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Krishna S, Kim R, Pochtar E, Papaioannou H. Heat-related illness and sun safety strategies for pediatric populations. Curr Opin Pediatr 2024:00008480-990000000-00201. [PMID: 39254671 DOI: 10.1097/mop.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PURPOSE OF REVIEW The ongoing rise in temperature poses significant public health concerns such as exposure to extreme heat and increased prevalence of heat-related illnesses. Given that pediatric populations are particularly vulnerable to heat-related risks, pediatricians need to be prepared to counsel caregivers and patients on heat protective strategies and treatment recommendations. RECENT FINDINGS Children are physiologically susceptible to heat-related complications. Heat-related illness is a spectrum of illnesses ranging from mild heat rash to potentially life-threatening heatstroke. Prevention is key to protecting children from heat-related illness and hazards. Recommended prevention strategies include clothing, sun avoidance, hydration, acclimatization, and sunscreen. SUMMARY It is important that pediatricians provide anticipatory guidance on summer sun safety practices to parents and patients. Should prevention fail, pediatricians must be aware of how to effectively distinguish and treat heat-related illness and harms.
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Affiliation(s)
- Shruthi Krishna
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Rachel Kim
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Emily Pochtar
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Helen Papaioannou
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
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Wu YP, Stump TK, Hay JL, Buller DB, Jensen JD, Grossman D, Shen J, Haaland BA, Jones J, Tercyak KP. Protocol for a cluster-randomized trial of a school-based skin cancer preventive intervention for adolescents. Contemp Clin Trials 2024; 140:107494. [PMID: 38458557 PMCID: PMC11065585 DOI: 10.1016/j.cct.2024.107494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Adolescents infrequently use sun protection and engage in intentional tanning more frequently compared to other age groups, leading to increased ultraviolet radiation (UVR) exposure that heightens skin cancer risk across the lifespan. High schools are therefore an ideal setting for offering skin cancer preventive interventions. Yet, there are limited UVR protection interventions for high school students, especially those that are personalized, tested using randomized designs, and include long-term outcome assessment to determine the durability of intervention effects. METHOD The Sun-safe Habits Intervention and Education (SHINE) cluster-randomized trial will test a novel, personalized intervention that targets high school adolescents' sun protection and tanning behaviors, and tracks their outcomes for up to one year following intervention. Enrolled high schools will be randomized to receive either the personalized SHINE intervention, which includes facial UVR photographs and sun protection action planning, or standard education using publicly available materials. Students in both conditions will receive information about skin cancer, sun protection, and skin self-examination. Outcome variables will include students' sun protection and tanning behaviors and sunburn occurrence. Potential moderators (e.g., race/ethnicity) and mediators (e.g., self-efficacy) will also be assessed and tested. CONCLUSIONS This trial examines the efficacy of a personalized intervention targeting sun protection and tanning of high school students. The project will lead to new scientific understanding of the theoretical mechanisms underlying outcomes and moderators of the intervention effects, which will inform future intervention tailoring to meet the needs of vulnerable subgroups.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, 30 N. Mario Capecchi Dr., Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Tammy K Stump
- Department of Dermatology, University of Utah, 30 N. Mario Capecchi Dr., Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 220, Golden, CO 80401, USA.
| | - Jakob D Jensen
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Communication, University of Utah, Salt Lake City, UT, USA.
| | - Douglas Grossman
- Department of Dermatology, University of Utah, 30 N. Mario Capecchi Dr., Salt Lake City, UT 84112, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jincheng Shen
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Benjamin A Haaland
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jacey Jones
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
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Friday S, Salisbury K, Snyder S, Strowd L. Evaluating How a School-Based Skin Cancer Prevention Program Can Change Behavior Among North Carolina Highschoolers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:174-179. [PMID: 38062342 DOI: 10.1007/s13187-023-02391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 04/05/2024]
Abstract
The incidence of skin cancer has risen steadily over recent decades. Childhood and adolescent sun exposure remains a critical risk factor in skin cancer development, making education of high schoolers imperative for promoting sun-safe behaviors. Medical students in North Carolina recognized this need and designed a skin cancer education program focused on portraying skin cancer in individuals with all Fitzpatrick skin phototypes. Eighty-seven students completed the pre-survey, and 84 completed the post-session survey. In the post-survey, 88% of students listed actionable behavioral changes they plan to make following the presentation. Following an educational session, students were able to demonstrate their new knowledge and provide meaningful behavioral changes. This program navigated challenges posed by COVID-19 and addressed the need for more inclusive skin cancer educational material.
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Affiliation(s)
- Sarah Friday
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Katherine Salisbury
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Stephanie Snyder
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Lindsay Strowd
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
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Wu YP, Stump TK, Hay JL, Aspinwall LG, Boucher KM, Deboeck PR, Grossman D, Mooney K, Leachman SA, Smith KR, Wankier AP, Brady HL, Hancock SE, Parsons BG, Tercyak KP. The Family Lifestyles, Actions and Risk Education (FLARE) study: Protocol for a randomized controlled trial of a sun protection intervention for children of melanoma survivors. Contemp Clin Trials 2023; 131:107276. [PMID: 37393004 PMCID: PMC10529923 DOI: 10.1016/j.cct.2023.107276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Children of parents who had melanoma are more likely to develop skin cancer themselves owing to shared familial risks. The prevention of sunburns and promotion of sun-protective behaviors are essential to control cancer among these children. The Family Lifestyles, Actions and Risk Education (FLARE) intervention will be delivered as part of a randomized controlled trial to support parent-child collaboration to improve sun safety outcomes among children of melanoma survivors. METHODS FLARE is a two-arm randomized controlled trial design that will recruit dyads comprised of a parent who is a melanoma survivor and their child (aged 8-17 years). Dyads will be randomized to receive FLARE or standard skin cancer prevention education, which both entail 3 telehealth sessions with an interventionist. FLARE is guided by Social-Cognitive and Protection Motivation theories to target child sun protection behaviors through parent and child perceived risk for melanoma, problem-solving skills, and development of a family skin protection action plan to promote positive modeling of sun protection behaviors. At multiple assessments through one-year post-baseline, parents and children complete surveys to assess frequency of reported child sunburns, child sun protection behaviors and melanin-induced surface skin color change, and potential mediators of intervention effects (e.g., parent-child modeling). CONCLUSION The FLARE trial addresses the need for melanoma preventive interventions for children with familial risk for the disease. If efficacious, FLARE could help to mitigate familial risk for melanoma among these children by teaching practices which, if enacted, decrease sunburn occurrence and improve children's use of well-established sun protection strategies.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Tammy K Stump
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, New York 10021, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 North 1530 East, Salt Lake City, UT 84112, USA.
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Internal Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT, USA.
| | - Pascal R Deboeck
- Department of Psychology, University of Utah, 380 North 1530 East, Salt Lake City, UT 84112, USA.
| | - Douglas Grossman
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Kathi Mooney
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; College of Nursing, University of Utah, 10 North, 2000 E, Salt Lake City, UT 84112, USA.
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Ave; Suite 16D, Portland, OR 97239, USA.
| | - Ken R Smith
- Utah Population Database Pedigree and Population Resource, Department of Population Sciences, Huntsman Cancer Institute, University of Utah, 675 Arapeen Drive; Suite 200, Salt Lake City, UT 84112, USA.
| | - Ali P Wankier
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Hannah L Brady
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Samuel E Hancock
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Bridget G Parsons
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Washington, DC 20007, USA.
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Lips P, de Jongh RT, van Schoor NM. Trends in Vitamin D Status Around the World. JBMR Plus 2021; 5:e10585. [PMID: 34950837 PMCID: PMC8674774 DOI: 10.1002/jbm4.10585] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 01/01/2023] Open
Abstract
Vitamin D status varies across all continents and countries. Vitamin D status usually is adequate in Latin America and Australia, but in contrast it is very low in the Middle East and some countries in Asia. Trends in vitamin D status, whether it improves or declines over the years, carry important messages. Trends usually are small, but can be predictors and indicators of general health. Vitamin D status has improved in the older population in the United States, and improvement relates to dairy use and vitamin D supplements. To the contrary, vitamin D status has declined in the Inuit population of Canada due to a change from a traditional fish diet to a Western diet. A large improvement was seen in Finland after mandatory fortification of dairy products was introduced. Determinants of decline are less sun exposure, increased use of sunscreen, increase of body mass index (BMI), less physical activity, and poor socioeconomic status. Determinants of increase are food fortification with vitamin D and vitamin D supplements. Food fortification can lead to a population-wide increase in vitamin D status as shown by the Finnish example. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Paul Lips
- Department of Internal Medicine, Endocrine SectionAmsterdam University Medical Centre, location VUMCAmsterdamThe Netherlands
| | - Renate T. de Jongh
- Department of Internal Medicine, Endocrine SectionAmsterdam University Medical Centre, location VUMCAmsterdamThe Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Data ScienceAmsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
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Anderson-Vildósola J, Hernández-Martín Á. Addressing Frequently Asked Questions and Dispelling Myths About Melanocytic Nevi in Children. Dermatol Clin 2021; 40:51-59. [PMID: 34799035 DOI: 10.1016/j.det.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Melanocytic nevi are congenital or acquired benign melanocytic neoplasms. The reason for the appearance of melanocytic nevi is not precisely known. Melanocytic nevi frequently occur in children, constituting a common reason for consultation in pediatric dermatology clinics. In our experience, many parents and caregivers present doubts and fears based more on popular beliefs than on data with valid scientific evidence. This review answers their frequently asked questions, such as the risk of malignancy, the importance of nevi location, the warning signs of malignant transformation, best prevention strategies, and optimal management, based on the most recent scientific evidence available.
