Review Article
A Social-Ecological Review of Cancer Disparities in Kentucky
Abstract
Cancer continuously ranks among the top 10 leading causes of death in the United States. The burden of cancer is particularly elevated in the Commonwealth of Kentucky and its 54-county Appalachian region, where cancer is the leading cause of death. Kentucky’s high rates of cancer have been attributed to a wide range of socioeconomic, behavioral, environmental, and policy influences, resulting in numerous disparities. The present review specifically evaluates the burden of lung, colorectal, cervical, and head and neck cancers in Kentucky, along with resultant cancer control research and community outreach efforts conducted by the state’s only National Cancer Institute–designated cancer center using an adapted version of McLeroy’s Social-Ecological Model. Here, we categorize disparities and identify relevant intervention approaches based on their level of influence (ie, individual, community, and policy).This content is limited to qualifying members.
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References
1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30.
2. Byers T, Wender RC, Jemal A, et al. The American Cancer Society challenge goal to reduce US cancer mortality by 50% between 1990 and 2015: results and reflections. CA Cancer J Clin 2016;66:359-369.
3. Centers for Disease Control and Prevention. Stats of the state of Kentucky. https://www.cdc.gov/nchs/pressroom/states/kentucky.htm. Accessed October 4, 2017.
4. US Cancer Statistics Working Group. United States Cancer Statistics. 1999-2014 Incidence and Mortality Web-based Report. https://www.cdc.gov/uscs. Accessed October 4, 2017.
5. National Cancer Institute. SEER*Stat Software Version 8.3.4. https://seer.cancer.gov/seerstat/. Accessed October 4, 2017.
6. McLeroy KR, Bibeau D, Steckler A, et al. An ecological perspective on health promotion programs. Health Educ Q 1988;15:351-377.
7. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K , eds. Health Behavior and Health Education: Theory, Research, and Practice 4th ed. San Francisco: Jossey-Bass;2008:465-486.
8. Appalachian Regional Commission. ARC-designated distressed counties, fiscal year 2017. https://www.arc.gov/program_areas/ARCDesignatedDistressedCountiesFiscalYear2017.asp. Accessed September 17, 2017.
9. Health Resources and Services Administration Data Warehouse. Data by geography-Kentucky. https://datawarehouse.hrsa.gov/Tools/DataByGeographyResults.aspx?geoTyp=State&geoCd=21. Accessed September 17, 2017.
10. Freeman HP, Wingrove B. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities. Rockville, MD: National Cancer Institute Center to Reduce Cancer Health Disparities 2005.
11. National Cancer Institute. Lung cancer prevention. https://www.cancer.gov/types/lung/patient/lung-prevention-pdq#section/_12. Accessed October 4, 2017.
12. Kentucky Department for Public Health. Kentucky Behavioral Risk Factor Surveillance System (BRFSS). http://chfs.ky.gov/dph/info/dpqi/cd/brfss.htm. Accessed October 6, 2017.
13. Centers for Disease Control and Prevention. BRFSS Prevalence and Trends Data. https://www.cdc.gov/brfss/brfssprevalence/index.html. Accessed October 6, 2017.
14. Campaign for Tobacco-Free Kids. Tobacco-growing states in the USA. https://www.tobaccofreekids.org/research/factsheets/pdf/0125.pdf. Published September 4, 2014. Accessed October 4, 2017.
15. Jemal A, Fedewa SA. Lung cancer screening with low-dose computed tomography in the United States-2010 to 2015. JAMA Oncol 2017;3:1278-1281.
16. US Preventive Services Task Force. Lung cancer: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Published December 2013. Accessed October 4, 2017.
17. Environmental Protection Agency. EPA map of radon zones. https://www.epa.gov/radon/epa-map-radon-zones. Accessed October 4, 2017.
18. Centers for Disease Control and Prevention. What we know about radon. https://www.cdc.gov/cancer/dcpc/prevention/policies_practices/radon/radon.htm. Updated September 27, 2017. Accessed October 4, 2017.
19. Kentucky Geological Survey. Karst Land in Kentucky. https://www.uky.edu/KGS/water/general/karst/index.htm. Modified August 1, 2012. Accessed October 4, 2017.
20. Hahn EJ, Gokun Y, Andrews WM, Jr et al. Radon potential, geologic formations, and lung cancer risk. Prev Med Rep 2015;2:342-346.
21. Hendryx M, O'Donnell K, Horn K. Lung cancer mortality is elevated in coal-mining areas of Appalachia. Lung Cancer 2008;62:1-7.
