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Heckman CJ, Mitarotondo A, Lin Y, Khavjou O, Riley M, Manne SL, Yaroch AL, Niu Z, Glanz K. Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial. J Med Internet Res 2024; 26:e55831. [PMID: 38954433 PMCID: PMC11252624 DOI: 10.2196/55831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations. OBJECTIVE This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer. METHODS This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn. RESULTS The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant. CONCLUSIONS The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed). TRIAL REGISTRATION ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492.
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Affiliation(s)
| | | | - Yong Lin
- Rutgers School of Public Health, Piscataway, NJ, United States
| | - Olga Khavjou
- RTI International, Research Triangle Park, NC, United States
| | | | - Sharon L Manne
- Rutgers Cancer Institute, New Brunswick, NJ, United States
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Zhaomeng Niu
- Rutgers School of Health Professions, Piscataway, NJ, United States
| | - Karen Glanz
- University of Pennsylvania, Philadelphia, PA, United States
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2
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Knipping S, Ter Haar E, Alkemade H, Bronkhorst E, Falk M, Hueskes K, Nij Bijvank C, Spillekom-van Koulil S, Lubeek S. Translation and Validation of the Dutch Version of the Sun Exposure and Protection Index. Dermatology 2023; 240:282-290. [PMID: 38011834 PMCID: PMC10997267 DOI: 10.1159/000535510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the person's propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research. METHODS Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer - Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearman's Rho. Internal consistency was assessed with Cronbach's Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out 3 weeks later, and scores were compared with Cohen's weighted Kappa. RESULTS Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76). CONCLUSION In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usages in daily clinical practice and research to evaluate individual ultraviolet exposure and measure a person's propensity to limit it.
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Affiliation(s)
- Sofie Knipping
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands,
| | - Elke Ter Haar
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Alkemade
- Department of Dermatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Magnus Falk
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kevin Hueskes
- General Practitioner's Office, Health Center Hazenkamp, Nijmegen, The Netherlands
| | - Carla Nij Bijvank
- General Practitioner's Office, Health Center De Vuursteen, Molenhoek, The Netherlands
| | | | - Satish Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Diver WR, Figueiro MG, Rea MS, Hodge JM, Flanders WD, Zhong C, Patel AV, Gapstur SM. Evaluation of a Novel Ambient Light Survey Question in the Cancer Prevention Study-3. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3658. [PMID: 36834353 PMCID: PMC9959116 DOI: 10.3390/ijerph20043658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/17/2023]
Abstract
Nighttime light exposure may increase cancer risk by disrupting the circadian system. However, there is no well-established survey method for measuring ambient light. In the Cancer Prevention Study-3, 732 men and women answered a light survey based on seven environments. The light environment in the past year was assessed twice, one year apart, and four one-week diaries were collected between the annual surveys. A total of 170 participants wore a meter to measure photopic illuminance and circadian stimulus (CS). Illuminance and CS values were estimated for lighting environments from measured values and evaluated with a cross validation approach. The kappas for self-reported light environment comparing the two annual surveys were 0.61 on workdays and 0.49 on non-workdays. Kappas comparing the annual survey to weekly diaries were 0.71 and 0.57 for work and non-workdays, respectively. Agreement was highest for reporting of darkness (95.3%), non-residential light (86.5%), and household light (75.6%) on workdays. Measured illuminance and CS identified three peaks of light (darkness, indoor lighting, and outdoor daytime light). Estimated illuminance and CS were correlated with the measured values overall (r = 0.77 and r = 0.67, respectively) but were less correlated within each light environment (r = 0.23-0.43). The survey has good validity to assess ambient light for studies of human health.
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Affiliation(s)
- W. Ryan Diver
- Department of Population Science, American Cancer Society, Kennesaw, GA 30144, USA
| | - Mariana G. Figueiro
- Light and Health Research Center, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10025, USA
| | - Mark S. Rea
- Light and Health Research Center, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10025, USA
| | - James M. Hodge
- Department of Population Science, American Cancer Society, Kennesaw, GA 30144, USA
| | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Charlie Zhong
- Department of Population Science, American Cancer Society, Kennesaw, GA 30144, USA
| | - Alpa V. Patel
- Department of Population Science, American Cancer Society, Kennesaw, GA 30144, USA
| | - Susan M. Gapstur
- Department of Population Science, American Cancer Society, Kennesaw, GA 30144, USA
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4
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Zhang R, Smit AK, Espinoza D, Allen M, Reyes-Marcelino G, Kimlin MG, Lo SN, Sharman AR, Law MH, Kanetsky PA, Mann GJ, Cust AE. Validation of self-reported sun exposure against electronic ultraviolet radiation dosimeters. Int J Epidemiol 2023; 52:324-328. [PMID: 36153755 DOI: 10.1093/ije/dyac179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/14/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ran Zhang
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Amelia K Smit
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Allen
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand
| | - Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Michael G Kimlin
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Ashleigh R Sharman
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland University of Technology (QUT), Brisbane, Australia
| | | | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, ANU, Canberra, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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5
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Soueid L, Triguero-Mas M, Dalmau A, Barrera-Gómez J, Alonso L, Basagaña X, Thieden E, Wulf HC, Diffey B, Young AR, Nieuwenhuijsen M, Dadvand P. Estimating personal solar ultraviolet radiation exposure through time spent outdoors, ambient levels and modelling approaches. Br J Dermatol 2021; 186:266-273. [PMID: 34403140 DOI: 10.1111/bjd.20703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence on validation of surrogates applied to evaluate the personal exposure levels of solar ultraviolet radiation (UVR) in epidemiological studies is scarce. OBJECTIVES To determine and compare the validity of three approaches, including (i) ambient UVR levels, (ii) time spent outdoors, and (iii) a modelling approach integrating the aforementioned parameters, to estimate personal UVR exposure over a period of six months among indoor and outdoor workers and in different seasons (summer/winter). METHODS This validation study was part of the EU ICEPURE project and was performed between July 2010 and January 2011 in a convenience sample of indoor and outdoor workers in Catalunya - Spain. We developed linear regression models to quantify the variation in the objectively measured personal UVR exposure that could be explained, separately, by the ambient UVR, time spent outdoors, and modelled UVR levels. RESULTS Our 39 participants - mostly male and with a median age of 35 years- presented a median daily objectively measured UVR of 0.37 standard erythemal doses (SEDs). The UVR dose was statistically significantly higher in summer and for outdoor workers. The modelled personal UVR exposure and self-reported time spent outdoors could reasonably predict the variation in the objectively measured personal UVR levels (R2 = (0.75, 0.79)), whereas ambient UVR was a poor predictor (R2 =0.21). No notable differences were found between seasons or occupation. CONCLUSIONS Time outdoors and our modelling approach were reliable predictors and of value to be applied in epidemiological studies of the health effects of current exposure to UVR.
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Affiliation(s)
- L Soueid
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Triguero-Mas
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Lab for Urban Environmental Justice and Sustainability, Barcelona, Spain.,Institute of Environmental Science and Technology, ICTA-UAB), Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - A Dalmau
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - J Barrera-Gómez
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Alonso
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - X Basagaña
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - E Thieden
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - H C Wulf
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - B Diffey
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England, UK
| | - A R Young
- King's College London, St John´s Institute of Dermatology, London, United Kingdom
| | - M Nieuwenhuijsen
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - P Dadvand
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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6
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Behavioral and Psychological Outcomes Associated with Skin Cancer Genetic Testing in Albuquerque Primary Care. Cancers (Basel) 2021; 13:cancers13164053. [PMID: 34439206 PMCID: PMC8394482 DOI: 10.3390/cancers13164053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Genetic information is publicly available but research examining the best use of such information has not engaged diverse members of the public. We examined public reactions to melanoma genetic testing (using the melanocortin-1 receptor [MC1R] gene) in a study randomizing (like the flip of a coin) 600 diverse primary care patients to a MC1R test offer or usual care. We found that testing did not improve sun protection and skin cancer screening, nor did it lead worry to increase. However, groups less aware of their skin cancer risk, including those who thought their risk was “unlikely” at the start of the study, showed significant improvements in sun protection at three months. In conclusion, testing might be very helpful for certain people who have the most to learn about their risk, who may become motivated to protect themselves from the damaging effects of the sun as a result of skin cancer genetic testing. Abstract Public availability of genetic information is increasing; thus, efforts to improve diversity in basic and translational research in genomics is a top priority. Given the increasing U.S. incidence and mortality of melanoma, and the prevalence of common melanocortin-1 receptor (MC1R) gene melanoma risk variants in the general population, we examined genomic testing of MC1R for skin cancer risk in a randomized controlled trial in Albuquerque, New Mexico primary care. Participants were 48% Hispanic and were randomized 5:1 to a MC1R test invitation or usual care. We assessed 3 month sun protection, skin cancer screening, and skin cancer worry outcomes associated with testing, and key effect moderators (e.g., cancer risk perceptions, and skin cancer risk factors). Our findings indicate that the primary outcomes were unchanged by the MC1R test offer, test acceptance, and level of risk feedback. Moderator analyses showed that those with lower risk perception, and those with skin that readily tans, significantly increased their sun protection in response to higher than average risk feedback. Risk feedback did not prompt cancer worry, and average risk feedback did not erode existing sun protection. This study paves the way for the development of tailored strategies to address low skin cancer risk awareness in this understudied context of public health genomics.