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Blázquez-Sánchez N, Rivas-Ruiz F, Bueno-Fernández S, Fernández-Morano MT, Arias-Santiago S, Rodríguez-Martínez A, DeCastro-Maqueda G, DeTroya-Martín M. Photoprotection habits, attitudes and knowledge among school communities in the Costa del sol (Spain). Eur J Public Health 2021; 31:508-514. [PMID: 33619546 DOI: 10.1093/eurpub/ckab010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Scholar photoprotection campaigns are among the most effective strategies for preventing skin cancer. Analysis of the target population constitutes a valuable starting point for the implementation of primary prevention strategies. Our aim is to study photoprotection habits, attitudes and knowledge among a Spanish school community. METHODS Descriptive cross-sectional study targeting schoolchildren, parents and teachers at 20 schools in the area of the Costa del Sol Health Agency in southern Spain. Two population-specific, validated questionnaires were used: the CHRESI (for children aged 0-10 years) and CHACES Questionnaire(for adults and adolescents aged > 11 years). We collected demographic data, skin colour, skin phototype, sunburn episodes, sun exposure and photoprotection practices, attitudes and knowledge. RESULTS 1728 questionnaires were analyzed (22% parents, 14.5% teachers, 44.8% adolescents and 18.6% children). The average ages were 8 years (children), 16 years (adolescents), 39 years (teachers) and 42 years (parents). Globally, the predominant features were: male sex (52%), Spanish nationality (92%) and phototypes II-III (61%). Children, followed by adolescents, reported the highest exposure to the sun, both in frequency and in duration. Adolescents had the higher rate of sunburn (75%), followed by parents/teachers (54.1%) and children (44.1%). Children and their parents were the most likely to adopt photoprotection measures, while adolescents presented more risky attitudes. Knowledge regarding photoprotection was acceptable (6.9/10). CONCLUSIONS This study highlights the need to improve photoprotection knowledge, habits and attitudes among our target population. Scholars, parents and teachers in our area should be addressed in campaigns to promote healthy sun exposure habits, thus reducing skin cancer-related morbidity and mortality in this region.
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Affiliation(s)
| | - F Rivas-Ruiz
- Investigation Department, Hospital Costa del Sol, Marbella, Spain
| | - S Bueno-Fernández
- Optometry and Ophthalmology Department, CEU San Pablo University, Madrid, Spain
| | | | - S Arias-Santiago
- Dermatology Department, Hospital Virgen de las Nieves, Granada University, Spain
| | | | - G DeCastro-Maqueda
- Department of Didactics of Physical, Plastic and Musical Education, Faculty of Educational Sciences, University of Cádiz, Spain
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Age and Cohort Trends of Malignant Melanoma in the United States. Cancers (Basel) 2021; 13:cancers13153866. [PMID: 34359766 PMCID: PMC8345588 DOI: 10.3390/cancers13153866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The occurrence of melanoma in the United States is increasing over time. We examined trends in melanoma by birth year and age groups to determine if individuals born more recently experience higher rates of melanoma as they age. We examined these trends separately among men and women and by the location on the body that the melanoma occurred. Melanoma incidence has continued to increase across more recent birth years and varies by body site and sex. Melanoma incidence will likely continue to increase as younger individuals age. While these are mostly thin melanomas, treatment to prevent cancer progression is still costly, both economically and emotionally, for patients. Abstract The incidence of malignant melanoma in the United States is increasing, possibly due to changes in ultraviolet radiation (UVR) exposure due to lifestyle or increased awareness and diagnosis of melanoma. To determine if more recent birth cohorts experience higher rates of melanoma as they age, we examined age and birth cohort trends in the United States stratified by anatomic site and cancer type (in situ vs. malignant) of the melanoma diagnosed from 1975–2017. Poisson regression of cutaneous melanoma cases per population for 1975–2017 from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was used to estimate age adjusted incidence for five-year birth cohorts restricted to Whites, ages 15–84. The rate of melanoma incidence across birth cohorts varies by anatomic site and sex. Melanomas at all anatomic sites continue to increase, except for head and neck melanomas in men. Much of the increase in malignant melanoma is driven by cases of thin (<1.5 mm) lesions. While increased skin exams may contribute to the increased incidence of in situ and thin melanoma observed across birth cohorts, the shifts in anatomic site of highest melanoma incidence across birth cohorts suggest changes in UVR exposure may also play a role.
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Chaudhry SB, Armbrecht ES, Gibbons M, Council ML, Knutson A, Lickerman S. Sun Protection Outreach Teaching by Students (SPOTS)-Evaluating the Efficacy of Skin Cancer Prevention Education for Adolescents. Dermatol Surg 2021; 47:926-930. [PMID: 34167128 DOI: 10.1097/dss.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Sun Protection Outreach Teaching by Students (SPOTS) program addresses an unmet need by training medical students to teach adolescents about skin cancer prevention and early detection. OBJECTIVE To measure (1) changes in adolescents' knowledge, attitudes, and behaviors regarding sun protection and (2) the impact on medical students' confidence in skin cancer preventive counseling. METHODS Pre-SPOTS and 1-month post-SPOTS program surveys were completed by adolescent participants and medical student instructors. RESULTS Amongst adolescent students, analysis of 1,142 pre-program surveys and 618 post-program surveys revealed statistically significant improvements in knowledge, attitudes, and behaviors. Among the favorable results, 26%, 41%, and 20% improvements over baseline were observed in SPF knowledge, preference for natural untanned skin, and intent to wear sunscreen, respectively (p < .001). One-third of adolescents reported having tried to increase sunscreen use. Amongst medical students, analysis of 78 pre-teaching and 74 post-teaching surveys revealed an increase in feeling "very confident" in counseling patients, from 23% pre-teaching to 82% post-teaching (p < .001). CONCLUSION SPOTS demonstrated a dual benefit to adolescents and medical students. The program is available for dermatologists to implement in their communities.
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Affiliation(s)
- Sofia B Chaudhry
- Department of Dermatology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Eric S Armbrecht
- Saint Louis University Center for Outcomes Research, St. Louis, Missouri
| | | | - M Laurin Council
- The Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Alex Knutson
- Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
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10
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Paulson KG, Gupta D, Kim TS, Veatch JR, Byrd DR, Bhatia S, Wojcik K, Chapuis AG, Thompson JA, Madeleine MM, Gardner JM. Age-Specific Incidence of Melanoma in the United States. JAMA Dermatol 2020; 156:57-64. [PMID: 31721989 DOI: 10.1001/jamadermatol.2019.3353] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Melanoma is epidemiologically linked to UV exposure, particularly childhood sunburn. Public health campaigns are increasing sun-protective behavior in the United States, but the effect on melanoma incidence is unknown. Objective To examine the incidence of melanoma in the United States and whether any age-specific differences are present. Design, Setting, and Participants Observational, population-based registry data were extracted on July 3, 2018, from the combined National Program of Cancer Registries-Surveillance Epidemiology and End Results United States Cancer Statistics database for 2001-2015. Deidentified data for 988 103 cases of invasive melanoma, with International Classification of Diseases for Oncology histologic categorization codes 8720 to 8790, were used for analysis. Data analysis was performed from July 1, 2018, to March 1, 2019. Main Outcomes and Measures The annual rates of melanoma in pediatric, adolescent, young adult, and adult age groups were determined. Analyses were stratified by sex, and incidence rates were age-adjusted to the 2000 US standard population. Annual percentage change (APC) in incidence rate was calculated over the most recent decade for which data were available (2006-2015) using the weighted least squares method. Results In 2015, 83 362 cases of invasive melanoma were reported in the United States, including 67 in children younger than 10 years, 251 in adolescents (10-19 years), and 1973 in young adults (20-29 years). Between 2006 and 2015, the overall incidence rate increased from 200.1 to 229.1 cases per million person-years. In adults aged 40 years or older, melanoma rates increased by an APC of 1.8% in both men (95% CI, 1.4%-2.1%) and women (95% CI, 1.4%-2.2%). In contrast, clinically and statistically significant decreases were seen in melanoma incidence for adolescents and young adults. Specifically, incidence rates decreased by an APC of -4.4% for male adolescents (95% CI, -1.7% to -7.0%), -5.4% for female adolescents (95% CI, -3.3% to -7.4%), -3.7% for male young adults (95% CI, -2.5% to -4.8%), and -3.6% for female young adults (95% CI, -2.8% to -4.5%). Data on skin pigmentation and sun protection history were unavailable; similar trends were observed with data limited to non-Hispanic whites. Young adult women appeared to have twice the risk of melanoma as young adult men. Conclusions and Relevance The incidence of invasive melanoma in the United States appeared to decrease in adolescents and young adults from 2006 to 2015, and this finding contrasted with increases in older populations. These incidence trends suggest that public health efforts may be favorably influencing melanoma incidence in the United States.
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Affiliation(s)
- Kelly G Paulson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, University of Washington, Seattle.,Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington
| | - Deepti Gupta
- Seattle Children's Hospital, Seattle, Washington.,Division of Dermatology, University of Washington, Seattle.,Department of Pediatrics, University of Washington, Seattle
| | - Teresa S Kim
- Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington.,Department of Surgery, University of Washington, Seattle
| | - Joshua R Veatch
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, University of Washington, Seattle.,Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington
| | - David R Byrd
- Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington.,Department of Surgery, University of Washington, Seattle
| | - Shailender Bhatia
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, University of Washington, Seattle.,Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington
| | - Katherine Wojcik
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Aude G Chapuis
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, University of Washington, Seattle.,Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington
| | - John A Thompson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, University of Washington, Seattle.,Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington
| | - Margaret M Madeleine
- Department of Epidemiology, University of Washington School of Public Health, Seattle.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jennifer M Gardner
- Melanoma and Skin Oncology, Seattle Cancer Care Alliance, Seattle, Washington.,Division of Dermatology, University of Washington, Seattle
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11
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Schlarbaum JP, Lazovich D, Dodd E, Hanson B, Polcari IC. Examination of use and barriers for five sun protection strategies in parents and their children. Pediatr Dermatol 2020; 37:827-832. [PMID: 32618020 DOI: 10.1111/pde.14250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Sun protection starting in childhood is an important means of skin cancer prevention. Factors associated with sunscreen use have been previously described. However, less is known about factors associated with children's utilization of non-sunscreen sun protection strategies. We sought to examine parent and child characteristics, parental use of sun protection, and barriers associated with children's use of five sun protection strategies: sunscreen, shirts with sleeves, wide-brimmed hats, sunglasses, and shade. METHODS A cross-sectional survey of parents of children entering kindergarten through grade 8. Survey participants were recruited at the 2016 Minnesota State Fair. RESULTS A total of 409 parents were surveyed. The most common sun protection strategies parents reported for their child were wearing a shirt with sleeves (69.9%) and using sunscreen (61.9%), while protection via shade, wide-brimmed hats, and sunglasses were reported by less than one-quarter of parents. For each individual strategy, parents' own use of that strategy was strongly associated with that strategy in their children. Lack of child cooperation was associated with decreased use of sunscreen, shirts with sleeves, and wide-brimmed hats. CONCLUSION Significant room for improvement exists in childhood sun protection. Parents should especially be encouraged to use shade, wide-brimmed hats, and sunglasses as methods of protection for their children. Advising parents to model seeking shade, applying sunscreen, and choosing appropriate clothing and hats may improve sun safety practices.