22. Jenkins WD, Christian WJ, Mueller G, et al. Population cancer risks associated with coal mining: a systematic review. PLoS One 2013;8:e71312.
23. Campaign for Tobacco-Free Kids. State cigarette excise tax rates and rankings. https://www.tobaccofreekids.org/assets/factsheets/0097.pdf. Published 2017. Accessed October 4, 2017.
24. Campaign for Tobacco-Free Kids. Broken promises to our children: a state-by-state look at the 1998 State Tobacco Settlement 17 years later. https://www.tobaccofreekids.org/microsites/statereport2016. Published 2015. Accessed October 4, 2017.
25. Kentucky Center for Smoke-Free Policy. 26 Kentucky communities with comprehensive smoke-free ordinances. http://www.uky.edu/breathe/sites/breathe.uky.edu/files/SFLawsRegsOCT2017.pdf. Published 2017. Accessed September 17, 2017.
26. Kentucky Center for Smoke-Free Policy. Percent of the Kentucky population covered by 100% smoke-free workplace laws. Updated October 1, 2017. http://www.uky.edu/breathe/sites/breathe.uky.edu/files/PercentSmoke-FreeWorkplaceLawsorRegulationsOCT2017.pdf. Accessed October 4, 2017.
27. Institute of Medicine. Health Implications of Raising the Minimum Age for Purchasing Tobacco Products. Washington, DC:The National Academies Press; 2015.
28. Adams J, Alvarado R, Carroll D, et al. Senate Bill 89 (BR 837). http://www.lrc.ky.gov/record/17RS/SB89.htm. Accessed October 5, 2017.
29. National Cancer Institute. Colorectal cancer prevention (PDQ®)-patient version. https://www.cancer.gov/types/colorectal/patient/colorectal-prevention-pdq. Updated February 8, 2017. Accessed October 4, 2017.
30. American Cancer Society. Colorectal cancer screening tests. https://www.cancer.org/cancer/colon-rectal-cancer/early-detection/screening-tests-used.html. Revised August 22, 2017. Accessed October 4, 2017.
31. Tucker T. Understanding the colorectal cancer burden in Kentucky: environmental, behavioral and genetic risk factors. http://www.kycancerc.org/docsandpubs/KYColonCaBurden2013.ppt. Published October 3, 2013. Accessed October 6, 2017.
32. Knight JR, Kanotra S, Siameh S, et al. Understanding barriers to colorectal cancer screening in Kentucky. Prev Chronic Dis 2015;12:E95.
33. Bachman AS, Cohen EL, Collins T, et al. Identifying communication barriers to colorectal cancer screening adherence among Appalachian Kentuckians. Health Commun 2017:1-9.
34. Seiber EE, Camacho F, Zeeshan MF, et al. Disparities in colorectal cancer treatment delay within Appalachia-the role of for profit hospitals. J Rural Health 2015;31:382-391.
35. Kentucky Cancer Consortium. Reducing barriers to colorectal cancer screening. http://www.kycancerc.org/policychange/coloncancerscreeningbarriers.php. Published 2017. Accessed September 17, 2017.
36. National Cancer Institute. Cervical cancer prevention (PDQ®)-patient version. https://www.cancer.gov/types/cervical/patient/cervical-prevention-pdq. Updated September 21, 2017. Accessed September 17, 2017.
37. Centers for Disease Control and Prevention. How many cancers are linked with HPV each year? http://www.cdc.gov/cancer/hpv/statistics/cases.htm. Updated March 3, 2017. Accessed September 17, 2017.
38. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination-updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405-1408.
39. Walker TY, Elam-Evans LD, Singleton JA, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years-United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:874-882.
40. Reiter PL, Katz ML, Paskett ED. HPV vaccination among adolescent females from Appalachia: implications for cervical cancer disparities. Cancer Epidemiol Biomarkers Prev 2012;21:2220-2230.
41. Vanderpool RC, Cohen E, Crosby RA, et al. "1-2-3 Pap" intervention improves HPV vaccine series completion among Appalachian women. J Commun 2013;63:95-115.
42. Mills LA, Head KJ, Vanderpool RC. HPV vaccination among young adult women: a perspective from Appalachian Kentucky. Prev Chronic Dis 2013;10:E17.
43. Vanderpool RC, Dressler EV, Stradtman LR, et al. Fatalistic beliefs and completion of the HPV vaccination series among a sample of young Appalachian Kentucky women. J Rural Health 2015;31:199-205.