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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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8
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Haynes A, Nathan A, Maitland C, Dixon H, Nicholson A, Wakefield M, Dobbinson S. Prevalence and Correlates of Observed Sun Protection Behaviors Across Different Public Outdoor Settings in Melbourne, Australia. HEALTH EDUCATION & BEHAVIOR 2021; 49:405-414. [PMID: 34238043 DOI: 10.1177/10901981211026535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Skin cancer prevention efforts in Australia have increasingly incorporated a focus on protection during incidental sun exposure. This complements the long-present messages promoting protection in high-risk settings and avoidance of acute intense bouts of sun exposure. Data from two waves of a cross-sectional direct observational survey was used to assess the prevalence and correlates of N = 12,083 adolescents' and adults' sun protection behavior (arm and leg cover, hat, sunglasses, and shade cover). Individuals were observed in public outdoor settings in Melbourne, Australia during peak ultraviolet (UV) times (11 a.m.-3 p.m.) on summer weekends. Settings included pools and beaches, parks and gardens, and for the first time in 2018, outdoor streets and cafés which may capture more incidental forms of sun exposure and represent another public setting where Australians commonly spend time outdoors. Females and older adults were consistently better protected than males and adolescents. Physical activity was strongly associated with low shade cover across settings. Weather was more strongly associated with sun protection at outdoor streets/cafes and parks/gardens than at pools/beaches but use of observed sun protection (particularly arm cover and covering hat) was low across settings. Continued public education about UV risk and its relation to weather and the seasons is needed to promote the routine use of multiple forms of sun protection during outdoor activities in peak UV times, especially among males and adolescents. Findings also highlight the importance of considering activity demands of public spaces in shade planning to optimize sun protection during outdoor activities in public spaces.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Andrea Nathan
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia
| | - Clover Maitland
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anna Nicholson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Suzanne Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
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9
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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: 7] [Impact Index Per Article: 2.3] [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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10
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Liew AYS, Cust AE. Changes in sun protection behaviours, sun exposure and shade availability among adults, children and adolescents in New South Wales, 2003-2016. Aust N Z J Public Health 2021; 45:462-468. [PMID: 34028925 DOI: 10.1111/1753-6405.13112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To inform skin cancer prevention policies and campaigns, we investigated changes over time in sun protection behaviours, sunburn, sun exposure and shade availability in public spaces among people living in New South Wales (NSW), Australia, between 2003 and 2016. METHODS We analysed cross-sectional data from the NSW Population Health Survey collected in 2003, 2007, 2014 and 2016, which included approximately 15,000 respondents of all ages in each year. Logistic regression models were used to analyse overall changes over time and for different age, sex and sociodemographic groups. RESULTS The use of sunscreen and protective clothing and the availability of shade increased between 2003 and 2016, but sunburn and sun exposure during peak times of ultraviolet radiation also increased. In subgroup analyses, there was no improvement in sun protection behaviours among adolescents and increases in sunburn and sun exposure were observed only among adults, particularly women and in areas with less social disadvantage. CONCLUSIONS Sun protection behaviours have improved over time among some population subgroups, but over-exposure to ultraviolet radiation remains prevalent. Implications for public health: Skin cancer prevention initiatives that specifically target adolescents and sun exposure during peak times are needed to help reduce population skin cancer risk.
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Affiliation(s)
- Andre Ying-Song Liew
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Anne E Cust
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW.,Melanoma Institute Australia, The University of Sydney, New South Wales
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11
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Time spent outdoors in childhood is associated with reduced risk of myopia as an adult. Sci Rep 2021; 11:6337. [PMID: 33737652 PMCID: PMC7973740 DOI: 10.1038/s41598-021-85825-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Myopia (near-sightedness) is an important public health issue. Spending more time outdoors can prevent myopia but the long-term association between this exposure and myopia has not been well characterised. We investigated the relationship between time spent outdoors in childhood, adolescence and young adulthood and risk of myopia in young adulthood. The Kidskin Young Adult Myopia Study (KYAMS) was a follow-up of the Kidskin Study, a sun exposure-intervention study of 1776 children aged 6–12 years. Myopia status was assessed in 303 (17.6%) KYAMS participants (aged 25–30 years) and several subjective and objective measures of time spent outdoors were collected in childhood (8–12 years) and adulthood. Index measures of total, childhood and recent time spent outdoors were developed using confirmatory factor analysis. Logistic regression was used to assess the association between a 0.1-unit change in the time outdoor indices and risk of myopia after adjusting for sex, education, outdoor occupation, parental myopia, parental education, ancestry and Kidskin Study intervention group. Spending more time outdoors during childhood was associated with reduced risk of myopia in young adulthood (multivariable odds ratio [OR] 0.82, 95% confidence interval [CI] 0.69, 0.98). Spending more time outdoors in later adolescence and young adulthood was associated with reduced risk of late-onset myopia (≥ 15 years of age, multivariable OR 0.79, 95% CI 0.64, 0.98). Spending more time outdoors in both childhood and adolescence was associated with less myopia in young adulthood.
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Abstract
During leisure time, people can decide if they want to expose themselves to solar ultraviolet (UV) radiation and to what extent. While working, people do not have this choice. Outdoor workers are exposed to solar UV radiation (UVR) on a daily basis. This may pose a certain health risk, which can be estimated when the personal solar UVR exposure (PE) is known. During past decades, a variety of studies were conducted to measure PE of outdoor workers and our knowledge of the PE of outdoor workers has increased remarkably. As shown by this review, studies clearly indicate that PE of most outdoor workers exceeds the internationally proposed threshold limit value, which is comparable to 1.0 to 1.3 standard erythema dose (SED), respectively, to 1.1 to 1.5 UV Index received over one hour. Besides working in a high UVR environ, monotonic workflow (limited movement, nearly static posture) is a risk factor. In such cases, PE can be higher than ambient UVR. In this review, we provide also a list of milestones, depicting the progress and the most important findings in this field during the past 45 years. However, in many respects our knowledge is still rudimentary, for several reasons. Different measuring positions have been used so that measured PE is not comparable. Few studies were designed to enable the extension of measured PE to other locations or dates. Although the importance of a proper calibration of the measuring devices in respect to the changing solar spectrum was pointed out from the beginning, this is often not performed, which leads to high uncertainties in the presented PE levels. At the end of our review, we provide some key points, which can be used to evaluate the quality of a study respectively to support the design of future studies.
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Dexter BR, King R, Parisi AV, Harrison SL, Igoe DP, Downs NJ. Electronic Sun Journal Versus Self-report Sun Diary: A Comparison of Recording Personal Sunlight Exposure Methods. Photochem Photobiol 2020; 97:641-649. [PMID: 33264423 DOI: 10.1111/php.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
This research compared personal sunlight exposure times monitored electronically within suburban Australian environments against self-report paper journals for determining the timing and total duration of individual exposure to daily solar radiation. A total of 90 Electronic Sun Journal (ESJ) daily readings and self-report timing and duration estimates of exposure for weekend and weekdays were compared. A Wilcoxon ranked sign test showed a significant difference (V = 157, P < 0.001) between the duration of exposure recorded electronically and the duration of exposure that was self-reported in a diary. There was also found to be a statistically significant difference between total exposure time measured using both methods for weekends (V = 10, P < 0.001) and weekdays (V = 87, P < 0.001). General trends in outdoor exposure timing confirmed that the most frequent daily exposures received over the weekend occurred between 1 and 2 h earlier than the most frequent exposures received on weekdays. This preliminary research found that exposure durations as recorded by the ESJ were longer on the weekends compared to weekdays (W = 402, P < 0.001) and confirmed that the ESJ is a viable alternative to self-reporting diaries.
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Affiliation(s)
- Benjamin R Dexter
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia
| | - Rachel King
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia
| | - Alfio V Parisi
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia.,School of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Simone L Harrison
- School of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Damien P Igoe
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia
| | - Nathan J Downs
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, Toowoomba, Australia.,School of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Tabbakh T, Wakefield M, Dobbinson SJ. Concerns about vitamin D and sun exposure behaviour among Australians. Health Promot J Austr 2020; 32:399-406. [PMID: 32557897 DOI: 10.1002/hpja.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/15/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022] Open
Abstract
ISSUES ADDRESSED Australians' concerns about vitamin D and influence on sun protection were last quantified a decade ago in Queensland amidst media attention on emerging evidence of non-skeletal benefits of vitamin D. Meanwhile these circumstances persist and impact is worth assessing. METHODS Measures of concern about vitamin D were included in three recent population-based cross-sectional surveys of Australians' sun-related behaviours during summer months (2010-2011, 2013-2014 and 2016-2017). We analysed characteristics, beliefs and behaviours associated with vitamin D concerns regarding regular sunscreen use among adults in 2016-2017 (N = 3614). RESULTS Concerns about vitamin D continued to persist among adults surveyed between 2010-2011 and 2016-2017. Vitamin D concerns regarding the sunscreen use were more common among women, older respondents and adults with skin that tans or is not susceptible to sunburn. Respondents concerned about vitamin D were more likely to exhibit pro-tanning beliefs, scepticism about sunscreen safety and have attempted a suntan. They were also less likely to use sun protection in everyday activities outdoors and less likely to use sunscreen on summer weekends. CONCLUSIONS Vitamin D concerns related to sunscreen use remained common among Australian adults. Skin cancer control advocates may be reassured that those with the greatest skin cancer risk (burn only) were less likely to hold these concerns, while the related infrequent sun protection and tanning among concerned adults are problematic. SO WHAT?: Continued education and research is needed to ensure that the general public understand the risks and benefits of sun exposure in Australia.
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Affiliation(s)
- Tamara Tabbakh
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Suzanne J Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
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15
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Lingham G, Milne E, Yazar S, Mackey DA, Cross D, Lucas RM. Recalling our day in the sun: comparing long-term recall of childhood sun exposure with prospectively collected parent-reported data. Photochem Photobiol Sci 2020; 19:382-389. [PMID: 32010915 DOI: 10.1039/c9pp00240e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To examine the impact of sun exposure on human health, accurate measures of past sun exposure are required. We investigated how young adults' recall of childhood sun-related behaviours compares with parent-reported measures collected during childhood. The Kidskin-Young Adult Myopia Study (KYAMS) is a follow-up of the Kidskin Study, a sun-protection intervention study conducted from 1995-2001. KYAMS participants, aged 25-30 years, reported time in sun, and use of hats and sunscreen, for each year from ages 5-26 years (n = 244). Using weighted kappa, we assessed agreement between these data and corresponding variables derived from the Kidskin Study parent questionnaires completed when KYAMS participants were aged 6-12 years. Ordinal logistic regression was used to test the association between self-reported sun-behaviours and corresponding parent-reported data. We found slight agreement between self-reported and parent-reported data for all sun-behaviour measures except hat use at 12 years. KYAMS recall of time in sun at 8-12 years was not associated with Kidskin Study parent-reported responses after adjustment for current time in sun. Recall of higher hat and sunscreen use was associated with higher parent-reported hat and sunscreen use (OR[hat] = 1.37, 95% CI: 1.16, 1.62; OR[sunscreen] = 1.23, 95% CI: 1.03, 1.48). However, KYAMS self-reported data were unable to predict corresponding parent-reported responses. Group data from retrospective recall of sun-related behaviours may be of limited value in studying the relationship between sun exposure and health outcomes; however, individual data are likely of little use.
