a relevant skin cancer survey instrument for SLRMFThe survey will comprise of a self-report questionnaire to be developed using the Agricultural Health Study Exposure Questionnaire model. A team of subject area experts, including the project's external evaluator will develop the survey and review it through multiple rounds of evaluation in order to improve its validity and reliability. The survey instrument will be coordinated by the PD, with the active participation of Co-PDs a dermatologist and the Burkardt Consulting Center.2. Assessing skin cancer prevalence and detection practices among SLRMFThe survey and focus groups will assess the prevalence of sun exposure behaviors among farmers and their current beliefs and practices to ascertain what, if any, protective measures are being taken. The survey and focus groups will also consider basic time and sun intensity-related information.To obtain a representative sample of SLRMF throughout Kentucky, at least three counties from each of the state's 15 Area Development Districts (ADD) will be surveyed. The survey will be administered online, via mail or face to face. A survey platform like QUALTRICS that allows the integration of other tools and customized forms will be favored. A token of appreciation will be available to all respondents of the survey.Participation will be strictly voluntary. The survey package will include:A cover letter and information sheet explaining the purpose of the study.Four sections (Demographics; Skin Cancer Prevalence; Knowledge and Awareness; and Behavior, Beliefs and Practices) A consent form, reiterating confidentiality to be signed by all respondents.Mail-in survey packages will carry a return postage paid envelope.Farmers will be identified and selected through individual contacts, KSU and UK County Extension agents, Kentucky Farm Alliance, and KSU's monthly "Third Thursday Thing" workshops. The survey will also be available online.3. Identify and understand sun exposure behaviors, beliefs, and attitudes among SLRMFFarmer skin cancer and sun exposure knowledge, attitude, beliefs and perceived risk will be determined using the Health Belief Model (HBM). The HBM suggests that beliefs or perceptions about the severity of or susceptibility to a disease, and costs or benefits inherent in the ability to change will influence ability to act. Skin cancer screening may identify people who are at risk, who may not know the difference between normal moles and atypical moles and do not feel sick. However (in the context of this study), the HBM can be useful for developing strategies to deal with those who do not believe they could be susceptible to skin cancer (Perceived Susceptibility) and that their condition (presence of moles) may have serious consequences (Perceived Severity). The HBM can also help people understand that taking action to protect themselves from ultraviolet light would reduce their susceptibility to skin cancer (Perceived Benefits) and that the barriers or consequences of not taking action are more costly than the benefits (Perceived Barriers). Study recommendations, presentations and workshops directed to farmers will encourage medical follows-ups of those susceptible (Cues to Action). This will increase awareness of sun protective measures and skin cancer risk factors, as well as adoption of prevention and early detection measures in the long-run (Self-Efficacy).4. Conduct focus groups in an engagement with SLRMFQualitative data will be drawn from 15 focus group of 6 to 10 participants, each drawn from Kentucky's fifteen ADDs. The study will use community-engaged-participatory-action approach, involving a Technical Assistance Board (TAB) and Community Advisory Board (CAB). Discussions will cover questions developed by the TAB and validated by the CAB. Both boards will also be responsible for recruitment and facilitating the focus groups. The CAB will consist of representation from stakeholders, while the TAB will consist of cancer research and education experts and members of the community.Data Management PlanThe primary approach for data analysis will be descriptive, with the independent relationships between variables determined by appropriate statistical tests; advanced statistical modeling will determine knowledge, prevalence, behavior and belief parameters. All data analysis will be conducted using SAS 9.4 statistical program. For variables that are significantly related to outcomes (P ≤ 0.01), multivariate regression analysis methods will be used, and only those that are significant at P ≤ 0.05 will be included in the final model.Qualitative data analysis will be guided by interpretive methods using content, categorical, and frame analysis. The process of analysis will involve sorting or coding the data into themes. The main categories of all the data sets will be refined and integrated at the level of their properties, dimensions, and relationships that will be tied to the conceptual elements of the HBM. SAMPLE SIZE AND POWER ANALYSISPower calculations were performed to determine the optimal sample size and to ensure a margin of error of no more than 0.02 (2%) proportional estimation for the study. Applying corrections for finite population (N=76,000), and assuming the most conservative proportion of 0.5, the necessary sample size to achieve the desired margin of error is n=2420. To account for an expected 50% non-response rate, no fewer than 4,840 farmers will be surveyed.PROTECTION OF HUMAN SUBJECTSKSU's IRB will conduct a review of the project's survey information to determine compliance with standards for research in humans. Essentially, the instrument should state that all epidemiological information will be kept confidential; it will be coded with identifying numbers and the identity of the individuals will be kept separate and secure from the data. All respondents will sign informed consent forms. All personal information will be destroyed upon conclusion of data collection and analysis; study results will only be presented in aggregate format.MENTORING PLANStudents and Extension Agents will be mentored on: a) survey development incorporating a platform of questions estimating skin cancer prevalence, detection practices and sun exposure behaviors for quantitative analysis; b) focus group engagement for qualitative analysis; and c) communication and leadership skill development practice. . INTERNAL EVALUATIONThe PD will direct planning sessions for each objective with the assistance of Co-PDs and other collaborators, on a quarterly basis, and ensure that each project activity is completed on schedule. There will be annual meetings to review project progress, to be chaired by KSU's Director of Land Grant Program. Recommendations emanating will be given due consideration. EXTERNAL EVALUATIONIn order to track progress for accountability and improvement, evaluation and monitoring by the external evaluator will be an on-going activity. Specific indicators to be measured will include effectiveness of collaborator and partner cooperation, county agent and student training, farmer understanding and effective survey reporting, overall improvement in survey administration expertise and partner satisfaction, implementation and impact assessment.