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Stapleton JL, Manne SL, Pagoto SL, Leip A, Greene K, Hillhouse JJ, Merritt AS, Shelton BJ. A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56562. [PMID: 38502173 PMCID: PMC10988380 DOI: 10.2196/56562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability. OBJECTIVE This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning. METHODS Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up. RESULTS This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up. CONCLUSIONS This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines. TRIAL REGISTRATION ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56562.
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Affiliation(s)
- Jerod L Stapleton
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Sherry L Pagoto
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States
| | - Allison Leip
- Department of Family Sciences, University of Kentucky, Lexington, KY, United States
| | - Kathryn Greene
- Department of Communication, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, United States
| | - Allison S Merritt
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Brent J Shelton
- Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, KY, United States
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Jilcott Pitts S, Moran NE, Laska MN, Wu Q, Harnack L, Moe S, Carr-Manthe P, Gates E, Chang J, Zaidi Y, Gelineau A, Berg L, Craft NE. Reflection Spectroscopy-Assessed Skin Carotenoids Are Sensitive to Change in Carotenoid Intake in a 6-Week Randomized Controlled Feeding Trial in a Racially/Ethnically Diverse Sample. J Nutr 2023; 153:1133-1142. [PMID: 36804322 PMCID: PMC10356992 DOI: 10.1016/j.tjnut.2023.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Reflection spectroscopy, utilized by the Veggie Meter, is a less-expensive, noninvasive method to quantify skin carotenoids and is a valid approximation of fruit and vegetable (FV) intake. However, it is unknown to what degree Veggie Meter-assessed skin carotenoid score change is responsive to changes in carotenoid intake. OBJECTIVES This study aimed to evaluate Veggie Meter-assessed skin carotenoid score response in a 6-wk randomized controlled trial of a carotenoid-containing juice to determine whether the Veggie Meter can be used to detect nutritionally relevant changes in carotenoid intake; and to compare skin and plasma carotenoid responses with the 6-wk trial. METHODS In this 6-wk trial, participants (n = 162) who self-identified as one of 4 US racial/ethnic groups (25% Black, 25% Asian, 27% non-Hispanic White, 23% Hispanic) were randomized to a control group, receiving negligible carotenoids (177 mL apple juice/d), moderate-dose group, receiving 4 mg total carotenoids/d (177 mL orange-carrot juice/d), or high-dose group, receiving 8 mg total carotenoids/d (355 mL orange-carrot juice/d). Skin carotenoid score and plasma total carotenoid concentrations (α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein, zeaxanthin) were assessed at baseline, 3 wk, and 6 wk (n = 158 completed the trial). Repeated measures linear models were used to examine skin and plasma carotenoids over time and between groups. RESULTS At 6 wk, participants in the high-dose and moderate-dose groups had significantly higher mean skin carotenoid scores [414.0 (SD = 100.6) and 369.7 (SD = 100.3), respectively] compared with those in the control group [305.2 (100.5)]. In the high-dose group, there was a 42% change in skin carotenoids from baseline (mean = 290.4) to a 6-wk follow-up (increase of 123, 123/290 = 42.4%). There was a 61% change in the plasma carotenoids in the high-dose group. CONCLUSIONS The Veggie Meter is sensitive to increases in daily carotenoid intake in diverse racial/ethnic groups over 6 wk. CLINICAL TRIALS REGISTRY NUMBER This trial was registered at clinicaltrials.gov as ID: NCT04056624. Study URL: https://clinicaltrials.gov/ct2/show/NCT04056624.
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Affiliation(s)
| | | | | | - Qiang Wu
- East Carolina University Department of Public Health, Greenville, NC, USA
| | | | - Stacey Moe
- University of Minnesota, Minneapolis, MN, USA
| | | | - Elizabeth Gates
- East Carolina University Department of Public Health, Greenville, NC, USA
| | | | - Yusuf Zaidi
- Baylor College of Medicine, Houston, TX, USA
| | | | - Lauren Berg
- University of Minnesota, Minneapolis, MN, USA
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Bowers JM, Hamilton JG, Wu YP, Moyer A, Hay JL. Acculturation, Sun Tanning Behavior, and Tanning Attitudes Among Asian College Students in the Northeastern USA. Int J Behav Med 2022; 29:25-35. [PMID: 33942255 PMCID: PMC9272584 DOI: 10.1007/s12529-021-09993-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND College students participate in high levels of tanning, a skin cancer risk behavior due to ultraviolet radiation exposure, yet little is known about Asian college students' behavior. This study examined the relationship between tanning attitudes, acculturation to the USA (cultural assimilation), and tanning behavior. METHOD An online survey was used to recruit 211 Asian college students in the northeastern USA (47.4% born outside of the USA) to respond to questions about recent tanning behavior, sun protection strategies, attitudes about tanning, and acculturation to the USA. RESULTS Attitudes about tanning, particularly desire for a darker skin tone and social norms, along with acculturation to the USA, were predictive of intentional tanning. The sample reported high levels of sun protection, which was associated with low acculturation. CONCLUSION The significant role of acculturation in this study indicates that it may be a useful factor to include in future tanning intervention studies of relevant populations.
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Affiliation(s)
- Jennifer M. Bowers
- Department of Psychology, Stony Brook University, 100 Nichols Road, Stony Brook, NY 11794-2500, USA,Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Jada G. Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT 84132, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, 100 Nichols Road, Stony Brook, NY 11794-2500, USA
| | - Jennifer L. Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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Jilcott Pitts SB, Moran NE, Wu Q, Harnack L, Craft NE, Hanchard N, Bell R, Moe SG, Johnson N, Obasohan J, Carr-Manthe PL, Laska MN. Pressure-Mediated Reflection Spectroscopy Criterion Validity as a Biomarker of Fruit and Vegetable Intake: A 2-Site Cross-Sectional Study of 4 Racial or Ethnic Groups. J Nutr 2022; 152:107-116. [PMID: 34562088 PMCID: PMC8754514 DOI: 10.1093/jn/nxab349] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Valid biomarkers of fruit and vegetable (FV) intake are needed for field-based nutrition research. OBJECTIVES To examine criterion-related validity of pressure-mediated reflection spectroscopy as a proxy measure of FV intake, using plasma carotenoids and self-reported FV and carotenoid intake as primary and secondary criterion measures, respectively. METHODS Healthy adults 18-65 y of age, self-identifying as African American/black (n = 61), Asian (n = 53), white (n = 70), or Hispanic (n = 29), in North Carolina and Minnesota were recruited. Skin carotenoids were assessed via pressure-mediated reflection spectroscopy (Veggie Meter), skin melanin via spectrophotometer, and total plasma carotenoid concentration by HPLC-photodiode array detection. Self-reported carotenoid and FV intake was assessed using a semiquantitative FFQ. Relations between skin carotenoids, plasma carotenoids, FV, and carotenoid intake, with differences by race or ethnicity, age, sex, weight status, cholesterol, and melanin index, were examined by bivariate correlations and adjusted multivariate linear regressions. RESULTS The overall unadjusted correlation between skin and total plasma carotenoids was r = 0.71 and ranged from 0.64 (non-Hispanic black) to 0.80 (Hispanic). Correlations between skin carotenoids and self-reported FV intake ranged from 0.24 (non-Hispanic black) to 0.53 (non-Hispanic white), with an overall correlation of r = 0.35. In models adjusted for age, sex, racial or ethnic group, and BMI, skin carotenoids were associated with plasma carotenoids (R2 = 0.55), FV (R2 = 0.17), and carotenoid intake (R2 = 0.20). For both plasma carotenoid and FV measures, associations with skin carotenoids did not vary by race, but these relations did differ by skin melanin-those with lower melanin had a lower correlation between skin and plasma carotenoids. CONCLUSIONS Reflection spectroscopy-assessed skin carotenoids may be a reasonable alternative to measurement of plasma carotenoids, a biomarker used to approximate FV intake.