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Affiliation(s)
- Gareth Lingham
- Centrefor Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia.
| | - Elizabeth Milne
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Seyhan Yazar
- Centrefor Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - David A Mackey
- Centrefor Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Donna Cross
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Robyn M Lucas
- Centrefor Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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Are Environmental Interventions Targeting Skin Cancer Prevention among Children and Adolescents Effective? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020529. [PMID: 31947667 PMCID: PMC7013813 DOI: 10.3390/ijerph17020529] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022]
Abstract
Skin cancer, which is increasing exceedingly worldwide, is substantially preventable by reducing unprotected exposure to ultraviolet radiation (UVR). Several comprehensive interventions targeting sun protection behaviors among children and adolescents in various outdoor settings have been developed; however, there is a lack of insight on stand-alone effectiveness of environmental elements. To compose future skin cancer prevention interventions optimally, identification of effective environmental components is necessary. Hence, an extensive systematic literature search was conducted, using four scientific databases and one academic search engine. Seven relevant studies were evaluated based on stand-alone effects of various types of environmental sun safety interventions on socio-cognitive determinants, sun protection behaviors, UVR exposure, and incidence of sunburns and nevi. Free provision of sunscreen was most often the environmental component of interest, however showing inconsistent results in terms of effectiveness. Evidence regarding shade provision on shade-seeking behavior was most apparent. Even though more research is necessary to consolidate the findings, this review accentuates the promising role of environmental components in skin cancer prevention interventions and provides directions for future multi-component sun safety interventions targeted at children and adolescents in various outdoor settings.
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Tabbakh T, Volkov A, Wakefield M, Dobbinson S. Implementation of the SunSmart program and population sun protection behaviour in Melbourne, Australia: Results from cross-sectional summer surveys from 1987 to 2017. PLoS Med 2019; 16:e1002932. [PMID: 31593565 PMCID: PMC6782093 DOI: 10.1371/journal.pmed.1002932] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Australia has one of the highest skin cancer rates in the world. 'SunSmart' is a multi-component, internationally recognised community-wide skin cancer prevention program implemented in Melbourne, Australia, since summer 1988-1989. Following recent reductions in melanoma rates among younger Australian cohorts, the extent of behaviour change and the potential contribution of prevention programs to this decline in melanoma rates are of interest. Sun protection is a multifaceted behaviour. Measures previously applied to monitor change over time in preventive behaviour for this population focused on individual behaviours. The omission of multiple behaviours that reduce exposure to ultraviolet radiation (UV) may have led to underestimates of behaviour change, meriting further analysis of long-term trends to contribute to this debate. METHODS AND FINDINGS A population-based survey was conducted in Melbourne in the summer before SunSmart commenced (1987-1988) and across summers in 3 subsequent decades (1988-2017). During summer months, residents (14-69 years) were recruited to cross-sectional weekly telephone interviews assessing their tanning attitudes, sun protection behaviour, and sunburn incidence on the weekend prior to interview. Quotas were used to ensure the sample was proportional to the population by age and sex, while younger respondents were oversampled in some years. The majority of the respondents reported their skin was susceptible to sunburn. Changes in sun protection behaviour were analysed for N = 13,285 respondents in multivariable models, cumulating surveys within decades (1987-1988: N = 1,655; 1990s: N = 5,258; 2000s: N = 3,385; 2010s: N = 2,987) and adjusting for relevant ambient weather conditions and UV levels on weekend dates. We analysed specific and composite behaviours including a novel analysis of the use of maximal sun protection, which considered those people who stayed indoors during peak UV hours together with those people well-protected when outdoors. From a low base, use of sun protection increased rapidly in the decade after SunSmart commenced. The odds of use of at least 1 sun protection behaviours on summer weekends was 3 times higher in the 1990s than pre-SunSmart (adjusted odds ratio [AOR] 3.04, 95% CI 2.52-3.68, p < 0.001). There was a smaller increase in use of maximal sun protection including shade (AOR = 1.68, 95% CI 1.44-1.97, p < 0.001). These improvements were sustained into the 2000s and continued to increase in the 2010s. Inferences about program effects are limited by the self-reported data, the absence of a control population, the cross-sectional study design, and the fact that the survey was not conducted in all years. Other potential confounders may include increasing educational attainment among respondents over time and exposure to other campaigns such as tobacco and obesity prevention. CONCLUSIONS With an estimated 20-year lag between sun exposure and melanoma incidence, our findings are consistent with SunSmart having contributed to the reduction in melanoma among younger cohorts.
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Shade coverage, ultraviolet radiation and children's physical activity in early childhood education and care. Int J Public Health 2019; 64:1325-1333. [PMID: 31473782 DOI: 10.1007/s00038-019-01289-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/17/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To investigate the association between shade coverage in early childhood education and care (ECEC) centres and pre-school children's physical activity, outdoor time and ultraviolet radiation (UVR) exposure. METHODS A total of 48 ECEC centres (678 children) in the Western Australian Play Spaces and Environments for Children's Physical Activity (PLAYCE) study took part. Physical activity at ECEC was measured using 7-day accelerometry. UVR exposure was measured using polysulphone film attached to children's shoulders. Educators reported time spent outdoors. The Shade Factor and remote sensing imagery captured shade coverage. RESULTS Centre vegetation but not Shade Factor was significantly negatively associated with children's UVR exposure (p < 0.001). Higher levels of vegetation were associated with increased time outdoors, but higher levels of the Shade Factor were associated with decreased time outdoors (all p < 0.001). Neither shade measure was significantly associated with physical activity. Outdoor time moderated the relationships between shade measures, physical activity and UVR exposure. CONCLUSIONS The provision of shade, particularly through natural forms such as tree canopy, is an important sun protection strategy and enabler of outdoor time in children attending ECEC.
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Olmedo-Martín RV, González-Molero I, Olveira G, Amo-Trillo V, Jiménez-Pérez M. Sunlight exposure in inflammatory bowel disease outpatients: Predictive factors and correlation with serum vitaminD. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:604-613. [PMID: 31472991 DOI: 10.1016/j.gastrohep.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/04/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Sunlight exposure is the main source of vitaminD. Our aim was to describe both sun exposure and sun protection behaviour in a series of patients with inflammatory bowel disease (IBD), and to study their potential association with vitaminD concentration. PATIENTS AND METHODS A cross sectional, observational study. The clinical-demographic variables were obtained via clinical interviews and medical history review. The sunlight exposure assessment was carried out using the Sun Exposure Questionnaire and the concentration of 25-hydroxy vitaminD (25OHD) was measured by an electro-chemiluminescence immunoassay. Questionnaires were conducted on quality of life, physical activity, weekly vitaminD intake and sun protection behaviour. RESULTS 149 patients were included. In 69% of patients, deficient or insufficient 25OHD values were recorded. 67% showed low sun exposure. A modest significant correlation was observed between the total score of the solar exposure questionnaire and the 25OHD concentration in the complete series (r=0.226, P=.006) and in the summer (r=0.274, P=.01). The sun protection behaviour questionnaire score did not influence the 25OHD concentration. In the multivariate analysis, only the presence of clinical activity was associated with low sun exposure (OR=3.23). DISCUSSION Sun exposure according to the questionnaire used was low, was associated with the presence of clinical activity and was weakly correlated with serum 25OHD concentration. More studies are needed to explore the use of individual questionnaires for sun exposure and its relationship with vitaminD in patients with IBD.
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Affiliation(s)
- Raúl Vicente Olmedo-Martín
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional de Málaga, Málaga, España; Facultad de Medicina, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - Inmaculada González-Molero
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional de Málaga, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), CIBERDEM, Málaga, España
| | - Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional de Málaga, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), CIBERDEM, Málaga, España
| | - Victor Amo-Trillo
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional de Málaga, Málaga, España; Facultad de Medicina, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Miguel Jiménez-Pérez
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional de Málaga, Málaga, España; Facultad de Medicina, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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Coups EJ, Manne SL, Ohman Strickland P, Hilgart M, Goydos JS, Heckman CJ, Chamorro P, Rao BK, Davis M, Smith FO, Thorndike FP, Ritterband LM. Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection behaviors among individuals diagnosed with melanoma: study design and baseline characteristics. Contemp Clin Trials 2019; 83:117-127. [PMID: 31255801 PMCID: PMC6690854 DOI: 10.1016/j.cct.2019.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in sun protection behaviors. In this project, we are conducting a randomized controlled trial of an innovative, tailored, theory-driven Internet intervention-called mySmartSkin-to promote these behaviors among melanoma patients. This paper outlines the study design and characteristics of the study sample. A total of 441 patients were recruited (40.9% response rate) and randomized to the mySmartSkin or a Usual Care condition. Participants complete surveys at baseline and 8 weeks, 24 weeks, and 48 weeks later. The primary aim of the project is to examine the impact of mySmartSkin versus Usual Care on skin self-examination and sun protection behaviors. The secondary aim focuses on identifying mediators of the intervention's effects. In an exploratory aim, we will examine potential moderators of the impact of the intervention. At baseline, the recruited participants had a mean age of 61 years, 49% were female, 7.5% met criteria for having conducted a recent, thorough skin self-examination, and the mean score on the index of sun protection behaviors was 3.3 (on a scale from 1 to 5). The results of the project will determine whether the mySmartSkin intervention is efficacious in promoting skin self-examination and sun protection behaviors among individuals diagnosed with melanoma. Trial registration: ClinicalTrials.govNCT03028948.
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Affiliation(s)
- Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States.