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Affiliation(s)
- Jamie P Schlarbaum
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public, Health-University of Minnesota, Minneapolis, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erin Dodd
- Department of Medicine, Division of Dermatology, University of Chicago, Chicago, Illinois, USA
| | - Brooke Hanson
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ingrid C Polcari
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,Departments of Dermatology & Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Reynolds KD, Buller DB, Buller MK, Massie K, Berteletti J, Ashley J, Meenan R. Randomized controlled trial evaluating an intervention supporting implementation of sun safety policies in California public elementary schools. Prev Med 2020; 137:106125. [PMID: 32389679 PMCID: PMC7495886 DOI: 10.1016/j.ypmed.2020.106125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
Solar ultraviolet radiation (UV) exposure is the primary risk factor for skin cancer and children receive about one-quarter of lifetime UV exposure before age 18. Thus, skin cancer prevention is essential for children. The objective of this study was to test an intervention to facilitate implementation of district sun safety policies. Elementary schools (N = 118) from 40 California public school districts with a school board-approved policy for sun safety were recruited along with one principal and teacher from each school. Elementary schools were randomly assigned to receive the 20-month Sun Safe Schools intervention (N = 58) or to a minimal informational control condition (N = 60). Principals were 47.8 and teachers 44.3 years of age and were predominately female (principals 72.7%; teachers 86.7%) and White (principals 72.0%; teachers 68.2%). The 20-month Sun Safe Schools intervention was delivered to principals and included a coaching session, telephone and email contacts, provision of resources for practice implementation, and a small grant program. The principal (N = 118) and a teacher (N = 113) at each school reported on school sun protection practices 20-months post-baseline. The schools were diverse in student characteristics (M = 64.1% free/reduced price meals; M = 54.5% Hispanic). Intervention principals reported implementing more sun safety practices overall (control M = 2.7, intervention M = 4.2, p < .005) and more practices not present in the district's policy (control M = 0.4, intervention M = 0.9, p = .005). Principals and teachers combined replicated these findings and also reported implementing more practices present in the district policy (control M = 0.9, intervention M = 1.3, p = .005). In sum, the intervention increased sun safety practices in public elementary schools. Trial Registration. This study is registered in ClinicalTrials.gov, www.clinicaltrials.gov, with the identification number of NCT03243929.
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Affiliation(s)
- Kim D Reynolds
- School of Community & Global Health, Claremont Graduate University, 675 W, Foothill Blvd., Ste. 200, Claremont, CA 91711, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Mary K Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Kim Massie
- School of Community & Global Health, Claremont Graduate University, 675 W, Foothill Blvd., Ste. 200, Claremont, CA 91711, USA
| | - Julia Berteletti
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Jeff Ashley
- Sun Safety for Kids, 2625 W. Alameda Ave., Suite 517, Burbank, CA 91505, USA
| | - Richard Meenan
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA
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Cheng W, Brown R, Vernez D, Goldberg D. Estimation of Individual Exposure to Erythemal Weighted UVR by Multi-Sensor Measurements and Integral Calculation. SENSORS 2020; 20:s20154068. [PMID: 32707787 PMCID: PMC7435697 DOI: 10.3390/s20154068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023]
Abstract
Ultraviolet radiation (UVR) can be hazardous to humans, especially children, and is associated with sunburn, melanoma, and the risk of skin cancer. Understanding and estimating adults’ and children’s UVR exposure is critical to the design of effective interventions and the production of healthy UVR environments. Currently, there are limitations to the ways computer modeling and field measurements estimate individual UVR exposure in a given landscape. To address these limitations, this study developed an approach of integral calculation using six-directional (up, down, south, north, east, and west) field-measured UVR data and the estimated body exposure ratios (ER) for both children and adults. This approach showed high agreement when compared to a validated approach using ambient UVR and estimated ER data with a high r-square value (90.72% for child and adult models), and a low mean squared error (6.0% for child model and 5.1% for adult model) in an open area. This approach acting as a complementary tool between the climatology level and individual level can be used to estimate individual UVR exposure in a landscape with a complicated shady environment. In addition, measuring daily UVR data from six directions under open sky conditions confirmed that personal dosimeters underestimate actual individual UVR exposure.
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Affiliation(s)
- Wenwen Cheng
- College of Architecture, University of Oklahoma, Norman, OK 73019, USA
- Correspondence:
| | - Robert Brown
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA;
| | - David Vernez
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health, University of Lausanne, CH-1015 Lausanne, Switzerland;
| | - Daniel Goldberg
- Department of Geography, Texas A&M University, College Station, TX 77843, USA;
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Effectiveness of Educational Practices in University Students' Knowledge about Sun Protection and Its Relation to Sunlight Exposure: An Exploratory Study in a Portuguese Higher Education Institution. Eur J Investig Health Psychol Educ 2020; 10:720-732. [PMID: 34542507 PMCID: PMC8314291 DOI: 10.3390/ejihpe10030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022] Open
Abstract
Nowadays, there is worldwide recognition that health and educational outcomes are inextricably linked. It is also recognized that health education comprises opportunities to improve health literacy, including the improvement of knowledge and the development of life skills to promote individual health. It is also known that the behavioral practices regarding sun exposure are an important risk factor for skin cancer. Research is needed in this area to understand the contribution of the "Education for Health" curricular unit to these issues. Our exploratory research sought to collect information about the knowledge and practices regarding sun exposure of a group of Portuguese university students who have already attended this curricular unit. The results indicate that the participants show that, notwithstanding that they have already attended this curricular unit, they do not have more literacy on skin health, do not perceive that sun exposure habits are related to skin health and do not perceive that photoprotection constitutes prevention of skin cancer. The results support the need to promote the necessary reflection and debate on the way in which health education should be taught, as well as what is taught, in order to empower students to get decision-making skills associated with the adoption of healthier attitudes and practices, thus helping to prevent skin cancer.
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15
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Reynolds KD, Buller DB, Berteletti J, Massie K, Ashley J, Buller MK, Meenan RT, Liu X. School-Level Factors Associated with Sun Protection Practices in California Elementary Schools. THE JOURNAL OF SCHOOL HEALTH 2020; 90:386-394. [PMID: 32141621 PMCID: PMC7127930 DOI: 10.1111/josh.12884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/15/2019] [Accepted: 05/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study examined implementation of district sun safety policy in schools and tested correlates of implementation in California public school districts. METHODS Principals (N = 118) and teachers (N = 113) in California public elementary schools (N = 118) were recruited and completed a survey on sun protection policies and practices. The sample contained schools whose districts subscribed to the California School Boards Association and adopted Board Policy 5141.7 for sun safety. Principals and teachers reported on implementation of 10 school practices related to BP 5141.7 indicating which practices were implemented in the school. RESULTS Years in public education (Exponentiated Score (ES) = 0.51, p < .001), years worked in the current district (ES = 0.49, p < .001), perception that parents should take action to protect children from the sun (ES = 0.43, p < .01), and personal skin phenotype (Low Risk ES = 0.55; High Risk ES = 0.09, p < .05) were associated with number of practices implemented in the school using multiple Poisson regression. CONCLUSIONS Policy implementation is more likely among schools with experienced faculty, when parents are seen as important partners in student skin cancer prevention, and when school principals and teachers have a lower personal risk phenotype.
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Affiliation(s)
- Kim D. Reynolds
- Professor, School of Community & Global Health, Claremont Graduate University. 675 W. Foothill Blvd., Ste. 310, Claremont, CA 91711, USA
| | - David B. Buller
- Director of Research and Senior Scientist, Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Julia Berteletti
- Research Program Manager, Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Kim Massie
- Project Manager, School of Community & Global Health, Claremont Graduate University. 675 W. Foothill Blvd., Ste. 310, Claremont, CA 91711, USA
| | - Jeff Ashley
- President, Sun Safety for Kids. 2625 W. Alameda Ave., Suite 517, Burbank, CA 91505, USA
| | - Mary Klein Buller
- President, Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Richard T. Meenan
- Senior Investigator, Kaiser Permanente Center for Health Research. 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Xia Liu
- Biostatistical Manager, Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
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Abstract
In this article, we summarize the research that eventually led to the classification of the full ultraviolet (UV) radiation spectrum as carcinogenic to humans. We recall the pioneering works that led to the formulation of novel hypotheses on the reasons underlying the increasing burden of melanoma in light-skinned populations. It took long before having compelling evidence on the association between UV and melanoma, in particular, the importance of UV exposure during childhood for both the occurrence of melanoma and death. The role of UVA was established only after 2005. If molecular lesions caused by UV radiation are better known, the precise mechanism by which UV exposure drives melanoma occurrence and progression still needs to be elucidated. More research on the UV-melanoma relationships has led to more evidence-based sun-protection recommendations, especially for children, and to effective control of the artificial UV tanning fashion. Since around 1985-1995, the mortality because of melanoma has started to decrease in younger age groups in most light-skinned populations. If sun protection among children remain on top of public health agendas, there is a fairly great chance that melanoma mortality will stabilize and steadily decrease in all light-skinned populations. The introduction of effective therapies against metastatic disease will improve this reversal in mortality trends.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health, International Prevention Research Institute (iPRI), Dardilly, France
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Pettigrew S, Parnell A, Strickland M, Neale R, Lucas R. The Potential of Ultraviolet Radiation Meters in Secondary Schools as a Sun Protection Intervention Mechanism for Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041137. [PMID: 32053927 PMCID: PMC7068266 DOI: 10.3390/ijerph17041137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
The aim of this pilot study was to assess whether the installation of ultraviolet radiation (UVR) meters in secondary schools has the potential to improve adolescents’ sun protection-related knowledge, attitudes, and behaviours and reduce their exposure to UVR during school hours. Data were collected from students at two schools via online pre- and post-intervention surveys, measurement of sunscreen usage, polysulfone UVR exposure badges, and photographs of the schoolyards to assess hat and shade use. Several operational issues limited the quantity and quality of data that could be collected, and findings were mixed. While there were no significant changes in either self-reported or observed sun protection behaviours, there were significant improvements in UVR knowledge among students at the intervention school, and reactions to the meter were highly favourable. Students reported consulting the meter regularly and using it to make decisions about their sun protection behaviours. Overall, the study results offer some support for the use of UVR meters in areas frequented by adolescents and provide insights into the process issues that are likely to need to be addressed when attempting to trial sun protection interventions in schools.
