Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: Review from national surveys and case studies of 3 states

A Qualitative Exploration of Latinos' Perceptions About Skin Cancer: the Role of Gender and Linguistic Acculturation

Latinos have the highest rate of skin cancers among U.S. minorities. Despite a rising incidence of melanoma-the deadliest form of skin cancer-and greater disease burden, Latinos tend to have poor awareness of skin cancer risk factors which may inhibit preventive action. We expanded on prior work by qualitatively examining potential moderators (i.e., gender, acculturation) of skin cancer perceptions among Latinos from El Barrio in Harlem, New York City. Four focus groups stratified by language (English/Spanish) and gender were conducted. Discussions were recorded, transcribed, and coded using thematic analysis. Thirty-eight self-identified Latinos (32 % male) participated. Across groups, median age was 35 years; 50 % completed <high school degree, 82 % had annual incomes ≤$29,999, and 55 % were born in Mexico. Mean acculturation level was 8.5 (SD = 3.9, range = 4-20). Major themes included (1) knowledge of common skin cancer risk factors, (2) acknowledgment of personal risk although lighter-skin individuals are at greater risk, and (3) awareness of effective risk reduction methods, despite the presence of fatalistic beliefs. Compared to males, females discussed tanning norms and appearance-based factors, identified children as vulnerable, highlighted the benefits of sun exposure, and wanted more information. Few linguistic acculturation patterns were noted; English speakers questioned the carcinogenic effect of sunscreen and reported more skin cancer-related physician discussions than Spanish speakers. Despite generally low acculturation, Latinos correctly identified skin cancer risk factors and agreed that it is preventable with engagement in risk-reducing behaviors. Future educational interventions must capitalize upon and reinforce such beliefs and address fatalistic perceptions which may hinder prevention efforts.

Refinement of measures to assess psychosocial constructs associated with skin cancer risk and protective behaviors of young adults

The study's purpose was to select/refine measures assessing psychosocial constructs associated with skin cancer risk/protective behaviors. Cognitive interviewing was conducted with twenty participants locally, and a survey was conducted with 965 adults aged 18-25 years at moderate to high risk of developing skin cancer, recruited nationally online. Psychosocial measures assessed variables from the Integrative Model of Behavior Prediction. As a result of expert review and cognitive interviewing, items were removed, added, and/or made simpler, more personal, consistent, and less ambiguous. A factor analysis resulted in 14 scales and adequate model fit. Internal reliability and test-retest reliability was acceptable to good. Correlations among the psychosocial and behavioral variables were generally significant and in expected directions, demonstrating convergent validity. We have refined measures that assess important psychosocial constructs associated with skin cancer-related behaviors, that research participants can understand and complete successfully, and that are reliable and demonstrate evidence for validity.

Tanning and Teens: Is Indoor Exposure the Tip of the Iceberg?

Because of recent state regulations and the reduced availability of free-standing tanning salons, indoor tanning (IT) prevalence is beginning to decline. This may lead to unintended consequences, such as increases in outdoor intentional tanning. We advance a series of research directions to track and intervene to address all forms of intentional tanning. First, we advocate for enforcement of IT regulation and encourage collection of data on tanning salon compliance and alternative IT strategies. Second, we suggest questions about outdoor and IT should be included in national surveys. Third, we need to understand the potentially complex patterns of indoor and outdoor tanning that may exist among those who tan. Fourth, research examining changing motivations for intentional tanning is needed. Finally, IT intervention studies should include outdoor tanning as an outcome to examine the effect of interventions on these related risk behaviors. These advances will ensure the development of novel interventions to address intentional tanning through multiple routes, and to avoid any unintended negative consequence of IT regulation. The promising downward direction of IT use in the United States should now lead the public health field to sharpen its focus on outdoor tanning. Cancer Epidemiol Biomarkers Prev; 26(8); 1170-4. ©2017 AACR.

Use of social networking sites and associations with skin tone dissatisfaction, sun exposure, and sun protection in a sample of Australian adolescents

OBJECTIVE

Previous research has indicated that greater exposure to traditional media (i.e. television, film, and print) predicted skin cancer risk factors in adolescents; however, the relationship between social media usage and these outcomes remains unexplored. We examined whether social networking site (SNS) usage, and the particular manner of this use, was associated with skin tone dissatisfaction, sun exposure and sun protection among Australian adolescents. We also explored sex differences in SNS usage related to tanning.

METHOD

A total of 1856 South Australian secondary school students completed the Australian School Students Alcohol and Drug 2014 survey. SNS usage related to tanning comprised posting pictures, posting text, viewing pictures, viewing text and liking or sharing posts.

RESULTS

Adolescents spent 214.56 minutes, on average, per day using SNSs. Behaviours related to tanning that involved pictures (i.e. viewing pictures, posting pictures, and liking or sharing content) were significantly associated with more skin tone dissatisfaction, more sun exposure and less sun protection. Females performed all SNS-linked behaviours more frequently than did males, with the exception of posting text.

CONCLUSION

Australian adolescents spend a considerable amount of time using SNSs, and their behaviours related to tanning on these SNSs are significantly associated with skin cancer risk factors.

Prevalence of sun-protective behaviour and intentional sun tanning in German adolescents and adults: results of a nationwide telephone survey

BACKGROUND

The incidence rate of melanoma in the Caucasian population is rising worldwide. One of the major environmental risk factors for melanoma is the exposure to ultraviolet (UV) radiation. To prevent skin damage caused by UV exposure, several organizations recommend wearing protective clothing, staying in the shade, avoiding the outdoors during midday and using sunscreen.

OBJECTIVE

To provide representative data on factors associated with sun-protective behaviours and intentional sun exposure during summertime in the German population.