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Pamela Ohman Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Michelle Hilgart
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States; Department of Health Behavior, Systems & Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Paola Chamorro
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Moira Davis
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | - Franz O Smith
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, United States
| | | | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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Morton RL, Asher R, Peyton E, Tran A, Smit AK, Butow PN, Kimlin MG, Dobbinson SJ, Wordsworth S, Keogh L, Cust AE. Risk attitudes and sun protection behaviour: Can behaviour be altered by using a melanoma genomic risk intervention? Cancer Epidemiol 2019; 61:8-13. [DOI: 10.1016/j.canep.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
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De Castro-Maqueda G, Gutierrez-Manzanedo JV, Lagares-Franco C, Linares-Barrios M, de Troya-Martin M. Photoprotection practices, knowledge and sun-related skin damage in Spanish beach handball players. PeerJ 2019; 7:e7030. [PMID: 31249733 PMCID: PMC6587929 DOI: 10.7717/peerj.7030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/27/2019] [Indexed: 11/25/2022] Open
Abstract
Background Outdoor sports are a risk activity for skin cancer, especially if adequate sun protection measures are not used. The aim of this study is to examine the photoprotection habits of outdoor (beach) handball players, and to determine the relation between duration of sports practice, photoprotection behaviour and sun-related damage to the skin. Methods This cross-sectional study is based on a health survey of sun exposure and protection habits and practices conducted among beach handball players in southern Spain. This survey provided data for a descriptive and comparative analysis, by groups and gender, of photoprotection and skin self-examination practices. Results Among the whole sample, 76.9% had suffered at least one sunburn event during the last year. By groups, 73.97% of the older participants (Group I, University students) and 81.25% of the younger ones (Group II, youngers players) reported this outcome, and the difference was statistically significant (p = 0.003). With respect to photoprotection, 68.5% of the players in group I and 66.7% of those in group II used sun cream with a protection factor of 30 or higher, although 52.1% of group I and 35.4% of group II did not reapply it. As concerns self-examination, 94.5% of group I and 87.5% of group II had not examined their body for skin damage during the previous year. Medical examination revealed the presence of lentigines and freckles among many players, with no significant differences between the two groups. Conclusions Beach handball players are highly exposed to the effects of ultraviolet radiation and often take insufficient measures of sun protection. Programmes should be designed and implemented to raise awareness among adolescent and young adult sport competitors of the risks of skin cancer associated with their sports activity and to encourage them to improve their photoprotection and skin monitoring practices.
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McInerney-Leo AM, Finnane A. The personal touch: does the communication method affect response to melanoma genetic risk? Br J Dermatol 2019; 180:1288-1289. [PMID: 31157440 DOI: 10.1111/bjd.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, 4102, Australia
| | - A Finnane
- School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia
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Baczynska KA, Khazova M, O'Hagan JB. Sun exposure of indoor workers in the UK – survey on the time spent outdoors. Photochem Photobiol Sci 2019; 18:120-128. [DOI: 10.1039/c8pp00425k] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A lifestyle questionnaire has been used to obtain information on the time spent outdoors by indoor workers that could be used in combination with dosimetry studies in smaller targeted groups to quantify UV exposure for health risk/benefit analysis.
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Affiliation(s)
- K. A. Baczynska
- Centre for Radiation
- Chemical and Environmental Hazards
- Public Health England
- Oxfordshire
- UK
| | - M. Khazova
- Centre for Radiation
- Chemical and Environmental Hazards
- Public Health England
- Oxfordshire
- UK
| | - J. B. O'Hagan
- Centre for Radiation
- Chemical and Environmental Hazards
- Public Health England
- Oxfordshire
- UK
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Bleakley A, Lazovich D, B Jordan A, Glanz K. Compensation Behaviors and Skin Cancer Prevention. Am J Prev Med 2018; 55:848-855. [PMID: 30344038 DOI: 10.1016/j.amepre.2018.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/16/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Skin cancer prevention guidelines recommend practicing multiple behaviors to protect against harmful ultraviolet rays, yet few adults report practicing more than one recommended behavior. This study examines the extent to which skin cancer prevention behaviors are combined and may follow a pattern of compensation in which an individual's performance of one behavior (e.g., wearing sunscreen) precludes performing other protective behaviors (e.g., wearing a hat). METHODS Data from qualitative semi-structured interviews (n=80) in 2015 and a quantitative online national survey (n=940) in 2016 with non-Hispanic white adults aged 18-49 years from the U.S. were used to examine combinations of skin cancer prevention behaviors. Data were analyzed in 2017. RESULTS Protective behaviors like wearing sunglasses and sunscreen were a common approach to prevention, but protective, avoidant (i.e., seeking shade, avoiding outdoor tanning), and covering-up (i.e., wearing a hat, shirt) strategies were rarely used in combination. Regression analyses to determine correlates of protection, avoidance, and covering-up showed that age was positively associated with practicing each strategy; positive attitudes about tanning were negatively associated with avoidance and covering-up; and positive body image was positively associated with protection and negatively associated with avoidance. Demographics such as education, employment, and gender, but not skin cancer risk, were also related to the various strategies. CONCLUSIONS Although a full evaluation of compensation theory and skin cancer prevention was limited by the available data, the results suggest that application of the theory may yield clues for how to improve sun protection behaviors.
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Affiliation(s)
- Amy Bleakley
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Amy B Jordan
- School of Communication and Information, Rutgers the State University of New Jersey, New Brunswick, New Jersey
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Stump TK, Aspinwall LG, Gray EL, Xu S, Maganti N, Leachman SA, Alshurafa N, Robinson JK. Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory: Measure description and comparisons to UVR sensor and sun protection survey data. Prev Med Rep 2018; 11:305-311. [PMID: 30116702 PMCID: PMC6092553 DOI: 10.1016/j.pmedr.2018.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/20/2018] [Accepted: 07/21/2018] [Indexed: 12/01/2022] Open
Abstract
One in five US adults will be diagnosed with skin cancer. As most skin cancers are attributable to sun exposure, this risk factor is an important target for research and intervention. Most sun exposure measures assess frequency of specific sun-protection behaviors, which does not account for the use of multiple, potentially overlapping sun-protection methods. In contrast, the Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory assesses sun-protection behavior during self-reported activities, providing several useful metrics, including duration of unprotected sun exposure on 17 body sites, combined to yield an overall MUSE score weighted by percent of body exposed. The present study was conducted July–September 2017, in Chicago, IL USA. For 10 days, participants (39 melanoma survivors; Mage = 58.59, 64.5% female) wore an ultraviolet radiation (UVR) sensor and completed the Daily MUSE Inventory each evening. The Sun Habits Survey was completed at the end of the study. Outdoor time reported in the MUSE Inventory significantly predicted outdoor time recorded by UVR sensors, B = 0.53, p < .001. For all sun-protection behaviors except shade, reports from the Daily MUSE Inventory (i.e., percentage of outdoor time a particular strategy was used) correlated with frequency ratings of the same strategy from the Sun Habits Survey (rs = 0.66–0.75, p < .05). In sum, the Daily MUSE Inventory corresponds with sensor and survey data, and provides a novel metric of unprotected sun exposure that will be useful for evaluating overall extent of sun exposure, including exposure on several smaller body sites that are at high risk for skin cancer.
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Affiliation(s)
- Tammy K Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Dr., Suite 1500, Chicago, IL 60611, USA
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 S 1530 E, Rm 502, Salt Lake City, UT 84112, USA
| | - Elizabeth L Gray
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Dr., Suite 1400, Chicago, IL 60611, USA
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 1050, Chicago, IL 60611, USA.,Center for Bio-Integrated Electronics, Northwestern University, Technological Institute, B390, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - Nenita Maganti
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR 97239, USA
| | - Nabil Alshurafa
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Dr., Suite 1500, Chicago, IL 60611, USA
| | - June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 1050, Chicago, IL 60611, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 676 N. St. Clair, Suite 1200, Chicago, IL 60611, USA
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27
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Schmalwieser AW, Siani AM. Review on Nonoccupational Personal Solar UV Exposure Measurements. Photochem Photobiol 2018; 94:900-915. [PMID: 29856894 DOI: 10.1111/php.12946] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/25/2018] [Indexed: 01/22/2023]
Abstract
Solar ultraviolet (UV) radiation follows people during their whole life. Exposure to UV radiation is vital but holds serious risks, too. The quantification of human UV exposure is a complex issue. UV exposure is directly related to incoming UV radiation as well as to a variety of factors such as the orientation of the exposed anatomical site with respect to the sun and the duration of exposure. The use of badge-sensors allows assessing the UV exposure of differently oriented body sites. Such UV devices have been available for over 40 years, and a variety of measuring campaigns have been undertaken since then. This study provides an overview of those studies which reported measurements of the personal UV exposure (PE) during outdoor activities of people not related to their occupation. This overview is given chronologically to show the progress of knowledge in this research and is given with respect to different activities. Special focus is put on the ratio of personal exposure to ambient UV radiation. This ratio, when given as a function of solar elevation, allows estimating PE at any other location or date if ambient UV radiation is known.
