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Wu YP, Stump TK, Hay JL, Buller DB, Jensen JD, Grossman D, Shen J, Haaland BA, Jones J, Tercyak KP. Protocol for a cluster-randomized trial of a school-based skin cancer preventive intervention for adolescents. Contemp Clin Trials 2024; 140:107494. [PMID: 38458557 PMCID: PMC11065585 DOI: 10.1016/j.cct.2024.107494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Adolescents infrequently use sun protection and engage in intentional tanning more frequently compared to other age groups, leading to increased ultraviolet radiation (UVR) exposure that heightens skin cancer risk across the lifespan. High schools are therefore an ideal setting for offering skin cancer preventive interventions. Yet, there are limited UVR protection interventions for high school students, especially those that are personalized, tested using randomized designs, and include long-term outcome assessment to determine the durability of intervention effects. METHOD The Sun-safe Habits Intervention and Education (SHINE) cluster-randomized trial will test a novel, personalized intervention that targets high school adolescents' sun protection and tanning behaviors, and tracks their outcomes for up to one year following intervention. Enrolled high schools will be randomized to receive either the personalized SHINE intervention, which includes facial UVR photographs and sun protection action planning, or standard education using publicly available materials. Students in both conditions will receive information about skin cancer, sun protection, and skin self-examination. Outcome variables will include students' sun protection and tanning behaviors and sunburn occurrence. Potential moderators (e.g., race/ethnicity) and mediators (e.g., self-efficacy) will also be assessed and tested. CONCLUSIONS This trial examines the efficacy of a personalized intervention targeting sun protection and tanning of high school students. The project will lead to new scientific understanding of the theoretical mechanisms underlying outcomes and moderators of the intervention effects, which will inform future intervention tailoring to meet the needs of vulnerable subgroups.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, 30 N. Mario Capecchi Dr., Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Tammy K Stump
- Department of Dermatology, University of Utah, 30 N. Mario Capecchi Dr., Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 220, Golden, CO 80401, USA.
| | - Jakob D Jensen
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Communication, University of Utah, Salt Lake City, UT, USA.
| | - Douglas Grossman
- Department of Dermatology, University of Utah, 30 N. Mario Capecchi Dr., Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jincheng Shen
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Benjamin A Haaland
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jacey Jones
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
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Cole SE, Hawkins M, Miller KA, Allen MW, Cockburn M. Correlation Between Objective Measures of Sun Exposure and Self‐reported Sun Protective Behavior and Attitudes in Predominantly Hispanic Youth. Photochem Photobiol 2022; 99:1037-1046. [DOI: 10.1111/php.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah E. Cole
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
| | - Makenzie Hawkins
- Department of Pediatrics University of Utah Salt Lake City UT United States
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles CA United States
| | - Martin W. Allen
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Department of Electrical and Computer Engineering University of Canterbury Christchurch New Zealand
| | - Myles Cockburn
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles CA United States
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Miller KA, Huh J, Piombo SE, Richardson JL, Harris SC, Peng DH, Cockburn MG. Sun protection changes among diverse elementary schoolchildren participating in a sun safety intervention: A latent transition analysis of a randomized controlled trial. Prev Med 2021; 149:106601. [PMID: 33971211 PMCID: PMC8195865 DOI: 10.1016/j.ypmed.2021.106601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
Children are a priority population for skin cancer prevention as excessive sun exposure in childhood increases the risk of melanoma in adulthood. The complexity of sun protective behaviors has posed measurement challenges for trials testing intervention efficacy. The current study evaluated a sun safety intervention for schoolchildren using latent transition analysis (LTA) to examine patterns of sun protection behaviors over time. A three-armed randomized controlled trial was conducted between 2012 and 2016 with two intervention groups (N = 3368) and an observation-only control group (N = 342) among 4th and 5th graders from 24 public schools in Los Angeles County. Both interventions conditions were grouped and compared to controls. Five self-reported sun protective behaviors were measured at baseline and three-month follow-up: use of sunscreen, long sleeves, long pants, hats, and shade seeking. Participants comprised 3710 schoolchildren, mean age 9 years, 47% female and 69% Latino. At baseline, four patterns of sun protection behaviors were found: children who engaged in 1) all sun protective behaviors; 2) few protective behaviors; 3) protective clothing and shade only; and 4) hats only. Children in the control group were likely to remain in their baseline status or transition to a less protective status at three-month follow-up. By contrast, 30% of children in the intervention group transitioned to a more protective status at follow-up. In this RCT of a sun safety intervention, children in the intervention transitioned to more protective behaviors compared to controls. Using LTA enriches understanding of intervention efficacy by modeling the complexity of sun protection behaviors over time. TRIAL REGISTRATION: School-based Randomized Trial of SunSmart Interventions, ClinicalTrials.gov Identifier: NCT04176237 https://clinicaltrials.gov/ct2/show/NCT04176237?cond=School-based+Randomized+Trial+of+SunSmart+Interventions&draw=2&rank=1.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America.
