Aware, motivated and striving for a 'safe tan': an exploratory mixed-method study of sun-protection during holidays

Spatial clusters and temporal trends of cutaneous malignant melanoma mortality in Spain

OBJECTIVE

To analyse time trends in mortality due to cutaneous malignant melanoma (CMM) in Spain between 1980 and 2020, and to identify possible spatial clusters of provinces with an excess risk of CMM mortality during the period 2011-2020.

METHODS

Joinpoint regression models were used to assess temporal trends in data from the Spanish National Institute of Statistics. Crude rates, standardized mortality ratio (SMR), smoothed relative risk (RR), and posterior probabilities (PP) of RR >1 during the period 2011-2020 were calculated. The Global Moran I index was used to assess global spatial autocorrelation.

RESULTS

Two time-periods were detected in women: a significant increase during 1980-1994 (annual percent change [APC], 6.5% per year) and rate stabilization during 1994-2020 (nonsignificant APC, -0.17%). A similar pattern was observed in men, with three periods comprising a significant increase during 1980-1985 (APC, 16.59%), a slowing of the increase during 1985-1998 (APC, 4.40%), and stabilization during 1998-2020 (nonsignificant APC, 0.37%). Spatial analysis showed greater spatial heterogeneity with an east-north pattern in men compared with the pattern in women, which tended to be concentrated in north-western areas.

CONCLUSION

Mortality rates associated with CMM in Spain have remained stable in recent years. There were provincial clusters that exhibited an excess risk of mortality from CMM, with different patterns according to sex.

Is the threat of malignant melanoma in the UK still increasing? A comprehensive analysis of 30 years of historical data and Bayesian age-period-cohort model projections for 2030

Malignant melanoma, a highly aggressive skin cancer, though less common, significantly contributes to cancer-related mortality. In the UK, it is of growing concern with an aging population, making it crucial to analyze historical trends and forecast future burdens. We used Joinpoint regression and age-period-cohort models to analyze trends in incidence, prevalence, and mortality of malignant melanoma in the UK from 1990 to 2021. Bayesian age-period-cohort model was applied to predict the disease burden for different age groups by 2030. From 1991 to 2021, melanoma incidence and prevalence in the UK exhibited distinct temporal patterns: a significant upward trend until 2015, particularly pronounced in individuals aged 60 and older, followed by a downward trend after 2015. By 2030, incidence and prevalence are projected to decrease, particularly in younger and middle-aged populations, with incidence expected to fall from 20.78/100 000 in 2020 to 11.90/100 000, and prevalence from 167.80/100 000 to 80.13/100 000. Mortality is also expected to decrease. However, high-risk groups, especially those aged 85 and above, are predicted to maintain higher incidence and prevalence rates. Despite a historical rise, melanoma incidence, prevalence, and mortality have declined since 2015 and are projected to continue declining through 2030. However, the elderly population remains at higher risk, underscoring the need for targeted public health interventions.

Identification and validation of matrix metalloproteinase hub genes as potential biomarkers for Skin Cutaneous Melanoma

Objectives

The role of matrix metalloproteinases (MMPs) in Skin Cutaneous Melanoma (SKCM) development and progression is unclear so far. This comprehensive study delved into the intricate role of MMPs in SKCM development and progression.

Methods

RT-qPCR, bisulfite sequencing, and WES analyzed MMP gene expression, promoter methylation, and mutations in SKCM cell lines. TCGA datasets validated findings. DrugBank and molecular docking identified potential regulatory drugs, and cell line experiments confirmed the role of key MMP genes in tumorigenesis.

Results

Our findings unveiled significant up-regulation of MMP9, MMP12, MMP14, and MMP16, coupled with hypomethylation of their promoters in SKCM cell lines, implicating their involvement in disease progression. Mutational analysis highlighted a low frequency of mutations in these genes, indicating less involvement of mutations in the expression regulatory mechanisms. Prognostic assessments showcased a significant correlation between elevated expression of these genes and poor overall survival (OS) in SKCM patients. Additionally, functional experiments involving gene silencing revealed a potential impact on cellular proliferation, further emphasizing the significance of MMP9, MMP12, MMP14, and MMP16 in SKCM pathobiology.

Conclusion

This study identifies Estradiol and Calcitriol as potential drugs for modulating MMP expression in SKCM, highlighting MMP9, MMP12, MMP14, and MMP16 as key diagnostic and prognostic biomarkers.