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Affiliation(s)
- Alois W Schmalwieser
- Unit of Physiology and Biophysics, University of Veterinary Medicine, Vienna, Austria
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28
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Zink A, Tizek L, Schielein M, Böhner A, Biedermann T, Wildner M. Different outdoor professions have different risks - a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides. J Eur Acad Dermatol Venereol 2018; 32:1695-1701. [PMID: 29806193 DOI: 10.1111/jdv.15052] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND One of the main risk factors for non-melanoma skin cancer (NMSC), the most common cancer worldwide, is solar ultraviolet radiation (UVR). This has led to the recognition of NMSC as occupational disease for outdoor workers in several countries. However, outdoor professions are a very heterogeneous group with diverse daily activities and associated UVR exposure. OBJECTIVE To compare the prevalence of NMSC and associated risk behaviour in different outdoor professions. METHODS Cross-sectional study among outdoor workers (farmers, gardeners, mountain guides) and indoor workers (office employees) as control group using a paper-based questionnaire on UVR exposure and protective behaviour followed by a skin examination by a dermatologist. RESULTS A total of 563 participants (46.9% women, 46.9 ± 13.8 years) consisting of 348 outdoor workers (38.8% farmer, 35.3% gardener, 25.9% mountain guides) and 215 indoor workers were included in the study between March and September 2017. NMSC incl. actinic keratosis was diagnosed in 33.3% of mountain guides, 27.4% of farmers, 19.5% of gardeners and in 5.6% of indoor workers. Significant differences were seen between the outdoor professions with mountain guides at highest risk compared to farmers (OR = 2.6, 95% CI = 1.2-5.7). Substantial differences between the professions were also seen in skin cancer screening attendance rates (indoor worker 61.4%, mountain guides 57.8%, farmers 31.9%, gardeners 27.6%), daily UVR exposure during work and protective behaviour such as sunscreen use during work. CONCLUSION Different outdoor professions have significant different risks for NMSC and show different risk behaviour. Tailoring prevention efforts to different professions based on their individual needs could be the key to lower the global burden of (occupational) NMSC.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Böhner
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Wildner
- Bavarian Health and Food Safety Authority, Munich, Germany.,Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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29
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Hacker E, Horsham C, Allen M, Nathan A, Lowe J, Janda M. Capturing Ultraviolet Radiation Exposure and Physical Activity: Feasibility Study and Comparison Between Self-Reports, Mobile Apps, Dosimeters, and Accelerometers. JMIR Res Protoc 2018; 7:e102. [PMID: 29666044 PMCID: PMC5930172 DOI: 10.2196/resprot.9695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/01/2018] [Accepted: 03/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background Skin cancer is the most prevalent cancer in Australia. Skin cancer prevention programs aim to reduce sun exposure and increase sun protection behaviors. Effectiveness is usually assessed through self-report. Objective It was the aim of this study to test the acceptance and validity of a newly developed ultraviolet radiation (UVR) exposure app, designed to reduce the data collection burden to research participants. Physical activity data was collected because a strong focus on sun avoidance may result in unhealthy reductions in physical activity. This paper provides lessons learned from collecting data from participants using paper diaries, a mobile app, dosimeters, and accelerometers for measuring end-points of UVR exposure and physical activity. Methods Two participant groups were recruited through social and traditional media campaigns 1) Group A—UVR Diaries and 2) Group B—Physical Activity. In Group A, nineteen participants wore an UVR dosimeter wristwatch (University of Canterbury, New Zealand) when outside for 7 days. They also recorded their sun exposure and physical activity levels using both 1) the UVR diary app and 2) a paper UVR diary. In Group B, 55 participants wore an accelerometer (Actigraph, Pensacola, FL, USA) for 14 days and completed the UVR diary app. Data from the UVR diary app were compared with UVR dosimeter wristwatch, accelerometer, and paper UVR diary data. Cohen kappa coefficient score was used to determine if there was agreement between categorical variables for different UVR data collection methods and Spearman rank correlation coefficient was used to determine agreement between continuous accelerometer data and app-collected self-report physical activity. Results The mean age of participants in Groups A (n=19) and B (n=55) was 29.3 and 25.4 years, and 63% (12/19) and 75% (41/55) were females, respectively. Self-reported sun exposure data in the UVR app correlated highly with UVR dosimetry (κ=0.83, 95% CI 0.64-1.00, P<.001). Correlation between self-reported UVR app and accelerometer-collected moderate to vigorous physical activity data was low (ρ=0.23, P=.10), while agreement for low-intensity physical activity was significantly different (ρ=-0.49, P<.001). Seventy-nine percent of participants preferred the app over the paper diary for daily self-report of UVR exposure and physical activity. Conclusions This feasibility study highlights self-report using an UVR app can reliably collect personal UVR exposure, but further improvements are required before the app can also be used to collect physical activity data.
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Affiliation(s)
- Elke Hacker
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Caitlin Horsham
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Martin Allen
- Department of Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand.,The MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington, New Zealand
| | - Andrea Nathan
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - John Lowe
- Faculty of Science, Health, Education and Engineering, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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30
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Cust AE, Fenton GL, Smit AK, Espinoza D, Dobbinson S, Brodie A, Dang HTC, Kimlin MG. Validation of Questionnaire and Diary Measures of Time Outdoors Against an Objective Measure of Personal Ultraviolet Radiation Exposure. Photochem Photobiol 2018; 94:815-820. [DOI: 10.1111/php.12893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Prevention Research; Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Melanoma Institute Australia; The University of Sydney; Sydney NSW Australia
| | - Georgina L Fenton
- Cancer Epidemiology and Prevention Research; Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
| | - Amelia K Smit
- Cancer Epidemiology and Prevention Research; Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Melanoma Institute Australia; The University of Sydney; Sydney NSW Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre; The University of Sydney; Sydney NSW Australia
| | | | - Alison Brodie
- The University of the Sunshine Coast; Maroochydore Qld Australia
| | | | - Michael G Kimlin
- The University of the Sunshine Coast; Maroochydore Qld Australia
- Cancer Council Queensland; Brisbane Qld Australia
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31
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King L, Xiang F, Swaminathan A, Dear K, Harrison SL, van der Mei I, Kimlin MG, D'Este C, Lucas RM. Validation of Sun Exposure Reported Annually Against Interim Self-report and Daily Sun Diaries. Photochem Photobiol 2017; 93:1294-1302. [DOI: 10.1111/php.12780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/20/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Laura King
- National Centre for Epidemiology and Population Health; Research School of Population Health; The Australian National University; Canberra ACT Australia
| | - Fan Xiang
- National Centre for Epidemiology and Population Health; Research School of Population Health; The Australian National University; Canberra ACT Australia
| | | | | | - Simone L. Harrison
- College of Public Health, Medical & Veterinary Sciences; James Cook University; Townsville Qld Australia
| | - Ingrid van der Mei
- Menzies Research Institute Tasmania; University of Tasmania; Hobart Tasmania
| | - Michael G. Kimlin
- Queensland University of Technology; Brisbane Qld Australia
- University of the Sunshine Coast; Sippy Downs Qld Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health; Research School of Population Health; The Australian National University; Canberra ACT Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health; Research School of Population Health; The Australian National University; Canberra ACT Australia
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32
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Mays D, Evans WD. The Effects of Gain-, Loss-, and Balanced-Framed Messages for Preventing Indoor Tanning among Young Adult Women. JOURNAL OF HEALTH COMMUNICATION 2017; 22:604-611. [PMID: 28598730 PMCID: PMC6085748 DOI: 10.1080/10810730.2017.1332119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Indoor tanning (IT) increases the risks of skin cancer, but evidence on how to design health education messaging targeting IT among young adult women remains limited. This study investigated the effects of theory-guided gain-, loss-, and balanced-framed IT prevention messages. Young adult women ages 18-30 who indoor tan (n = 552, mean age = 24.9 years [standard deviation = 3.1]) were recruited online, completed pre-exposure measures, and were randomized to view a gain-, loss-, or balanced-framed message. Participants completed post-exposure measures of message response (emotional response, message receptivity), IT risk (perceived severity, susceptibility), and efficacy (self-efficacy, perceived benefits of avoiding IT) beliefs, and IT behavioral intentions. Loss- and balanced-framed messages promoted significantly greater emotional response and message receptivity and lower IT behavioral intentions than gain-framed messages. The effects of loss- and balanced-framed messages on IT behavioral intentions were mediated by greater emotional response and message receptivity compared with the gain-framed message. These results can inform the development of public health education campaigns to prevent and reduce IT among young adult women. Future research can build from these findings by investigating additional message themes and tailoring strategies to maximize their effects, examining the effects of framed messages prospectively, and investigating ways to enhance message receptivity, such as through novel message delivery channels (e.g., mobile devices).
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Affiliation(s)
- Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, Suite 4100, Washington, DC 20007, USA
- Correspondence to: D. Mays.
| | - W. Douglas Evans
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue, NW, 2 floor, Washington, DC 20037, USA
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33
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Køster B, Søndergaard J, Nielsen JB, Allen M, Olsen A, Bentzen J. The validated sun exposure questionnaire: association of objective and subjective measures of sun exposure in a Danish population-based sample. Br J Dermatol 2016; 176:446-456. [PMID: 27412948 DOI: 10.1111/bjd.14861] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Few questionnaires used in monitoring sun-related behaviour have been tested for validity. OBJECTIVES We established the criteria validity of a questionnaire developed for monitoring population sun-related behaviour. METHODS During May-August 2013, 664 Danes wore a personal electronic ultraviolet radiation (UVR) dosimeter for 1 week that measured their outdoor time and dose of erythemal UVR exposure. In the following week, they answered a questionnaire on their sun-related behaviour in the measurement week. RESULTS Outdoor time measured by dosimetry correlated strongly with both outdoor time and the developed exposure scale measured in the questionnaire. Exposure measured in standard erythema dose (SED) by dosimetry correlated strongly with the exposure scale. In a linear regression model of UVR (SED) received, 41% of the variation was explained by skin type, age, week of participation and exposure scale, with exposure scale as the main contributor. The weekly sunburn fraction correlated strongly with the number of ambient sun hours (r = 0·73, P < 0·001). CONCLUSIONS This criteria-validated questionnaire provides evidence of the exposure that the questionnaire aimed to measure. The evidence provided showed a strong link between the objectively measured behaviour and the behaviour measured by this survey construct. The questionnaire is the first validated tool to measure the UVR exposure in a national population-based sample.