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Affiliation(s)
- Simone Pettigrew
- Food Policy Division, The George Institute for Global Health, Newtown, NSW 2042, Australia
- Correspondence: ; Tel.: +61-428-888-202
| | - Ashleigh Parnell
- Kurongkurl Katitjin, Edith Cowan University, Joondalup, WA 6050, Australia;
| | - Mark Strickland
- Cancer Prevention & Research, Cancer Council Western Australia, Subiaco, WA 6008, Australia;
| | - Rachel Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia;
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia;
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18
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Stanganelli I, Naldi L, Cazzaniga S, Gandini S, Magi S, Quaglino P, Ribero S, Simonacci M, Pizzichetta MA, Spagnolo F, Palmieri G, Queirolo P. Sunburn-related variables, secular trends of improved sun protection and short-term impact on sun attitude behavior in Italian primary schoolchildren: Analysis of the educational campaign "Il Sole Amico" ("The sun as a friend"). Medicine (Baltimore) 2020; 99:e18078. [PMID: 31895765 PMCID: PMC6946412 DOI: 10.1097/md.0000000000018078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sun protection early in life is an essential issue for primary prevention of skin cancers. The Il Sole per Amico was an educational campaign among 66 Italian primary schools. A total of 12,188 questionnaires were completed at baseline. Overall, 9.4% children reported >1 sunburn during the last year and 44.7% parents a use of sunlamps. Independent factors associated with sunburns were: age, lower level of parents' education, light eye and skin color, freckles, nevi on arms, intense sun exposure during the last year, sporadic use of sunscreens, and parental use of sunlamps. A total of 7280 (59.7%) questionnaires were completed at the end of the educational intervention. No significant difference was documented about behavior between the pre- and post-intervention periods. A significant reduction was instead found in both prevalence of recent sunburns and total number of sunburn episodes after comparison with the data obtained by identical questionnaire in the same geographic areas in the "Sole Si Sole No" project in 2001.
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Affiliation(s)
- Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
- Department of Medicine and Surgery, University of Parma
| | - Luigi Naldi
- Centro Studi GISED, Bergamo
- U.O.C. Dermatologia, Ospedale San Bortolo - Vicenza, Vicenza
| | | | - Sara Gandini
- Division of Epidemiology and Biostatistics Unit, European Institute of Oncology, Milan
| | - Serena Magi
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin
| | - Simone Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin
| | | | | | | | - Giuseppe Palmieri
- Unit of Cancer Genetics, National Research Council (CNR), Institute of Biomolecular Chemistry (ICB), Sassari, Italy
| | - Paola Queirolo
- Department of Medical Oncology, Ospedale Policlinico San Martino, Genoa
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19
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A characterization of sun protection attitudes and behaviors among children and adolescents in the United States. Prev Med Rep 2019; 16:100988. [PMID: 31660287 PMCID: PMC6807366 DOI: 10.1016/j.pmedr.2019.100988] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
Children and adolescents may be vulnerable to increased ultraviolet radiation exposure and greater risk for subsequent sun-related pathologies. This study examined the demographic, geographic, and phenotypic factors influencing sun exposure and protective behaviors among children and adolescents living in the United States. A cross-sectional survey on perceived sun exposure and protective behaviors was administered at three sports medicine clinics in California, Colorado, and Hawaii. Responses were measured with a 5-item frequency scale: Never, Rarely (25% of the time or less), Sometimes (50% of the time), Often (75% of the time or more), and Always. Sun protective behavior was examined using univariate and multivariate analyses. In total, 860 surveys were collected (52% female, 48% male; mean age 12.7 years). Females reported significantly greater frequency of using sunscreen (p = 0.001), staying in the shade or using an umbrella while in the sun (p = 0.004), and tanning (p < 0.001). Age was inversely associated with sunscreen use frequency (p < 0.001); the percentage of participants who reported always wearing sunscreen decreased as age increased. Participants in Hawaii reported using sunscreen less frequently than those in California and Colorado (p < 0.001). These results identify high-risk populations such as males, older adolescents, and Hawaii's youth who may not be practicing frequent sun protective behaviors. While it is important for youth to stay active, they must also be reminded to adopt protective behaviors while outdoors to prevent unnecessary sun damage and lower the risk of sun exposure complications.
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20
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Paul SP. Ensuring the Safety of Sunscreens, and Their Efficacy in Preventing Skin Cancers: Challenges and Controversies for Clinicians, Formulators, and Regulators. Front Med (Lausanne) 2019; 6:195. [PMID: 31552252 PMCID: PMC6736991 DOI: 10.3389/fmed.2019.00195] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
When people think about sun-protection or prevention of skin cancer, sunscreens readily come to mind. Sunscreen effectiveness is tested in vivo by the ability to prevent erythema of skin, yet testing methods vary between markets, and many sunscreens fail to achieve their claims. This article discusses the mechanism of action of sunscreens, Sun Protection Factor (SPF), safety concerns and the challenges for regulators. Many sunscreens that prevent erythema do not provide adequate protection as they contain anti-inflammatory agents; others have ingredients whose risks have not been fully evaluated. This article reviews the imperfect science behind sunscreens and points out the gaps in knowledge regarding safety, efficacy, public knowledge, and perception. Regulations vary between countries and only adds to the confusion. To truly prevent skin cancer, clinicians, formulators and regulators need to come together to research more and improve public education.
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Affiliation(s)
- Sharad P. Paul
- Faculty of Design and Creative Technologies, Auckland University of Technology, Auckland, New Zealand
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
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21
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Skiljevic D, Sreckovic L. Ultraviolet radiation exposure among Belgrade high school students: analysis of knowledge, attitudes and behaviour. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:63-75. [PMID: 30811695 DOI: 10.1111/jdv.15312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The incidence of melanoma has been increasing worldwide. Extended UV exposure during childhood or adolescence significantly increases the probability of skin cancer in adulthood. OBJECTIVE The objective of this study was to analyse knowledge, attitudes and behaviour regarding exposure to natural and artificial UV radiation among Belgrade high school students. METHODS The study was conducted using a questionnaire among 549 students of 3rd and 4th grade (17 and 18 years of age) in four Belgrade high schools. The questionnaire had 32 questions: questions about gender, date and month of birth and parents' education, nine questions regarding sunbed use, nine questions regarding behaviour in the sun during summer months, four questions regarding personal and family history and skin phototype and seven questions regarding attitude and general knowledge about effects of UV radiation. Assessment of frequency rate and relative numbers was used as methods of descriptive statistics. RESULTS As many as 39% of participants had used a sunbed at least once, 38% plan on using it in the future. One quarter spends more than 3 hours in the sun on the beach during summer without any protection, and only one-third of participants had not experienced sunburn during last summer. Only one-half of students know what melanoma is, while 37% stated that they do not know. CONCLUSION General awareness of risk factors regarding sun exposure as well as general knowledge about melanoma is not on a high level among Belgrade high school students. Therefore, besides legislative measures, it is extremely important to conduct adequate education programmes in high schools.
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Affiliation(s)
- D Skiljevic
- Clinic of Dermatovenereology, Clinical Centre of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - L Sreckovic
- Clinic of Dermatovenereology, Clinical Centre of Serbia, Belgrade, Serbia
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22
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Abstract
Skin cancer is the most common cancer in the United States, and risk for melanoma is greatly increased with a serious sunburn in childhood or adolescence. Skin cancer also is one of the most preventable cancers, as sun exposure is an almost entirely modifiable risk factor. Proper skin protection should start early in life when infants begin to be exposed to the outdoors. [Pediatr Ann. 2019;48(6):e213-e214.].
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23
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Wu YP, Parsons BG, Nagelhout E, Haaland B, Jensen J, Zaugg K, Caputo H, Lensink R, Harding G, Yancey J, Klein SZ, Leachman SA, Tercyak KP. A four-group experiment to improve Western high school students' sun protection behaviors. Transl Behav Med 2019; 9:468-479. [PMID: 31094440 PMCID: PMC6520801 DOI: 10.1093/tbm/ibz021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multicomponent skin cancer preventive interventions for adolescents that aim to decrease ultraviolet radiation (UVR) exposure and sunburns are particularly needed given their intentional tanning and infrequent use of sun protection. The purpose of this study was to conduct an early-phase study within the Multiphase Optimization Strategy framework that experimentally tested four unique intervention components targeting high school students' skin cancer prevention behaviors. Schools (11 total, N = 1,573 students) were assigned to receive one of four interventions: skin cancer education (control), education plus a sunscreen activity (to illustrate sunscreen's UVR-blocking properties), or behavior change worksheet (sun protection goal setting and planning) or receipt of a personalized UV damage photograph (photograph of facial damage). Sun protection, sunburn, and tanning outcomes were assessed before intervention and at 1-month follow-up. Within- and between-intervention changes in outcomes were examined using generalized estimating equation modeling. All interventions were associated with significant improvements in sun protection. The photograph was superior in controlling intentional tanning and sunburn when compared to the behavior change worksheet (ps < .05). In contrast, the worksheet was associated with greater increases in sun protection use when compared with the photograph (ps < .05). In this experiment testing four skin cancer preventive intervention components that varied in approach, content, and interactivity, the behavior change worksheet was superior in improving sun protection use whereas the UV photograph was superior in controlling intentional tanning and sunburn. Future randomized trials to test combinations of these intervention components are needed, and could identify mechanisms underlying improved effects and demographic or behavioral moderators of intervention effects.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Bridget G Parsons
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Nagelhout
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jakob Jensen
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kelsey Zaugg
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Heloisa Caputo
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Riley Lensink
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Garrett Harding
- Community Outreach and Prevention Education, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey Yancey
- Community Outreach and Prevention Education, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Stephanie Z Klein
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, NW Washington, DC, USA
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24
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Iacopetta K, Collins-Praino LE, Buisman-Pijlman FTA, Hutchinson MR. Can neuroimmune mechanisms explain the link between ultraviolet light (UV) exposure and addictive behavior? Brain Behav Immun 2018; 73:125-132. [PMID: 30009997 DOI: 10.1016/j.bbi.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 12/22/2022] Open
Abstract
High ultraviolet (UV) light exposure on the skin acts as a reinforcing stimulus, increasing sun-seeking behavior and even addiction-like sun seeking behavior. However, the physiological mechanisms that underlie this process remain to be defined. Here, we propose a novel hypothesis that neuroimmune signaling, arising from inflammatory responses in UV-damaged skin cells, causes potentiated signaling within the cortico-mesolimbic pathway, leading to increased sun-seeking behaviors. This hypothesized UV-induced, skin-to-brain signaling depends upon cell stress signals, termed alarmins, reaching the circulation, thereby triggering the activation of innate immune receptors, such as toll-like receptors (TLRs). This innate immune response is hypothesized to occur both peripherally and centrally, with the downstream signaling from TLR activation affecting both the endogenous opioid system and the mesolimbic dopamine pathway. As both neurotransmitter systems play a key role in the development of addiction behaviors through their actions at key brain regions, such as the nucleus accumbens (NAc), we hypothesize a novel connection between UV-induced inflammation and the activation of pathways that contribute to the development of addiction. This paper is a review of the existing literature to examine the evidence which suggests that chronic sun tanning resembles a behavioral addiction and proposes a novel pathway by which persistent sun-seeking behavior could affect brain neurochemistry in a manner similar to that of repeated drug use.