METHODS

A population-based sample of 3000 German residents aged 14-45 years (response: 32.1%) was interviewed via telephone from October to December 2015. Survey participants provided data on the use of recommended sun-protective measures on a sunny summer day and their intentional sun exposure during summertime. Data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample.

RESULTS

Wearing long-sleeved clothes was the most frequently reported protective measure (53.9%), while wearing headgear was the least common (17.9%). Significantly lower frequencies of almost all recommended sun-protective measures were identified for males, participants between 14 and 25 years, those with an immigrant background and those with low levels of education. Using sun protection was positively associated with female gender (OR = 1.62), higher levels of education (OR_high = 1.27), sunburn during childhood (OR = 1.33) and paying attention to healthy nutrition (OR = 1.64; all P < 0.05). Sun tanning behaviour was associated with female gender (OR = 1.42), younger age, lower level of education, sunbed use (OR = 5.24) and smoking status (OR = 1.50; all P < 0.001).

CONCLUSION

As individual sun-protective measures are easy to implement and provide effective protection against high-risk UV exposure, campaigns on skin cancer prevention in Germany should put a stronger focus on young adults, men, less educated individuals and those with immigration background.

Sun Safety Practices Among Schools in the United States

Importance

Exposure to the sun's UV radiation is a leading cause of skin cancer. Positive attitudes and beliefs about sun safety behavior, which would make sun protective behavior more likely, could be promoted and supported by school policies and practices.

Objective

To identify school characteristics associated with having adopted practices that promote sun safety.

Design, Setting, and Participants

School-level data from the February 3 to July 23, 2014, School Health Policies and Practices Study's Healthy and Safe School Environment questionnaire were analyzed. The School Health Policies and Practices Study uses a 2-stage sampling design to select a nationally representative sample of schools. All public, state-administered, Catholic, and non-Catholic private schools with any of the grades from kindergarten through 12 were eligible for inclusion. All analyses were conducted using weighted data.

Main Outcomes and Measures

Prevalence of sun safety practices.

Results

In a nationally representative sample of 828 US schools, representatives of 577 schools (69.7%) responded. Overall, sun safety practices were not common among schools. The most frequent practice was having teachers allow time for students to apply sunscreen at school (47.6%; 95% CI, 42.4%-52.9%). Few schools made sunscreen available for students to use (13.3%; 95% CI, 10.2%-17.0%), almost always or always scheduled outdoor activities to avoid times when the sun was at peak intensity (15.0%; 95% CI, 11.4%-19.6%), or asked parents to ensure that students applied sunscreen before school (16.4%; 95% CI, 12.9%-20.6%). High schools were less likely than elementary schools and middle schools to adopt several practices: for instance, 37.5% of high schools (95% CI, 29.7%-46.0%), 51.6% of middle schools (95% CI, 43.3%-59.7%), and 49.5% of elementary schools (95% CI, 42.0%-57.0%) had teachers allow time for students to apply sunscreen at school, and 11.8% of high schools (95% CI, 7.7%-17.5%), 18.2% of middle schools (95% CI, 13.3%-24.4%), and 14.7% of elementary schools (95% CI, 9.6%-21.8%) almost always or always scheduled outdoor activities to avoid times when the sun was at peak intensity. Other school characteristics were either not significantly associated with the adoption of any of the sun safety school practices studied (eg, metropolitan status) or were inconsistently associated with such policies and practices (eg, region, percentage of students eligible for free or reduced-price lunch, and school enrollment).

Conclusions and Relevance

School practices that could protect children and adolescents from sun exposure and that could change norms about sun safety are not common. Interventions aimed at increasing the adoption of sun safety practices among schools are needed regardless of the level, location, size, and poverty concentration of the school. Such practices would cost little to implement and would support other messages targeted toward children, adolescents, adults, and parents, with an aim to reduce skin cancer morbidity and mortality.

Unintended Sunburn: A Potential Target for Sun Protection Messages

New Zealand (NZ) has the highest melanoma incidence rate in the world. Primary prevention efforts focus on reducing sunburn incidence and increasing sun protective practices in the population. However, sunburn from excessive ultraviolet radiation (UVR) remains common. To reduce sunburn incidence, it is important to examine those individuals who experience unintended sunburn. This study aims to use data from the NZ Triennial Sun Protection Survey to describe respondents who were not intending to tan but were sunburnt after outdoor UVR exposure. Information on sociodemographics, concurrent weather conditions, sun protection attitudes and knowledge, and outdoor behaviour was also collected. The results showed 13.5% of respondents' experienced unintended sunburn during the survey weekend but had not attempted to obtain a tan that summer. Respondents who reported unintended sunburn were more likely than others to have been near water and in unshaded areas, used sunscreen, had higher SunSmart knowledge scores, had lower positive attitudes towards tanning, and were outdoors for a longer duration with less body coverage. As sunburn was unintended these respondents' outdoor sun protective behaviours may be amenable to change. Future public health initiatives should focus on increasing sun protection (clothing and shade) and reducing potential barriers to sun protection.

Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study

Background

Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages.

Objective

The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs.

Methods

We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline.

Results

Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t₆=–2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t₂₀=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol.

Conclusions

This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages.

Correlates of sun protection behaviors among Hispanic children residing in a high UVR environment

BACKGROUND/PURPOSE

Rates of melanoma are rising in Hispanics in the United States. Excessive sun exposure in childhood increases the risk of melanoma in adulthood, and little is known about the factors motivating sun protection behaviors among Hispanic youth.

METHODS

Correlates of sun protection were examined among Hispanic children residing in Los Angeles, California (N = 1891). Associations between multiple constructs (psychosocial, familial, and cultural) and sun protection outcomes (use of sunscreen, protective clothing, and shade seeking/sun avoidance) were examined.

