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Yu H, Zhu L, Zhang J, Zheng S, Ming WK, Ip CC, Jiang Y, Chen W, Wu S, Lyu J, Deng L. Joinpoint regression analysis of recent trends in desmoplastic malignant melanoma incidence and mortality: 15-year multicentre retrospective study. Arch Dermatol Res 2024; 316:273. [PMID: 38796649 DOI: 10.1007/s00403-024-02928-y] [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: 09/02/2023] [Revised: 02/18/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Recent data reveal a marked rise in the detection and mortality rates of Desmoplastic Malignant Melanoma (DMM). This trend underscores the imperative for an in-depth analysis of DMM's epidemiology, which is crucial for the formulation of precise medical and public health strategies. This investigation seeks to elucidate the variations in the incidence and mortality of DMM over a 15-year period (2005-2019). METHODS Data on DMM patients was sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Both incidence and incidence-based mortality rates (IBM) were directly extracted from the SEER database. Joinpoint regression was used to analyze and calculate the average annual percent change (AAPC) and its 95% confidence interval (CI). RESULTS Between 2005 and 2019, 3,384 DMM cases were identified, boasting an age-adjusted incidence rate of 36.3 cases per 1000,000 person-years (95% CI 3.51-3.76) and an IBM of 1.65cases per 1000,000 person-years (95% CI 1.57-1.74). Of these, 2,353 were males (69.53%) and 1,031 were females (30.47%). There were 1894 patients (55.97%) who were over 70 years old. Predominantly, DMM lesions manifested in exposed areas: Limbs (955, 28.22%), Face (906, 26.77%), and Scalp and Neck (865, 25.56%). The incidence of DMM increased significantly at a rate of APC = 0.9% during 2005-2019, while the incidence-based mortality showed a significant upward trend (APC = 7%) during 2005-2012, and slowly increasing trend (APC = 0.6%) during 2012-2019. In contrast to the modest upward trajectory in female incidence and mortality, male incidence initially surged, later declining, while male mortality peaked and stabilized post-2012. The primary sites for incidence and mortality were chronically sun-exposed areas: Face, Scalp and Neck, and Limbs. CONCLUSIONS In recent years, the incidence and incidence-based mortality of DMM have significantly increased. Each subgroup analysis has different trends, and these trends can provide better support for our exploration of DMM.
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Affiliation(s)
- Hai Yu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Linna Zhu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Jinrong Zhang
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Suzheng Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | | | - Yuzhen Jiang
- Royal Free Hospital & University College London, London, UK
| | - Wenhui Chen
- Shanghai Aige Medical Beauty Clinic Co., Ltd. (Agge), Shanghai, China
| | - Shi Wu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Liehua Deng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China.
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, China.
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Stapleton JL, Manne SL, Pagoto SL, Leip A, Greene K, Hillhouse JJ, Merritt AS, Shelton BJ. A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56562. [PMID: 38502173 PMCID: PMC10988380 DOI: 10.2196/56562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability. OBJECTIVE This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning. METHODS Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up. RESULTS This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up. CONCLUSIONS This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines. TRIAL REGISTRATION ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56562.
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Affiliation(s)
- Jerod L Stapleton
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Sherry L Pagoto
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States
| | - Allison Leip
- Department of Family Sciences, University of Kentucky, Lexington, KY, United States
| | - Kathryn Greene
- Department of Communication, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, United States
| | - Allison S Merritt
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Brent J Shelton
- Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, KY, United States
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Blanco E, Algranti E, Cifuentes LA, López-Carrillo L, Mora AM, Rodríguez-Guzmán J, Rodríguez-Villamizar LA, Veiga LHS, Canelo-Aybar C, Nieto-Gutierrez W, Feliu A, Espina C, Ferreccio C. Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer. Cancer Epidemiol 2023; 86 Suppl 1:102381. [PMID: 37852723 DOI: 10.1016/j.canep.2023.102381] [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: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 10/20/2023]
Abstract
Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.