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Affiliation(s)
- Krystal Iacopetta
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Femke T A Buisman-Pijlman
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Mark R Hutchinson
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, University of Adelaide, Adelaide, SA, Australia.
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25
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Stump TK, Aspinwall LG, Kohlmann W, Champine M, Hauglid J, Wu YP, Scott E, Cassidy P, Leachman SA. Genetic Test Reporting and Counseling for Melanoma Risk in Minors May Improve Sun Protection Without Inducing Distress. J Genet Couns 2018; 27:955-967. [PMID: 29349527 PMCID: PMC6039245 DOI: 10.1007/s10897-017-0185-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
Genetic testing of minors is advised only for conditions in which benefits of early intervention outweigh potential psychological harms. This study investigated whether genetic counseling and test reporting for the CDKN2A/p16 mutation, which confers highly elevated melanoma risk, improved sun protection without inducing distress. Eighteen minors (Mage = 12.4, SD = 1.9) from melanoma-prone families completed measures of protective behavior and distress at baseline, 1 week (distress only), 1 month, and 1 year following test disclosure. Participants and their mothers were individually interviewed on the psychological and behavioral impact of genetic testing 1 month and 1 year post-disclosure. Carriers (n = 9) and noncarriers (n = 9) reported significantly fewer sunburns and a greater proportion reported sun protection adherence between baseline and 1 year post-disclosure; results did not vary by mutation status. Anxiety symptoms remained low post-disclosure, while depressive symptoms and cancer worry decreased. Child and parent interviews corroborated these findings. Mothers indicated that genetic testing was beneficial (100%) because it promoted risk awareness (90.9%) and sun protection (81.8%) without making their children scared (89.9%); several noted their child's greater independent practice of sun protection (45.4%). In this small initial study, minors undergoing CDKN2A/p16 genetic testing reported behavioral improvements and consistently low distress, suggesting such testing may be safely implemented early in life, allowing greater opportunity for risk-reducing lifestyle changes.
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Affiliation(s)
- Tammy K Stump
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Dr., Suite 1500, Chicago, IL, 60611, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jamie Hauglid
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Emily Scott
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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26
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Hanigan D, Truong L, Schoepf J, Nosaka T, Mulchandani A, Tanguay RL, Westerhoff P. Trade-offs in ecosystem impacts from nanomaterial versus organic chemical ultraviolet filters in sunscreens. WATER RESEARCH 2018; 139:281-290. [PMID: 29656193 DOI: 10.1016/j.watres.2018.03.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 05/20/2023]
Abstract
Both nanoparticulate (nZnO and nTiO2) and organic chemical ultraviolet (UV) filters are active ingredients in sunscreen and protect against skin cancer, but limited research exists on the environmental effects of sunscreen release into aquatic systems. To examine the trade-offs of incorporating nanoparticles (NPs) into sunscreens over the past two decades, we targeted endpoints sensitive to the potential risks of different UV filters: solar reactive oxygen production in water and disruption of zebrafish embryo development. First, we developed methodology to extract nanoparticles from sunscreens with organic solvents. Zebrafish embryos exposed to parts-per-million NPs used in sunscreens displayed limited toxicological effects; nZnO particles appeared to be slightly more toxic than nTiO2 at the highest concentrations. In contrast, seven organic UV filters did not affect zebrafish embryogenesis at or near aqueous solubility. Second, to simulate potent photo-initiated reactions upon release into water, we examined methylene blue (MB) degradation under UV light. nTiO2 from sunscreen caused 10 times faster MB loss than nZnO and approached the photocatalytic degradation rate of a commercial nTiO2 photocatalysts (P25). Organic UV filters did not cause measurable MB degradation. Finally, we estimated that between 1 and 10 ppm of sunscreen NPs in surface waters could produce similar steady state hydroxyl radical concentrations as naturally occurring fluvic acids under sunlight irradiation. Incorporation of NPs into sunscreen may increase environmental concentrations of reactive oxygen, albeit to a limited extent, which can influence transformation of dissolved substances and potentially affect ecosystem processes.
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Affiliation(s)
- David Hanigan
- Department of Civil and Environmental Engineering, University of Nevada, Reno, NV 89557-0258, United States.
| | - Lisa Truong
- Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97333, United States
| | - Jared Schoepf
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, 85287-5506, United States
| | - Takayuki Nosaka
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, 85287-5506, United States
| | - Anjali Mulchandani
- School of Sustainable Engineering and the Built Environment, Nanosystems Engineering Research Center for Nanotechnology-Enabled Water Treatment, Arizona State University, Tempe, AZ 85287-3005, United States
| | - Robert L Tanguay
- Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97333, United States
| | - Paul Westerhoff
- School of Sustainable Engineering and the Built Environment, Nanosystems Engineering Research Center for Nanotechnology-Enabled Water Treatment, Arizona State University, Tempe, AZ 85287-3005, United States
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27
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Olsen CM, Green AC, Whiteman DC. Widespread regular sunscreen application deemed not useful in the U.S.A.: reply from authors. Br J Dermatol 2018; 179:543-544. [PMID: 29877591 DOI: 10.1111/bjd.16794] [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)
- C M Olsen
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,The University of Queensland, School of Public Health, 300 Herston Road, Herston, QLD, 4006, Australia
| | - A C Green
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia.,The University of Queensland, School of Public Health, 300 Herston Road, Herston, QLD, 4006, Australia
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28
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Hubbard G, Kyle RG, Neal RD, Marmara V, Wang Z, Dombrowski SU. Promoting sunscreen use and skin self-examination to improve early detection and prevent skin cancer: quasi-experimental trial of an adolescent psycho-educational intervention. BMC Public Health 2018; 18:666. [PMID: 29843654 PMCID: PMC5975556 DOI: 10.1186/s12889-018-5570-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Skin cancer rates are increasing. Interventions to increase adolescent sunscreen use and skin self-examination (SSE) are required. Methods Quasi-experimental design; 1 control and 4 intervention group schools in Scotland, UK. Participants were 15–16 year old students on the school register. The intervention was a theoretically-informed (Common-Sense Model and Health Action Process Approach) 50-min presentation, delivered by a skin cancer specialist nurse and young adult skin cancer survivor, to students in a classroom, supplemented by a home-based assignment. Outcome variables were sunscreen use intention, SSE intention/behaviour, planning, illness perceptions and skin cancer communication behaviour, measured 2 weeks pre- and 4 weeks post- intervention using self-completed pen and paper survey. School attendance records were used to record intervention up-take; students self-reported completion of the home-based assignment. Pearson’s chi-square test, analysis of variance, and non-parametric Wilcoxon Signed Ranks Test were used to measure outcomes and associations between variables. Focus groups elicited students’ (n = 29) views on the intervention. Qualitative data were analysed thematically. Results Five of 37 invited schools participated. 639 (81%) students in intervention schools received the intervention; 33.8% completed the home-based assignment. 627 (69.6%) of students on the school register in intervention and control schools completed a questionnaire at baseline; data for 455 (72.6%) students were available at baseline and follow-up. Focus groups identified four themes – personal experiences of skin cancer, distaste for sunscreen, relevance of SSE in adolescence, and skin cancer conversations. Statistically significant (p < 0.05) changes were observed for sunscreen use, SSE, planning, and talk about skin cancer in intervention schools but not the control. Significant associations were found between sunscreen use, planning and 2 illness perceptions (identity and consequence) and between SSE, planning and 3 illness perceptions (timeline, causes, control). Conclusions It is feasible to promote sunscreen use and SSE in the context of an adolescent school-based psychoeducation intention. Further research is required to improve study uptake, intervention adherence and effectiveness. Trial registration ISRCTN11141528 Electronic supplementary material The online version of this article (10.1186/s12889-018-5570-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gill Hubbard
- School of Health, Social Care and Life Sciences, Centre for Health Sciences, University of the Highlands and Islands (UHI), Old Perth Road, Inverness, IV2 3JH, Scotland.
| | - Richard G Kyle
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN, UK
| | - Richard D Neal
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Vincent Marmara
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta, Humanities B (FEMA), Msida, MSD, 2080, Malta
| | - Ziyan Wang
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
| | - Stephan U Dombrowski
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, FK10 4LA, Stirling, Scotland
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29
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Mahler HIM. Effects of multiple viewings of an ultraviolet photo on sun protection behaviors. Public Health 2018; 160:33-40. [PMID: 29729530 DOI: 10.1016/j.puhe.2018.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/25/2018] [Accepted: 03/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine whether multiple viewings of one's ultraviolet (UV) facial photo differentially affects subsequent sun protection behaviors relative to a single viewing. STUDY DESIGN Pretest-posttest control group. METHODS Southern California college students (N = 151) were randomly assigned to be shown their UV facial photo one time, multiple times over the course of 2 weeks, or not at all. Emotional reactions, perceived susceptibility to skin damage, and sun protection intentions were assessed immediately, and sun protection behaviors were assessed during a surprise telephonic follow-up 1 month later. RESULTS Immediately after viewing a UV photo of their face, participants reported significantly greater perceived susceptibility to skin damage, greater intentions to engage in future sun protection, and more negative emotions than those who had not seen a UV photo. Moreover, 1 month later, those who had viewed their UV photo were less likely to report having sunbathed and reported significantly greater sun protection than did controls. There were no differences in sun protection behaviors between those who had been shown their UV photo only once during the initial intervention session and those who had been sent their UV photo several times thereafter. However, among those who had been sent their UV photo several times, those who reported having viewed their photo on additional occasions reported significantly greater sun protection behaviors than those who had not. CONCLUSIONS Being randomly assigned to view a UV facial photo multiple times generally neither strengthened nor weakened effects on subsequent sun protection behaviors relative to being shown the photo just once. However, among those who were sent their photo and thus had the option of viewing it more often than they had been assigned to, those who chose to view their photo more frequently also engaged in more sun protection behaviors.