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Sarah E Piombo
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Susan C Harris
- Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States of America
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
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School-based interventions to improve sun-safe knowledge, attitudes and behaviors in childhood and adolescence: A systematic review. Prev Med 2021; 146:106459. [PMID: 33609617 DOI: 10.1016/j.ypmed.2021.106459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Ultraviolet radiation exposure is the leading cause of skin cancer, and childhood and adolescence is a particularly susceptible life period for exposure. This systematic review assessed whether interventions in elementary and secondary school settings reduced sun exposure, sunburns, and development of melanocytic nevi, and improved sun-safe knowledge, attitudes and sun protection behaviors in childhood and adolescence. A systematic search up to June 2020 of MEDLINE, Embase, CINAHL, Cochrane and ProQuest databases was undertaken, for studies conducted among students in an elementary or secondary school setting that compared an intervention group with a pre-intervention or separate control group. Data were summarized using qualitative synthesis. Pooled effects from meta-analysis with random effects were also reported where appropriate. Sixty-five studies were included (22 randomized, 43 non-randomized). Most studies assessed measures of sun-safe behaviors, knowledge and attitudes (57, 48 and 33 studies, respectively), and observed improved sun protection behaviors and sun-safe knowledge, whereas few studies reduced time in the sun. About half improved participants' attitudes towards tanning desirability. Sunburns and nevus counts were less frequently assessed, but about half of these studies observed a reduction. There was substantial heterogeneity for outcomes except attitudes towards the desirability of tanning (pooled odds ratio from 6 studies: 0.81, 95% confidence interval 0.70-0.94). Key positive intervention features included: elementary school settings, interactive features or multiple components, and incorporating social norm influences. Most studies were classified at high risk of bias. In conclusion, school-based sun-related interventions had positive impacts on behaviors and attitudes among elementary and secondary school children.
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Miller KA, Huh J, Unger JB, Richardson JL, Allen MW, Peng DH, Cockburn MG. Correlates of sun protection behaviors among Hispanic children residing in a high UVR environment. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 33:75-83. [PMID: 27995652 DOI: 10.1111/phpp.12287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND/PURPOSE Rates of melanoma are rising in Hispanics in the United States. Excessive sun exposure in childhood increases the risk of melanoma in adulthood, and little is known about the factors motivating sun protection behaviors among Hispanic youth. METHODS Correlates of sun protection were examined among Hispanic children residing in Los Angeles, California (N = 1891). Associations between multiple constructs (psychosocial, familial, and cultural) and sun protection outcomes (use of sunscreen, protective clothing, and shade seeking/sun avoidance) were examined. RESULTS Family variables were associated with more frequent sun protection among Hispanic children across outcomes, as were perceived peer norms, perceived self-efficacy, and fewer sun protection barriers. Skin cancer risk factors such as lighter skin and sunburn experience, and level of acculturation were not associated with greater sun protection. CONCLUSION Family sun protection habits are instrumental to Hispanic children's sun safe behaviors, and interventions that engage the family may be most effective. Increasing risk communication to high-risk subgroups of Hispanic children (those with lighter, more sun reactive skin) is important when developing intervention strategies. However, there is overlap between Hispanic children's sun protection correlates and those observed among non-Hispanic white children, suggesting that interventions to improve sun protection may generalize across cultural contexts.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Martin W Allen
- Department of Electrical and Computer Engineering, MacDiarmid Institute for Advanced Materials and Nanotechnology, University of Canterbury, Christchurch, New Zealand
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Razi S, Enayatrad M, Mohammadian-Hafshejani A, Salehiniya H, Fathali-Loy-Dizaji M, Soltani S. The Epidemiology of Skin Cancer and its Trend in Iran. Int J Prev Med 2015; 6:64. [PMID: 26288708 PMCID: PMC4521305 DOI: 10.4103/2008-7802.161074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/21/2015] [Indexed: 01/30/2023] Open
Abstract
Background: One of the most common cancers is skin cancer worldwide. Since incidence and cost of treatment of the cancer are increasing, it is necessary to further investigate to prevent and control this disease. This study aimed to determine skin cancer trend and epidemiology in Iran. Methods: This study was done based on existing data. Data used in this study were obtained from a national registry of cancer cases and the Disease Management Center of Ministry of Health in Iran. All cases registered in the country were included during 2004–2008. Incidence rates were reported based on the direct method and standard population of World Health Organization. Results: Based on the results of this study, the incidence of skin cancer is rising in Iran and the sex ratio was more in men than women in all provinces. The age-standardized incidence rate (ASR) of skin cancer was highest in males in Semnan, Isfahan, and Hamedan provinces (34.9, 30.80, and 28.84, respectively). The highest ASRs were seen in females in Semnan, Yazd, and Isfahan provinces (26.7, 24.14, and 18.97, respectively). The lowest ASR in male was observed in Sistan and Baluchestan, and in female in Hormozgan provinces. Conclusions: The incidence of skin cancer is increasing in the country. Therefore, the plan for the control and prevention of this cancer must be a high priority for health policy makers.