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Affiliation(s)
- Estela Blanco
- Centro de Investigación en Sociedad y Salud y Nucleo Milenio SocioMed, Universidad Mayor, Badajoz 130, Oficina 1305, Las Condes, Santiago 7550000, Chile; Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile
| | | | - Luis Abdon Cifuentes
- Departamento de Ingeniería, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile
| | - Lizbeth López-Carrillo
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico
| | - Ana M Mora
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, 1995 University Avenue, Suite 265, Berkeley, CA 94720-7392, USA
| | | | - Laura Andrea Rodríguez-Villamizar
- Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Cra. 32 #29-31, Bucaramanga, Santander 680002, Colombia
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, MSC 9776, Bethesda 20892, MD, USA
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Wendy Nieto-Gutierrez
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, CEDEX 0769366, Lyon, France
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, CEDEX 0769366, Lyon, France
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile.
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Kim SE, Kim YJ, Kim YW, Cheon YW. Heating Pretreatment of the Recipient Site Enhances Survival of Transplanted Fat in a Mouse Model. Plast Reconstr Surg 2023; 152:787-795. [PMID: 36847665 DOI: 10.1097/prs.0000000000010328] [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: 03/01/2023]
Abstract
BACKGROUND Despite several studies about the preparation of the recipient site in fat grafting, optimizing techniques with clinical usefulness is still necessary. Through previous animal studies reporting that heat can increase tissue vascular endothelial growth factor and vascular permeability, the authors hypothesize that pretreatment heating of the recipient site will increase retention of grafted fat. METHODS Twenty 6-week-old female BALB/c mice had two pretreatment sites on their back, one for the experimental temperatures (44°C and 48°C) and the other for the control. A digitally controlled aluminum block was used to apply the contact thermal damage. Human fat (0.5 mL) was grafted on each site and harvested on days 7, 14, and 49. The percentage volume and weight, histologic changes, and peroxisome proliferator-activated receptor gamma expression, a key regulator of adipogenesis, were measured by the water displacement method, light microscopy, and quantitative real-time polymerase chain reaction, respectively. RESULTS The harvested percentage volumes were 74.0% ± 3.4%, 82.5% ± 5.0%, and 67.5% ± 9.6% for the control, 44°C-pretreatment, and 48°C-pretreatment groups, respectively. The percentage volume and weight of the 44°C-pretreatment group was higher than the other groups ( P < 0.05). The 44°C-pretreatment group exhibited significantly higher integrity with fewer cysts and vacuoles than the other groups. Both heating pretreatment groups showed markedly higher rates of vascularity than the control group ( P < 0.017), and also increased the expression of peroxisome proliferator-activated receptor gamma over two-fold. CONCLUSION Heating preconditioning of the recipient site during fat grafting can increase the retention volume and improve the integrity, which is partly explained by increased adipogenesis in a short-term mouse model. CLINICAL RELEVANCE STATEMENT Tanning could be an alternative pretreatment for fat grafting.