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Affiliation(s)
- H I M Mahler
- University of California, San Diego, USA; California State University, San Marcos, USA.
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30
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Prevalence of Tanning Addiction and Behavioral Health Conditions among Ethnically and Racially Diverse Adolescents. J Invest Dermatol 2018; 138:1511-1517. [PMID: 29481903 DOI: 10.1016/j.jid.2018.02.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/15/2022]
Abstract
Evidence indicates that tanning may be addictive and is associated with other behavioral health conditions. Few studies have examined tanning addiction among adolescents. We performed a cross-sectional study to explore the relationship between tanning addiction, substance use, and psychological conditions among a racially and ethnically diverse adolescent population. Tanning addiction was assessed using the modified CAGE measure among 11th grade students in Los Angeles (N = 2,637; response rate 78%). Overall, 7.02% of the sample met tanning addiction criteria. Tanning addiction was significantly associated with past 30-day smoking and marijuana use, problem substance use, depression, panic disorder, obsessive-compulsive disorder, and bipolar disorder in regression models. After controlling for all significant substance use and psychological variables, we found that problem marijuana use and obsessive-compulsive disorder remained significantly associated with tanning addiction (odds ratio = 2.06 [95% confidence interval = 1.03-4.09] and odds ratio = 2.54 [95% confidence interval = 1.73-3.72], respectively.) Tanning addiction was also significantly associated with multiple problem substance use and behavioral health conditions. Our findings indicate an appreciable prevalence of tanning addiction among ethnically and racially diverse adolescents and suggest the importance of addressing tanning addiction in the context of comorbid behavioral conditions to reduce this high-risk behavior among diverse youth.
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31
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Buller DB, Reynolds KD, Berteletti J, Massie K, Ashley J, Buller MK, Meenan RT. Accuracy of Principal and Teacher Knowledge of School District Policies on Sun Protection in California Elementary Schools. Prev Chronic Dis 2018; 15:E07. [PMID: 29346065 PMCID: PMC5774306 DOI: 10.5888/pcd15.170342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction Policy is a key aspect of school-based efforts to prevent skin cancer. We explored the extent and accuracy of knowledge among principals and teachers in California public school districts about the elements specified in their district’s written sun safety policy. Methods The sample consisted of California public school districts that subscribed to the California School Boards Association, had an elementary school, adopted Board Policy 5141.7 for sun safety, and posted it online. The content of each policy was coded. Principals (n = 118) and teachers (n = 113) in elementary schools were recruited from September 2013 through December 2015 and completed a survey on sun protection policies and practices from January 2014 through April 2016. Results Only 38 of 117 principals (32.5%) were aware that their school district had a sun protection policy. A smaller percentage of teachers (13 of 109; 11.9%) than principals were aware of the policy (F108 = 12.76, P < .001). We found greater awareness of the policy among principals and teachers who had more years of experience working in public education (odds ratio [OR] = 1.05, F106 = 4.71, P = .03) and worked in schools with more non-Hispanic white students (OR = 7.65, F109 = 8.61, P = .004) and fewer Hispanic students (OR = 0.28, F109 = 4.27, P = .04). Conclusion Policy adoption is an important step in implementing sun safety practices in schools, but districts may need more effective means of informing school principals and teachers of sun safety policies. Implementation will lag without clear understanding of the policy’s content by school personnel.
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Affiliation(s)
- David B Buller
- Klein Buendel, Inc, 1667 Cole Blvd, Suite 225, Golden, CO 80401.
| | - Kim D Reynolds
- School of Community & Global Health, Claremont Graduate University, Claremont, California
| | | | - Kim Massie
- School of Community & Global Health, Claremont Graduate University, Claremont, California
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32
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Olsen C, Wilson L, Green A, Biswas N, Loyalka J, Whiteman D. How many melanomas might be prevented if more people applied sunscreen regularly? Br J Dermatol 2017; 178:140-147. [DOI: 10.1111/bjd.16079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 01/09/2023]
Affiliation(s)
- C.M. Olsen
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
- The University of Queensland School of Public Health Herston Queensland 4006 Australia
| | - L.F. Wilson
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
| | - A.C. Green
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
- The University of Queensland School of Public Health Herston Queensland 4006 Australia
- Cancer Research U.K. Manchester Institute and University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - N. Biswas
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
| | - J. Loyalka
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
| | - D.C. Whiteman
- Population Health Department QIMR Berghofer Medical Research Institute 300 Herston Road Herston Queensland 4006 Australia
- The University of Queensland School of Public Health Herston Queensland 4006 Australia
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33
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Balk SJ, Gottschlich EA, Holman DM, Watson M. Counseling on Sun Protection and Indoor Tanning. Pediatrics 2017; 140:peds.2017-1680. [PMID: 29127209 PMCID: PMC5892197 DOI: 10.1542/peds.2017-1680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The US Preventive Services Task Force recommends clinical counseling for individuals ages 10 to 24 years to decrease skin cancer risk. METHODS A national, random sample of US American Academy of Pediatrics members practicing primary care in 2002 (response rate 55%) and 2015 (response rate 43%). Surveys explored attitudes and experiences regarding sun protection counseling; indoor tanning questions were added in 2015. χ2 tests compared demographics and counseling responses across years, and multivariable logistic regression models examined counseling predictors. RESULTS More pediatricians in 2015 (34%) than in 2002 (23%) reported discussing sun protection during recent summer months with ≥75% of patients. This pattern held across all patient age groups (each P <.001). Female and suburban pediatricians counseled more; those in the South and West counseled less. More pediatricians in 2015 than in 2002 named time as a barrier. Sun protection ranked lowest among preventive topics in both years. In 2015, approximately one-third of pediatricians reported discussing indoor tanning at least once with 10 to 13 year-old patients; approximately half discussed this with older adolescents. Most (70%) did not know if their states had laws on minors' indoor tanning access; those stating they knew whether a law existed counseled more. CONCLUSIONS Although improved, sun protection counseling rates remain low. Indoor tanning counseling can be improved. Because early-life exposure to UV radiation increases risk and clinician counseling can positively impact prevention behaviors, pediatricians have an important role in skin cancer prevention; counseling may save lives. Time constraints remain a barrier.
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Affiliation(s)
- Sophie J. Balk
- Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | | | - Dawn M. Holman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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34
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Intentional outdoor tanning in the United States: Results from the 2015 Summer ConsumerStyles survey. Prev Med 2017; 101:137-141. [PMID: 28601617 PMCID: PMC5664932 DOI: 10.1016/j.ypmed.2017.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
There is limited literature about adults in the United States who usually or always spend time outdoors for the purpose of developing a tan, defined as intentional outdoor tanning. Using data from the 2015 Summer ConsumerStyles, an online cross-sectional survey weighted to the US adult population (n=4,127), we performed unadjusted and adjusted multivariable logistic regressions to examine the associations between demographic characteristics, behaviors, and belief factors related to skin cancer risk and intentional outdoor tanning. Nearly 10% of the study population intentionally tanned outdoors. Outdoor tanning was more prevalent among women (11.4%), non-Hispanic white individuals (11.5%), those aged 18-29years (14.1%), those without a high school diploma (12.7%), and those in the northeast United States (13.2%). The adjusted odds of outdoor tanning were significantly higher among women than men (adjusted odds ratio [AOR] 1.51, 95% confidence interval [CI] 1.12-2.04); those with a history of indoor tanning or recent sunburn than those without (AOR 2.61, CI 1.94-3.51; AOR 1.96, CI 1.46-2.63, respectively); those who agreed they looked better with a tan than those who did not (AOR 6.69, CI 3.62-12.35); and those who did not try to protect their skin from the sun when outdoors than those who did (AOR 2.17, CI 1.56-3.04). Adults who engaged in other risky behaviors that expose a person to ultraviolet (UV) radiation were more likely to tan outdoors, further increasing their risk of skin cancer. These findings may guide potential interventions to reduce UV exposure from outdoor tanning.
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35
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College Students' Perceptions of Worry and Parent Beliefs: Associations with Behaviors to Prevent Sun Exposure. J Skin Cancer 2017; 2017:4985702. [PMID: 28804653 PMCID: PMC5540521 DOI: 10.1155/2017/4985702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/26/2017] [Accepted: 06/18/2017] [Indexed: 11/17/2022] Open
Abstract
More research is needed to understand how attitudes impact behaviors that afford sun protection. The current study examined the impact of students' perceptions of parental beliefs about sun exposure and its influence on their practiced sun protection behaviors and worry about sun exposure. Participants were college students (N = 462) at a large Midwestern university. They completed a survey to examine their perceptions of risks and messages about sun exposure and sun exposure behaviors. Results indicated that gender and students' perceptions of parental beliefs about sun exposure were related to sun protection behaviors and their own worry over sun exposure. Specifically, males showed lower levels of sun protection behaviors, with the exception of wearing a hat with a brim, and lower levels of worry about sun exposure compared to females. Roughly a third of our sample had a family history of skin cancer, and this variable was related to worry about sun exposure and parental beliefs. Prevention messages and interventions to reduce sun risk for college students should address risks of sun exposure as well as educating young adults about the importance of wearing sunscreen, protective clothing, and hats to improve sun protection.