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Affiliation(s)
- B Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark.,Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - J Søndergaard
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - J B Nielsen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - M Allen
- Electrical and Computer Engineering, University of Canterbury, Canterbury, U.K
| | - A Olsen
- Research Centre, Danish Cancer Society, Copenhagen Ø, Denmark
| | - J Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
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34
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Heckman CJ, Handorf EA, Darlow SD, Ritterband LM, Manne SL. An online skin cancer risk-reduction intervention for young adults: Mechanisms of effects. Health Psychol 2016; 36:215-225. [PMID: 27819460 DOI: 10.1037/hea0000420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study's purpose was to investigate moderator, implementation, and mediator variables related to the efficacy of UV4.me, an Internet intervention that decreased ultraviolet radiation (UV) exposure and increased skin protection behaviors among young adults. METHOD A total of 965 18-25 year olds at risk for skin cancer were recruited nationally online. Participants were randomized to an experimental website (UV4.me), a control website, or assessment only. Participant characteristics (moderators), engagement with and perceptions of interventions (implementation measures), and exposure and protection attitudinal variables (mediators) were assessed. Linear regression and mediation analyses were conducted. RESULTS Intervention effects on skin protection were greater for participants with a family history of skin cancer (p = .01). Intervention effects on UV exposure were greater among recent indoor tanners (p = .04). Improvements in skin protection (but not UV exposure) were associated with perceiving the interventions as satisfying or helpful (ps < .01). The experimental group had better outcomes if they completed more modules (ps < .01) or set more behavioral goals (ps < .01). Knowledge and exposure decisional balance mediated intervention effects for UV exposure (ps < .05), and protection decisional balance, self-efficacy, and intentions mediated intervention effects for protection (ps < .05). CONCLUSIONS The experimental intervention was more efficacious for certain high risk groups. The more individuals liked and engaged with the interventions (e.g., by setting goals), the better their outcomes. Mediation results inform theory about change mechanisms and differed by behavioral outcome. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Sharon L Manne
- ncer Prevention and Control, Rutgers Cancer Institute of New Jersey
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35
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Smit AK, Espinoza D, Newson AJ, Morton RL, Fenton G, Freeman L, Dunlop K, Butow PN, Law MH, Kimlin MG, Keogh LA, Dobbinson SJ, Kirk J, Kanetsky PA, Mann GJ, Cust AE. A Pilot Randomized Controlled Trial of the Feasibility, Acceptability, and Impact of Giving Information on Personalized Genomic Risk of Melanoma to the Public. Cancer Epidemiol Biomarkers Prev 2016; 26:212-221. [PMID: 27702805 DOI: 10.1158/1055-9965.epi-16-0395] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/15/2016] [Accepted: 09/24/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Communication of personalized melanoma genomic risk information may improve melanoma prevention behaviors. METHODS We evaluated the feasibility and acceptability of communicating personalized genomic risk of melanoma to the public and its preliminary impact on behaviors and psychosocial outcomes. One hundred eighteen people aged 22 to 69 years provided a saliva sample and were randomized to the control (nonpersonalized educational materials) or intervention (personalized booklet presenting melanoma genomic risk as absolute and relative risks and a risk category based on variants in 21 genes, telephone-based genetic counseling, and nonpersonalized educational materials). Intention-to-treat analyses overall and by-risk category were conducted using ANCOVA adjusted for baseline values. RESULTS Consent to participate was 41%, 99% were successfully genotyped, and 92% completed 3-month follow-up. Intervention participants reported high satisfaction with the personalized booklet (mean = 8.6, SD = 1.6; on a 0-10 scale) and genetic counseling (mean = 8.1, SD = 2.2). No significant behavioral effects at 3-month follow-up were identified between intervention and control groups overall: objectively measured standard erythemal doses per day [-16%; 95% confidence interval (CI), -43% to 24%] and sun protection index (0.05; 95% CI, -0.07 to 0.18). There was increased confidence identifying melanoma at 3 months (0.40; 95% CI, 0.10-0.69). Stratified by risk category, effect sizes for intentional tanning and some individual sun protection items appeared stronger for the average-risk group. There were no appreciable group differences in skin cancer-related worry or psychologic distress. CONCLUSIONS Our results demonstrate feasibility and acceptability of providing personalized genomic risk of melanoma to the public. IMPACT Genomic risk information has potential as a melanoma prevention strategy. Cancer Epidemiol Biomarkers Prev; 26(2); 212-21. ©2016 AACR.
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Affiliation(s)
- Amelia K Smit
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Ainsley J Newson
- Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, The University of Sydney, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Georgina Fenton
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.,The Centre for Genetics Education, NSW Health, Sydney, Australia
| | - Lucinda Freeman
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.,The Centre for Genetics Education, NSW Health, Sydney, Australia
| | - Kate Dunlop
- The Centre for Genetics Education, NSW Health, Sydney, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michael G Kimlin
- The University of the Sunshine Coast and Cancer Council Queensland, Brisbane, Australia
| | - Louise A Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | | | - Judy Kirk
- Westmead Clinical School, and Westmead Institute for Medical Research, Sydney Medical School, The University of Sydney, Australia
| | - Peter A Kanetsky
- Cancer Epidemiology Program, Moffitt Cancer Center, Tampa, Florida
| | - Graham J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia. .,Melanoma Institute Australia, The University of Sydney, Australia
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36
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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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Hansen L, Tjønneland A, Køster B, Brot C, Andersen R, Lundqvist M, Christensen J, Olsen A. Sun Exposure Guidelines and Serum Vitamin D Status in Denmark: The StatusD Study. Nutrients 2016; 8:nu8050266. [PMID: 27164133 PMCID: PMC4882679 DOI: 10.3390/nu8050266] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 12/29/2022] Open
Abstract
Little is known on how vitamin D status is affected by adherence to UVB-limiting sun exposure guidelines. Our aim was to investigate the relationship between adherence to the Danish sun exposure guidelines and vitamin D status. In total, 3194 Danes (2625 adults, 569 children) were recruited among the general population, and more than 92% had blood samples taken both autumn and spring. Using linear regression, we associated serum vitamin D concentrations to questionnaire responses on: seeking shade, wearing a sunhat, wearing protective clothing or using sunscreen. The odds ratio (OR) of either low (<25 or 50 nmol/L) or adequate/high (≥50 nmol/L) vitamin D status was examined using logistic regression. For adults, those who always sought shade or wore protective clothing compared to those who did not had lower levels of vitamin D (autumn concentrations for shade: 7.2 nmol/L lower (−11.0–−3.6 nmol/L); for protective clothing: 9.9 nmol/L lower (−13.6–−6.2 nmol/L). Adherence to all four guidelines was also associated with lower vitamin D concentrations (autumn: 9.7 nmol/L lower (−14.3–−5.1 nmol/L). Use of sunscreen was associated with adequate vitamin D status, as those who always sought shade compared to those who did not had an OR (95% CI) of 1.68 (1.25–2.35) of having ≥50 nmol/L during both spring and autumn. No associations were found with wearing a sunhat, and there were no clear associations for children. In conclusion, adherence to the sun exposure guidelines on shade and protective clothing was associated with lower vitamin D status among Danish adults, but not children.
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Affiliation(s)
- Louise Hansen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen DK-2100, Denmark.
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen DK-2100, Denmark.
| | - Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Copenhagen DK-2100, Denmark.
| | - Christine Brot
- Danish Health Authority, Health Promotion, Copenhagen DK-2300, Denmark.
| | - Rikke Andersen
- Technical University of Denmark, National Food Institute, Division for Diet, Disease Prevention and Toxicology, Research Group for Risk-Benefit, Søborg DK-2860, Denmark.
| | - Marika Lundqvist
- Statens Serum Institute, Department of Congenital Disorders, Danish Centre for Neonatal Screening, Copenhagen DK-2300, Denmark.
| | - Jane Christensen
- Unit of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen DK-2100, Denmark.
| | - Anja Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen DK-2100, Denmark.
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Køster B, Søndergaard J, Nielsen JB, Allen M, Bjerregaard M, Olsen A, Bentzen J. Effects of smartphone diaries and personal dosimeters on behavior in a randomized study of methods to document sunlight exposure. Prev Med Rep 2016; 3:367-72. [PMID: 27419038 PMCID: PMC4929184 DOI: 10.1016/j.pmedr.2016.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/09/2016] [Accepted: 04/20/2016] [Indexed: 11/20/2022] Open
Abstract
Dosimeters and diaries have previously been used to evaluate sun-related behavior and UV exposure in local samples. However, wearing a dosimeter or filling in a diary may cause a behavioral change. The aim of this study was to examine possible confounding factors for a questionnaire validation study. We examined the effects of wearing dosimeters and filling out diaries, measurement period and recall effect on the sun-related behavior in Denmark in 2012. Our sample included 240 participants eligible by smartphone status and who took a vacation during weeks 26–32 in 2012, randomized by gender, age, education and skin type to six groups: 1) Control + diary, 2) Control, 3) 1-week dosimetry measurement, 4) 1-week dosimetry measurement + diary, 5) 3-week dosimetry measurement and 6) 1-week dosimetry measurement with 4 week delayed questionnaire. Correlation coefficients between reported outdoor time and registered outdoor time for groups 3–6 were 0.39, 0.45, 0.43 and 0.09, respectively. Group 6 was the only group not significantly correlated. Questionnaire reported outdoor exposure time was shorter in the dosimeter measurement groups (3–6) than in their respective controls. We showed that using a dosimeter or keeping a diary seems to increase attention towards the behavior examined and therefore may influence this behavior. Receiving the questionnaire with 4 week delay had a significant negative influence on correlation and recall of sunburn. When planning future UV behavior questionnaire validations, we suggest to use a 1-week interval for dosimetry measurements, no diary, and to minimize the time from end of measurement to filling out questionnaires. Personal UV dosimeters and diaries were previously applied in studies of UV radiation. Effects of using UV dosimeters and diaries on participants' behavior were not previously examined. Correlation between objective and subjective measures of outdoor exposure time was shown. Their correlation coefficient depends on length of recall (bias). The use of dosimeters and diaries increases attention towards the examined behavior.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
- Research Unit of General Practice, University of Southern, Denmark
- Corresponding author at: Strandboulevarden 49, DK-2100, Denmark.Strandboulevarden 49DK-2100Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, University of Southern, Denmark
| | | | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, New Zealand
| | - Mette Bjerregaard
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Anja Olsen
- Research Centre, Danish Cancer Society, Denmark
| | - Joan Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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Zhu GA, Raber I, Sakshuwong S, Li S, Li AS, Tan C, Chang ALS. Estimation of individual cumulative ultraviolet exposure using a geographically-adjusted, openly-accessible tool. BMC DERMATOLOGY 2016; 16:1. [PMID: 26790927 PMCID: PMC4721109 DOI: 10.1186/s12895-016-0038-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/06/2016] [Indexed: 12/22/2022]
Abstract
Background Estimates of an individual’s cumulative ultraviolet (UV) radiation exposure can be useful since ultraviolet radiation exposure increases skin cancer risk, but a comprehensive tool that is practical for use in the clinic does not currently exist. The objective of this study is to develop a geographically-adjusted tool to systematically estimate an individual’s self-reported cumulative UV radiation exposure, investigate the association of these estimates with skin cancer diagnosis, and assess test reliability. Methods A 12-item online questionnaire from validated survey items for UV exposure and skin cancer was administered to online volunteers across the United States and results cross-referenced with UV radiation indices. Cumulative UV exposure scores (CUES) were calculated and correlated with personal history of skin cancer in a case–control design. Reliability was assessed in a separate convenience sample. Results 1,118 responses were included in the overall sample; the mean age of respondents was 46 (standard deviation 15, range 18 – 81) and 150 (13 %) reported a history of skin cancer. In bivariate analysis of 1:2 age-matched cases (n = 149) and controls (n = 298), skin cancer cases were associated with (1) greater CUES prior to first skin cancer diagnosis than controls without skin cancer history (242,074 vs. 205,379, p = 0.003) and (2) less engagement in UV protective behaviors (p < 0.01). In a multivariate analysis of age-matched data, individuals with CUES in the lowest quartile were less likely to develop skin cancer compared to those in the highest quartile. In reliability testing among 19 volunteers, the 2-week intra-class correlation coefficient for CUES was 0.94. We have provided the programming code for this tool as well as the tool itself via open access. Conclusions CUES is a useable and comprehensive tool to better estimate lifetime ultraviolet exposure, so that individuals with higher levels of exposure may be identified for counseling on photo-protective measures. Electronic supplementary material The online version of this article (doi:10.1186/s12895-016-0038-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gefei A Zhu
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St., Redwood City, CA, 94063, USA.
| | - Inbar Raber
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St., Redwood City, CA, 94063, USA.
| | | | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St., Redwood City, CA, 94063, USA.
| | - Angela S Li
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St., Redwood City, CA, 94063, USA.
| | - Caroline Tan
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St., Redwood City, CA, 94063, USA.
