Health Literacy in the Context of Kidney Cancer & Smoking

The goal of this innovative and feasible project is to use a multidisciplinary approach to examine Health Literacy (HL) in the context of kidney cancer and smoking among rural populations in southern and central Illinois (rural; largely white and lower SES) compared to urban cohorts. Kidney cancer is the fifth most common malignancy in the U.S. Recent work from SIUSM focusing on rural populations in Southern and Central Illinois found a significant difference between urban and rural counties for kidney cancer and kidney cancer mortality therein. These results demonstrate that rural residence is associated with increased urologic cancer mortality on a county level in Illinois. One possible contributing factor associated with this relationship is a difference in HL concerning the link between smoking and kidney cancer.

In recent work outside of rural Illinois, limited HL has been associated with higher nicotine dependence, more positive and less negative smoking outcome perceptions, reduced knowledge about smoking risks, and overall lower risk perceptions. There is evidence that limited HL may serve as a critical risk factor for impaired smoking cessation among low SES, racially/ethnically diverse smokers. Since HL has been consistently associated with SES and race/ethnicity in the US, research is needed to investigate potential mechanisms underlying this relationship. The investigators posit that despite high levels of symptoms, rural patients will report lower levels of disease impact and bother.

Thus, the investigators expect to find correlations of different magnitudes between symptom levels and bother in rural compared to urban patients. They propose the following specific aims:

1. Examine whether health literacy and cancer literacy differ by geographic region (rural vs. urban)
2. Investigate whether knowledge of smoking and kidney cancer differs by geographic region.
3. Compare threshold for the bothersomeness of urologic symptoms by geographic region.

The pilot findings generated by this proposed study will be critical in multiple future grant applications from this new collaborative group of investigators. An innovative aspect of this proposal is the measurement of differences in the level of urologic symptoms required before they become bothersome enough to seek help. This proposal has regional and national implications: HL and knowledge differences between urban and rural populations will point the way to targeted smoking cessation programs for rural residents, has implications for urology density and workforce distribution as well opening the door for renal cancer genomics and biomarkers.