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Jha D, Jha S, Ghosh S, Smylie M, Taher M. Sun-Smart Practices Amongst School Students (Grades 5, 7, and 9) in Alberta, Canada. J Cutan Med Surg 2017; 21:137-144. [DOI: 10.1177/1203475417692574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study was to assess the current knowledge children possess on melanoma and sun-protective behaviour. Methods: A one-page survey was administered to students in grades 5, 7, and 9. Results: Three hundred ninety-two students from 11 schools in Edmonton were surveyed. Seventy-one percent of students knew that sun exposure can cause skin cancers. Sixty-nine percent were taught by their parents about sun protection, but only 44% of students received similar instructions from teachers. Twenty percent of students indicated that they never or rarely wore sunscreen. Twenty-five percent of students had experienced painful sunburns, and only 46% were willing to use sunscreen if it were available at school. More Caucasian students reported painful or peeling sunburns in each grade level than their non-Caucasian peers (for grade 5, P = .003; for grade 7, P < .0001; for grade 9, P = .001). For all grade levels, the percentage of Caucasian students who indicated that they would not wear sunscreen when going out in the sun was greater than among their non-Caucasian peers (for grade 5, P < .001; for grade 7, P = .003; for grade 9, P = .015). Conclusions: A comprehensive and focused approach to sun-smart education is recommended for students.
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Affiliation(s)
- Divya Jha
- Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - Shankar Jha
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Sunita Ghosh
- Department of Medical Oncology, University of Alberta, Edmonton, AB, Canada
| | - Michael Smylie
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Muba Taher
- Department of Dermatology, University of Alberta, Edmonton, AB, Canada
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Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol 2017; 76:S110-S121. [PMID: 28038884 DOI: 10.1016/j.jaad.2016.09.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation. Therefore, personalized photoprotection recommendations concerning skin cancer risk factors, desired treatment outcomes, health needs (eg, vitamin D), and photoaging based on the needs and preferences of the patient are essential. It is clear that additional research is needed on optimal levels of protection against ultraviolet radiation for people of color.
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Affiliation(s)
- Tania Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul, School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Kesha Buster
- Buster Dermatology, Tulsa, Oklahoma; University of Alabama at Birmingham, Birmingham, Alabama
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Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now. CA Cancer J Clin 2016; 66:460-480. [PMID: 27232110 PMCID: PMC5124531 DOI: 10.3322/caac.21352] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.
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Affiliation(s)
- Mary K Tripp
- Instructor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meg Watson
- Epidemiologist, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sophie J Balk
- Attending Pediatrician, Children's Hospital at Montefiore, and Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Susan M Swetter
- Professor, Department of Dermatology, and Director, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA
- Professor and Assistant Chief, Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jeffrey E Gershenwald
- Dr. John M. Skibber Professor, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Professor, Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
- Co-Leader, Melanoma Moon Shot, The University of Texas MD Anderson Cancer Center, Houston, TX
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Tripp MK, Peterson SK, Prokhorov AV, Shete SS, Lee JE, Gershenwald JE, Gritz ER. Correlates of Sun Protection and Sunburn in Children of Melanoma Survivors. Am J Prev Med 2016; 51:e77-85. [PMID: 27067306 PMCID: PMC5482415 DOI: 10.1016/j.amepre.2016.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/04/2016] [Accepted: 02/26/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sunburns during childhood increase melanoma risk. Children of melanoma survivors are at higher risk, but little is known about their sunburn and sun protection. One study showed that almost half of melanoma survivors' children experienced sunburn in the past year. This study evaluated sunburn and sun protection in melanoma survivors' children, and relevant survivor characteristics from Social Cognitive Theory and the Health Belief Model. METHODS Melanoma survivors (N=340) were recruited from a comprehensive cancer center. Survivors completed a baseline questionnaire administered by telephone to report on the behavior of their children (N=340) as part of an RCT of a sun protection intervention. Data were collected in 2008 and analyzed in 2015. RESULTS In the prior 6 months, 28% of children experienced sunburn. "Always" or "frequent" sun protection varied by behavior: sunscreen, 69%; lip balm, 15%; wide-brimmed hats, 9%; sleeved shirts, 28%; pants, 48%; sunglasses, 10%; shade, 33%; and limiting time outdoors, 45%. Survivors' sunburn and sun protection were positively associated with these outcomes in children. Correlates of sunburn also included older child age and higher risk perceptions. Correlates of sun protection behaviors included younger child age; stronger intentions, higher self-efficacy, and more positive outcome expectations about sun protection; and greater number of melanomas in survivors. CONCLUSIONS Melanoma survivors may have a heightened awareness of the importance of their children's sun protection, but their children are not routinely protected. Correlates of children's sunburn and sun protection suggest subgroups of survivors to target with interventions to improve sun protection.
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Affiliation(s)
- Mary K Tripp
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander V Prokhorov
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjay S Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey E Gershenwald
- Departments of Surgical Oncology and Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Koch S, Pettigrew S, Hollier LP, Slevin T, Strickland M, Minto C, Jalleh G, Lin C. Trends in Australian adolescents' sun-protection behaviours: implications for health campaigns. Aust N Z J Public Health 2016; 40:468-473. [PMID: 27523880 DOI: 10.1111/1753-6405.12561] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/01/2016] [Accepted: 04/01/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Protecting the skin from ultraviolet (UV) radiation is critical during adolescence to reduce the risk of developing skin cancer later in life, but adolescents tend to be less likely to engage in sun-protective behaviours than adults. The present study examined changes and trends (2001/02-2011/12) in sun-protection behaviours among adolescents living in Western Australia - a region with high levels of UV radiation. METHODS A cross-sectional survey was conducted during 10 summers between 2001/02 and 2011/12 to investigate how often adolescents engaged in various sun-protection behaviours, including outdoor protective measures (wearing a hat, wearing protective clothing, using sunscreen, wearing sunglasses, seeking shade) and avoidance of UV radiation by staying inside. RESULTS Hat use significantly decreased between 2001/02 and 2011/12, whereas use of sunscreen and wearing covering clothes were unchanged in most survey years relative to 2001/02. Use of sunglasses peaked in 2006/07 and 2007/08, but returned to first survey year levels in 2011/12, while staying inside was more frequently reported from 2006/07 onwards. CONCLUSIONS New approaches are needed to minimise reactance responses in adolescents while fostering favourable attitudes to sun protection. Implications and opportunities for interventions to promote better sun-protection practices among adolescents are provided.
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Affiliation(s)
| | | | | | - Terry Slevin
- Curtin University, Western Australia.,Cancer Council Western Australia
| | | | | | | | - Chad Lin
- Curtin University, Western Australia
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Starfelt Sutton LC, White KM. Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis. Psychol Health 2016; 31:1272-92. [DOI: 10.1080/08870446.2016.1204449] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ho BK, Reidy K, Huerta I, Dilley K, Crawford S, Hultgren BA, Mallett KA, Turrisi R, Robinson JK. Effectiveness of a Multicomponent Sun Protection Program for Young Children: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:334-42. [PMID: 26857829 PMCID: PMC5522744 DOI: 10.1001/jamapediatrics.2015.4373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Emphasizing sun protection behaviors among young children may minimize sun damage and foster lifelong sun protection behaviors that will reduce the likelihood of developing skin cancer, especially melanoma. OBJECTIVE To determine whether a multicomponent sun protection program delivered in pediatric clinics during the summer could increase summertime sun protection among young children. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled clinical trial with 4-week follow-up that included 300 parents or relatives (hereafter simply referred to as caregivers [mean age, 36.0 years]) who brought the child (2-6 years of age) in their care to an Advocate Medical Group clinic during the period from May 15 to August 14, 2015. Of the 300 caregiver-child pairs, 153 (51.0%) were randomly assigned to receive a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors (intervention group) and 147 (49.0%) were randomly assigned to receive the information usually provided at a well-child visit (control group). Data analysis was performed from August 20 to 30, 2015. INTERVENTION Multicomponent sun protection program composed of a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors. MAIN OUTCOMES AND MEASURES Outcomes were caregiver-reported use of sun protection by the child (seeking shade and wearing sun-protective clothing and sunscreen) using a 5-point Likert scale, duration of outdoor activities, and number of children who had sunburn or skin irritation. The biologic measurement of the skin pigment of a child's arm was performed with a spectrophotometer at baseline and 4 weeks later. RESULTS Of the 300 caregiver-child pairs, the 153 children in the intervention group had significantly higher scores related to sun protection behaviors on both sunny (mean [SE], 15.748 [0.267] for the intervention group; mean [SE], 14.780 [0.282] for the control group; mean difference, 0.968) and cloudy days (mean [SE], 14.286 [0.282] for the intervention group; mean [SE], 12.850 [0.297] for the control group; mean difference, 1.436). Examination of pigmentary changes by spectrophotometry revealed that the children in the control group significantly increased their melanin levels, whereas the children in the intervention group did not have a significant change in melanin level on their protected upper arms (P < .001 for skin type 1, P = .008 for skin type 2, and P < .001 for skin types 4-6). CONCLUSIONS AND RELEVANCE A multicomponent intervention using text-message reminders and distribution of read-along books and swim shirts was associated with increased sun protection behaviors among young children. This was corroborated by a smaller change in skin pigment among children receiving the intervention. This implementable program can help augment anticipatory sun protection guidance in pediatric clinics and decrease children's future skin cancer risk. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02376517.