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St., Redwood City, CA, 94063, USA.
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Haluza D, Simic S, Höltge J, Cervinka R, Moshammer H. Gender aspects of recreational sun-protective behavior: results of a representative, population-based survey among Austrian residents. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 32:11-21. [PMID: 26431724 DOI: 10.1111/phpp.12213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Lifetime risk for melanoma skin cancer is enlarged by sunlight exposure and reduced by sun protection. Austrian melanoma incidence and mortality rates are constantly rising with higher rates in males. Thus, we aimed at investigating gender-specific recreational sun exposure habits among the Austrian population. METHODS We conducted a telephone survey among 1500 adults (50.5% females) representing sociodemographic characteristics of the Austrian population. Using a structured questionnaire, we studied gender-specific sun exposure-related knowledge, motives to tan, and behavior. RESULTS Overall, using sunscreen, wearing sunglasses, and seeking shade were among the three most frequent sun safe measures. Basic skin health knowledge and tanning motives were similar among genders, although females protected themselves more. In general, sunburn occurrence (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.0-1.8), skin type IV (OR = 2.4, 95% CI = 1.3-4.5), ex-/non-smoking (OR = 1.4-1.6, 95% CI = 1.0-2.1), low motives to tan (both OR = 1.3, 95% CI = 1.0-1.7), no outdoor sport (OR = 1.3, 95% CI = 1.0-1.7), all P < 0.05, as well as the use of sunscreen with lower SPF values (OR = 1.0-3.0, 95% CI = 1.4-4.3) and male gender (OR = 1.6, 95% CI = 1.2-2.0), both P < 0.001, increased the odds of practicing low sun protection. CONCLUSION The results of this investigation suggest considering gender specificity when planning Public (Skin) Health-related educative campaigns and programs, for example, by highlighting the appearance-related benefits of sun light avoidance.
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Affiliation(s)
- Daniela Haluza
- Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Stana Simic
- University of Natural Resources and Life Sciences, Vienna, Austria
| | - Jan Höltge
- Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Renate Cervinka
- Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Hanns Moshammer
- Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Detert H, Hedlund S, Anderson CD, Rodvall Y, Festin K, Whiteman DC, Falk M. Validation of sun exposure and protection index (SEPI) for estimation of sun habits. Cancer Epidemiol 2015; 39:986-93. [PMID: 26547793 DOI: 10.1016/j.canep.2015.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In both Sweden and Australia high incidence rates of skin cancer have become a major health problem. In prevention and risk communication, it is important to have reliable ways for identifying people with risky sun habits. In this study the validity and reliability of the questionnaire Sun Exposure Protection Index (SEPI), developed to assess individual's sun habits and their propensity to increase sun protection during routine, often brief, clinical encounters, has been evaluated. The aim of our study was to evaluate validity and reliability of the proposed SEPI scoring instrument, in two countries with markedly different ultraviolet radiation environments (Sweden and Australia). METHOD Two subpopulations in Sweden and Australia respectively were asked to fill out the SEPI together with the previously evaluated Readiness to Alter Sun Protective Behaviour questionnaire (RASP-B) and the associated Sun-protective Behaviours Questionnaire. To test reliability, the SEPI was again filled out by the subjects one month later. RESULTS Comparison between SEPI and the questions in the Sun-protective Behaviours Questionnaire, analyzed with Spearman's Rho, showed good correlations regarding sun habits. Comparison between SEPI and RASP-B regarding propensity to increase sun protection showed concurrently lower SEPI mean scores for action stage, but no difference between precontemplation and contemplation stages. The SEPI test-retest analysis indicated stability over time. Internal consistency of the SEPI, assessed with Cronbach's alpha estimation showed values marginally lower than the desired >0.70 coefficient value generally recommended, and was somewhat negatively affected by the question on sunscreen use, likely related to the classic "sunscreen paradox". There were some differences in the performance of the SEPI between the Swedish and Australian samples, possibly due to the influence of "available" sunlight and differing attitudes to behaviour and protection "at home" and on vacation. CONCLUSIONS SEPI appears to be a stable instrument with an overall acceptable validity and reliability, applicable for use in populations exposed to different UVR environments, in order to evaluate individual sun exposure and protection.
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Affiliation(s)
- H Detert
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - S Hedlund
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - C D Anderson
- Division of Dermatology, Department of Clinical and Experimental Medicine, Linköping University, S-581 83 Linköping, Sweden.
| | - Y Rodvall
- Department of Public Health Sciences, Karolinska Institutet, S-171 77 Stockholm, Sweden.
| | - K Festin
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Qld 4029 Herston, Australia.
| | - M Falk
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
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Verkouteren JA, Smedinga H, Steyerberg EW, Hofman A, Nijsten T. Predicting the Risk of a Second Basal Cell Carcinoma. J Invest Dermatol 2015; 135:2649-2656. [DOI: 10.1038/jid.2015.244] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/29/2015] [Accepted: 06/13/2015] [Indexed: 12/31/2022]
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King L, Xiang F, Swaminathan A, Lucas RM. Measuring sun exposure in epidemiological studies: Matching the method to the research question. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 153:373-9. [PMID: 26555640 DOI: 10.1016/j.jphotobiol.2015.10.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
Sun exposure has risks and benefits for health. Testing these associations requires tools for measuring sun exposure that are feasible and relevant to the time-course of the health outcome. Recent sun exposure, e.g. the last week, is best captured by dosimeters and sun diaries. These can also be used for medium-term sun exposure e.g. over several weeks, but incur a high participant burden. Self-reported data on "typical time outdoors" for working and non-working days, is less detailed and not influenced by day-to-day variation. Over a longer period, e.g. the lifetime, or for particular life stages, proxies of sun exposure, such as latitude of residence or ambient ultraviolet (UV) radiation levels (from satellites or ground-level monitoring) can be used, with additional detail provided by lifetime sun exposure calendars that include locations of residence, usual time outdoors, and detail of sunburn episodes. Objective measures of lifetime sun exposure include microtopography of sun-exposed skin (e.g. using silicone casts) or conjunctival UV autofluorescence. Potential modifiers of the association between sun exposure and the health outcome, such as clothing coverage and skin colour, may also need to be measured. We provide a systematic approach to selecting sun exposure measures for use in epidemiological health research.
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Affiliation(s)
- Laura King
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 0200, Australia.
| | - Fan Xiang
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 0200, Australia
| | - Ashwin Swaminathan
- Acute and General Medicine Service, The Canberra Hospital, Canberra 2605, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 0200, Australia
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Køster B, Søndergaard J, Nielsen JB, Allen M, Bjerregaard M, Olsen A, Bentzen J. Feasibility of smartphone diaries and personal dosimeters to quantitatively study exposure to ultraviolet radiation in a small national sample. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 31:252-60. [DOI: 10.1111/phpp.12179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Jens Søndergaard
- Research Unit of General Practice; University of Southern Denmark; Odense Denmark
| | - Jesper B. Nielsen
- Research Unit of General Practice; University of Southern Denmark; Odense Denmark
| | - Martin Allen
- Electrical and Computer Engineering; University of Canterbury; Christchurch New Zealand
| | | | - Anja Olsen
- Danish Cancer Society; Copenhagen Ø Denmark
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White KM, Starfelt LC, Young RM, Hawkes AL, Cleary C, Leske S, Wihardjo K. A randomised controlled trial of an online theory-based intervention to improve adult Australians' sun-protective behaviours. Prev Med 2015; 72:19-22. [PMID: 25572618 DOI: 10.1016/j.ypmed.2014.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 12/17/2014] [Accepted: 12/26/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a single-session online theory of planned behaviour (TPB)-based intervention to improve sun-protective attitudes and behaviour among Australian adults. METHODS Australian adults (N=534; 38.7% males; Mage=39.3 years) from major cities (80.9%), regional (17.6%) and remote areas (1.5%) were recruited and randomly allocated to an intervention (N=265) and information only group (N=267). The online intervention focused on fostering positive attitudes, perceptions of normative support, and control perceptions for sun protection. Participants completed questionnaires assessing standard TPB measures (attitude, subjective norm, perceived behavioural control, intention, behaviour) and extended TPB constructs of group norm (friends, family), personal norm, and image norm, pre-intervention (Time 1) and one week (Time 2) and one month post-intervention (Time 3). Repeated Measures Multivariate Analysis of Variance tested intervention effects across time. RESULTS Intervention participants reported more positive attitudes towards sun protection and used sun-protective measures more often in the subsequent month than participants receiving information only. The intervention effects on control perceptions and norms were non-significant. CONCLUSIONS A theory-based online intervention fostering more favourable attitudes towards sun safety can increase sun protection attitudes and self-reported behaviour among Australian adults in the short term.