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Affiliation(s)
| | - Nancy E Moran
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC,
USA
| | - Lisa Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Neil Hanchard
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ronny Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacey G Moe
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Nevin Johnson
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Justice Obasohan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Pamela L Carr-Manthe
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Sun Exposure, Tanning Behaviors, and Sunburn: Examining Activities Associated With Harmful Ultraviolet Radiation Exposures in College Students. J Prim Prev 2021; 42:425-440. [PMID: 34155576 DOI: 10.1007/s10935-021-00638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Understanding the behaviors that lead to sunburn is an important objective toward developing intervention strategies to reduce risk for skin cancers. Our cross-sectional study surveyed 400 college students aged 18 and older at a public state university in the northeastern US in 2018 to assess tanning behaviors, outdoor activities, sun protection, and sunburn over the past year. Sunburn was exceedingly common; over half reported one or more sunburns in the past 12 months. Outdoor intentional and unintentional tanning were also common. Male sex, White race, sun sensitive skin type, and outdoor intentional and unintentional tanning were independently associated with increased odds of sunburn. Water and non-water sports, sunbathing, and vacations were also associated with sunburn. These results indicate that tanning and outdoor activities such as sports are important behaviors on which to focus for sunburn prevention among college students. Understanding the behaviors that are associated with sunburn provides useful opportunities to prevent skin cancer among young people.
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Cho H, Song C(C, Adams D. Efficacy and Mediators of a Web-Based Media Literacy Intervention for Indoor Tanning Prevention. JOURNAL OF HEALTH COMMUNICATION 2020; 25:105-114. [PMID: 31984873 PMCID: PMC7138715 DOI: 10.1080/10810730.2020.1712500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Extant media literacy interventions have been delivered in person, limiting their potential for large scale reach, implementation, and dissemination. Although emerging evidence suggests the interventions can impact behavior, the theoretical mediators that can explain the efficacy remain unknown. This study investigated the efficacy and mediators of a web-based media literacy intervention for reducing indoor tanning behavior among young women. Participants were randomly assigned to one of three conditions: a media literacy intervention with counter argument production, a media literacy intervention with counter story production, or an assessment-only control condition. The outcomes of indoor tanning behavior and intention were evaluated with 3- and 6-month follow-ups. Results indicated significant effects of the web-based intervention on reducing indoor tanning behavior at the follow-ups. Changes in perceived media realism completely mediated the intervention effects on behavior. Perceived media realism, positive and negative outcome expectancies, and collective efficacy partially mediated intervention effects on intention. This study demonstrates the efficacy of a web-based media literacy intervention and the theoretical mechanisms underlying the efficacy. It indicates that by altering perceived media realism, outcome expectancies, and collective efficacy, web-based media literacy interventions could generate behavioral effects.
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Affiliation(s)
| | - Chi (Chuck) Song
- Division of Biostatistics, The Ohio State University, Columbus,
OH
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7
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Heckman CJ, Auerbach MV, Darlow S, Handorf EA, Raivitch S, Manne SL. Association of Skin Cancer Risk and Protective Behaviors with Health Literacy Among Young Adults in the USA. Int J Behav Med 2019; 26:372-379. [PMID: 31147962 DOI: 10.1007/s12529-019-09788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. METHOD A US national sample of 958 adults, 18-25 years old, at moderate to high risk of developing skin cancer, completed a survey online. Behavioral outcomes were ultraviolet (UV) radiation exposure (e.g., indoor and outdoor tanning, sunburn) and protective (e.g., sunscreen use, sunless tanning) behaviors. Multivariable regression analyses were conducted to determine whether health literacy (a four-item self-report measure assessing health-related reading, understanding, and writing) was associated with behavioral outcomes while controlling for demographic factors. RESULTS Higher health literacy was independently associated with less sunbathing, odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.98; less indoor tanning, OR = 0.38, CI = 0.31-0.48; and less use of tanning oils, OR = 0.54, CI = 0.43-0.69. However, health literacy was also associated with a lower likelihood of wearing long pants, OR = 0.76, CI = 0.58-0.99, or a hat, OR = 0.68, CI = 0.53-0.87, when outdoors. On the other hand, higher health literacy was associated with higher incidental UV exposure, OR = 1.69, CI = 1.34-2.14, and a greater likelihood of ever having engaged in sunless tanning, OR = 1.50, CI = 1.17-1.92. CONCLUSION Interestingly, higher health literacy was associated with lower levels of intentional tanning yet also higher incidental UV exposure and lower skin protection among US young adults. These findings suggest that interventions may be needed for young adults at varying levels of health literacy as well as populations (e.g., outdoor workers, outdoor athletes/exercisers) who may be receiving large amounts of unprotected incidental UV.
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Affiliation(s)
- Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA.
| | | | - Susan Darlow
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | | | | | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA
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8
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Bowers JM, Moyer A. 'I am happier with my fairer complexion': factors associated with former indoor tanning and reasons for quitting in college women. PSYCHOL HEALTH MED 2018; 24:344-354. [PMID: 30354529 DOI: 10.1080/13548506.2018.1537497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study of 312 female undergraduates investigated the association of recently, formerly, or never indoor tanning with self-perceptions and social influence, and examined reasons to tan and not to tan. Previous research on indoor tanning has focused on recent or current tanners, and few studies have examined former indoor tanners. By examining self-perceptions and social influence, this study aimed to understand how these common tanning correlates, measured in former indoor tanners, compared to those who have never tanned indoors (i.e., never tanners) and those who have recently tanned indoors. Appearance and global self-perceptions were more positive in former indoor tanners compared to never tanners and recent tanners. Recent indoor tanning was positively associated with both higher outdoor tanning frequency and having a higher number of friends performing skin cancer risk behaviors, and formerly indoor tanning was also associated with both, but to a lesser extent. Appearance and social influence were commonly described as reasons for indoor tanning, and perceived health risk, appearance, and social influence were described as prominent reasons for tanning cessation. This study improves what is known about former indoor tanners, which may be useful for behavior change maintenance efforts and developing approaches for skin cancer screening interventions.