RESULTS

Family variables were associated with more frequent sun protection among Hispanic children across outcomes, as were perceived peer norms, perceived self-efficacy, and fewer sun protection barriers. Skin cancer risk factors such as lighter skin and sunburn experience, and level of acculturation were not associated with greater sun protection.

CONCLUSION

Family sun protection habits are instrumental to Hispanic children's sun safe behaviors, and interventions that engage the family may be most effective. Increasing risk communication to high-risk subgroups of Hispanic children (those with lighter, more sun reactive skin) is important when developing intervention strategies. However, there is overlap between Hispanic children's sun protection correlates and those observed among non-Hispanic white children, suggesting that interventions to improve sun protection may generalize across cultural contexts.

An online skin cancer risk-reduction intervention for young adults: Mechanisms of effects

OBJECTIVE

The study's purpose was to investigate moderator, implementation, and mediator variables related to the efficacy of UV4.me, an Internet intervention that decreased ultraviolet radiation (UV) exposure and increased skin protection behaviors among young adults.

METHOD

A total of 965 18-25 year olds at risk for skin cancer were recruited nationally online. Participants were randomized to an experimental website (UV4.me), a control website, or assessment only. Participant characteristics (moderators), engagement with and perceptions of interventions (implementation measures), and exposure and protection attitudinal variables (mediators) were assessed. Linear regression and mediation analyses were conducted.

RESULTS

Intervention effects on skin protection were greater for participants with a family history of skin cancer (p = .01). Intervention effects on UV exposure were greater among recent indoor tanners (p = .04). Improvements in skin protection (but not UV exposure) were associated with perceiving the interventions as satisfying or helpful (ps < .01). The experimental group had better outcomes if they completed more modules (ps < .01) or set more behavioral goals (ps < .01). Knowledge and exposure decisional balance mediated intervention effects for UV exposure (ps < .05), and protection decisional balance, self-efficacy, and intentions mediated intervention effects for protection (ps < .05).

CONCLUSIONS

The experimental intervention was more efficacious for certain high risk groups. The more individuals liked and engaged with the interventions (e.g., by setting goals), the better their outcomes. Mediation results inform theory about change mechanisms and differed by behavioral outcome. (PsycINFO Database Record

Disparities in the Context of Opportunities for Cancer Prevention in Early Life

Persistent health disparities are a major contributor to disproportionate burden of cancer for some populations. Health disparities in cancer incidence and mortality may reflect differences in exposures to risk factors early in life. Understanding the distribution of exposures to early life risk and protective factors for cancer across different populations can shed light on opportunities to promote health equity at earlier developmental stages. Disparities may differentially influence risk for cancer during early life and create opportunities to promote health equity. Potential risk and protective factors for cancer in early life reveal patterns of disparities in their exposure. These disparities in exposures can manifest in downstream disparities in risk for cancer. These risk and protective factors include adverse childhood experiences; maternal alcohol consumption in pregnancy; childhood obesity; high or low birth weight; benzene exposure; use of assisted reproductive technologies; pesticide and insecticide exposure; isolated cryptorchidism; early pubertal timing; exposure to radiation; exposure to tobacco in utero and in early life; allergies, asthma, and atopy; and early exposure to infection. Disparities on the basis of racial and ethnic minority status, economic disadvantage, disability status, sex, geography, and nation of origin can occur in these risk and protective factors. Vulnerable populations experience disproportionally greater exposure to risk factors in early life. Addressing disparities in risk factors in early life can advance opportunities for prevention, promote health equity, and possibly reduce risk for subsequent development of cancer.

Screening sunscreens: protecting the biomechanical barrier function of skin from solar ultraviolet radiation damage

OBJECTIVE

Solar ultraviolet (UV) radiation is ubiquitous in human life and well known to cause skin damage that can lead to harmful conditions such as erythema. Although sunscreen is a popular form of protection for some of these conditions, it is unclear whether sunscreen can maintain the mechanical barrier properties of skin. The objective of this study was to determine whether in vitro thin-film mechanical analysis techniques adapted for biological tissue are able to characterize the efficacy of commonly used UV inhibitors and commercial sunscreens to protect the biomechanical barrier properties of stratum corneum (SC) from UV exposure.

METHODS

The biomechanical properties of SC samples were assayed through measurements of the SC's drying stress profile and delamination energy. The drying stresses within SC were characterized from the curvature of a borosilicate glass substrate onto which SC had been adhered. Delamination energies were characterized using a double-cantilever beam (DCB) cohesion testing method. Successive DCB specimens were prepared from previously separated specimens by adhering new substrates onto each side of the already tested specimen to probe delamination energies deeper into the SC. These properties of the SC were measured before and after UV exposure, both with and without sunscreens applied, to determine the role of sunscreen in preserving the barrier function of SC.

RESULTS

The drying stress in SC starts increasing sooner and rises to a higher plateau stress value after UVA exposure as compared to non-UV-exposed control specimens. For specimens that had sunscreen applied, the UVA-exposed and non-UV-exposed SC had similar drying stress profiles. Additionally, specimens exposed to UVB without protection from sunscreen exhibited significantly lower delamination energies than non-UV-exposed controls. With commercial sunscreen applied, the delamination energy for UV-exposed and non-UV-exposed tissue was consistent, even up to large doses of UVB.

CONCLUSION

In vitro thin-film mechanical analysis techniques can readily characterize the effects of SC's exposure to UV radiation. The methods used in this study demonstrated commercial sunscreens were able to preserve the biomechanical properties of SC during UV exposure, thus indicating the barrier function of SC was also maintained.

