[ { "page": 1, "items": [ { "page": 1, "type": "TEXT", "location": { "l": 97.92, "t": 632.88, "r": 462, "b": 621.12 }, "text": "Information about the Kentucky State University Cooperative Extension Program\n2024", "reading_order": 0 }, { "page": 1, "type": "TITLE", "location": { "l": 146.16, "t": 608.64, "r": 464.64, "b": 576.72 }, "text": "Skin Cancer Prevention for Farmers and Farmworkers: Role of Cooperative Extension Professionals", "reading_order": 1, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 143.52, "t": 567.36, "r": 467.76, "b": 555.84 }, "text": "Frederick N. Bebe Ph.D, Assistant Research Professor Kentucky State University", "reading_order": 2 }, { "page": 1, "type": "FIGURE", "location": { "l": 116.88, "t": 527.52, "r": 255.84, "b": 427.68 }, "text": "", "reading_order": 3 }, { "page": 1, "type": "TEXT", "location": { "l": 88.8, "t": 425.28, "r": 282.96, "b": 402.24 }, "text": "A Dermatologist using a Dermatoscope\nin the diagnosis of skin cancer –Courtesy IStock", "reading_order": 4 }, { "page": 1, "type": "FIGURE", "location": { "l": 353.28, "t": 526.8, "r": 497.28, "b": 429.12 }, "text": "", "reading_order": 5 }, { "page": 1, "type": "TEXT", "location": { "l": 351.6, "t": 426, "r": 498.96, "b": 403.92 }, "text": "Close up image of a suspicious mole\n- Courtesy iStock", "reading_order": 6 }, { "page": 1, "type": "TEXT", "location": { "l": 68.4, "t": 374.16, "r": 540.24, "b": 280.56 }, "text": "Skin cancer is the most common type of cancers, one of the more preventable and highly treatable, if caught early. Melanoma skin cancer causes the vast majority of skin cancer deaths. It is estimated to result in 100,640 cases and 8,290 deaths this year1. The incidence rate has been on the rise the past few decades, and this trend is expected to continue, especially among minority populations. Ultraviolet rays exposure through sunlight is considered the main risk factor for skin cancer, and farmers and farmworkers whose outdoor work exposes them to excessive amounts of sun are among the most vulnerable2.", "reading_order": 7 }, { "page": 1, "type": "TEXT", "location": { "l": 68.4, "t": 267.12, "r": 542.4, "b": 105.84 }, "text": "Studies have shown that farmers are quite knowledgeable about skin cancer, and know sun protective measures are beneficial, but adherence to such measure is suboptimal3. This suboptimal adherence to sun protective behaviors (e.g. the use of sunscreens and wearing of long sleeve shirts and wide-brim hats) represents a significant gap in care, perhaps an indication that decades of public health campaigns have failed to adequately address the increasing incidence of skin cancer among farmers and farmers4. Prevention and management are the keys to reducing risk of diseases, disabilities and deaths, which is the focus of the US Department of Health and Human Services (USDHHS) “Health People 2030” agenda. Thus, interventions aimed at promoting evidence-based skin cancer screenings and preventive measures are essential to achieving this objective. Within this framework, the USDHHS in collaboration with the Centers for Disease Control (CDC) and the US Department of Agriculture (USDA) seek to increase the number of Americans healthy at every stage of life and reduce the financial burden of skin cancer.", "reading_order": 8 } ] }, { "page": 2, "items": [ { "page": 2, "type": "TEXT", "location": { "l": 68.88, "t": 719.04, "r": 532.56, "b": 598.08 }, "text": "As far as the wellbeing of farmers and farmworkers is concerned, the Cooperative Extension Service is uniquely positioned to leverage its human and professional resources in the prevention and management of skin cancer within the framework of its role as educators and collaborators in chronic disease prevention and management5. The American Academy of Dermatology (AAD) urges Americans to protect themselves from the sun in order to minimize risk of skin cancer6. However, a 2021 study conducted by Tribby and Colleagues concluded that the “general public does not have enough information in deciding key factors to consider in choosing best sunscreen products”7. This is particularly relevant to farmers and farmworkers as skin cancer rates rise among limited-resource, low income and minority farmers3.", "reading_order": 0 }, { "page": 2, "type": "TEXT", "location": { "l": 68.64, "t": 584.88, "r": 537.12, "b": 517.2 }, "text": "Cooperative Extension Agents (CEAs) are expert educators, and trusted sources of research-supported health information. Thus, their role falls within the scope of practice for delivering health programs envisaged by the 2014 Cooperative Extension’s National Framework for Health and Wellness5. This role includes the education of farmers and farmworkers on a) how to protect themselves from the sun and reduce the risk of developing skin cancer, and b) education on selection and proper use of sunscreens.", "reading_order": 1 }, { "page": 2, "type": "TEXT", "location": { "l": 68.88, "t": 504.24, "r": 540.96, "b": 396 }, "text": "Therefore, it is important for CEAs to know that the FDA regulates active ingredients in sunscreens as “Over-the Counter” drugs, and identifies those that are “Generally Recognized” as safe and effective photo filters. Secondly, CEAs should be able to provide up-to-date information on sunscreens products, especially those considered to have a high sun protection factor (SPF) and broad-spectrum coverage. Thirdly, CEAs should encourage farmers to seek timely care, and navigate local resources needed if there are any concerning lesions or symptoms for skin cancer. Lastly, they should actively respond to skin cancer myths and misinformation, and help to build trust on professional authorities