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Affiliation(s)
- Byron K. Ho
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katie Reidy
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Imelda Huerta
- Advocate Children’s Hospital, Park Ridge and Oak Lawn, Illinois
| | | | - Susan Crawford
- Advocate Children’s Hospital, Park Ridge and Oak Lawn, Illinois
| | - Brittney A. Hultgren
- Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
| | - Kimberly A. Mallett
- Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
| | - Rob Turrisi
- Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
| | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois4Editor, JAMA Dermatology
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Hollier L, Pettigrew S, Slevin T, Strickland M, Minto C. Comparing online and telephone survey results in the context of a skin cancer prevention campaign evaluation. J Public Health (Oxf) 2016; 39:193-201. [DOI: 10.1093/pubmed/fdw018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Taylor MF, Westbrook D, Chang P. Using UV photoaged photography to better understand Western Australian teenagers' attitudes towards adopting sun-protective behaviors. Int J Adolesc Med Health 2016; 28:45-53. [PMID: 25781666 DOI: 10.1515/ijamh-2014-0071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/01/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND This study aimed to determine whether the viewing of a personal photoaged photograph had the capacity to alter Western Australian teenagers' pro-tanning attitudes. METHOD Semi-structured interviews were conducted with fifteen teenagers. FINDINGS The teenagers' pro-tanning attitudes prior to viewing their photoaged photograph are encapsulated in the study's central theme: 'You've got to look after your skin and use sunscreen, but I always forget!'. Post-viewing their photoaged facial image many teenagers reiterated their intentions to adopt (when they remembered) skin-protective measures. However, photoaged photography did not alter other teenagers' intention to tan. NEW KNOWLEDGE: Teenagers who choose to continue to tan were aware of the long-term health risks associated with ultra-violet over-exposure. However, their desire remained strong to emulate the media promoted image of bronzed youth being popular individuals. Indeed, the social benefits of being considered attractive to their peers became an attitudinal barrier to the teenagers' adoption of skin-protective behaviours. Those teenagers who changed their pro-tanning attitudes following their viewing of their ultra-violet photoaged photograph did so because of the shock they received when they saw their sun-damaged facial image. This suggests that photoageing photography can be effective with many adolescents because it reduces the cause-and-effect delay that exists between the occurrence of sun-damage and its visual presentation in later-life. CONCLUSION Greater effort needs to be focused on increasing teenagers' understanding of how sun-damage occurs, when it is appropriate to apply sunscreen, as well as in changing the prevailing media image of an attractive body being a tanned body.
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Sumen A, Oncel S. Effect of Skin Cancer Training Provided to Maritime High School Students on Their Knowledge and Behaviour. Asian Pac J Cancer Prev 2015. [DOI: 10.7314/apjcp.2015.16.17.7769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Touboul C. Methodology of the EDIFICE Melanoma survey. J Eur Acad Dermatol Venereol 2015; 29 Suppl 2:2-5. [PMID: 25639925 DOI: 10.1111/jdv.12894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma accounts for a small proportion of skin cancers but is the most serious. The prognosis is, however, good if it is diagnosed early, before the metastatic stages. For these reasons, population awareness and knowledge with regard to melanoma and the associated risk factors are critical to improving the effectiveness of melanoma primary prevention campaigns. OBJECTIVES The EDIFICE Melanoma survey was designed to cover a large number of topics related to sun exposure and melanoma: knowledge and awareness of the risks associated with sun and artificial ultraviolet exposure, knowledge of melanoma and the associated risk factors, behaviour regarding protective measures in adults and children. METHODS The survey questionnaire was administered by experienced independent interviewers from the Kantar Health Institute using the Computer-Assisted Telephone Interview technique. It was important to avoid the effects of 'contamination' in answers to questions about sun exposure habits. Questions about exposure habits were therefore asked before those relating to knowledge of best practices for sun protection. A sample of 1502 individuals aged 18 years and over was interviewed. The survey data were weighted to eliminate structural variations between the sample interviewed and the reference population. Quantitative data were described by the means and standard deviations and categorical data by the numbers in each category and corresponding percentages. Three multivariate logistic regression analyses were conducted and expressed in terms of odds ratio and 95% confidence intervals. RESULTS In addition to the classic questions relating to sociodemographic characteristics, the EDIFICE Melanoma study questionnaire was organized around three themes: the opinion, attitude and knowledge of individuals regarding sun exposure and melanoma. The survey questionnaire lasted approximately 20 min. CONCLUSIONS This study provided a complete 'snapshot' of opinions, attitudes and knowledge of French people in 2011 with regard to sun exposure.
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Glenn BA, Lin T, Chang LC, Okada A, Wong WK, Glanz K, Bastani R. Sun protection practices and sun exposure among children with a parental history of melanoma. Cancer Epidemiol Biomarkers Prev 2015; 24:169-77. [PMID: 25587110 DOI: 10.1158/1055-9965.epi-14-0650] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation (UVR) is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. METHODS The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0-17 years; N = 324). RESULTS Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average-risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn, whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. CONCLUSIONS Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed. IMPACT Intervening in high-risk populations may help reduce the burden of melanoma in the United States.
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Affiliation(s)
- Beth A Glenn
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.
| | - Tiffany Lin
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - L Cindy Chang
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Ashley Okada
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Weng Kee Wong
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roshan Bastani
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
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Heckman C, Darlow S, Munshi T, Caruso C, Ritterband L, Raivitch S, Fleisher L, Manne S. Development of an Internet Intervention to Address Behaviors Associated with Skin Cancer Risk among Young Adults. Internet Interv 2015; 2:340-350. [PMID: 26640776 PMCID: PMC4669098 DOI: 10.1016/j.invent.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Skin cancer is the most common cancer in the US, and its incidence is increasing. The major risk factor for skin cancer is exposure to ultraviolet radiation (UV). Young adults tend to expose themselves to large amounts of UV and engage in minimal skin protection, which increases their skin cancer risk. Interventions are needed to address risk behaviors among young adults that may lead to skin cancer. The nternet offers a cost-effective way to widely disseminate efficacious interventions. The current paper describes the development of an online skin cancer risk reduction intervention (UV4.me) for young adults. PROCEDURES The iterative development process for UV4.me followed best-practice guidelines and included the following activities: individual interviews, focus groups, content development by the expert team, acceptability testing, cognitive interviewing for questionnaires, quality control testing, usability testing, and a pilot randomized controlled trial. Participant acceptability and usability feedback was assessed. PRINCIPAL RESULTS The development process produced an evidence-informed intervention that is individually-tailored, interactive, and multimedia in nature based on the Integrative Model of Behavior Prediction, a model for internet interventions, and other best-practice recommendations, expert input, as well as user acceptability and usability feedback gathered before, during, and after development. MAJOR CONCLUSIONS Development of an acceptable intervention intended to have a significant public health impact requires a relatively large investment in time, money, expertise, and ongoing user input. Lessons learned and recommendations are discussed. The comprehensive process used may help prepare others interested in creating similar behavioral health interventions.
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Affiliation(s)
- Carolyn Heckman
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Susan Darlow
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Teja Munshi
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Carolyn Caruso
- BeHealth Solutions, LLC, 375 Greenbrier Drive, Charlottesville, VA 22901
| | - Lee Ritterband
- BeHealth Solutions, LLC, 375 Greenbrier Drive, Charlottesville, VA 22901,University of Virginia Health System, 1215 Lee Street, Charlottesvile, VA 22908
| | | | - Linda Fleisher
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Sharon Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901-1914
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Walkosz BJ, Buller DB, Andersen PA, Scott MD, Liu X, Cutter GR, Dignan MB. Translation of a Ski School Sun Safety Program to North American Ski and Snowboard Schools. Health Promot Pract 2015; 16:560-70. [PMID: 25761916 PMCID: PMC4485589 DOI: 10.1177/1524839915577081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health promotion programs that develop and implement strategies to promote sun safety practices to children have the potential to reduce skin cancer occurrence later in life. Go Sun Smart (GSS), a sun safety program for employees and guests of ski areas, was distributed to determine if an enhanced dissemination strategy was more effective than a basic dissemination strategy at reaching parents at ski and snowboard schools. On-site observations of GSS use and surveys of 909 parents/caregivers with children enrolled in ski and snowboard schools at 63 ski areas were conducted and analyzed using techniques for clustered designs. No differences were identified by dissemination strategy. Greater implementation of GSS (>5 messages posted) was associated with greater parental recall, 36.6% versus 16.7%, of materials, but not greater sun protection practices. Greater recall of messages, regardless of level of implementation, resulted in greater sun protection practices including applying sunscreen (p < .05), providing sunglasses and goggles (p < .01), and more use of all sun protection practices (p < .01). Ski areas with more program materials appeared to reach parents with sun safety advice and thus convinced them to take more precautions for their children. Sun safety need not be at odds with children's outdoor recreation activities.
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Affiliation(s)
| | | | | | | | - X Liu
- Klein Buendel, Inc., Golden, CO, USA
| | - G R Cutter
- University of Alabama, Birmingham, AL, USA
| | - M B Dignan
- University of Kentucky, Lexington, KY, USA
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50
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Melanoma Incidence in Children and Adolescents: Decreasing Trends in the United States. J Pediatr 2015; 166:1505-13. [PMID: 25866386 DOI: 10.1016/j.jpeds.2015.02.050] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 12/23/2014] [Accepted: 02/18/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess trends in the incidence of melanoma in children and adolescents in the US from 2000-2010. STUDY DESIGN Using the Surveillance, Epidemiology, and End Results cancer registry data, we calculated age-adjusted incidence rates of melanoma in children and adolescents (age <20 years) from 2000-2010, as well as annual percent changes. We analyzed incidence trends using joinpoint regression models. We further stratified incidence rates and trends by age group, sex, race, and melanoma-specific characteristic (histology, anatomic site, Breslow depth, ulceration status, lymph node involvement, and presence of metastasis). RESULTS We included 1185 pediatric patients (age <20 years) diagnosed with melanoma from 2000-2010. In patients age <20 years overall, we found a significant decreasing incidence (11.58% per year) from 2004-2010. Overall, significant decreasing incidence trends were also noted in males, melanoma located on the trunk, melanoma located on the upper extremities, superficial spreading melanoma, and melanoma with good prognostic indicators. When further subdividing the pediatric population by age group, these significant decreasing incidence trends were most notable in adolescents (age 15-19 years), decreasing 11.08% per year from 2003-2010. Furthermore, in 15- to 19-year-olds, decreasing trends were found to be significant in melanoma located on the trunk, superficial spreading melanoma, and melanoma with good prognostic indicators. CONCLUSIONS Decreasing trends in melanoma incidence in the pediatric population from 2000-2010 stand in contrast to previous reports of increasing long-term incidence trends. Possible contributors to these decreasing trends include effective public health initiatives, decreased time spent outdoors, and increased sunscreen use.
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