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Affiliation(s)
- Jennifer M Bowers
- a Department of Psychology , Stony Brook University , Stony Brook , NY , USA
| | - Anne Moyer
- a Department of Psychology , Stony Brook University , Stony Brook , NY , USA
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9
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Diehl K, Görig T, Schilling L, Greinert R, Breitbart EW, Schneider S. Profile of sunless tanning product users: Results from a nationwide representative survey. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:40-46. [PMID: 30113096 DOI: 10.1111/phpp.12419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/26/2018] [Accepted: 08/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sunless tanning products (STPs) are often seen as "healthy alternative" to sunbathing and indoor tanning. However, STP use may entail indirect risks such as overestimating an individual's natural skin type, resulting in risky (natural and artificial) tanning behavior. We aimed to explore STP use in combination with other health-related risk behaviors (eg, smoking), skin cancer risk, risk awareness of ultraviolet radiation, and preventive behavior. METHODS We used data from the NCAM, a nationwide representative cross-sectional sample (n = 3000, aged 14-45, 48.6% female) interviewed via telephone. Differences between STP users and nonusers regarding the abovementioned aspects were identified using chi²-test. RESULTS The 1-year prevalence of STP use was 7.5%. Tanning bed users showed a higher prevalence of STP use than past and never users (16.1% vs 9.6% vs 5.8%, P < 0.05). Although STP users had a higher skin cancer risk based on individual characteristics, they were less likely to have participated in a skin cancer screen. CONCLUSION The identified parallel use of STPs and tanning beds can have severe health consequences, since the "fake tan" of STPs may lead to an overestimation of the individual's skin type, which may result in overdosed UV exposure. The lower risk awareness among STP users accompanied with their higher skin cancer risk calls for target group-specific prevention.
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Affiliation(s)
- Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Schilling
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rüdiger Greinert
- Association of Dermatological Prevention (ADP), Hamburg, Germany.,Center of Dermatology, Elbe Clinics, Buxtehude, Germany
| | | | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Glanz K, Jordan A, Lazovich D, Bleakley A. Frequent Indoor Tanners' Beliefs About Indoor Tanning and Cessation. Am J Health Promot 2018; 33:293-299. [PMID: 29973065 DOI: 10.1177/0890117118784235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Indoor tanning is associated with an increased risk of developing skin cancer. In the United States, nearly 1 in 5 white women aged 18 to 25 are indoor tanners. This study elicited beliefs about tanning indoors and quitting/cutting back on indoor tanning. DESIGN Semi-structured interviews. PARTICIPANTS AND SETTING Forty 18- to 25-year-old white females who engaged in frequent indoor tanning participated in either in-person or telephone interviews. Most were college students from southeastern Pennsylvania and Delaware. METHOD A semi-structured interview was used to elicit beliefs about indoor tanning and quitting or cutting back. Data analyses using NVivo and multiple coders identified key themes about going and quitting/cutting back on indoor tanning. RESULTS Key themes stated as reasons for indoor tanning included improving physical appearance, social acceptance, increased confidence, and happiness. The main themes identified as advantages of quitting/cutting back on indoor tanning were to decrease skin cancer risk and save money. Perceived disadvantages of quitting/cutting back included themes of concerns about being pale and a decline in self-confidence. The prospect of saving money and warm weather were seen as facilitating quitting/cutting back. CONCLUSION Findings suggest the necessity of addressing appearance concerns, psychological benefits associated with feeling more attractive, and short-term gains such as saving money. These findings provide a foundation for developing effective anti-indoor tanning communication.
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Affiliation(s)
- Karen Glanz
- 1 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- 2 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Jordan
- 3 Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - DeAnn Lazovich
- 4 School of Public Health, University of Minnesota, MN, USA
| | - Amy Bleakley
- 3 Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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11
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Blashill AJ, Rooney BM, Luberto CM, Gonzales M, Grogan S. A brief facial morphing intervention to reduce skin cancer risk behaviors: Results from a randomized controlled trial. Body Image 2018; 25:177-185. [PMID: 29698824 DOI: 10.1016/j.bodyim.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 12/19/2022]
Abstract
The current study was designed to test the efficacy of an appearance-based facial morphing program to reduce intentional UV exposure among individuals at risk for skin cancer. A three-arm randomized controlled trial was employed (N = 219) comparing facial morphing + health information to: (1) mindfulness + health information; and (2) health information only. Participants were young adults with a history of recent intentional tanning and future intentions to tan. Primary outcomes were indoor and outdoor tanning frequency and tanning intentions, with secondary outcomes of tanning attitudes, body image, and affect. Facial morphing participants reported less frequent tanning, compared to mindfulness and control participants at 1-month follow-up. Facial morphing participants also generally reported lower intentions to tan at immediate follow-up, although the magnitude of these effects weakened at 1-month follow-up. Facial morphing programs may offer a brief, efficacious, and scalable augmentation to standard of care in reducing intentional UV exposure. This trial is registered with clinicaltrials.gov (NCT03237013).
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Affiliation(s)
- Aaron J Blashill
- San Diego State University, United States; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, United States.
| | | | - Christina M Luberto
- Harvard Medical School, United States; Massachusetts General Hospital, United States
| | | | - Sarah Grogan
- Manchester Metropolitan University, United States
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12
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Daniel CL, Gassman NR, Fernandez AM, Bae S, Tan MCB. Intentional tanning behaviors among undergraduates on the United States' Gulf Coast. BMC Public Health 2018; 18:441. [PMID: 29615031 PMCID: PMC5883533 DOI: 10.1186/s12889-018-5345-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background Rates of melanoma have dramatically increased among adolescents and young adults in recent years, particularly among young women. Exposure to ultraviolet radiation from intentional tanning practices is likely a major contributor to this epidemic. Southern and coastal regions have higher melanoma mortality rates among non-Hispanic whites in other parts of the U.S., yet little is known about tanning practices of adolescents and young adults in these regions. This study determines the prevalence and methods of intentional tanning utilized by an undergraduate population located on the United States’ Gulf Coast. Methods Undergraduate students enrolled at a university on the Gulf Coast completed an online survey from March–April 2016, self-reporting their engagement, knowledge, and attitudes regarding outdoor tanning (OT), indoor tanning (IT) and spray tanning (ST). Univariate and multivariate analyses were performed to identify factors associated with tanning behaviors. Results 2668 undergraduates completed the survey. Of these, 64.9% reported OT tanning, 50.7% reported ever IT, and 21.2% reported ever ST. Conclusions In the largest study to date of intentional tanning behaviors of adolescents and young adults from coastal regions, we found high rates of intentional tanning behaviors. There was also significant engagement in spray tanning by this population, not previously reported for adolescents and young adults in a sample of this size. We also identified a high association between different tanning methods, indicating this population engages in multiple tanning behaviors, a phenomenon whose health consequences are not yet known.