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Affiliation(s)
- Sun Eung Kim
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine
| | - Yu Jin Kim
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine
| | - Yang Woo Kim
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine
| | - Young Woo Cheon
- From the Department of Plastic and Reconstructive Surgery, Gil Medical Center, Gachon University College of Medicine
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5
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de Vere Hunt I, Cai ZR, Nava V, Admassu NE, Bousheri S, Johnson T, Tomz A, Thompson J, Zhang L, Pagoto S, Wehner MR, Mathur MB, Linos E. A Social Media-Based Public Health Campaign to Reduce Indoor Tanning in High-Risk Populations. AJPM FOCUS 2023; 2:None. [PMID: 37662553 PMCID: PMC10465716 DOI: 10.1016/j.focus.2023.100123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction Indoor tanning beds cause more than 450,000 new skin cancers each year, yet their use remains common, with a global indoor tanning prevalence of 10.4%. Social media provides an opportunity for cost-effective, targeted public health messaging. We sought to direct Instagram users at high risk of indoor tanning to accurate health information about the risks of indoor tanning and to reduce indoor tanning bed use. Methods We disseminated a public health campaign on Instagram on April 6-27, 2022 with 34 video and still-image advertisements. We had 2 target audiences at high risk of indoor tanning: women aged 18-30 years in Kentucky, Nebraska, Ohio, or Tennessee interested in indoor tanning and men aged 18-45 years in California interested in indoor tanning. To evaluate the impact of the campaign, we tracked online metrics, including website visits, and conducted an interrupted time-series analysis of foot traffic data in our target states for all tanning salons documented on SafeGraph from January 1, 2018 to 3 months after the campaign. Results Our indoor tanning health information advertisements appeared on Instagram feeds 9.1 million times, reaching 1.06 million individuals. We received 7,004 views of our indoor tanning health information landing page (Average Time on Page of 56 seconds). We did not identify a significant impact on foot traffic data on tanning salons. Conclusions We show the successful use of social media advertising to direct high-risk groups to online health information about indoor tanning. Future research quantifying tanning visits before and after indoor tanning interventions is needed to guide future public health efforts.
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Affiliation(s)
- Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Stanford, California
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Zhuo Ran Cai
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Vanessa Nava
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | | | - Stephanie Bousheri
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Tiffani Johnson
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Anna Tomz
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Jessica Thompson
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Lucy Zhang
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Mansfield, Connecticut
| | - Mackenzie R. Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maya B. Mathur
- Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Stanford, California
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, California
- Department of Dermatology, Stanford University, Stanford, California
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6
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Gosselin S, Thaivalappil A, Papadopoulos A, McWHIRTER JE. Public Health Messaging to Address Indoor Tanning: A Scoping Review. JOURNAL OF HEALTH COMMUNICATION 2023; 28:241-253. [PMID: 36992625 DOI: 10.1080/10810730.2023.2196519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Indoor tanning (IT) is an avoidable skin cancer risk. Although numerous communication interventions have been assessed for IT deterrence, less attention has been paid to the persuasive messages within these interventions. This scoping review summarizes the current peer-reviewed literature on persuasive messages for IT. Overall, 20 articles (21 studies) were included. Most were experimental or quasi-experimental and conducted in the US. Participants were mostly young women who had tanned indoors before. Few studies evaluated persuasive theme; in those that did, health and appearance themes were effective. Narrative and statistical evidence formats were also effective. The included studies also supported normative messages, loss-framed messages, and images. Improved reporting on message design and evaluation would be beneficial for future evidence synthesis. Our understanding of persuasive messages for IT has expanded in recent years, but more research is needed to optimize them.
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Affiliation(s)
- Sydney Gosselin
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Abhinand Thaivalappil
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Jennifer E McWHIRTER
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Wilkerson AH, Davis RE, Sharma M, Harmon MB, McCowan HK, Mockbee CS, Ford MA, Nahar VK. Use of the multi-theory model (MTM) in explaining initiation and sustenance of indoor tanning cessation among college students. Arch Dermatol Res 2023; 315:191-199. [PMID: 35235004 DOI: 10.1007/s00403-022-02338-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/22/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
Skin cancer, including melanoma, is the most common cancer worldwide and a significant public health concern. A significant risk factor for melanoma is through increased exposure to ultraviolet (UV) radiation through the use of indoor tanning beds. Although rates of indoor tanning bed use have decreased in recent years, young adults, particularly White, college-age women, comprise the majority of indoor tanning bed users in the United States. The purpose of this cross-sectional study was to explore and explain the initiation and sustenance of indoor tanning cessation among college students using the multi-theory model (MTM) of health behavior change. Data were collected from 254 college students who reported current indoor tanning use using a validated 46-item survey to assess demographics and the MTM constructs. Data were analyzed using multiple linear regression to determine the ability of the MTM constructs to predict the initiation and sustenance of indoor tanning cessation. For initiation of indoor tanning cessation, participatory dialogue: advantages (B = 0.038, p = 0.001), behavioral confidence (B = 0.129, p < 0.001) and changes in the physical environment (B = 0.088, p < 0.001) were significantly associated with indoor tanning cessation following covariate adjustment. For sustenance, only emotional transformation (B = 0.140, p < 0.001) demonstrated a significant relationship with indoor tanning cessation, following adjustment. Findings from this study demonstrate the utility of the MTM in explaining indoor tanning cessation and designing intervention strategies and clinical recommendations to encourage indoor tanning cessation among college students.