Death Narratives, Negative Emotion, and Counterarguing: Testing Fear, Anger, and Sadness as Mechanisms of Effect

Narrative messaging research has demonstrated that story outcome (e.g., whether the main character lives or dies) can impact audience behavior, but more research explicating and testing mechanistic pathways is needed. The current study tests fear, anger, and sadness as mechanisms of persuasion, assessing effects on counterarguing, reading flow, and behavioral intention. The current study utilized a 2 (story outcome: death vs. survivor) × 4 (story character: Marla, Erin, Don, and Ray) between-participants experiment (N = 735) to test the effect of story outcome on behavioral intentions via discrete emotion. Death narratives generated greater fear, anger, and sadness. Fear was related to greater behavioral intention and reading flow and diminished counterarguing. Sadness had the opposite effect. Anger produced a mixed persuasive effect, increasing both counterarguing and reading flow. Results have implications for discrete emotions theorizing and underscore the importance of conceptualizing narrative stimuli along multiple affective dimensions rather than single dimensions.

Determinants of Sailors' Protective Behaviors in Fishing Spots against the Risks of Sunlight and Skin Cancer: A Qualitative Study in Iran

Introduction

The growing rate of nonmelanoma skin cancer (NMSC) and melanoma has been a great challenge for global health system. The present research aims to determine sailors' protective behaviors against the risks of sunlight and skin cancer in Iran.

Materials and Methods

The present research was qualitative in type, and its data were collected from August to December 2019. To this aim, 23 participants were recruited with whom semistructured interviews were held. The data collection continued until data saturation, and the interviews were coded in MAXQDA 10. Conventional content analysis was used to analyze the qualitative data.

Results

Analysis of sailors' perceptions and experiences revealed 7 categories: protective behaviors, hard personal and familial conditions, social interactions, poor social support, feeling of satisfaction, self-care, and fear.

Conclusion

Sailors are prone to skin cancer due to their specific work conditions. Perceptions and determinants of skin cancer and protective behaviors against sunlight were identified among sailors. Promotion of protective behaviors and beliefs that impeded preventive behaviors are among issues that require special attention.

Preventing Skin Cancer Among Staff and Guests at Seaside Hotels

Beach users and outdoor workers in resort areas are major risk groups for skin cancer, and therefore seaside hotels constitute a strategic area in which to conduct awareness-raising campaigns and interventions. The main aim of the present study is to describe habits, attitudes and knowledge related to sun exposure, the sunburn events experienced and potentially malignant skin lesions observed among hotel staff and guests recruited during a skin cancer prevention campaign at seaside hotels in the western Costa del Sol (southern Spain). This descriptive cross-sectional study was conducted at four seaside hotels in the western Costa del Sol. An 8-day awareness-raising campaign on skin cancer was conducted for hotel guests and staff, who were invited to complete a questionnaire about their habits, attitudes and knowledge regarding photoprotection, and to receive a comprehensive skin examination. The questionnaire on habits, attitudes and knowledge related to sun exposure was completed by 542 participants. The most common photoprotection practice was the use of sunglasses (79.3%). Potentially dangerous lesions were identified in 39 persons (14%). In addition, 94.0% reported having gained new knowledge, 89.6% had changed their attitudes towards sun tanning and 94.7% intended to improve their photoprotection practices in the future. Seaside hotels are an optimal scenario for conducting studies aimed at skin cancer prevention and reduction. Further studies should be carried out in other geographical areas to confirm our results, to evaluate the costs and benefits of such interventions and determine their long-term impact on health.

Evaluating perceived threat of skin cancer and preventive measures in South Iranian sailors: A qualitative study

BACKGROUND

Sailors are exposed to sunlight as their job requires and are, in the long run, more prone to different types of skin cancer. This study aimed to explore sailors' experience of perceived threat and to show protective behaviors against sunlight in the south of Iran.

MATERIALS AND METHODS

The present follows a qualitative approach and directed content analysis in 2018-2019 among sailors who were selected purposively through an interview procedure. Finally, 22 sailors and 3 patients with skin cancer with an experience of sailing were interviewed until data satiation occurred. The data were collected through a semi-structured interview based on two constructs, perceived susceptibility and perceived severity of protection motivation theory, and were instantly transcribed and read more than once by the present researcher. Simultaneously, the data were entered into MAXQDA 10 for the primary categorization.

RESULTS

Data analysis results were classified into 5 categories and 12 subcategories: protective attempts (change of work time and use of protectives), passivity in self-protection (not showing protective behaviors and not examining skin), inadequate perception of affliction risk (beliefs hindering preventive behaviors and low sensitivity), perceived threat to personal and familial conditions (loss of peace and loss of occupational-familial positions), and threat to health (incurable disease and perceived skin disease).

CONCLUSIONS

Awareness of these factors helps planners to choose the best preventive strategies with a focus on correcting beliefs and promoting protective behaviors as well as examining and screening sailors regularly to diagnose skin cancer. Moreover, to develop practical measures of protective strategies against sunlight among sailors, the required steps should be taken. This can help to reduce the rate of work-related risks while exposed to sunlight in this population.