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Affiliation(s)
- Casey L Daniel
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA.
| | - Natalie R Gassman
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Alyssa M Fernandez
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL, 36604, USA
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL, 35205, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcus C B Tan
- Department of Surgery, University of South Alabama College of Medicine, 2451 Fillingim Street, Mobile, AL, 36617, USA
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13
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Stapleton JL, Manne SL, Day AK, Levonyan-Radloff K, Pagoto SL. Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability. JMIR Res Protoc 2018; 7:e54. [PMID: 29463495 PMCID: PMC5840477 DOI: 10.2196/resprot.9429] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/06/2018] [Accepted: 01/06/2018] [Indexed: 12/29/2022] Open
Abstract
Background There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. Objective To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). Conclusions This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings suggest that Facebook metrics of intervention post engagement (ie, likes and comments) may vary based on post types and that designing specifically labeled discussion posts may be helpful for soliciting engagement as well as challenging beliefs.
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Affiliation(s)
- Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers University, New Brunswick, NJ, United States
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers University, New Brunswick, NJ, United States
| | - Ashley K Day
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | | | - Sherry L Pagoto
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States
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14
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Cho H, Yu B, Cannon J, Zhu YM. Efficacy of a Media Literacy Intervention for Indoor Tanning Prevention. JOURNAL OF HEALTH COMMUNICATION 2018; 23:643-651. [PMID: 30058942 PMCID: PMC6605049 DOI: 10.1080/10810730.2018.1500659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Indoor tanning leads to melanoma, the fifth most common cancer in the USA. The highest rate of indoor tanning is among young women whose exposure to tanned images in the media is linked to protanning attitudes. This study evaluated the efficacy of a media literacy intervention for reducing young women's indoor tanning. Intervention participants analyzed the content and functions of the media influencing protanning attitudes and produced counter-messages to help themselves and peers resist harmful media effects. The message production was of two types: digital argument production or digital story production. The control group received assessments only. This three-group randomized design involved 26 sorority chapters and 247 members in five Midwestern states where indoor tanning is prevalent. At 2- and 6-month follow-up assessments, those in the two intervention conditions were less likely to be indoor tanners (p = .033) and reported lower indoor tanning intentions (p = .002) compared to those in the control condition. No difference between the two intervention groups was found for behavior. Although the argument group exhibited slightly weaker indoor tanning intentions than the story group, the difference was not significant. The results provide the first evidence of the efficacy of a media literacy intervention for indoor tanning reduction. Implications for participative engagement interventions are discussed.
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Affiliation(s)
- Hyunyi Cho
- Corresponding author Hyunyi Cho, School of Communication, The Ohio State University 154 N. Oval Mall Columbus, OH 43210 Phone: 614-247-1691,
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15
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Blashill AJ, Rooney BM, Wells KJ. An integrated model of skin cancer risk in sexual minority males. J Behav Med 2017; 41:99-108. [PMID: 28815351 DOI: 10.1007/s10865-017-9879-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
Abstract
Sexual minority males are an at-risk group for developing skin cancer. Elevated rates of skin cancer among this population are thought to be driven by excess indoor tanning; however, motivations to indoor tan among this population are unknown. Theoretically, appearance-based and affect regulation motives may be proximal predictors of increased indoor tanning in this population. The current study tests an integrated biopsychosocial model of indoor tanning behaviors and future intentions among a sample of sexual minority males. Participants were 231 sexual minority males, between the age of 14 and 35 years, residing in San Diego County, California, who completed a battery of self-report questionnaires online. Constructs assessed included skin tone, perceived susceptibility to skin cancer, sociocultural pressures to tan, appearance-based motives to tan, affect regulation in regard to indoor tanning, indoor tanning behaviors over the previous 3 months, and future intentions to indoor tan. The three proposed proximal predictors of indoor tanning all displayed significant pathways; however, results varied depending upon the specific outcome measure modeled. Affect regulation was significantly associated with increased odds of indoor tanning, and future intentions to indoor tan. Increased appearance reasons to tan were significantly associated with future intentions to indoor tan, while increased appearance reasons not to tan were significantly associated with fewer number of indoor tanning sessions. Results underscore the unique pathways of affect regulation and appearance-based motives in indoor tanning behaviors. Skin cancer prevention programs focusing on sexual minority males may wish to address affect and appearance concerns.
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Affiliation(s)
- Aaron J Blashill
- Department of Psychology, San Diego State University, 6363 Alvarado Ct. Suite 103, San Diego, CA, 92120, USA. .,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Benjamin M Rooney
- Department of Psychology, San Diego State University, 6363 Alvarado Ct. Suite 103, San Diego, CA, 92120, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, 6363 Alvarado Ct. Suite 103, San Diego, CA, 92120, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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16
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Heckman CJ, Handorf E, Darlow SD, Yaroch AL, Raivitch S. Refinement of measures to assess psychosocial constructs associated with skin cancer risk and protective behaviors of young adults. J Behav Med 2017; 40:574-582. [PMID: 28155000 PMCID: PMC5501995 DOI: 10.1007/s10865-017-9825-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/05/2017] [Indexed: 11/29/2022]
Abstract
The study's purpose was to select/refine measures assessing psychosocial constructs associated with skin cancer risk/protective behaviors. Cognitive interviewing was conducted with twenty participants locally, and a survey was conducted with 965 adults aged 18-25 years at moderate to high risk of developing skin cancer, recruited nationally online. Psychosocial measures assessed variables from the Integrative Model of Behavior Prediction. As a result of expert review and cognitive interviewing, items were removed, added, and/or made simpler, more personal, consistent, and less ambiguous. A factor analysis resulted in 14 scales and adequate model fit. Internal reliability and test-retest reliability was acceptable to good. Correlations among the psychosocial and behavioral variables were generally significant and in expected directions, demonstrating convergent validity. We have refined measures that assess important psychosocial constructs associated with skin cancer-related behaviors, that research participants can understand and complete successfully, and that are reliable and demonstrate evidence for validity.