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Affiliation(s)
- Saeid Razi
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mostafa Enayatrad
- Department of Epidemiology and Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamid Salehiniya
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahin Soltani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Razi S, Rafiemanesh H, Ghoncheh M, Khani Y, Salehiniya H. Changing Trends of Types of Skin Cancer in Iran. Asian Pac J Cancer Prev 2015; 16:4955-8. [DOI: 10.7314/apjcp.2015.16.12.4955] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Miller KA, Langholz BM, Ly T, Harris SC, Richardson JL, Peng DH, Cockburn MG. SunSmart: evaluation of a pilot school-based sun protection intervention in Hispanic early adolescents. HEALTH EDUCATION RESEARCH 2015; 30:371-379. [PMID: 25801103 PMCID: PMC4434952 DOI: 10.1093/her/cyv011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
The incidence of melanoma is rising among Hispanic populations in the United States. The purpose of this study is to evaluate the impact of a pilot sun safety educational intervention conducted from 2006 to 2012 on Hispanic early adolescents in a high ultraviolet environment. Nineteen schools with high Hispanic enrollment were recruited from urban neighborhoods in Los Angeles. The analytic sample was restricted to students identifying as Hispanic or Latino (n = 777). A mixed effects linear model was used to test mean changes from pre- to posttest on students' sun protection knowledge, attitudes and behaviors. Significant improvements were observed across several cognitive outcomes related to sun protection, including knowledge of and attitudes toward sun protection and self-efficacy to wear sunscreen. However, changes in sun protective behaviors were not achieved. Although some improvements were observed, future studies should identify the factors that motivate sun protection in this population and develop tailored prevention strategies, as improving the sun safe behaviors of Hispanic youths may aid in reducing the risk of melanoma in adulthood in this population.
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Affiliation(s)
- K A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - B M Langholz
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - T Ly
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - S C Harris
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - J L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - D H Peng
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - M G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
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Hingle MD, Snyder AL, McKenzie NE, Thomson CA, Logan RA, Ellison EA, Koch SM, Harris RB. Effects of a short messaging service-based skin cancer prevention campaign in adolescents. Am J Prev Med 2014; 47:617-23. [PMID: 25053602 PMCID: PMC4205167 DOI: 10.1016/j.amepre.2014.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/13/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages. PURPOSE To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents. METHODS The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11-14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety-themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests. RESULTS Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends. CONCLUSIONS A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects.
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Affiliation(s)
- Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona.
| | - Aimee L Snyder
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Naja E McKenzie
- Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | | | - Eden A Ellison
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Stephanie M Koch
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Robin B Harris
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
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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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Sun-protection habits of primary students in a coastal area of Greece. J Skin Cancer 2012; 2012:629652. [PMID: 23091726 PMCID: PMC3467799 DOI: 10.1155/2012/629652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/23/2012] [Accepted: 09/03/2012] [Indexed: 11/24/2022] Open
Abstract
Aim. The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1) years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set to P ≤ 0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0–5 km away from the sea (urban area), 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.