Sun-protective behaviours of Turkish young adults

BACKGROUND

The prevalence of skin cancers, including melanoma, has increased significantly in the past five decades. The main environmental factor implicated in their development is excessive sun exposure. Data on sun-protective behaviours in the Turkish population are very limited.

OBJECTIVES

We aim to assess sun protection behaviours and the prevalence of exposure through broad participation among a young adult population in a national university in Turkey.

METHODS

A multiple-choice questionnaire including 27 questions to evaluate sun protection behaviours was sent to e-mail addresses of all undergraduates. From 40 000 undergraduates, 17 769 of them were included in the study, with a response rate of 44.4%.

RESULTS

Sunscreen usage was the most preferred sun protection method, used by 64% of the study population, followed by the use of sunglasses (60%), tending to remain in the shade (49%), the use of a hat (34%) and wearing long-sleeved clothing (23%). Forty-four percentage of the students used at least two methods, whereas 7% did not use any sun protection method. The prevalence rates of the use of sunscreen, sunglasses, wearing long-sleeved clothing and preferring to remain in the shade in the summer were all significantly higher among women. In addition, the prevalence rates of the use of sunscreen and preferring to remain in the shade were higher among students in the faculty of medicine.

CONCLUSION

We found that when compared to the countries with the highest incidences of skin cancer, such as Australia and the United States, young adults in Turkey are protecting themselves more from the sun. This rate was even higher among women and faculty of medicine undergrads.

'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer

BACKGROUND

Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks.

OBJECTIVES

To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs.

METHODS

Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis.

RESULTS

Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest.

CONCLUSIONS

Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.

Developing Behavior Change Interventions for Self-Management in Chronic Illness: An Integrative Overview

More people than ever are living longer with chronic conditions such as obesity, type 2 diabetes, and heart disease. Behavior change for effective self-management can improve health outcomes and quality of life in people living with such chronic illnesses. The science of developing behavior change interventions with impact for patients aims to optimize the reach, effectiveness, adoption, implementation, and maintenance of interventions and rigorous evaluation of outcomes and processes of behavior change. The development of new services and technologies offers opportunities to enhance the scope of delivery of interventions to support behavior change and self-management at scale. Herein, we review key contemporary approaches to intervention development, provide a critical overview, and integrate these approaches into a pragmatic, user-friendly framework to rigorously guide decision-making in behavior change intervention development. Moreover, we highlight novel emerging methods for rapid and agile intervention development. On-going progress in the science of intervention development is needed to remain in step with such new developments and to continue to leverage behavioral science's capacity to contribute to optimizing interventions, modify behavior, and facilitate self-management in individuals living with chronic illness.

Systematic and Iterative Development of a Smartphone App to Promote Sun-Protection Among Holidaymakers: Design of a Prototype and Results of Usability and Acceptability Testing

Background

Sunburn and intermittent exposure to ultraviolet rays are risk factors for melanoma. Sunburn is a common experience during holidays, making tourism settings of particular interest for skin cancer prevention. Holidaymakers are a volatile populations found at different locations, which may make them difficult to reach. Given the widespread use of smartphones, evidence suggests that this might be a novel, convenient, scalable, and feasible way of reaching the target population.

Objective

The main objective of this study was to describe and appraise the process of systematically developing a smartphone intervention (mISkin app) to promote sun-protection during holidays.

Methods

The iterative development process of the mISkin app was conducted over four sequential stages: (1) identify evidence on the most effective behavior change techniques (BCTs) used (active ingredients) as well as theoretical predictors and theories, (2) evidence-based intervention design, (3) co-design with users of the mISkin app prototype, and (4) refinement of the app. Each stage provided key findings that were subsequently used to inform the design of the mISkin app.

Results

The sequential approach to development integrates different strands of evidence to inform the design of an evidence-based intervention. A systematic review on previously tested interventions to promote sun-protection provided cues and constraints for the design of this intervention. The development and design of the mISkin app also incorporated other sources of information, such as other literature reviews and experts’ consultations. The developed prototype of the mISkin app was evaluated by engaging potential holidaymakers in the refinement and further development of the mISkin app through usability (ease-of-use) and acceptability testing of the intervention prototype. All 17 participants were satisfied with the mISkin prototype and expressed willingness to use it. Feedback on the app was integrated in the optimization process of the mISkin app.

Conclusions

The mISkin app was designed to promote sun-protection among holidaymakers and was based on current evidence, experts’ knowledge and experience, and user involvement. Based on user feedback, the app has been refined and a fully functional version is ready for formal testing in a feasibility pilot study.