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Affiliation(s)
- C J Heckman
- Fox Chase Cancer Center, Philadelphia, PA, 19111, USA.
| | - E Handorf
- Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - S D Darlow
- Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - A L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, 68114, USA
| | - S Raivitch
- Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
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17
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Stapleton JL, Hillhouse J, Coups EJ, Pagoto S. Social media use and indoor tanning among a national sample of young adult nonHispanic white women: A cross-sectional study. J Am Acad Dermatol 2017; 75:218-20. [PMID: 27317521 DOI: 10.1016/j.jaad.2016.01.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick; Department of Health Education and Behavioral Sciences, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway.
| | - Joel Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City
| | - Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick; Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick; Department of Health Education and Behavioral Sciences, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway
| | - Sherry Pagoto
- Department of Medicine, University of Massachusetts Medical School, North Worcester
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18
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Stapleton JL, Manne SL, Darabos K, Greene K, Ray AE, Turner AL, Coups EJ. Randomized controlled trial of a web-based indoor tanning intervention: Acceptability and preliminary outcomes. Health Psychol 2016; 34S:1278-85. [PMID: 26651469 DOI: 10.1037/hea0000254] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This article describes the acceptability and preliminary behavioral outcomes of a pilot randomized control trial of a web-based indoor tanning intervention for young adult women. The intervention targets indoor tanning users' perceptions of the benefits and value of tanning and addresses the role of body image-related constructs in indoor tanning. METHOD Participants were 186 young adult women who reported indoor tanning at least once in the past 12 months. The study design was a 2-arm randomized controlled trial with pre- and postintervention assessments and random assignment to an intervention or control condition. Intervention acceptability was assessed by obtaining participants' evaluation of the intervention. Regression analyses were used to test for intervention condition differences in preliminary behavioral outcomes measured at 6 weeks postintervention. RESULTS Participants provided favorable evaluations of the intervention on several dimensions and a highly positive overall rating. Intervention participants were more likely to report abstaining from indoor tanning and indicated a lower likelihood of using indoor tanning in the future compared with control participants on the postintervention assessment. No differences were found for sunburns. CONCLUSIONS The results of this pilot randomized controlled trial provide evidence that the indoor tanning intervention is acceptable to participants and may encourage cessation of indoor tanning behavior. The findings provide preliminary support for an indoor tanning intervention that engages tanners to challenge their beliefs about the benefits of indoor tanning. The use of a web-based indoor tanning intervention is unique and provides strong potential for dissemination.
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Affiliation(s)
- Jerod L Stapleton
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey
| | - Sharon L Manne
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey
| | - Katie Darabos
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey
| | - Kathryn Greene
- Department of Communication, Rutgers, The State University of New Jersey
| | - Anne E Ray
- Center of Alcohol Studies, Rutgers, The State University of New Jersey
| | - Amber L Turner
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey
| | - Elliot J Coups
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey
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19
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Heckman CJ, Darlow SD, Ritterband LM, Handorf EA, Manne SL. Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults. Am J Prev Med 2016; 51:1-11. [PMID: 26810358 PMCID: PMC4914462 DOI: 10.1016/j.amepre.2015.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/22/2015] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Skin cancer is the most common cancer, and its incidence is increasing. Young adults expose themselves to large amounts of ultraviolet radiation (UV) and engage in minimal skin protection, which increases their risk. Internet interventions are effective in modifying health behaviors and are highly disseminable. The current study's purpose was to test an Internet intervention to decrease UV exposure and increase skin protection behavior among young adults. STUDY DESIGN RCT conducted in 2014, with data analyzed in 2015. SETTING/PARTICIPANTS A national sample of adults aged 18-25 years at moderate to high risk of developing skin cancer by a self-report measure was recruited online. INTERVENTION Participants were randomized to one of three intervention conditions: assessment only, the website of a skin cancer organization, or a tailored interactive multimedia Internet intervention program (UV4.me) based on the Integrative Model of Behavioral Prediction. MAIN OUTCOME MEASURES Self-reported overall UV exposure and skin protection assessed at 3 and 12 weeks after baseline. Secondary outcomes were self-reported intentional and incidental UV exposure, sunburns, sunscreen use, and skin cancer screening. RESULTS For the intervention arm, there were significant decreases in UV exposure and increases in skin protection at both follow-up time points compared with the assessment-only condition (p<0.001). The effect sizes (Cohen's d) comparing the experimental and assessment-only arm for exposure behaviors were 0.41 at 3-week follow-up and 0.43 at 12-week follow-up. The effect sizes for protection behaviors were 0.41 at 3-week follow-up and 0.53 at 12-week follow-up. The control condition was not significantly different from the assessment only condition. All three conditions exhibited decreased exposure and increased protection at both follow-ups (p<0.01), but the effect was much stronger in the intervention group. Secondary outcomes were generally also significantly improved in the intervention condition compared with the other conditions. CONCLUSIONS This is the first published report describing the results of an RCT of an Internet intervention to modify skin cancer risk behaviors among young adults. The UV4.me intervention significantly improved self-reported skin cancer prevention behaviors. Future research will investigate mechanisms of change and approaches for dissemination. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02147080.
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Affiliation(s)
- Carolyn J Heckman
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Susan D Darlow
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Lee M Ritterband
- BeHealth Solutions, LLC, Charlottesville, Virginia; University of Virginia Health System, Charlottesville, Virginia
| | | | - Sharon L Manne
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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20
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Kelley DE, Noar SM, Myrick JG, Morales-Pico B, Zeitany A, Thomas NE. An Empirical Analysis of Indoor Tanners: Implications for Audience Segmentation in Campaigns. JOURNAL OF HEALTH COMMUNICATION 2016; 21:564-574. [PMID: 27115046 DOI: 10.1080/10810730.2015.1114051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tanning bed use before age 35 has been strongly associated with several types of skin cancer. The current study sought to advance an understanding of audience segmentation for indoor tanning among young women. Panhellenic sorority systems at two universities in the Southeastern United States participated in this study. A total of 1,481 young women took the survey; 421 (28%) had tanned indoors in the previous 12 months and were the focus of the analyses reported in this article. Results suggested two distinct tanner types: regular (n = 60) and irregular (n = 353) tanners. Regular tanners tanned more frequently (M = 36.2 vs. 8.6 times per year) and reported significantly higher positive outcome expectations (p < .001) and lower negative outcome expectations (p < .01) than irregular tanners, among other significant differences. Hierarchical logistic regression analysis revealed several significant (p < .001) predictors of regular tanning type, with tanning dependence emerging as the strongest predictor of this classification (OR = 2.25). Implications for developing anti-tanning messages directed at regular and irregular tanners are discussed.
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Affiliation(s)
- Dannielle E Kelley
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Seth M Noar
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | | | - Brenda Morales-Pico
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Alexandra Zeitany
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Nancy E Thomas
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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21
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Stapleton JL, Manne SL, Greene K, Darabos K, Carpenter A, Hudson SV, Coups EJ. Sociocultural experiences, body image, and indoor tanning among young adult women. J Health Psychol 2016; 22:1582-1590. [PMID: 26929174 DOI: 10.1177/1359105316631198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this survey study was to evaluate a model of body image influences on indoor tanning behavior. Participants were 823 young adult women recruited from a probability-based web panel in the United States. Consistent with our hypothesized model, tanning-related sociocultural experiences were indirectly associated with lifetime indoor tanning use and intentions to tan as mediated through tan surveillance and tan dissatisfaction. Findings suggest the need for targeting body image constructs as mechanisms of behavior change in indoor tanning behavioral interventions.
