Through the Lens: Youth Experiences with Cancer in Rural Appalachian Kentucky Using Photovoice.

Katie Gaines,Chris Prichard,Nathan L Vanderford,Courtney Martin

doi:10.3390/ijerph19010205

Abstract

Rural Appalachian Kentucky experiences disproportionately high cancer incidence and mortality rates. This cancer burden is due to social determinants of health and cultural factors prominent in the region. The firsthand experiences of community members—especially young people—can highlight these factors and identify areas for improvement. The purpose of this study was to encourage Appalachian Kentucky youth to consider determinants of cancer and visualize the effects that cancer has on their families or communities by asking them to take photographs of cancer-related objects around them. Content analysis was performed on 238 photographs submitted by 25 students, and photographs were organized into themes, subthemes, and subtopics. The six themes that emerged were risk factors and exposures, marketing, awareness and support, health care, experiences, and metaphorical representations. Many of the submitted photographs aligned with cultural, environmental and/or situational factors prevalent in Appalachian Kentucky. Of the submitted photographs, 54 were displayed as an installment in two Kentucky art galleries. Viewer comments at the exhibitions demonstrated that young community members can educate and motivate change in those around them. Ultimately, this project demonstrates that young community members can recognize cancer-related issues around them and connect personal experiences back to the larger Appalachian Kentucky cancer disparity while also having an impact on other community members.

Highlights

Cancer is the second leading cause of death in the United States (US) annually, behind heart disease, and cancer death rates have decreased 31% in the past thirty years, some areas of the country still struggle disproportionately from the disease [1].In recent years, Kentucky has consistently ranked first in overall cancer incidence and mortality rates within the US, and, importantly, overall cancer incidence and mortality rates are significantly higher in the Appalachian region of the state [1,2,3,4]
Social and ecological factors have contributed to the cancer burden in Appalachian Kentucky: lower income and education levels, barriers to access, lack of screening and immunization, increased obesity rates, environmental exposures, and unsupportive health policies have fostered a patient population which is more susceptible to various types of cancer [4]
Cultural factors such as diet and community history of coal mining and tobacco farming were included in the submitted photos, suggesting that culture tends to play a strong role in how rural Kentucky communities experience cancer

Summary

Introduction

Kentucky has consistently ranked first in overall cancer incidence and mortality rates within the US, and, importantly, overall cancer incidence and mortality rates are significantly higher in the Appalachian region of the state [1,2,3,4]. Appalachian Kentucky has much higher lung cancer incidence and mortality rates compared to the rest of the US due to increased smoking rates [1,4]. Social and ecological factors have contributed to the cancer burden in Appalachian Kentucky: lower income and education levels, barriers to access, lack of screening and immunization, increased obesity rates, environmental exposures, and unsupportive health policies have fostered a patient population which is more susceptible to various types of cancer [4]. Many people living in Appalachia (and especially in Appalachian Kentucky) hold negative perceptions regarding cancer prevention and diagnoses such as “everything causes cancer,”

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