April 2001 // Volume 39 // Number 2 // Research in Brief // 2RIB2

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Understanding Cancer Risk Among Extension Professionals: A Program Development Perspective

The study reported here was predicated on the belief that it is necessary to assess the knowledge level of cancer risk among Extension professionals before programming can be developed as part of the overall educational mission. Extension professionals significantly increased their knowledge level of cancer risk through a pre-test assessment, application of a non-invasive educational intervention, and a post-test follow-up among a random sample of Ohio State University Extension personnel. In the areas of emerging research related to cancer risk, Extension professionals significantly increased their correct response percentage with the intervention. To fully incorporate cancer risk information into Extension education programming, it is essential that Extension professionals are up-to-date in non-traditional, as well as traditional arenas.

Sereana Howard Dresbach
Assistant Professor/State Specialist, Health Education
The Ohio State University
Columbus, Ohio
Internet Address: dresbach.7@osu.edu

Cancer risk reduction educational efforts are relatively new in Extension. Thus, a key stakeholder in the educational program must be Extension educators themselves. These are the individuals who are expected, in turn, to convey sound information to the target audiences. Tobacco use and nutrition/diet constitute a major focus in cancer risk reduction. In Extension, however, the educational focus on cancer risk is limited. Healthy lifestyle choices and decision-making processes have been the primary educational foci of other organizations, not exclusive to Extension.

Cancer research indicates that 75-85% of factors contributing to individual risk are lifestyle related, including tobacco use, nutrition, exposure to the sun, lack of exercise, and lack of health screenings (Buckman, 1997; Ward, 1995). These same factors influence a host of other chronic and acute conditions of the human body that, in turn, affect productivity and functionality in the family, on the job, and in general society. However, the perception among the general population is that the primary factors that put one at risk, are those beyond individual control. Therefore, consumers ignore healthy lifestyle practices that can be controlled (DeVita et al., 1993; Merck et al. 1996).

Because the foundation for Extension programming is research-based information, Extension educators themselves need to become informed about the traditional and emerging areas of cancer risk reduction in order to be fully effective in healthy lifestyle education. Extension already has a history of programming for healthy lifestyle choices, including but not limited to, 1) nutrition, 2) various 4-H/Youth Development activities focused on sound decision making, and 3) financial management decisions that impact family economics. Despite this diverse and rich background in educational programs, Extension has few programs specifically focused on health choices such as cancer risk reduction.

Purpose of Study

As stakeholders, as well as educators, Extension personnel have the ability to deliver research-based information in various formats that can impact the beliefs and attitudes of citizens. For cancer risk reduction education to be an effective Extension program, it must be clear that such a program fits within Extension's educational mission strategy.

For any new program to be a priority for any Extension educator, the relevancy and importance must be established for each individual educator. Relevancy of healthy lifestyle choices as cancer risk reduction efforts must be framed in the context of the Extension educator's program before it can be joined to existing programs and extend the impact to audiences for long-term behavioral changes in the public.

As scientific research about cancer advances, information changes rapidly. Without updates and specialized training, Extension educators' knowledge base can easily become outdated, rendering Extension educators unable to provide recommendations for current practices. Particularly in this technological age, when almost anyone has access to new information, the Extension educator, who normally provides the latest research and innovations, must be current (Seevers et al., 1997). Complicating the effort to advance accurate, current information is the reality that public awareness and attitudes are distorted by media hype and inaccurate or misleading reports (Atkin et al., 1990; Brown & Walsh-Childers, 1994; Weaver, 1994; Bennett, 1996; Nelkin, 1996).

Given these premises, to effectively design cancer risk reduction programs for Extension, it is important to first assess the knowledge of Extension educators regarding cancer risks.


The study reported here had a pre/post control group design. The study used a mail survey with a non-invasive educational intervention. A random sample of Extension field professional staff in Ohio was selected from a total population of 580. The sample population (n=218) was drawn using a random sample digit table, and all participants were mailed a survey of cancer risk questions.

The survey was comprised of eight knowledge questions with multiple choice or multiple answer categories. The questions focused on basic cancer risk accepted by the broad disciplinary base of research and health practices (Khare et al., 1998; Wang et al.. 1998; Greenwald, 1996; Swan & Ford, 1997). All survey participants were notified that there would be a follow-up survey after 4 months to discern if there were any changes in knowledge about cancer risk.

Half of the respondents were selected a priori to receive the intervention. The control half of the respondents did not receive any specific material from Extension, but it is assumed that they may have gotten this information some way from the university, organizations, health care practitioners, or other sources. Responses from these surveys were compared between the intervention group and the control group using a paired t-test.


The non-invasive, educational intervention was a four-page informational fact sheet answering basic questions about cancer risk reduction presented in the original survey. The intervention referenced the first survey and encouraged recipients to read the material to determine correct answers to survey questions. A copy of the original questions was included with the intervention, as well as an answer sheet with correct answers clearly marked.


For several questions related to basic cancer risk education, Extension educators were able to identify correct responses to the questions in a relatively consistent manner. With the intervention, the difference between the pre- and post-test means did not significantly increase in the areas addressing cancer risk related to chemoprevention, lung cancer risk, and nutrition.