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22
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Heckman CJ, Munshi T, Darlow S, Kloss JD, Manne SL, Perlis C, Oslin D. The association of tanning behavior with psycho-tropic medication use among young adult women. PSYCHOL HEALTH MED 2015; 21:60-6. [PMID: 26068581 DOI: 10.1080/13548506.2015.1051060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite its known association with skin cancer, tanning remains popular among young adult women. Indoor tanning behavior has been found to be associated with affective and addictive disorders. To better understand potential psychological and biological mechanisms of tanning behavior, we investigated associations between tanning and medication (psychotropic and other) use among young women. Two hundred and fifty-three women age 18-29 years old were recruited from two northeastern university campus communities. Women self-reported tanning frequency and chronic medication use. In both univariate and multivariate analyses, indoor tanning ≥12 times last year was significantly associated with use of psychotropic medication and anti-depressants in particular. Sunbathing was not associated with medication use. Potential reasons for associations between tanning and psychotropic medication use are discussed. Indoor tanners should be warned that some psychotropic medications are photosensitizing, thus increasing risk for burns and other skin damage from indoor tanning.
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Affiliation(s)
- Carolyn J Heckman
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Teja Munshi
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Susan Darlow
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Jacqueline D Kloss
- b Department of Psychology , Drexel University , 3141 Chestnut St, Philadelphia , PA 19104 , USA
| | - Sharon L Manne
- c Cancer Prevention and Control Program , Rutgers Cancer Institute of New Jersey , New Brunswick , NJ , USA
| | - Clifford Perlis
- d Department of Dermatology , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - David Oslin
- e Department of Psychiatry , University of Pennsylvania School of Medicine , Philadelphia , PA , USA
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23
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Janssen E, van Osch L, Lechner L, de Vries H. Influencing feelings of cancer risk: direct and moderator effects of affectively laden phrases in risk communication. JOURNAL OF HEALTH COMMUNICATION 2015; 20:321-327. [PMID: 25569710 DOI: 10.1080/10810730.2014.965362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Evidence is accumulating for the importance of feelings of risk in explaining cancer preventive behaviors, but best practices for influencing these feelings are limited. This study investigated the direct and moderational influence of affectively laden phrases in cancer risk messages. Two experimental studies were conducted in relation to different cancer-related behaviors--sunbed use (n = 112) and red meat consumption (n = 447)--among student and nonstudent samples. Participants were randomly assigned to one of two conditions: (a) a cognitive message using cognitively laden phrases or (b) an affective message using affectively laden phrases. The results revealed that affective phrases did not directly influence feelings of risk in both studies. Evidence for a moderational influence was found in Study 2, suggesting that affective information strengthened the relation between feelings of risk and intention (i.e., participants relied more on their feelings in the decision-making process after exposure to affective information). These findings suggest that solely using affective phrases in risk communication may not be sufficient to directly influence feelings of risk and other methods need to be explored in future research. Moreover, research is needed to replicate our preliminary indications for a moderational influence of affective phrases to advance theory and practice.
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Affiliation(s)
- Eva Janssen
- a Faculty of Health, Medicine, and Life Sciences, Department of Health Promotion, School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
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24
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Quinn M, Alamian A, Hillhouse J, Scott C, Turrisi R, Baker K. Prevalence and Correlates of Indoor Tanning and Sunless Tanning Product Use among Female Teens in the United States. Prev Med Rep 2015; 2:40-43. [PMID: 25621199 PMCID: PMC4302332 DOI: 10.1016/j.pmedr.2014.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens. METHODS Teenage females (N=778) aged 12-18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use. RESULTS Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR=1.82, 95% CI:1.07-3.10). Age, geographic regions, and race increased the likelihood of IT and STP use. CONCLUSIONS Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.
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Affiliation(s)
- Megan Quinn
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Joel Hillhouse
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Colleen Scott
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Rob Turrisi
- Prevention Research Center and Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, United
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
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Noar SM, Myrick JG, Zeitany A, Kelley D, Morales-Pico B, Thomas NE. Testing a social cognitive theory-based model of indoor tanning: implications for skin cancer prevention messages. HEALTH COMMUNICATION 2015; 30:164-174. [PMID: 25470441 DOI: 10.1080/10410236.2014.974125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The lack of a theory-based understanding of indoor tanning is a major impediment to the development of effective messages to prevent or reduce this behavior. This study applied the Comprehensive Indoor Tanning Expectations (CITE) scale in an analysis of indoor tanning behavior among sorority women (total N = 775). Confirmatory factor analyses indicated that CITE positive and negative expectations were robust, multidimensional factors and that a hierarchical structure fit the data well. Social cognitive theory-based structural equation models demonstrated that appearance-oriented variables were significantly associated with outcome expectations. Outcome expectations were, in turn, significantly associated with temptations to tan, intention to tan indoors, and indoor tanning behavior. The implications of these findings for the development of messages to prevent and reduce indoor tanning behavior are discussed in two domains: (a) messages that attempt to change broader societal perceptions about tan skin, and (b) messages that focus more narrowly on indoor tanning-challenging positive expectations, enhancing negative expectations, and encouraging substitution of sunless tanning products.
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Affiliation(s)
- Seth M Noar
- a School of Journalism and Mass Communication , University of North Carolina at Chapel Hill
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26
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150:390-400. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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McMichael JR, Ezirike J, Veledar E, Rice JE, Chen SC. The social acceptability of handheld umbrellas for sun protection. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 30:220-7. [DOI: 10.1111/phpp.12123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Emir Veledar
- Center for Research and Grants; Baptist Health South Florida; Miami FL USA
| | | | - Suephy C. Chen
- Dermatology; Emory University; Atlanta GA USA
- Division of Dermatology; Atlanta VAMC Decatur; Atlanta GA USA
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Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014; 70:847-57.e1-18. [PMID: 24629998 DOI: 10.1016/j.jaad.2013.11.050] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 11/05/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tanning beds are associated with increased risk of melanoma. OBJECTIVE We sought to update the evidence of the association of melanoma and indoor tanning focusing on frequency of use and exposure to newer tanning beds. METHODS We searched Scopus, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature on August 14, 2013. We included all observational studies that included patients with melanoma who had indoor tanned. Odds ratios (OR) with 95% confidence intervals (CI) were extracted and combined using generic inverse variance methods assuming a random effects model. RESULTS In all, 31 studies were included with data available on 14,956 melanoma cases and 233,106 controls. Compared with never using, the OR for melanoma associated with ever using indoor tanning beds was 1.16 (95% CI 1.05-1.28). Similar findings were identified in recent studies with enrollment occurring in the year 2000 onward (OR 1.22, 95% CI 1.03-1.45) and in subjects attending more than 10 tanning sessions (OR 1.34, 95% CI 1.05-1.71). LIMITATIONS The quality of evidence contributing to review results ranges from poor to mediocre. CONCLUSION Using tanning beds is associated with a subsequent melanoma diagnosis. Exposure from more than 10 tanning sessions is most strongly associated and there was no statistically significant difference in this association before and after 2000, suggesting that newer tanning technology is not safer than older models.