Predictors of sun protection behaviours and sunburn among Australian adolescents

BACKGROUND

Excessive sun exposure and sunburn increase individuals' risk of skin cancer. It is especially important to prevent sunburn in childhood due to the higher relative risk of skin cancer across the life span compared to risk associated with sunburn episodes experienced later in life. This study examined demographic and attitudinal factors associated with engagement in a range of sun protection behaviours (wearing a hat, wearing protective clothing, staying in the shade, and staying indoors during the middle of the day) and the frequency of sunburn among Western Australian adolescents to provide insights of relevance for future sun protection campaigns.

METHODS

Cross-sectional telephone surveys were conducted annually with Western Australians between 2005/06 and 2014/15. The results from 4150 adolescents aged 14-17 years were used to conduct a path analysis of factors predicting various sun protection behaviours and sunburn.

RESULTS

Significant primary predictors of the sun protection behaviours included in the study were skin type (sun sensitivity), gender, tanning-related attitudes and behaviours, and perceived relevance of public service advertisements that advocate sun protection. Of the four sun protection behaviours investigated, staying in the shade and staying indoors during the middle of the day were associated with a lower frequency of sunburn.

CONCLUSION

There is a particular need to target sun protection messages at adolescent males who are less likely to engage in the most effective sun protection behaviours and demonstrate an increased propensity to experience sunburn. The results suggest that such future sun protection messages should include a focus on the importance of staying in the shade or indoors during periods of high UV radiation to increase awareness of the efficacy of these methods of avoiding skin cancer.

Coverage of Skin Cancer Risk Factors and UV Behaviors in Popular U.S. Magazines from 2000 to 2012

Mass media is an influential source of skin cancer and tanning information for the public, but we know little about its content or emphasis. The objective of this research was to describe the volume and nature of skin cancer and tanning messages in 20 popular U.S. men's and women's magazines (2000-2012). We used a directed content analysis to determine frequency information about risk factors and ultraviolet (UV) behaviors in 608 articles and 930 images. Chi-square and Fisher's exact tests determined coverage differences based on content type (text vs. image) and target audience (women vs. men). UV exposure was the most common risk factor mentioned (37.7 %) and sunscreen use the most common behavior encouraged (60.0 %); information about other risk factors and protective behaviors was uncommon. Both articles (25.2 %) and images (36.9 %) promoted the tanned look as attractive. In most cases, images infrequently contained helpful information on skin cancer risk factors and prevention, except for high-SPF sunscreens. Women's magazines published more articles on skin cancer and tanning than men's magazines (456 vs. 159, χ(2) = 143.43, P < .01), and the nature of the messages differed between them. Magazine skin cancer and tanning content may contribute to inaccurate public understanding of risks and prevention. These findings are relevant to cancer educators, who may wish to counter potentially harmful messages and enhance positive ones through cancer education efforts.

Environmental variables associated with vacationers' sun protection at warm weather resorts in North America

BACKGROUND

Vacationing at sunny, warm weather locations is a risk factor for excessive solar ultraviolet (UV) radiation exposure and skin cancer.

OBJECTIVES

This study examined the association of environmental variables related to UV levels with vacationers' sun protection.

METHODS

Vacationers at 41 summer resorts in 17 states and 1 Canadian Province were interviewed (n=3531) and observed (N=4347) during 2012 and 2013. Clothing coverage, sunglasses, and shade use were observed. Use of sunscreen and sunburns were self-reported. Environmental information was recorded by research staff or acquired from ground stations and the weather service.

RESULTS

Temperature was positively associated with sun protection behaviors; however clothing coverage was negatively associated with temperature. Cloud cover was negatively associated with sun protection, with the exception of clothing coverage which was positively associated with it. Elevation showed a mixed pattern of associations with vacationer's sun protection. Latitude of a resort was negatively associated with most sun protection behaviors, such that sun protection increased at more southerly resorts. Similarly, the farther south a vacationer traveled to the resort, the less sun protection they employed. The UV index showed a weak, positive relationship with some sun protection behaviors even when controlling for temperature.

CONCLUSIONS

Vacationers appeared aware that UV is higher at southern latitudes and may learn UV is intense when living in southern regions. However, many used temperature, an unreliable cue, to judge UV intensity and seemed to adjust clothing for warmth not UV protection. Efforts are needed to help individuals make more accurate sun safety decisions.

Application of the Health Belief Model to U.S. Magazine Text and Image Coverage of Skin Cancer and Recreational Tanning (2000-2012)

The health belief model (HBM) has been widely used to inform health education, social marketing, and health communication campaigns. Although the HBM can explain and predict an individual's willingness to engage in positive health behaviors, its application to, and penetration of the underlying constructs into, mass media content has not been well characterized. We examined 574 articles and 905 images about skin cancer and tanning risks, behaviors, and screening from 20 U.S. women's and men's magazines (2000-2012) for the presence of HBM constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Susceptibility (48.1%) and severity (60.3%) information was common in text. Perceived benefits (36.4%) and barriers (41.5%) to prevention of skin cancer were fairly equally mentioned in articles. Self-efficacy (48.4%) focused on sunscreen use. There was little emphasis on HBM constructs related to early detection. Few explicit cues to action about skin cancer appeared in text (12.0%) or images (0.1%). HBM constructs were present to a significantly greater extent in text versus images (e.g., severity, 60.3% vs. 11.3%, respectively, χ(2) = 399.51, p < .0001; benefits prevention, 36.4% vs. 8.0%, respectively, χ(2) = 184.80, p < .0001), suggesting that readers are not visually messaged in ways that would effectively promote skin cancer prevention and early detection behaviors.