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Affiliation(s)
- Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia.
| | - Louise C Starfelt
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Ross McD Young
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Anna L Hawkes
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia
| | - Catherine Cleary
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Stuart Leske
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Kylie Wihardjo
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
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Glanz K, Volpicelli K, Jepson C, Ming ME, Schuchter LM, Armstrong K. Effects of tailored risk communications for skin cancer prevention and detection: the PennSCAPE randomized trial. Cancer Epidemiol Biomarkers Prev 2014; 24:415-21. [PMID: 25432953 DOI: 10.1158/1055-9965.epi-14-0926] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prevention and early detection measures for melanoma, such as sun avoidance and skin examinations, are important, but are practiced inconsistently. In this replication of the Project SCAPE trial, we sought to determine whether tailored print materials were more effective at improving adherence than generic print materials for patients at increased risk of skin cancer. METHODS Participants were randomized to receive personalized mailed communications about their skin cancer risk and recommended sun protection, or generic mailings. Participants were Caucasian adults, at moderate or high risk for skin cancer, recruited in outpatient primary care. The main outcomes were overall sun protection behaviors and specific protective behaviors including use of sunscreen, shirt, hat, sunglasses, shade, and sun avoidance; recent sunburns; and skin self-examination and provider skin examination. RESULTS One hundred ninety-two (93.2%) subjects completed the study. Six outcome variables showed significant intervention condition effects in mixed effects models: overall sun protection behavior (P = 0.025); sunscreen use (P = 0.026); use of sunglasses (P = 0.011); sunburns in the past three months (P = 0.033); recency of last skin self-exam (P = 0.017); and frequency of skin exams by health care provider (P = 0.016). CONCLUSIONS Relative to generic communications, tailored risk communications resulted in improved adherence to six skin cancer protective behaviors, including a composite sun protection behavior measure, sunburns, and health care provider skin examinations. IMPACT Tailored interventions can be more effective in improving patient prevention behaviors than nontailored, generic information for patients at moderate to high risk of skin cancer.
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Affiliation(s)
- Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kathryn Volpicelli
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Jepson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael E Ming
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lynn M Schuchter
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bélanger D, Gosselin P, Valois P, Abdous B. Perceived adverse health effects of heat and their determinants in deprived neighbourhoods: a cross-sectional survey of nine cities in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11028-53. [PMID: 25347192 PMCID: PMC4245598 DOI: 10.3390/ijerph111111028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/26/2014] [Accepted: 10/07/2014] [Indexed: 11/17/2022]
Abstract
This study identifies several characteristics of individuals who report their physical and/or mental health as being adversely affected by summertime heat and humidity, within the most disadvantaged neighbourhoods of the nine largest cities of Québec (Canada). The study is cross-sectional by stratified representative sample; 3485 people were interviewed in their residence. The prevalence of reported impacts was 46%, mostly physical health. Female gender and long-term medical leave are two impact risk indicators in people <65 years of age. Low income and air conditioning at home are risk indicators at all ages. Results for having ≥2 diagnoses of chronic diseases, particularly for people self-describing as in poor health (odds ratio, OR<65 = 5.6; OR≥65 = 4.2), and perceiving daily stress, are independent of age. The prevalence of reported heat-related health impacts is thus very high in those inner cities, with notable differences according to age, stress levels and long-term medical leave, previously unmentioned in the literature. Finally, the total number of pre-existing medical conditions seems to be a preponderant risk factor. This study complements the epidemiologic studies based on mortality or severe morbidity and shows that the heat-related burden of disease appears very important in those communities, affecting several subgroups differentially.
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Affiliation(s)
- Diane Bélanger
- Institut National de la Recherche Scientifique Centre Eau Terre Environnement, 490, rue de la Couronne, QC G1K 9A9, Canada.
| | - Pierre Gosselin
- Institut National de Santé Publique du Québec, 945, Avenue Wolfe, QC G1V 5B3, Canada.
| | - Pierre Valois
- Université Laval, 2325 rue de l'Université, QC G1V 0A6, Canada.
| | - Belkacem Abdous
- Centre de Recherche du Centre Hospitalier Universitaire de Québec, 2705, Boulevard Laurier, QC G1V 4G2, Canada.
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48
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de Bruyn JR, van Heeckeren R, Ponsioen CY, van den Brink GR, Löwenberg M, Bredenoord AJ, Frijstein G, D'Haens GR. Vitamin D deficiency in Crohn's disease and healthy controls: a prospective case-control study in the Netherlands. J Crohns Colitis 2014; 8:1267-73. [PMID: 24666975 DOI: 10.1016/j.crohns.2014.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/26/2014] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Vitamin D deficiency has been observed in a wide range of medical conditions including Crohn's disease (CD). We aimed to assess whether CD patients have lower vitamin D levels than healthy controls, and to determine risk factors for vitamin D deficiency. METHODS 25(OH)D was measured by chemiluminescent immunoassay in serum obtained from 101 CD patients and 41 controls. Demographics, sunlight exposure, dietary vitamin D intake, comorbidities and medication were recorded using validated questionnaires. In CD patients the Harvey-Bradshaw index, Montreal classification and surgical resections were also evaluated. 25(OH)D levels of > 75 nmol/L, between 50 and 75 nmol/L and < 50 nmol/L were considered as normal, suboptimal and deficient, respectively. RESULTS Vitamin D levels were rather low but comparable among CD patients and controls (mean 25(OH)D 51.6 nmol/L(± 26.6) in CD, and 60.8 nmol/L(± 27.6) in controls. Multivariate regression analysis revealed BMI, sun protection behaviour, non-Caucasian ethnicity, no use of tanning beds, and no holidays in the last year as significantly associated with serum 25(OH)D levels in CD patients (R=0.62). In the control group no statistically significant factors were identified that had an impact on 25(OH)D serum levels. CONCLUSIONS Vitamin D deficiency is common in CD patients, but also in healthy controls. Appropriate vitamin D screening should be advised in patients with CD. Moreover, the positive effect of sunlight on the vitamin D status should be discussed with CD patients, but this should be balanced against the potential risk of developing melanomas, especially in patients using thiopurines.
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Affiliation(s)
- Jessica R de Bruyn
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Rosanne van Heeckeren
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Gijs R van den Brink
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Mark Löwenberg
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Albert J Bredenoord
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Gerard Frijstein
- Dept. of Occupational Health, Safety and Environment, Academic Medical Center (AMC) Amsterdam, The Netherlands
| | - Geert R D'Haens
- Dept. of Gastroenterology and Hepatology, Academic Medical Center (AMC) Amsterdam, The Netherlands.
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49
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Vuong K, Trevena L, Bonevski B, Armstrong BK. Feasibility of a GP delivered skin cancer prevention intervention in Australia. BMC FAMILY PRACTICE 2014; 15:137. [PMID: 25070692 PMCID: PMC4128422 DOI: 10.1186/1471-2296-15-137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/16/2014] [Indexed: 11/30/2022]
Abstract
Background Despite years of public education, sun-related behaviours are difficult to change and a recent survey showed low levels of sun protection. In this study we evaluated the feasibility and acceptability of an opportunistic skin cancer prevention intervention in general practice. Methods We used a controlled pre-and-post intervention design. Participants (n = 100) were recruited sequentially from patients attending two general practices in Sydney, Australia, from November to December 2010. Participants in the intervention practice (n = 50) received general practitioner delivered sun protection advice after completing a skin cancer risk assessment tool, and a sun protection pamphlet, in addition to routine care, at a single attendance. The skin cancer risk assessment tool provided three levels of risk. The general practitioner (GP) reinforced the level of risk and discussed sun protection. Participants in the control practice (n = 50) received routine care. We measured feasibility by patients’ and GPs’ participation in the intervention and time taken, and acceptability by intervention participants and GPs ratings of the intervention. We measured reported sun-related knowledge, attitudes and behaviour between the two groups at 1 and 13 months. Results The intervention was found to be feasible within existing primary care team arrangements. Participation at baseline was 81% (108/134), and repeated participation was 88% (88/100) at 1 month and 70% (70/100) at 13 months. Participants and practitioners found the intervention acceptable. At 1 month, sun-related knowledge had increased in both patient groups, with a greater increase in the intervention group (adjusted mean difference 0.48, p = 0.034). There were no differences between groups in sun-related knowledge, attitudes and behaviour at 13 months. Conclusions A brief opportunistic skin cancer prevention intervention in general practice is feasible and acceptable. Further research in this setting with a more intensive intervention would be justified.
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Affiliation(s)
- Kylie Vuong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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50
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Cheng TYD, Millen AE, Wactawski-Wende J, Beresford SAA, LaCroix AZ, Zheng Y, Goodman GE, Thornquist MD, Neuhouser ML. Vitamin D intake determines vitamin d status of postmenopausal women, particularly those with limited sun exposure. J Nutr 2014; 144:681-9. [PMID: 24598886 PMCID: PMC3985825 DOI: 10.3945/jn.113.183541] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Few detailed data are available on the wide range of determinants of vitamin D status among postmenopausal women, and it is also unclear whether there may be undiscovered determinants. The objective of this study was to comprehensively evaluate determinants of serum 25-hydroxyvitamin D [25(OH)D] concentrations in a large cohort of postmenopausal women. Data from a subset of the Women's Health Initiative Observational Study were analyzed (50-79 y; n = 3345). Information on diet, lifestyle behaviors, secondhand smoke, use of dietary supplements and medication, chronic diseases, and anthropometry was collected at baseline (1993-1998) and on sun exposure at year 4 follow-up. Linear regression was performed to estimate regression coefficients (β). Significant determinants were total vitamin D intake (food plus supplements per 100 IU/d, β = 2.08), years of supplemental vitamin D use (β = 0.15), total fat intake (grams per day, β = -0.03), smoking status (β = -2.64, current vs. never), regional solar irradiance (β = 6.26, 475-500 vs. 300-325 Langleys), daylight time spent outdoors in summer (β = 5.15, >2 h vs. <30 min/d), recreational physical activity (metabolic equivalent task per hour per week, β = 0.13), waist circumference (centimeters, β = -0.26), and race/ethnicity (β = -11.94, black vs. white). Total vitamin D intake (partial R(2) = 0.09) explained the most variance in serum 25(OH)D concentrations (total R(2) = 0.29). The association between total vitamin D intake and serum 25(OH)D concentrations was stronger among participants who spent less rather than more daylight time outdoors in summer (P-interaction = 0.026). History and medications for hypertension, hyperlipidemia, and type 2 diabetes and secondhand smoke exposure were not associated with serum 25(OH)D. In conclusion, dietary factors and sun exposure remain important determinants of vitamin D status in postmenopausal women. Vitamin D intake should be emphasized for those with limited sun exposure.
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Affiliation(s)
- Ting-Yuan David Cheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Departments of Epidemiology and,To whom correspondence should be addressed. E-mail:
| | - Amy E. Millen
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY; and
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY; and
| | - Shirley A. A. Beresford
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Departments of Epidemiology and
| | - Andrea Z. LaCroix
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Departments of Epidemiology and
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Biostatistics, University of Washington, Seattle, WA
| | - Gary E. Goodman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark D. Thornquist
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Biostatistics, University of Washington, Seattle, WA
| | - Marian L. Neuhouser
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA,Departments of Epidemiology and
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