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Affiliation(s)
- Amanda H Wilkerson
- Department of Health Science, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Robert E Davis
- Substance Use and Mental Health Laboratory, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Mallory B Harmon
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street - L216, Jackson, MS, 39216, USA
| | - Hannah K McCowan
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street - L216, Jackson, MS, 39216, USA
| | - Chelsea S Mockbee
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street - L216, Jackson, MS, 39216, USA
| | - M Allison Ford
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, University, Jackson, MS, USA
| | - Vinayak K Nahar
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street - L216, Jackson, MS, 39216, USA. .,Department of Preventive Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
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8
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An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers. Curr Oncol 2022; 29:8886-8903. [PMID: 36421352 PMCID: PMC9689757 DOI: 10.3390/curroncol29110699] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Indoor tanning (sunbeds, solarium) uses artificial ultraviolet radiation (UVR) to stimulate cosmetic tanning of the skin. Indoor tanning has been officially classified as a human carcinogen in 2009 by the International Agency for Research on Cancer of the World Health Organization (WHO). The differences in the prevalence of sunbed use across countries and over the years highlight underlying legislative, climatic, and cultural differences. Indoor tanning-seeking behaviors may be driven by motivations for an appealing appearance, largely influenced by gender and age, and several misconceptions that a prevacation tan safeguards the skin, that sunbeds can be used to treat acne or to increase vitamin D, or that tanning is a healthy habit. This review provides an epidemiological update on the prevalence of sunbed use, who tends to use sunbeds and why, and details the current evidence on the association of sunbeds with skin cancers, including cutaneous melanoma, basal cell carcinoma (BCC), and cutaneous squamous cell carcinoma (cSCC). A statistically significant higher risk of cutaneous melanoma, BCC and cSCC with the use of sunbeds has been consistently demonstrated. This risk of skin cancer is even higher with the more frequent use of sunbeds, underscoring a dose-response relationship, and in those first exposed to sunbeds at a younger age. Preventive measures against sunbed use include legislation restricting sunbed use, educational campaigns to inform and discourage from indoor tanning, as well as using the internet, online advertising messages and the social media to reach larger audiences and to promote an untanned appearance.
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9
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Gosselin S, McWhirter JE, Mutti-Packer S, McEwen SA, Papadopoulos A, Rosen CF, Beecker J. "I Think There Should Be Photos": Female Indoor Tanners' Perceptions of Health Warning Labels for Tanning Beds. HEALTH COMMUNICATION 2022; 37:1378-1388. [PMID: 33650448 DOI: 10.1080/10410236.2021.1890876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study explores female indoor tanners' perceptions of the current, text-only Canadian health warning label (HWL) for tanning equipment, as well as pictorial, evidence-based alternative HWLs. We created 10 test HWLs that depicted skin health effects, eye damage, premature aging, and death. Young women who had tanned indoors in the past year discussed these and the current federal HWL in focus groups. Although the current Canadian HWL was seen as informative, several participants did not recognize it, and many said that they would not read it due to the small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text was important for encouraging reading, many participants expressed a desire for more information in the test HWLs. Premature aging was of great concern to many participants, but the images selected for these HWLs were not perceived as effective. Although the text was seen as effective in the death HWLs, most participants dismissed the images. This research has implications for IT HWLs in Canada and globally. These results suggest that graphic images may be impactful in IT HWLs. Images must be supplemented with informative text that increases believability, relatability, and comprehensibility. These modifications would create HWLs that are engaging, informative, and that form part of a wider effort to spread awareness about the harmful effects of IT.