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Allinson S, Asmuss M, Baldermann C, Bentzen J, Buller D, Gerber N, Green AC, Greinert R, Kimlin M, Kunrath J, Matthes R, Pölzl-Viol C, Rehfuess E, Rossmann C, Schüz N, Sinclair C, van Deventer E, Webb A, Weiss W, Ziegelberger G. Validity and use of the UV index: report from the UVI working group, Schloss Hohenkammer, Germany, 5-7 December 2011. HEALTH PHYSICS 2012; 103:301-306. [PMID: 22850235 DOI: 10.1097/hp0b013e31825b581e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The adequacy of the UV Index (UVI), a simple measure of ambient solar ultraviolet (UV) radiation, has been questioned on the basis of recent scientific data on the importance of vitamin D for human health, the mutagenic capacity of radiation in the UVA wavelength, and limitations in the behavioral impact of the UVI as a public awareness tool. A working group convened by ICNIRP and WHO met to assess whether modifications of the UVI were warranted and to discuss ways of improving its effectiveness as a guide to healthy sun-protective behavior. A UV Index greater than 3 was confirmed as indicating ambient UV levels at which harmful sun exposure and sunburns could occur and hence as the threshold for promoting preventive messages. There is currently insufficient evidence about the quantitative relationship of sun exposure, vitamin D, and human health to include vitamin D considerations in sun protection recommendations. The role of UVA in sunlight-induced dermal immunosuppression and DNA damage was acknowledged, but the contribution of UVA to skin carcinogenesis could not be quantified precisely. As ambient UVA and UVB levels mostly vary in parallel in real life situations, any minor modification of the UVI weighting function with respect to UVA-induced skin cancer would not be expected to have a significant impact on the UV Index. Though it has been shown that the UV Index can raise awareness of the risk of UV radiation to some extent, the UVI does not appear to change attitudes to sun protection or behavior in the way it is presently used. Changes in the UVI itself were not warranted based on these findings, but rather research testing health behavior models, including the roles of self-efficacy and self-affirmation in relation to intention to use sun protection among different susceptible groups, should be carried out to develop more successful strategies toward improving sun protection behavior.
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Schüz N, Eid M. Beyond the usual suspects: target group- and behavior-specific factors add to a theory-based sun protection intervention for teenagers. J Behav Med 2012; 36:508-19. [DOI: 10.1007/s10865-012-9445-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
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Jerant A, Franks P, Kravitz RL. Associations between pain control self-efficacy, self-efficacy for communicating with physicians, and subsequent pain severity among cancer patients. PATIENT EDUCATION AND COUNSELING 2011; 85:275-280. [PMID: 21159483 DOI: 10.1016/j.pec.2010.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 10/21/2010] [Accepted: 11/21/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Coaching patients to be more active in health encounters may improve communication with physicians but does not necessarily improve health outcomes. We explored this discrepancy by examining relationships between self-efficacy for communicating with physicians and pain control self-efficacy and subsequent pain severity among cancer patients participating in a coaching trial. METHODS We analyzed data from 244 English-speaking adults with various cancer types reporting significant pain, recruited from 49 oncology physicians' offices. Mixed model linear regression examined relationships between post-intervention communication self-efficacy and pain control self-efficacy and subsequent pain severity over 12 weeks. RESULTS Post-intervention pain control self-efficacy (but not communication self-efficacy) was significantly related to subsequent pain severity: a one standard deviation increase was associated with a 0.19 point decrease (95% confidence interval=-0.33, -0.04; p=0.01) in pain severity over time, approximately 25% of the effect size of the influence of post-intervention pain on subsequent pain. CONCLUSION Among cancer patients enrolled in a coaching trial, post-intervention pain control self-efficacy, but not communication self-efficacy, was significantly related to subsequent pain severity. PRACTICE IMPLICATIONS Identifying behavioral mediators of cancer pain severity may lead to coaching interventions that are more effective in improving cancer pain control.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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15
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Risk perception moderates how intentions are translated into sunscreen use. J Behav Med 2010; 33:392-8. [DOI: 10.1007/s10865-010-9269-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
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Johnson KM, Jones SC, Iverson D. Guidelines for the development of social marketing programmes for sun protection among adolescents and young adults. Public Health 2009; 123 Suppl 1:e6-10. [PMID: 19748644 DOI: 10.1016/j.puhe.2009.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 06/09/2009] [Accepted: 06/29/2009] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To formulate 'best practice' guidelines for social marketing programmes for adolescents' and young adults' sun protection. STUDY DESIGN A Delphi consensus process. METHODS Eleven experts in sun protection and social marketing participated in a Delphi consensus process, where they were asked to provide up to 10 key points, based on their knowledge and practical experience, which they felt were most important in developing social marketing interventions for the primary prevention of skin cancer among adolescents and young adults. After reaching consensus, the evidence base for each guideline was determined and graded via the Scottish Intercollegiate Guideline Network grading system. Participants were then asked to indicate how strongly they rated the finalized 15 recommendations based on all aspects relating to their knowledge and practical opinion, as well as the research evidence, on a visual analogue scale. RESULTS The resultant 15 guidelines offer general principles for sun protection interventions utilizing a social marketing approach. CONCLUSIONS This method of guideline development brought the expertise of practitioners to the forefront of guideline development, whilst still utilizing established methods of evidence confirmation. It thus offers a useful method for guideline development in a public health context.