Prevalence of major risk factors and use of screening tests for cancer in the United States

Much of the suffering and death from cancer could be prevented by more systematic efforts to reduce tobacco use, improve diet, increase physical activity, reduce obesity, and expand the use of established screening tests. Monitoring the prevalence of cancer risk factors and screening is important to measure progress and strengthen cancer prevention and early detection efforts. In this review article, we provide recent prevalence estimates for several cancer risk factors, including tobacco, obesity, physical activity, nutrition, ultraviolet radiation exposure as well as human papillomavirus and hepatitis B vaccination coverage and cancer screening prevalence in the United States. In 2013, cigarette smoking prevalence was 17.8% among adults nationally, but ranged from 10.3% in Utah to 27.3% in West Virginia. In addition, 15.7% of U.S. high school students were current smokers. In 2011-2012, obesity prevalence was high among both adults (34.9%) and adolescents (20.5%), but has leveled off since 2002. About 20.2% of high school girls were users of indoor tanning devices, compared with 5.3% of boys. In 2013, cancer screening prevalence ranged from 58.6% for colorectal cancer to 80.8% for cervical cancer and remains low among the uninsured, particularly for colorectal cancer screening where only 21.9% of eligible adults received recommended colorectal cancer screening.

A Randomized Controlled Trial of a Mobile Medical App for Kidney Transplant Recipients: Effect on Use of Sun Protection

BACKGROUND

Perception of skin cancer risk, belief that sun protection prevents skin cancer, and having sun protection choices enhance sun protection behaviors by kidney transplant recipients, who are at greater risk of developing skin cancer than the general population.

METHODS

A randomized controlled trial used stratified recruitment of non-Hispanic White, non-Hispanic Black, and Hispanic/Latino kidney transplant recipients, who received a transplant 2-24 months prior to the study. The same culturally sensitive SunProtect™ program was delivered to all recipients with tablet personal computers in two urban ambulatory offices. Text messages reminders were provided at two week intervals. Self-reported surveys and skin pigmentation measured prior to the intervention and six weeks later were analyzed.

RESULTS

Among 552 eligible participants, 170 participated (62 non-Hispanic Whites, 60Blacks, and 48 Hispanics). Among participants receiving the intervention with skin that burns after sun exposure and becomes tan or becomes irritated and gets darker, there was a statistically significant increase in self-reported knowledge, recognition of personal skin cancer risk, confidence in sun protection preventing skin cancer, and sun protection behaviors in participants compared to those receiving usual education (p<0.05). At the six week follow-up, participants in the intervention group with skin that burns or becomes irritated, had significantly less darkening of the sun-exposed forearm than control participants (p<0.05).

CONCLUSIONS

Providing sun protection education with SunProtect™ in the springwith reminders during the summer facilitated adoption of sun protection behaviors among kidney transplant recipients with skin that burns or becomes irritated.

Patterns of sun protective behaviors among Hispanic children in a skin cancer prevention intervention

BACKGROUND

Invasive melanoma is becoming more common in U.S. Hispanics, yet little is known about the sun protection behaviors in this population, particularly children and adolescents who incur high ultraviolet (UV) exposures.

METHODS

We used latent class analysis to examine patterns of sun protective behaviors in a cross-sectional survey of Hispanic elementary students participating in a sun safety intervention in Los Angeles from 2013- to 2014 (N=972). Five behavior indicators in two environments (school and home) representing multiple methods of sun protection were selected for the model.

RESULTS

Results suggested a four-class model best fit the data. Classes were labeled in order of increasing risk as multiple protective behaviors (28%), clothing and shade (32%), pants only (15%), and low/inconsistent protective behaviors (25%). Children who reported high parental engagement with sun protection were significantly more likely to be classified in high overall protective categories (odds ratio (OR)=4.77). Girls were more likely than boys to be classified in the highest protecting class (OR=3.46), but were also more likely to be in the "pants only" class (OR=2.65). Sensitivity to sunburn was associated with less likelihood of being in the "clothing and shade" class (OR=0.53).

CONCLUSION

The differences among these classes and their predictors reveal the heterogeneity and complexity of Hispanic children's sun protective behaviors. These findings have implications for the design and delivery of future sun protection interventions targeting Hispanic children, as strategies tailored to specific subgroups may be more effective in achieving meaningful behavioral changes.

Rationale, design, samples, and baseline sun protection in a randomized trial on a skin cancer prevention intervention in resort environments

INTRODUCTION

Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations.

MATERIALS AND METHODS

Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits.

RESULTS

Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2ft. to 9726ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35-60years old, highly educated (college education=68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned.

CONCLUSIONS

The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.

Validation of sun exposure and protection index (SEPI) for estimation of sun habits

BACKGROUND

In both Sweden and Australia high incidence rates of skin cancer have become a major health problem. In prevention and risk communication, it is important to have reliable ways for identifying people with risky sun habits. In this study the validity and reliability of the questionnaire Sun Exposure Protection Index (SEPI), developed to assess individual's sun habits and their propensity to increase sun protection during routine, often brief, clinical encounters, has been evaluated. The aim of our study was to evaluate validity and reliability of the proposed SEPI scoring instrument, in two countries with markedly different ultraviolet radiation environments (Sweden and Australia).

METHOD

Two subpopulations in Sweden and Australia respectively were asked to fill out the SEPI together with the previously evaluated Readiness to Alter Sun Protective Behaviour questionnaire (RASP-B) and the associated Sun-protective Behaviours Questionnaire. To test reliability, the SEPI was again filled out by the subjects one month later.