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Affiliation(s)
| | | | | | | | | | - Cheryl F Rosen
- Division of Dermatology, Toronto Western Hospital, University Health Network, University of Toronto
| | - Jennifer Beecker
- Division of Dermatology, University of Ottawa
- Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute
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Salaheldin TA, Adhami VM, Fujioka K, Mukhtar H, Mousa SA. Photochemoprevention of ultraviolet Beam Radiation-induced DNA damage in keratinocytes by topical delivery of nanoformulated Epigallocatechin-3-gallate. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 44:102580. [PMID: 35768037 DOI: 10.1016/j.nano.2022.102580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Ultraviolet Beam (UVB) radiation is the main cause of skin cancer worldwide. Besides biocompatibility, the instability and limited skin permeability are the most challenging features of many effective photochemopreventive agents. (-)-Epigallocatechin-3-gallate (EGCG) is a natural polyphenolic compound extracted from Camellia sinensis that has been demonstrated to have antioxidant, anti-inflammatory, and anti-cancer properties. We evaluated the efficacy of three innovative EGCG nanoformulations in chemoprevention of UVB-induced DNA damage in keratinocytes. Results indicated that the EGCG nanoformulations reduced UVB-induced oxidative stress elevation and DNA damage. The nanoformulations also reduced the UVB-induced formation of pyrimidine and pyrimidone photoproducts in 2D human immortalized HaCaT keratinocytes and SKH-1 hairless mice through antioxidant effects and possibly through absorption of UVB radiation. In addition, EGCG nanoformulations inhibited UVB-induced chemokine/cytokine activation and promoted EGCG skin permeability and stability. Taken together, the results suggest the use of EGCG nanoformulations as potential natural chemopreventive agents during exposure to UVB radiation.
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Affiliation(s)
- Taher A Salaheldin
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
| | - Vaqar M Adhami
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kazutoshi Fujioka
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
| | - Hasan Mukhtar
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Shaker A Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA.
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11
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Stockfleth E, Revol O. Encouraging sun protection early in life: from a successful prevention programme in children to the identification of psychological barriers in adolescents. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:12-21. [PMID: 35738808 DOI: 10.1111/jdv.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Children and adolescents have high rates of sunburn and high levels of ultraviolet radiation (UVR) exposure and are therefore at risk of developing skin cancer in later life. Minimizing UVR exposure in childhood and adolescence may be the most important component of skin cancer prevention efforts. Thus, age-adapted prevention campaigns, targeting children, adolescents and caregivers, are needed to change sun protection behaviour among individuals in these age groups. In the first part of this review, we describe the 'SunPass' programme, which was initiated in Germany in 2010 as the first nationwide educational intervention for sun safety designed to teach kindergarten children and their caregivers how to protect themselves from overexposure to the sun. Implemented in 55 kindergartens, this programme has been shown to be effective at improving sun protection behaviour (P < 0.001) and hat use (P = 0.029) among kindergarten children, as well as at improving shade practices and increasing demand for protective clothing (P < 0.001). Up to 40 000 children, 50 000 parents/grandparents and 2500 kindergarten caregivers took part in the SunPass programme in Germany from 2019 to June 2021. The programme has also been adapted and implemented in several other European countries and could be readily adapted for use elsewhere. In the second part of this review, we discuss the specific challenges faced by adolescents and consider how these issues may impact their sun protection behaviour. Adolescents have difficulties suppressing responses to reward-related cues and projecting themselves into the future. They also place a lot of importance on social acceptance and cosmetic appearance, and their higher risk of depression, addiction and impulsivity make them vulnerable to tanning addiction. These specificities need to be acknowledged by dermatologists, so they can adapt their therapeutic relationship and develop effective sun protection interventions for this generation.