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Affiliation(s)
| | - Michael B Bracken
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut.
| | - Jennifer Beecker
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon MA, Natale-Pereira A, Goydos JS. Linguistic acculturation and skin cancer-related behaviors among Hispanics in the southern and western United States. JAMA Dermatol 2013; 149:679-86. [PMID: 23752366 DOI: 10.1001/jamadermatol.2013.745] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the association between linguistic acculturation (assessed using the Language Use and Linguistic Preference subscales from the Bidimensional Acculturation Scale for Hispanics) and skin cancer-related behaviors among US Hispanic adults to determine whether, compared with Hispanics denoted as Spanish-acculturated, English-acculturated Hispanics would report less frequent shade seeking and use of sun protective clothing and higher rates of sunscreen use, sunbathing, and indoor tanning. DESIGN Online survey study conducted in September 2011. SETTING Five southern and western US states. PARTICIPANTS A population-based sample of 788 Hispanic adults drawn from a nationally representative web panel. MAIN OUTCOME MEASURES Self-reported sunscreen use, shade seeking, use of sun protective clothing, sunbathing, and indoor tanning. RESULTS Multivariate regression analyses were conducted to examine predictors of the skin cancer-related behaviors. As hypothesized, English-acculturated Hispanics had lower rates of shade seeking and use of sun protective clothing and reported higher rates of sunbathing and indoor tanning than Spanish-acculturated Hispanics. English-acculturated Hispanics and bicultural Hispanics (ie, those with high Spanish and high English acculturation) reported comparably high rates of sunbathing and indoor tanning. Results suggested that bicultural Hispanics seek shade and wear sun protective clothing less often than Spanish-acculturated Hispanics but more often than English-acculturated Hispanics. Acculturation was not associated with sunscreen use. CONCLUSIONS Hispanic adults do not routinely engage in behaviors that reduce their risk of skin cancer. Bicultural and English-acculturated Hispanics are particularly in need of skin cancer prevention interventions.
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Affiliation(s)
- Elliot J Coups
- The Cancer Institute of New Jersey, 195 Little Albany St, Room 5567, New Brunswick, NJ 08901, USA.
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Wickenheiser M, Baker MK, Gaber R, Blatt H, Robinson JK. Sun protection preferences and behaviors among young adult males during maximum ultraviolet radiation exposure activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3203-16. [PMID: 23912201 PMCID: PMC3774433 DOI: 10.3390/ijerph10083203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 11/16/2022]
Abstract
This study explores sun protection attitudes, preferences, and behaviors among young adult males participating in an open-field activity with extreme ultraviolet radiation exposure. Male drum corps members (n = 137) responded to survey questions regarding their behavior and willingness to engage in sun protection and barriers to sunscreen usage. A subset of members (n = 31) participated in cognitive interviews exploring various sunscreen products and intervention techniques. Participants were knowledgeable about health risks and protection benefits regarding sun exposure. Generally, males had positive attitudes and normative beliefs about using sunscreen. A barrier to sunscreen re-application was lack of adequate time to reapply sunscreen during the open field activity. Males preferred a towelette application method, but were unfamiliar with its efficacy and proper use. Thus, they were more likely to use the more familiar sunscreen spray. To increase sun protection behaviors and lower skin cancer risk for males participating in open-field activities, breaks must be allotted every 2 h and have sufficient time to allow sunscreen application. Future development and research into delivery systems that rapidly and evenly apply sunscreen may help lower exposure in this population.
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Affiliation(s)
- Marilyn Wickenheiser
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; E-Mails: (M.W.); (R.G.); (H.B.)
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Mary Kate Baker
- Department of Community & Behavioral Health, East Tennessee State University College of Public Health, Johnson City, TN 37614, USA; E-Mail:
| | - Rikki Gaber
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; E-Mails: (M.W.); (R.G.); (H.B.)
| | - Hanz Blatt
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; E-Mails: (M.W.); (R.G.); (H.B.)
| | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; E-Mails: (M.W.); (R.G.); (H.B.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-312-926-7428; Fax: +1-312-643-1821
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Day AK, Wilson CJ, Hutchinson AD, Roberts RM. The role of skin cancer knowledge in sun-related behaviours: A systematic review. J Health Psychol 2013; 19:1143-62. [DOI: 10.1177/1359105313485483] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin cancer is the most commonly diagnosed cancer in many Western countries. This systematic review provides a comprehensive overview of the relationship between skin cancer knowledge and sun-protective, exposure and tanning behaviours in the general population. A total of 34 studies, published in peer-reviewed journals over three decades, were reviewed and synthesised. Sun-protective behaviour was positively associated with skin cancer knowledge in most cases. Findings were inconsistent regarding other sun-related behaviours. Heterogeneity in measurement compromised the capacity to definitively link knowledge and sun-related behaviours. There is a need for development and utilisation of a standardised skin cancer knowledge scale, and guidelines are suggested.
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Affiliation(s)
| | - Carlene J Wilson
- Flinders University, Australia
- Cancer Council South Australia, Australia
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Heckman CJ, Cohen-Filipic J, Darlow S, Kloss JD, Manne SL, Munshi T. Psychiatric and addictive symptoms of young adult female indoor tanners. Am J Health Promot 2013; 28:168-74. [PMID: 23621780 DOI: 10.4278/ajhp.120912-quan-442] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Indoor tanning (IT) increases risk for melanoma and is particularly common among young adult women. IT has also been linked with some psychiatric symptoms, and frequent tanning may indicate tanning dependence (addiction) associated with endorphin release during ultraviolet radiation exposure. The objective of the current study was to investigate associations between IT, tanning dependence, and psychiatric and substance use symptoms in young adult women. DESIGN Cross-sectional survey and psychiatric interview. SETTING Online, except for the Mini International Neuropsychiatric Interview (MINI), which was completed over the telephone. SUBJECTS Participants were 306 female university students aged 18 to 25 years. MEASURES MINI, Seasonal Scale Index, tanning dependence scales, reporting ever having used a tanning bed or booth with tanning lamps (single item), reporting smoking a cigarette in the last 30 days (single item). ANALYSIS Descriptive statistics, χ(2) analysis, multivariate logistic regression. RESULTS Forty-six percent of the sample reported a history of IT, and 25% were classified as tanning dependent. Multivariate logistic regression analyses showed that IT was significantly associated with symptoms of alcohol use disorders, generalized anxiety, and not having social anxiety. Tanning dependence was associated with symptoms of alcohol use disorders. CONCLUSION Tanning is of concern not only for its association with skin cancer but for its association with psychiatric and substance use symptoms. Young women with certain psychological problems may seek relief from their symptoms by IT. These findings suggest that indoor tanners may benefit from health behavior and other psychosocial interventions.