such as the American Academy of Dermatology and the American Cancer Society.", "reading_order": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 68.88, "t": 383.28, "r": 524.4, "b": 343.44 }, "text": "Cooperative Extension Agents must operate within the guidelines of their profession by providing appropriate information that does not cross the line into medical advice, and should refer farmers to their healthcare providers when personal or out of scope questions are asked about skin cancer.", "reading_order": 3 }, { "page": 2, "type": "TITLE", "location": { "l": 69.84, "t": 315.84, "r": 168, "b": 303.12 }, "text": "Take Home Message", "reading_order": 4, "level": 2 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 86.88, "t": 288.72, "r": 528.24, "b": 262.8 }, "text": "AAD encourages Americans to minimize the risk of skin cancer by protecting against excessive sun exposure", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 5 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 87.12, "t": 248.88, "r": 512.4, "b": 222.48 }, "text": "Farmers whose professional activities expose them to excessive amounts of sun should be proactive in sun protection", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 6 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 87.36, "t": 208.56, "r": 541.2, "b": 168.24 }, "text": "Risk factors and prevention practices are self-evident; symptoms are generally visible and easy to detect – unlike other types of cancers. Thus, one of the most preventable and highly treatable cancers when caught early.", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 7 }, { "page": 2, "type": "LIST_ITEM", "location": { "l": 87.12, "t": 155.28, "r": 539.04, "b": 102.24 }, "text": "CEAs have an important role to play, which includes a) providing information for prevention and self-management of skin cancer, b) selection and proper use of sunscreens, and c) referring farmers to their healthcare providers when personal or individualized skin cancer professional advice is warranted.", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 8 } ] }, { "page": 3, "items": [ { "page": 3, "type": "TITLE", "location": { "l": 70.32, "t": 704.64, "r": 124.8, "b": 692.16 }, "text": "References", "reading_order": 0, "level": 2 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 87.84, "t": 681.6, "r": 540.48, "b": 643.44 }, "text": "American cancer Society. Cancer Facts and Figures, Atlanta GA, 2024. https://www.cancer.org/content/dam/CRC/PDF/Public/8823.00.pdf https://www.aad.org/public/public-health/skin-cancer-awareness", "marker": "1.", "links": [ { "uri": "https://www.cancer.org/content/dam/CRC/PDF/Public/8823.00.pdfhttps:/www.aad.org/public/public-health/skin-cancer-awareness", "dest": null, "action_type": "/URI", "bbox": [ 69.75, 656.16, 542.25, 669.59 ] }, { "uri": "https://www.cancer.org/content/dam/CRC/PDF/Public/8823.00.pdfhttps:/www.aad.org/public/public-health/skin-cancer-awareness", "dest": null, "action_type": "/URI", "bbox": [ 69.75, 642.74, 279.23, 656.16 ] } ], "list_id": "L2", "level": 0, "reading_order": 1 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 88.32, "t": 641.28, "r": 528, "b": 616.32 }, "text": "Smit-Kroner C, Brumby S. Farmers sun exposure, skin protection and public health campaigns: An Australian perspective. Preventive Medicine Reports, 2, 602-607, 2015.", "marker": "2.", "list_id": "L2", "level": 0, "reading_order": 2 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 88.56, "t": 614.4, "r": 533.04, "b": 589.44 }, "text": "Carley A and Sratman E. Skin cancer beliefs, knowledge and preventive practices: a comparison of farmers and non-farmers in a MidWestern population. J. Aromedicine, 20(2):85-92, 2015.", "marker": "3.", "list_id": "L2", "level": 0, "reading_order": 3 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 88.8, "t": 588, "r": 534.48, "b": 563.28 }, "text": "US Department of Health and Human Services. Surgeon Generals Call for Action to Prevent Skin Cancer. Washington DC, 2016.", "marker": "4.", "list_id": "L2", "level": 0, "reading_order": 4 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 88.56, "t": 561.12, "r": 514.8, "b": 509.28 }, "text": "Parisi M. Scope of practice for extension agents delivering health programs. Clemson (SC): Clemson Cooperative Extension, Land-Grant Press by Clemson Extension; 2020. LGP 1049. http://lgpress.clemson.edu/publication/scope-of-practice-for-extension-agents-delivering-health-programs.", "marker": "5.", "links": [ { "uri": "http://lgpress.clemson.edu/publication/scope-of-practice-for-extension-agents-delivering-health-programs", "dest": null, "action_type": "/URI", "bbox": [ 69.75, 521.89, 542.25, 535.31 ] }, { "uri": "http://lgpress.clemson.edu/publication/scope-of-practice-for-extension-agents-delivering-health-programs", "dest": null, "action_type": "/URI", "bbox": [ 69.75, 508.46, 184.91, 521.89 ] } ], "list_id": "L2", "level": 0, "reading_order": 5 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 88.56, "t": 507.12, "r": 514.8, "b": 482.4 }, "text": "Mohammad TF, Lim HW. The Important Role of Dermatologists in Public Education on Sunscreens. JAMA Dermatol. 2021; 157(5):509–511. doi:10.1001/jamadermatol.2020.5393", "marker": "6.", "list_id": "L2", "level": 0, "reading_order": 6 }, { "page": 3, "type": "LIST_ITEM", "location": { "l": 88.8, "t": 480.48, "r": 534.48, "b": 441.6 }, "text": "Tribby CP, Julian AK, Perna FM. Perceived Usefulness and Recall of Sunscreen Label Information by Consumers. JAMA Dermatol. 2021 May 1;157(5):573-576. doi: 10.1001/jamadermatol.2020.5394. PMID: 33760056; PMCID: PMC7992019.", "marker": "7.", "list_id": "L2", "level": 0, "reading_order": 7 } ] } ]