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Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie und Ruhr-Universität Bochum, Gudrunstrasse 52, Bochum, Germany
| | - O Revol
- Child Development Unit, Hospices Civils de Lyon, Bron, France
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12
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Bonilla C, Mejia-Lancheros C. The Skin We Live in: Pigmentation Traits and Tanning Behaviour in British Young Adults, an Observational and Genetically-Informed Study. Genes (Basel) 2022; 13:896. [PMID: 35627282 PMCID: PMC9140533 DOI: 10.3390/genes13050896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
Skin cancer incidence has been increasing worldwide, representing a particularly high burden for populations of European ancestry. Outdoor and indoor tanning using ultraviolet (UV) radiation devices are major risk factors for skin cancer. While tanning behaviours can be modified by targeted interventions to reduce skin cancer rates, there is insufficient evidence on the motivations for tanning preferences and their relationship with pigmentation phenotypes. The present observational and genetically-informed study investigates motives for tanning and the role that pigmentation phenotypes play on outdoor and indoor tanning behaviour in British young adults. This study included 3722 participants from the Avon Longitudinal Study of Parents and Children in South West England, with data on pigmentation features, tanning ability and preferences, and SNP genotypes. Liking to tan and outdoor tanning were strongly influenced by pigmentary traits and tanning ability. However, the association of these phenotypes with UV indoor tanning was weaker. Our results provide evidence to support the implementation of skin cancer preventative interventions that consider individual biological characteristics and motives for undergoing outdoor and indoor tanning.
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Affiliation(s)
- Carolina Bonilla
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo CEP 01246-903, Brazil
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada;
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13
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Morais P. Artificial tanning devices (Sunbeds): where do we stand? Cutan Ocul Toxicol 2022; 41:123-128. [PMID: 35298329 DOI: 10.1080/15569527.2022.2050748] [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: 11/03/2022]
Abstract
Exposure to ultraviolet radiation emitted by indoor tanning devices (sunbeds) has well-documented negative effects on human health, but no clear benefit beyond cosmetic outcomes. Sunbed use is responsible for a significant proportion of both melanoma and non-melanoma skin cancers, especially in patients exposed to this practice in early life, premature skin ageing, immunosuppression, skin burns, and eye damage. Artificial tanning is now seen as a public health issue. In this review we discuss the potential additive effect of indoor tanning, misleading facts regarding sunbed benefit, safety concerns and negative effects on human health, indoor tanning legislation and current position of several international organisations, and the impact of some policies adopted in order to mitigate the effects of this dangerous practice.
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Affiliation(s)
- Paulo Morais
- Dermatology Unit, Hospital da Luz Clínica de Amarante, Amarante, Portugal.,Dermatology Unit, Trofa Saúde Hospital de Alfena, Valongo, Portugal
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14
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Female university students’ knowledge, attitudes, and behaviours towards sun exposure and the use of artificial tanning devices: the essence of reducing risky behaviours. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Aim
To investigate female university students’ knowledge, attitudes, and behaviours towards sun exposure and the use of artificial tanning devices.
Subject and methods
A descriptive correlational survey design using online questionnaires, targeting a population of female university students aged 18–25 from one university in the United Kingdom.
Results
Three hundred and thirty-five students participated (response rate = 26.4%). Students demonstrated average knowledge and good attitude to tanning behaviours, but neither were statistically significantly associated with tanning behaviours. Students showed a history of substantial tanning behaviours, including the use of sunbeds, primarily because having a tanned skin made them look good and thus feel better.