44. Oldach BR, Katz ML. Ohio Appalachia public health department personnel: human papillomavirus (HPV) vaccine availability, and acceptance and concerns among parents of male and female adolescents. J Community Health 2012;37:1157-1163.
45. Schoenberg N, Baltisberger J, Bardach S, et al. Perspectives on Pap test follow-up care among rural Appalachian women. Women Health 2010;50: 580-597.
46. National Conference of State Legislatures. HPV vaccine: state legislation and statutes. http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx. Accessed November 13, 2016.
47. Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years-United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:850-858.
48. Kentucky Center for Economic Policy. Protecting Medicaid’s role in advancing a healthy Kentucky. http://kypolicy.org/dash/wp-content/uploads/2016/05/Medicaid-Advancing-a-Healthy-Kentucky.pdf. Published May 2016. Accessed September 17, 2017.
49. National Cancer Institute. Oral cavity and oropharyngeal cancer prevention. https://www.cancer.gov/types/head-and-neck/patient/oral-prevention-pdq#section/_20. Accessed October 4, 2017.
50. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Prevalence and trends data. Kentucky: topic: smokeless tobacco. https://www.cdc.gov/brfss/brfssprevalence/index.html. Published 2016. Accessed October 4, 2017.
51. University of Kentucky HealthCare. University of Kentucky Markey Cancer Center National Cancer Institute designation. https://ukhealthcare.uky.edu/markey-cancer-center/about/nci. Published 2017. Accessed October 4, 2017.
52. University of Kentucky Markey Cancer Center. Markey Network. https://ukhealthcare.uky.edu/markey/network. Accessed October 4, 2017.
53. Schoenberg NE, Hatcher J, Dignan MB, et al. Faith moves mountains: an Appalachian cervical cancer prevention program. Am J Health Behav 2009;33:627-638.
54. Schoenberg NE, Studts CR, Shelton BJ, et al. A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents. Prev Med Rep 2016;3:317-323.
55. Cardarelli R, Reese D, Roper KL, et al. Terminate lung cancer (TLC) study-a mixed-methods population approach to increase lung cancer screening awareness and low-dose computed tomography in eastern Kentucky. Cancer Epidemiol 2017;46:1-8.
56. Cardarelli R, Roper KL, Cardarelli K, et al. Identifying community perspectives for a lung cancer screening awareness campaign in Appalachia Kentucky: the Terminate Lung Cancer (TLC) Study. J Cancer Educ 2017;32:125-134.
57. Kentucky LEADS Collaborative. About. https://www.kentuckyleads.org/about. Accessed December 12, 2016.
58. Fallin A, Goodin A, Rayens MK, et al. Smoke-free policy implementation: theoretical and practical considerations. Policy Polit Nurs Pract 2014;15:81-92.
59. Hahn EJ, Rayens MK, Adkins S, et al. A controlled community-based trial to promote smoke-free policy in rural communities. J Rural Health 2015;31: 76-88.
60. Pyles MK, Hahn EJ. Economic effects of smoke-free laws on rural and urban counties in Kentucky and Ohio. Nicotine Tob Res 2012;14:111-115.
61. Hahn EJ, Rayens MK, Kercsmar SE, et al. Dual home screening and tailored environmental feedback to reduce radon and secondhand smoke: an exploratory study. J Environ Health 2014;76:156-161.
62. Cohen EL, Head KJ, McGladrey MJ, et al. Designing for dissemination: lessons in message design from "1-2-3 pap." Health Commun 2015;30:196-207.
63. Vanderpool RC, Breheny PJ, Tiller PA, et al. Implementation and evaluation of a school-based human papillomavirus vaccination program in rural Kentucky. Am J Prev Med 2015;49:317-323.
64. Crosby RA, Hagensee ME, Vanderpool R, et al. Community-based screening for cervical cancer: a feasibility study of rural Appalachian women. Sex Transm Dis 2015;42:607-611.
65. Vanderpool RC, Jones MG, Stradtman LR, et al. Self-collecting a cervico-vaginal specimen for cervical cancer screening: an exploratory study of acceptability among medically underserved women in rural Appalachia. Gynecol Oncol 2014;132(Suppl 1):S21-S25.
66. Gregory A. UK partners with community to answer environmental health questions through new research center. https://uknow.uky.edu/research/uk-partners-community-answer-environmental-health-questions-through-new-research-center. Published August 7, 2017. Accessed October 4, 2017.
