Original Article

Training Appalachian Kentucky Youth Cancer Advocates

Authors: Lauren Hudson, Chris Prichard, BA, L. Todd Weiss, MSPH, Melinda J. Ickes, PhD, Nathan L. Vanderford, PhD, MBA


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.
Posted in: Medical Oncology27

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7–30.
2. State Cancer Profiles: Dynamic View of Cancer Statistics for Prioritizing Cancer Control Efforts Across the Nation. National Cancer Institute. 2019. https://statecancerprofiles.cancer.gov/quick-profiles/index.php?statename=kentucky. Accessed April 13, 2021.
3. Centers for Disease Control and Prevention. Rates of New Cancers in the United States. US Cancer Statistics: The Official Federal Cancer Statistics. 2016. https://gis.cdc.gov/Cancer/USCS/DataViz.html. Accessed April 13, 2021.
4. Siegel RL, Miller KD, Fuchs HE, et al. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71:7–33.
5. Rodriguez SD, Vanderford NL, Huang B, et al. A social-ecological review of cancer disparities in Kentucky. South Med J 2018;111:213–219.
6. US Department of Agriculture. Rural-urban continuum codes. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. Published 2013. Accessed March 21, 2021.
7. Crosby RA, Wendel M, Vanderpool RC, et al. Rural Populations and Health: Determinants, Disparities, and Solutions. New York: Wiley; 2012.
8. Appalachian Region Commission. Issue brief: health disparities related to smoking in Appalachia: practical strategies and recommendations for communication. https://healthinappalachia.org/issue-briefs/smoking. Published 2019. Accessed March 21, 2021.
9. Hoffman B, Stovall E. Survivorship perspectives and advocacy. J Clin Oncol 2006;24:5154–5159.
10. Davis C, Salo L, Redman S. Evaluating the effectiveness of advocacy training for breast cancer advocates in Australia. Eur J Cancer Care (Engl) 2001;10:82–86.
11. Walsh-Burke K, Marcusen C. Self-advocacy training for cancer survivors. The Cancer Survival Toolbox. Cancer Pract 2001;7:297–301.
12. Mays N, Pope C. Qualitative research: rigour and qualitative research. Br Med J 1995;311:109–112.
13. Holden DJ, Messeri P, Evans WD, et al. Conceptualizing youth empowerment within tobacco control. Health Educ Behav 2004;31:548–563.
14. US Census Bureau. 2018. U.S. Census Bureau releases 2013-2017 ACS 5-year estimates. https://www.census.gov/programs-surveys/acs/news/updates/2018.html. Published December 6, 2018. Accessed March 21, 2021.
15. Ickes MJ, Sampson S, Parsons J, et al. Tobacco-free ambassador partnership: empowering youth advocates in Appalachian communities. Health Promot Pract 2020;21(1 suppl):98S–109S.
16. Braun S. The history of breast cancer advocacy. Breast J 2003;9(suppl 2): S101–S103.