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Affiliation(s)
- K M Johnson
- Centre for Health Initiatives, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
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Reynolds KD, Buller DB, Yaroch AL, Maloy J, Geno CR, Cutter GR. Effects of program exposure and engagement with tailored prevention communication on sun protection by young adolescents. JOURNAL OF HEALTH COMMUNICATION 2008; 13:619-636. [PMID: 18958776 PMCID: PMC4278428 DOI: 10.1080/10810730802412149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Few family-based interventions to increase sun safe behavior among adolescents have been evaluated. The present study tested an intervention that included tailored and nontailored print communications delivered by mail to adolescents (age 11 to 15) and their parents who were also participating in an evaluation of an in-school intervention. The use of sunscreen, protective clothing, and avoidance of the sun were promoted, and family communication and environmental change strategies were fostered. Adolescents and their parents were pretested in May of 2002 and posttested from August to October. Adolescents (N = 599) were stratified on experimental condition in the in-school study (in-school intervention vs control) and randomly were assigned from within strata to receive (N = 288) or not receive (N = 311) the summer intervention materials. No statistically significant effects were found for adolescents between the randomized experimental conditions. Parents' had increased knowledge (F = 5.52, p < .05) and propensity to have their child wear sunglasses (F = 4.07, p < .05). Greater program exposure/engagement led to enhanced sun protection behavior (e.g., fewer sunburns) and psychosocial factors among adolescents and parents. Greater exposure/engagement led to improvements in family interaction and home environment (e.g., shade audit completed). Future research is needed on exposure/engagement with family-based health messaging and on family-based sun safety programs for adolescents.
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Affiliation(s)
- Kim D Reynolds
- Claremont Graduate University, Claremont, California, USA.
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Abstract
AIM To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention. DESIGN The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants randomized to either an enhanced intervention condition or a basic information-only control condition. SETTING Internet in US and Canada. PARTICIPANTS Our secondary analyses focused upon 402 participants who visited the web-based program at least once, whose baseline self-efficacy rating showed room for improvement, who reported that they were still using tobacco at the 6-week assessment, and for whom both 3- and 6-month follow-up data were available. INTERVENTION An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text, interactive activities, testimonial videos and an ask-an-expert forum and a peer forum. The basic control condition delivered tobacco cessation content using static text only. MEASUREMENTS Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up. FINDINGS While both participant self-efficacy and program exposure satisfied the requirements for simple mediation, only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation. CONCLUSIONS Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention. While program exposure was found to be a simple mediator of tobacco abstinence, it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex, possibly reciprocal relationship with the tobacco abstinence outcome. Our results underscore the utility of searching for mediators in research on web-based interventions.
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Andreeva VA, Reynolds KD, Buller DB, Chou CP, Yaroch AL. Concurrent psychosocial predictors of sun safety among middle school youth. THE JOURNAL OF SCHOOL HEALTH 2008; 78:374-81; quiz 408-10. [PMID: 18611212 PMCID: PMC2921699 DOI: 10.1111/j.1746-1561.2008.00317.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Sun-induced skin damage, which increases skin cancer risk, is initiated in early life and promoted through later sun exposure patterns. If sun safety determinants are well understood and addressed during the school years, skin cancer incidence might be reduced. This study tested psychosocial influences on youth's sun safety and assessed their strength within and across gender and ethnicity in a sample of 1782 middle school students. METHODS Predictors included sunburn and skin cancer knowledge, tanning attitudes, peer norms, and barriers regarding sun exposure and were assessed with a self-administered, validated questionnaire. The hypothesized relationships were tested with structural equation models and confirmed with multilevel regression. RESULTS Across gender and ethnicity, knowledge emerged as an important sun safety predictor with both direct and indirect effects mediated through tanning attitudes. The relationship with barriers did not reach statistical significance within any of the subgroups, possibly due to measurement limitations. An indirect effect of peer norms on sun safety, mediated through tanning attitudes, was confirmed only among girls. Also, an indication that peer norms operate differently within the ethnic groups was found, since this predictor had a statistically significantly stronger relationship with sun safety among non-Hispanics. CONCLUSIONS Youth's sun safety is a multifactorial practice, partially determined by ethnicity- and gender-based standards. In order to ensure health-promoting school environments, needed are multicomponent programs where peer norms and knowledge are salient and where sun safety is addressed individually and together with other health risk behaviors.