RESULTS

Comparison between SEPI and the questions in the Sun-protective Behaviours Questionnaire, analyzed with Spearman's Rho, showed good correlations regarding sun habits. Comparison between SEPI and RASP-B regarding propensity to increase sun protection showed concurrently lower SEPI mean scores for action stage, but no difference between precontemplation and contemplation stages. The SEPI test-retest analysis indicated stability over time. Internal consistency of the SEPI, assessed with Cronbach's alpha estimation showed values marginally lower than the desired >0.70 coefficient value generally recommended, and was somewhat negatively affected by the question on sunscreen use, likely related to the classic "sunscreen paradox". There were some differences in the performance of the SEPI between the Swedish and Australian samples, possibly due to the influence of "available" sunlight and differing attitudes to behaviour and protection "at home" and on vacation.

CONCLUSIONS

SEPI appears to be a stable instrument with an overall acceptable validity and reliability, applicable for use in populations exposed to different UVR environments, in order to evaluate individual sun exposure and protection.

Sun protection practices and sun exposure among children with a parental history of melanoma

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.

Development of an Internet Intervention to Address Behaviors Associated with Skin Cancer Risk among Young Adults

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.

Ultraviolet Radiation on the Skin: A Painful Experience?

Excessive exposure of skin to ultraviolet radiation (UVR) has dramatic clinical effects in humans, and it is a significant public health concern. Discomfort and sensory changes caused by skin sunburn are the main common features experienced by many of us, a phenomena triggered by the combination of long and short wavelengths radiation (UVA and UVB, respectively). Although the biological processes underlying UVR exposure are not fully understood, in the last few years many studies have made significant progress in characterizing sunburn at the cellular and molecular levels, making use of both humans and laboratory animal models. Here we review and reason that UVR can be used as an excellent model of sensitization and inflammation for pain research. UVR, particularly UVB, produces a controllable and sterile inflammation that causes a robust dose‐dependent hypersensitivity with minimal confounding effects. Importantly, we show that UVR animal models precisely recapitulate the sensory, cellular, and molecular changes observed in human skin, giving it great confidence as a translational model. Furthermore, in this article, we give an overview of the pharmacology underlying UVB inflammation, the latest advances in the field, and potential new targets for inflammatory pain.

Smartphone mobile application delivering personalized, real-time sun protection advice: a randomized clinical trial

IMPORTANCE

Mobile smartphones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications (apps), they can access remote databases, track time and location, and integrate user input to provide tailored health information.

OBJECTIVE

A smartphone mobile app providing personalized, real-time sun protection advice was evaluated in a randomized clinical trial.

DESIGN, SETTING, AND PARTICIPANTS

The trial was conducted in 2012 and had a randomized pretest-posttest controlled design with a 10-week follow-up. Data were collected from a nationwide population-based survey panel. A sample of 604 non-Hispanic and Hispanic adults from the Knowledge Panel 18 years or older who owned an Android smartphone were enrolled.

INTERVENTIONS

The mobile app provided advice on sun protection (ie, protection practices and risk of sunburn) and alerts (to apply or reapply sunscreen and get out of the sun), hourly UV Index, and vitamin D production based on the forecast UV Index, the phone's time and location, and user input.

MAIN OUTCOMES AND MEASURES

Percentage of days using sun protection and time spent outdoors (days and minutes) in the midday sun and number of sunburns in the past 3 months were collected.

RESULTS

Individuals in the treatment group reported more shade use (mean days staying in the shade, 41.0% vs 33.7%; P = .03) but less sunscreen use (mean days, 28.6% vs 34.5%; P = .048) than controls. There was no significant difference in number of sunburns in the past 3 months (mean, 0.60 in the treatment group vs 0.62 for controls; P = .87). Those who used the mobile app reported spending less time in the sun (mean days keeping time in the sun to a minimum, 60.4% for app users vs 49.3% for nonusers; P = .04) and using all protection behaviors combined more (mean days, 39.4% vs 33.8%; P = .04).

CONCLUSIONS AND RELEVANCE

The mobile app improved some sun protection. Use of the mobile app was lower than expected but associated with increased sun protection. Providing personalized advice when and where people are in the sun may help reduce sun exposure.

Evaluation of immediate and 12-week effects of a smartphone sun-safety mobile application: a randomized clinical trial

IMPORTANCE

Mobile applications on smartphones can communicate a large amount of personalized, real-time health information, including advice on skin cancer prevention, but their effectiveness may be affected by whether recipients can be convinced to use them.

OBJECTIVE

To evaluate a smartphone mobile application (Solar Cell) delivering real-time advice about sun protection for a second time in a randomized clinical trial.

DESIGN, SETTING, AND PARTICIPANTS

A previous trial conducted in 2012 used a randomized pretest-posttest design. For the present trial, we collected data from a volunteer sample of 202 adults 18 years or older who owned a smartphone. Participants were recruited nationwide through online promotions. Screening procedures and a 3-week run-in period were added to increase the use of the mobile application. We conducted follow-ups at 3 and 8 weeks after randomization to examine the immediate and the longer-term effects of the intervention.

INTERVENTIONS

Use of the mobile application. The application gave feedback on sun protection (ie, sun-safety practices and the risk for sunburn) and alerted users to apply or to reapply sunscreen and to get out of the sun. The application also displayed the hourly UV Index and vitamin D production based on the forecast UV Index, time, and location.

MAIN OUTCOMES AND MEASURES

Percentage of days with the use of sun protection, time spent outdoors in the midday sun (days and hours), and the number of sunburns in the last 3 months.

RESULTS

Participants in the intervention group used wide-brimmed hats more at 7 weeks than control participants (23.8% vs 17.4%; F = 4.07; P = .045). Women who used the mobile application reported using all sun protection combined more than men (46.4% vs 43.3%; F = 1.49; P = .04), whereas men and older individuals reported less use of sunscreen (32.7% vs 35.5%; F = 5.36; P = .02) and hats (15.6% vs 17.9%; F = 4.72; P = .03).