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Cohen L, Brown J, Haukness H, Walsh L, Robinson JK. Sun protection counseling by pediatricians has little effect on parent and child sun protection behavior. J Pediatr 2013; 162:381-6. [PMID: 22954897 PMCID: PMC3547152 DOI: 10.1016/j.jpeds.2012.07.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/15/2012] [Accepted: 07/19/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare counseling concerning sun protection and outdoor exercise with the parent's report of the behavior of a child aged 9-16 years old. STUDY DESIGN Structured interviews of medical personnel in 3 Chicago area practices elicited information about counseling methods and recommendations. In each practice, a convenience sample of parents completed a self-reported survey of their and their child's behavior. RESULTS Sun protection counseling occurred more frequently than exercise counseling in all practices (P = .014). Sun protection counseling was associated with parental prompting (P = .004), performing a summer camp physical (P = .002), and the child having a sunburn (P = .003). After controlling for the child's age, sex, and skin tone, sun protection counseling was not associated with the child's use of sun protection. In multivariate analysis of the child's sun protection behavior, parental sunburns, indoor tanning in the last 12 months, perception of skin cancer risk, and sun protection self-efficacy were significant (P = .02). Children who pursued outdoor sports were twice as likely to use inadequate sun protection and sustain sunburns (CI 1.3-1.7). CONCLUSIONS The child's sun protection behavior was influenced by parental sun protection, parental perception of skin cancer risk, and parental sun protection self-efficacy; therefore, sun protection for children needs to be aimed at parents as well as children. Communication with parents in a way that incorporates the principles of motivational interviewing may be more effective in promoting behavioral change than admonitions to use sunscreen.
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Affiliation(s)
- Liza Cohen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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35
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Day AK, Oxlad M, Roberts RM. Predictors of sun-related behaviors among young women: comparisons between outdoor tanners, fake tanners, and tan avoiders. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2013; 61:315-322. [PMID: 23930746 DOI: 10.1080/07448481.2013.806926] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Skin cancer incidence continues to rise as a tanned appearance remains desirable, particularly among young women. Fake tanning provides a tanned appearance without exposure to ultraviolet radiation. In order to advance our understanding of the factors that contribute to long-term behavior change, this study explores determinants associated with different types of tanning. PARTICIPANTS The sample included 162 female students from the University of Adelaide, Australia, aged 18-26 years. Data were collected in July 2010. METHODS The current study measured differences in skin type, skin cancer knowledge, unrealistic optimism, appearance motivation, and sun-protective and sun exposure behaviors amongst outdoor tanners, fake tanners, and tan avoiders through an online survey. RESULTS Differences were observed for skin type, skin cancer knowledge, unrealistic optimism, sun protection, and sun exposure. CONCLUSIONS A "one-size-fits-all" approach to skin cancer prevention may not be appropriate; type of tanning behavior may need to be considered in health promotion work.
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Affiliation(s)
- Ashley K Day
- School of Psychology , University of Adelaide, Adelaide, SA 5005, Australia.
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Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Natale-Pereira A, Goydos JS. Skin cancer surveillance behaviors among US Hispanic adults. J Am Acad Dermatol 2012. [PMID: 23182066 DOI: 10.1016/j.jaad.2012.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little skin cancer prevention research has focused on the US Hispanic population. OBJECTIVE This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. METHODS A population-based sample of 788 Hispanic adults residing in 5 southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. RESULTS The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. LIMITATIONS The cross-sectional design limits conclusions regarding the causal nature of observed associations. CONCLUSIONS Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors.
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Affiliation(s)
- Elliot J Coups
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey.
| | - Jerod L Stapleton
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shawna V Hudson
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey
| | | | | | - Marsha Gordon
- The Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ana Natale-Pereira
- Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - James S Goydos
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Janssen E, van Osch L, de Vries H, Lechner L. The influence of narrative risk communication on feelings of cancer risk. Br J Health Psychol 2012; 18:407-19. [PMID: 23025465 DOI: 10.1111/j.2044-8287.2012.02098.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/25/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evidence is accumulating for the importance of feelings of risk in explaining cancer preventive behaviours, but best practices for influencing these feelings are limited. The aim of this experimental study was to compare the effects of narrative and non-narrative risk communication about sunbed use on ease of imagination and feelings of cancer risk. DESIGN AND METHODS A total of 233 female sunbed users in the general Dutch population were randomly assigned to one of three conditions: a narrative message (i.e., personal testimonial), a non-narrative cognitive message (i.e., factual risk information using cognitive-laden words), or a non-narrative affective message (i.e., factual risk information using affective-laden words). Ease of imagination and feelings of risk were assessed directly after the risk information was given (T1). Three weeks after the baseline session, feelings of risk were measured again (T2). RESULTS The results revealed that sunbed users who were exposed to narrative risk information could better imagine themselves developing skin cancer and reported higher feelings of skin cancer risk at T1. Moreover, ease of imagination mediated the effects of message type on feelings of risk at T1 and T2. CONCLUSION The findings provide support for the effects of narrative risk communication in influencing feelings of cancer risk through ease of imagination. Cancer prevention programmes may therefore benefit from including narrative risk information. Future research is important to investigate other mechanisms of narrative information and their most effective content and format. STATEMENT OF CONTRIBUTION What is already known on this subject? Evidence is growing for the importance of feelings of risk in explaining cancer preventive behaviours. Narratives have increasingly been considered as an effective format for persuasive risk messages and studies have shown narrative risk communication to be effective in influencing cognitive risk beliefs. What does this study add? Increasing understanding of how feelings of cancer risk can be influenced since best practices for influencing these feelings are limited. Extending knowledge about the underlying mechanisms of narrative effects on feelings of cancer risk (i.e., the mediating role of ease of imagination) using a non-student sample. The findings provide support for the effects of narrative risk communication in influencing feelings of cancer risk through ease of imagination.
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Affiliation(s)
- Eva Janssen
- Department of Health Promotion, school CAPHRI, Maastricht University, the Netherlands.
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Buller DB, Cokkinides V, Hall HI, Hartman AM, Saraiya M, Miller E, Paddock L, Glanz K. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: Review from national surveys and case studies of 3 states. J Am Acad Dermatol 2011; 65:S114-23. [DOI: 10.1016/j.jaad.2011.05.033] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/26/2011] [Accepted: 05/19/2011] [Indexed: 02/08/2023]
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Dennis LK, Kancherla V, Snetselaar LG. Adolescent attitudes towards tanning: does age matter? PEDIATRIC HEALTH 2009; 3:565-578. [PMID: 22707979 PMCID: PMC3374604 DOI: 10.2217/phe.09.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Adolescents seem to be obsessed with tanning. One third of both adolescents and adults report sunbathing. On average, about 20% of adolescents report ever-using of artificial UV tanning devices with 15% currently using them. Tanning attitudes appear similar for adolescents and adults. The top three reasons for tanning included beliefs that a tan makes them more comfortable socializing with friends, looks better and is attractive. The top reason for using artificial UV tanning devices is also aesthetics, followed by relaxation. Other reasons for using artificial UV tanning devices include vacation preparation and to gain a protective base. Attitudes related to appearance that result in more frequent tanning may be difficult to change.
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Affiliation(s)
- Leslie K Dennis
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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