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Affiliation(s)
- Valentina A. Andreeva
- Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1000 S Fremont Ave, Alhambra, CA 91803
| | - Kim D. Reynolds
- Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1000 S Fremont Ave, Alhambra, CA 91803
| | - David B. Buller
- Klein Buendel, Inc., 1667 Cole Blvd, Suite 225, Golden, CO 80401
| | - Chih-Ping Chou
- Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1000 S Fremont Ave, Alhambra, CA 91803
| | - Amy L. Yaroch
- Health Promotion Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Rm 4074/MSC 7335, Bethesda, MD 20892
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Buller DB, Buller MK, Reynolds KD. A survey of sun protection policy and education in secondary schools. J Am Acad Dermatol 2006; 54:427-32. [PMID: 16488293 PMCID: PMC1448612 DOI: 10.1016/j.jaad.2005.11.1030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 10/24/2005] [Accepted: 11/01/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) issued recommendations for school programs to reduce skin cancer. OBJECTIVE Personnel at US secondary schools were surveyed to describe sun protection policy and education before the CDC recommendations. METHODS School principals or other personnel at 484 secondary schools in 27 cities responded to a telephone survey in January and February 2002 (response rate = 31%). RESULTS A sun protection policy was reported at 10% of the schools, but sun protection education occurred at nearly all schools (96%). Policies were more prevalent in regions with high ultraviolet radiation (P < .0001), but education was not. Many personnel were willing to adopt a policy (41%) and interested in obtaining a sun safety curriculum (96%). LIMITATIONS Self-report measures, nonresponse, and new schools not in the sampling frame. CONCLUSION Sun protection was a low policy priority for US schools. Sun safety education was prevalent, but written materials were used infrequently. A substantial proportion of school personnel were receptive to the CDC's advice.
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Buller DB, Reynolds KD, Yaroch A, Cutter GR, Hines JM, Geno CR, Maloy JA, Brown M, Woodall WG, Grandpre J. Effects of the Sunny Days, Healthy Ways curriculum on students in grades 6 to 8. Am J Prev Med 2006; 30:13-22. [PMID: 16414419 PMCID: PMC1448611 DOI: 10.1016/j.amepre.2005.08.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 07/20/2005] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND There are few effective sun-safety education programs for use in secondary schools. Project aims were to create a sun-safety curriculum for grades 6 to 8, and to test whether exposure to the curriculum would increase children's sun-protection behavior. DESIGN A pair-matched, group-randomized, pre--post test, controlled trial was performed with middle schools as the unit of randomization. Teachers implemented the six-unit sun-safety curriculum in 2001-2003, and analyses were performed in 2003-2004. SETTING/PARTICIPANTS A total of 2038 children from 30 middle schools in Colorado, New Mexico, and Arizona. MAIN OUTCOME MEASURES Self-reported sun-protection behavior using frequency ratings and diary. RESULTS Compared to control schools, children receiving the curriculum reported more frequent sun protection (p=0.0035), and a greater proportion wore long-sleeved shirts during recess (p<0.0001) and applied sunscreen (p<0.0001). Exposure to the curriculum improved knowledge (p<0.0001), decreased perceived barriers to using sunscreen (p=0.0046), enhanced self-efficacy expectations (p=0.0577) about sun safety, and reduced favorable attitudes toward sun tanning (p=0.0026 to <0.0001). In intent-to-treat analyses, the treatment effect was eliminated only under the most conservative assumptions about dropouts. CONCLUSIONS Educational approaches to sun safety in middle school may be effective for improving children's sun safety. Potential trial limitations include measuring short-term outcomes, focusing on young adolescents, using active parental consent, and testing in the American Southwest.
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