CONCLUSIONS AND RELEVANCE

The mobile application initially appeared to confer weak improvement of sun protection. Use of the mobile application was greater than in a previous trial and was associated with greater sun protection, especially among women. Strategies to increase the use of the mobile application are needed if the application is to be deployed effectively to the general adult population.

Brazilian consensus on photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Patterns of sunscreen use on the face and other exposed skin among US adults

BACKGROUND

Sunscreen is a common form of sun protection, but little is known about patterns of use.

OBJECTIVE

We sought to assess patterns of sunscreen use on the face and other exposed skin among US adults.

METHODS

Using cross-sectional data from the 2013 Summer ConsumerStyles survey (N = 4033), we calculated descriptive statistics and adjusted risk ratios to identify characteristics associated with regular sunscreen use (always/most of the time when outside on a warm sunny day for ≥1 hour).

RESULTS

Few adults regularly used sunscreen on the face (men: 18.1%, 95% confidence interval [CI] 15.8-20.6; women: 42.6%, 95% CI 39.5-46.7), other exposed skin (men: 19.9%, 95% CI 17.5-22.6; women: 34.4%, 95% CI 31.5-37.5), or both the face and other exposed skin (men: 14.3%, 95% CI 12.3-16.6; women: 29.9%, 95% CI 27.2-32.8). Regular use was associated with sun-sensitive skin, an annual household income ≥$60,000, and meeting aerobic activity guidelines (Ps < .05). Nearly 40% of users were unsure if their sunscreen provided broad-spectrum protection.

LIMITATIONS

Reliance on self-report and lack of information on sunscreen reapplication or other sun-safety practices are limitations.

CONCLUSION

Sunscreen use is low, especially among certain demographic groups. These findings can inform sun-safety interventions and the interpretation of surveillance data on sunscreen use.

Framing Indoor Tanning Warning Messages to Reduce Skin Cancer Risks Among Young Women: Implications for Research and Policy

OBJECTIVES

We investigated the impact of indoor tanning device warnings that communicate the risks associated with indoor tanning (i.e., loss framed) or the benefits of avoiding indoor tanning (i.e., gain framed).

METHODS

A convenience sample of non-Hispanic White women aged 18 to 30 years who tanned indoors at least once in the past year (n = 682) participated in a within-subjects experiment. Participants completed baseline measures and reported indoor tanning intentions and intentions to quit indoor tanning in response to 5 warning messages in random order. A text-only control warning was based on Food and Drug Administration-required warnings for indoor tanning devices. Experimental warnings included graphic content and were either gain or loss framed.

RESULTS

In multivariable analyses, gain-framed warnings did not differ from the control warning on women's intentions to tan indoors, but they prompted stronger intentions to quit than the control message. Loss-framed warnings significantly reduced intentions to tan indoors and increased intentions to quit indoor tanning compared with control and gain-framed warnings.

CONCLUSIONS

The public health impact of indoor tanning device warnings can be enhanced by incorporating graphic content and leveraging gain- and loss-framed messaging.

Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes

BACKGROUND

This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes.

METHODS

We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents.

RESULTS

African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy.

CONCLUSIONS

Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.

Sustained use of an occupational sun safety program in a recreation industry: follow-up to a randomized trial on dissemination strategies

The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess sustainability of Go Sun Smart (GSS), an occupational skin cancer prevention program disseminated to the North American ski industry. Fifty-three of the 68 ski areas from the original dissemination trial participated in 2012 and 2013, 5 to 7 years after program distribution by enhanced or basic dissemination strategies. Sustained use was measured by: (1) on-site observation of sun protection communication and (2) an online survey with senior managers. In the sustainability assessment, sun safety communication had declined, and dissemination strategy did not affect continued use. Managers held weaker attitudes about skin cancer importance and program fit, but more managers provided free/reduced-cost sunscreen than in the dissemination trial. Manager turnover was a key factor in program discontinuance. Sustainability remains a challenge. Additional research is needed to determine the best strategies for sustainability.

Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

OBJECTIVE

Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant.

DESIGN

Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention.

MAIN OUTCOME MEASURES

Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use.

RESULTS

With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126-.614), and the pros predicted the outcomes (r = .181-.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes.

CONCLUSION

In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.

Fostering multiple healthy lifestyle behaviors for primary prevention of cancer

The odds of developing cancer are increased by specific lifestyle behaviors (tobacco use, excess energy and alcohol intakes, low fruit and vegetable intake, physical inactivity, risky sexual behaviors, and inadequate sun protection) that are established risk factors for developing cancer. These behaviors are largely absent in childhood, emerge and tend to cluster over the life span, and show an increased prevalence among those disadvantaged by low education, low income, or minority status. Even though these risk behaviors are modifiable, few are diminishing in the population over time. We review the prevalence and population distribution of these behaviors and apply an ecological model to describe effective or promising healthy lifestyle interventions targeted to the individual, the sociocultural context, or environmental and policy influences. We suggest that implementing multiple health behavior change interventions across these levels could substantially reduce the prevalence of cancer and the burden it places on the public and the health care system. We note important still-unresolved questions about which behaviors can be intervened upon simultaneously in order to maximize positive behavioral synergies, minimize negative ones, and effectively engage underserved populations. We conclude that interprofessional collaboration is needed to appropriately determine and convey the value of primary prevention of cancer and other chronic diseases.

