Evidence for Cancer Literacy Knowledge Retention among Kentucky Middle and High School Students after a Brief Educational Intervention

Lauren Hudson, Chris Prichard, L. Todd Weiss, Nathan L. Vanderford

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objectives Although cancer is seen in every state in the United States, it does not affect every geographic area and population equally. Kentucky has the highest cancer incidence and mortality rates in the country, with an unusually high number of cases localized in its Appalachian region. Risk factors such as sun exposure, tobacco use, poor diet/exercise, poverty, and lack of access to healthcare centers contribute to this disparity. Because education levels in the area are low, cancer literacy (defined as how well a person can understand the advice of a healthcare professional and make appropriate lifestyle decisions) also is low. In this study, we examined the short-term and long-term effects of a brief cancer-related intervention on the cancer literacy of Kentucky middle and high school students. Methods This study targeted middle and high school students in Kentucky. We administered an online 10-item cancer literacy pretest, followed by a brief educational intervention and a posttest to 164 students at six Kentucky middle and high schools. This posttest also included questions asking how likely students would be to change their habits or to encourage others to change their habits as a result of the intervention. All of the participating students also were sent a 3-month follow-up online survey with items identical to the pretest; 48 students completed the 3-month follow-up test, leading to a response rate of 29.2%. The data were summarized as frequencies, averages, median, and confidence intervals (CIs) of correctly marked answers. A paired t test was used to test for significance. Results We observed an increase in the overall average test score from 50.2% (95% CI 47.8%-52.6%) on the pretest to 77.1% (95% CI 74.6%-79.7%) on the posttest immediately following the intervention. There also was an increase in the average number of correct responses on each item. The 3-month follow-up test similarly showed average test score improvement (75.4%). When asked how likely students would be to change their habits as a result of the intervention on a scale from 1 to 10 (1 = extremely unlikely, 10 = extremely likely), the median was 6. When asked how likely students would be to encourage another to change their habits, the median was an 8. Conclusions These results provide evidence that a brief educational intervention can increase cancer literacy, improve cancer knowledge retention, and encourage behavior change in Appalachian Kentucky students. Increasing cancer literacy may result in increased participation in preventive cancer screenings and improved health habits, which could ultimately lower cancer rates in the region.

Original languageEnglish
Pages (from-to)541-548
Number of pages8
JournalSouthern Medical Journal
Issue number11
StatePublished - Nov 1 2020

Bibliographical note

Funding Information:
This study was supported by the University of Kentucky’s Appalachian Career Training in Oncology (ACTION) Program (National Cancer Institute [NCI] R25CA221765) and a Cancer Center Support Grant (NCI P30CA177558).

Publisher Copyright:
© Lippincott Williams & Wilkins.


  • Appalachian health disparities
  • cancer disparities
  • cancer literacy
  • educational intervention
  • health literacy

ASJC Scopus subject areas

  • Medicine (all)


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