The following table shows the questions and possible answers, percentage correct (pre and post), and significance between control and experimental groups.

Table 1

Question Pre-Test
Significance of t
Of the new cancer diagnoses each year, what percentage of cases is related to lifestyle choices (tobacco use, nutrition, exposure to UV, screenings, etc)?
A. 35-45%
B. 75-85%
C. 10-20%
D. 50-60%
0.38 0.66 0.003
Chemopreventive agents, such as nutraceuticals and phytochemicals.
A. Are toxic to the body and should be avoided
B. May be beneficial in helping prevent and treat disease
C. Increase the occurrence of cancer in humans
D. Are highly expensive and extremely dangerous
0.94 0.90 0.420
By age twenty, the average American receives what percentage of their lifetime ultraviolet radiation exposure?
A. Less than 10%
B. 20-40%
C. 50-80%
D. 90-99%
0.45 0.64 0.040
Of the newly diagnosed cases of cancer each year (approximately 1,000,000), what percentage is estimated to be preventable?
A. 15%
B. 30%
C. 65%
D. 90%
0.51 0.60 0.200
The leading contributor to lung cancer among Americans is:
A. Radon
B. Asbestos
C. Tobacco use
D. Environmental tobacco smoke
0.82 0.92 0.133
To reduce cancer risk, the National Cancer Institute's minimum recommended daily consumption is:
A. 5 or more fruits and vegetables
B. 5 or more servings of pasta
C. 6 or more servings of dairy products
D. 5 or more servings of meat or protein
0.96 1.00 0.159
Check all that you believe are correct. 0.6635 0.8125 0.002
Cancer is:
Characterized by uncontrolled cell growth 0.92 0.96 0.322
Over 100 different types of malignant tumors 0.69 0.88 0.017
Characterized by the ability of cells to invade or metastasize 0.81 0.92 0.083
Caused by three main categories: Chemicals, Viruses, and Irradiation 0.23 0.48 0.011
Check all that you believe are correct. 0.9038 0.9444 0.138
Which of the following are uncontrollable cancer risk factors?
Age 0.79 0.98 0.032
Tobacco use 0.96 0.94 0.659
Gender 0.83 0.94 0.083
Nutrition/diet 0.94 0.96 0.659
Tanning bed use 0.98 1.00 0.322
Ethnicity 0.77 0.90 0.051
Vitamin supplements 0.98 1.00 0.322
Genetics 0.92 0.98 0.083
Geographic location 0.88 0.79 0.168
Total Gain Score 0.69 0.77 0.000

Of those who received intervention, the correct response rates increased significantly on three questions and as a total gain score. A significant increase was noted between the pre- and post-tests as to the percentage of new cancer cases that had a relationship to lifestyle choices (p=.003).

A comparison of the pre-test and post-test answers indicated a significant increase in those who correctly responded to the question addressing age that the average American receives the majority of lifetime ultraviolet radiation exposure (p=.040). More remarkable differences between the pre- and post-tests were the increase in those able to correctly identify the four components of the definition of cancer (p=.02).

When the multiple response questions were broken out to identify increases, there were significant increases in correct answers when identifying two components: tumor ability to invade (p=.017) and causation by chemicals, viruses, and irradiation (p=.011). When participants were asked to identify uncontrollable risk factors, the correct responses were consistent between the pre-and post-tests, but the participants identified age (p=.032) at a significantly higher rate on the post-test. A total gain score was calculated between the pre- and post-test groups, and the difference of the means indicated significant difference (p=.000).


These findings indicate that certain fallacies were held by Extension professionals, such as understanding the role of lifestyle choices in cancer risk. The areas where there was a consistency in correct answers tended to align with disciplines in which Extension has a strong history of education delivery, agricultural health and safety, nutrition, and tobacco risks. Consistent with other literature, Extension professionals did not fully identify the relationship between age and amount of ultraviolet radiation exposure as a cancer risk, nor did they correctly respond to the definition of cancer.

To develop and implement a comprehensive cancer education program, all the components of cancer risk must be identified and integrated, not just the areas in which Extension has had a traditional presence. Further, Extension professionals must comprehend and consciously recognize that cancer risk education must include all aspects of lifestyle choices, not only the areas related to nutrition or tobacco use. This contention reflects the concept that Extension educators are stakeholders and can influence programming. If they don't understand risks, they will not see programming as important.

Basic cancer risk education can be enhanced through non-invasive intervention, as demonstrated by the significant increase in correct responses by the Extension professionals. These gains appeared in both specific cancer risk areas and overall cancer risk knowledge. Extension professionals did not initially identify some cancer risks, but after the intervention, they were able to significantly increase the correct responses.

As Extension professionals increase awareness of cancer risk research, they will be able to use their skills as educators to better define where this programming can be used effectively in their community.

This initial study of Ohio Extension professionals was a starting point to facilitate discussion of where cancer risk education can be integrated into current programming. Consistent with the literature, field professionals are stakeholders who influence programming at the grass-roots level of Extension, and, if they do not comprehend the importance of cancer risk education, it will not be viewed as compatible with current programming. If Extension is to be consistent with its mission to deliver up-to-date information, field professionals must first be aware of the risks and second be aware of risk reduction strategies for improved health decisions.


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