Projected changes in erythemal and vitamin D effective irradiance over northern-hemisphere high latitudes

Changes in the effective dose for the production of vitamin D and in the UV index are investigated for the past and future relative to the present over the northern high latitudes for two socioeconomic scenarios. Large decreases (the order of 30–50%) have been found between the present and the future.

The consequences for human health of stratospheric ozone depletion in association with other environmental factors

Ozone depletion, climate and human health.

Ultraviolet radiation and systemic lupus erythematosus

Exposure to ultraviolet (UV) radiation is among the environmental factors that have been proposed and studied in association with systemic lupus erythematosus (SLE). While it is known that UV radiation exposure may exacerbate pre-existing lupus, it remains unclear whether UV exposure is a risk factor for the development of SLE. Experimental studies show a significant immunomodulatory role for UV radiation, but strong epidemiologic data regarding its role in triggering SLE onset are lacking. Further studies are needed to assess the role of UV radiation in relation to development of incident SLE, yet they are challenging to design due to difficulties in accurate exposure assessment, the heterogeneous nature of SLE, and the challenge of assessing photosensitivity, a feature of SLE, which often precedes its diagnosis.

Effects of tailored risk communications for skin cancer prevention and detection: the PennSCAPE randomized trial

BACKGROUND

Prevention and early detection measures for melanoma, such as sun avoidance and skin examinations, are important, but are practiced inconsistently. In this replication of the Project SCAPE trial, we sought to determine whether tailored print materials were more effective at improving adherence than generic print materials for patients at increased risk of skin cancer.

METHODS

Participants were randomized to receive personalized mailed communications about their skin cancer risk and recommended sun protection, or generic mailings. Participants were Caucasian adults, at moderate or high risk for skin cancer, recruited in outpatient primary care. The main outcomes were overall sun protection behaviors and specific protective behaviors including use of sunscreen, shirt, hat, sunglasses, shade, and sun avoidance; recent sunburns; and skin self-examination and provider skin examination.

RESULTS

One hundred ninety-two (93.2%) subjects completed the study. Six outcome variables showed significant intervention condition effects in mixed effects models: overall sun protection behavior (P = 0.025); sunscreen use (P = 0.026); use of sunglasses (P = 0.011); sunburns in the past three months (P = 0.033); recency of last skin self-exam (P = 0.017); and frequency of skin exams by health care provider (P = 0.016).

CONCLUSIONS

Relative to generic communications, tailored risk communications resulted in improved adherence to six skin cancer protective behaviors, including a composite sun protection behavior measure, sunburns, and health care provider skin examinations.

IMPACT

Tailored interventions can be more effective in improving patient prevention behaviors than nontailored, generic information for patients at moderate to high risk of skin cancer.

Effects of a short messaging service-based skin cancer prevention campaign in adolescents

BACKGROUND

Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages.

PURPOSE

To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents.

METHODS

The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11-14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety-themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests.

RESULTS

Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends.

CONCLUSIONS

A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects.

Midlife dietary vitamin D intake and subsequent performance in different cognitive domains

BACKGROUND/AIMS

We evaluated the cross-time association between midlife dietary vitamin D intake and subsequent cognitive performance in a French general-population sample.

METHODS

Data from participants in both the SU.VI.MAX trial (1994-2002) and the SU.VI.MAX 2 observational study (2007-2009) were used. Dietary intake was estimated at baseline from 6 or more 24-hour records. Cognitive performance was evaluated 13 years later with a comprehensive neuropsychological battery. Parameter estimates of cognitive performance according to quartiles (Q) of vitamin D intake were estimated via ANCOVA.

RESULTS

In a sample of 1,990 aging adults, principal component analyses yielded two cognitive factors - for episodic/semantic memory and short-term memory/executive function; however, neither one displayed associations with dietary vitamin D intake. Midlife vitamin D intake was significantly and positively associated with scores on the forward digit span task measuring short-term memory (fully adjusted model: mean difference, Q4 vs. Q1 = 1.95; 95% CI 0.37-3.53; p(trend) = 0.03). No significant interaction with either sex or lifetime sun exposure was found.

CONCLUSIONS

Midlife vitamin D intake exhibited a cross-time and domain-specific association with cognition in the context of aging. Further investigations in this area of prevention are warranted given the rapidly expanding elderly population and the absence of curative treatment for dementia.

Tanning Shade Gradations of Models in Mainstream Fitness and Muscle Enthusiast Magazines

Tanned skin has been associated with perceptions of fitness and social desirability. Portrayal of models in magazines may reflect and perpetuate these perceptions. Limited research has investigated tanning shade gradations of models in men’s versus women’s fitness and muscle enthusiast magazines. Such findings are relevant in light of increased incidence and prevalence of melanoma in the United States. This study evaluated and compared tanning shade gradations of adult Caucasian male and female model images in mainstream fitness and muscle enthusiast magazines. Sixty-nine U.S. magazine issues (spring and summer, 2013) were utilized. Two independent reviewers rated tanning shade gradations of adult Caucasian male and female model images on magazines’ covers, advertisements, and feature articles. Shade gradations were assessed using stock photographs of Caucasian models with varying levels of tanned skin on an 8-shade scale. A total of 4,683 images were evaluated. Darkest tanning shades were found among males in muscle enthusiast magazines and lightest among females in women’s mainstream fitness magazines. By gender, male model images were 54% more likely to portray a darker tanning shade. In this study, images in men’s (vs. women’s) fitness and muscle enthusiast magazines portrayed Caucasian models with darker skin shades. Despite these magazines’ fitness-related messages, protanning images may promote attitudes and behaviors associated with higher skin cancer risk. To date, this is the first study to explore tanning shades in men’s magazines of these genres. Further research is necessary to identify effects of exposure to these images among male readers.