Conclusion
This study has re-affirmed that there is no simple correlation between individuals’ knowledge and attitudes and subsequent sun-tanning behaviours. Feeling good and looking good are critical attributes to female university students’ self-esteem, and these values and beliefs outweigh risk perception of sun-tanning behaviours, and female university students continue to engage in risky tanning behaviours. Focused health promotion activities by public health authorities and higher education institutions should target students’ principal belief of looking good feeling good, as such targeted health promotion may reduce harmful sun tanning behaviours and ultimately mitigate the rising incidence in skin cancers.
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15
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Abstract
Melanoma is a relentless type of skin cancer which involves myriad signaling pathways which regulate many cellular processes. This makes melanoma difficult to treat, especially when identified late. At present, therapeutics include chemotherapy, surgical resection, biochemotherapy, immunotherapy, photodynamic and targeted approaches. These interventions are usually administered as either a single-drug or in combination, based on tumor location, stage, and patients' overall health condition. However, treatment efficacy generally decreases as patients develop treatment resistance. Genetic profiling of melanocytes and the discovery of novel molecular factors involved in the pathogenesis of melanoma have helped to identify new therapeutic targets. In this literature review, we examine several newly approved therapies, and briefly describe several therapies being assessed for melanoma. The goal is to provide a comprehensive overview of recent developments and to consider future directions in the field of melanoma.
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Affiliation(s)
- Pavan Kumar Dhanyamraju
- Department of Pediatrics and Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Pavan Kumar Dhanyamraju, Department of Pediatrics and Pharmacology, Pennsylvania State University College of Medicine, Hershey, PA17033, USA. Tel: +1-6096474712, E-mail:
| | - Trupti N. Patel
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore Campus, Vellore, Tamil Nadu 632014, India
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16
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Use of Indoor Tanning Diagnosis Codes in Claims Data. JID INNOVATIONS 2021; 1:100048. [PMID: 34909745 PMCID: PMC8659372 DOI: 10.1016/j.xjidi.2021.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
The International Classification of Diseases: 10th Revision (effective from October 2015) included indoor tanning diagnosis codes for the first time. The majority of data on indoor tanning is self-reported. We used a large claims dataset to investigate the patients and settings in which indoor tanning International Classification of Diseases: 10th Revision codes are being used. We included encounters with the International Classification of Diseases: 10th Revision indoor tanning codes in Truven Health MarketScan data 2016–2018, which contain deidentified commercial insurance claims data for approximately 43 million patients. We used descriptive statistics to evaluate patient and encounter characteristics and normalized results using outpatient dermatology encounters. A total of 4,550 encounters were identified, 99.0% of which were outpatient, and 72.3% were with dermatology. Patients were majority female (85.0%) with ages ranging from 7 to 93. The Midwest region had the most indoor tanning encounters. Destruction of a premalignant lesion was performed in 15.1%, and biopsies were performed in 18.4% of encounters, suggesting that encounters may have been for skin cancer surveillance. Increased usage of indoor tanning International Classification of Diseases: 10th Revision codes in the coming years may strengthen the indoor tanning literature. Claims data are a potential tool to better understand patients who have a history of exposure to indoor tanning and their associated risk factors, comorbidities, behaviors, and healthcare utilization.
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17
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Mastroeni S, Sampogna F, Salcedo NM, Ricci F, Fania L, Antonelli F, Abeni D, Cristofolini M. Factors associated with sunbed use among 3692 outpatients in 18 centers of the Italian Cancer League (LILT). Sci Rep 2021; 11:23180. [PMID: 34848741 PMCID: PMC8633295 DOI: 10.1038/s41598-021-02026-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Indoor tanning is associated with an increased risk of skin cancer. Nonetheless, its use is still widespread. We aimed to investigate the socio-demographic and clinical characteristics of sunbed users in a group of participants in the skin cancer prevention campaign organized by the Italian Cancer League (LILT). During almost 2 years, 4409 individuals were screened in 18 centers. Participants reported having used sunbeds before the age of 15 years in 2.2% of cases, while after age 15 the prevalence of use was 22.2%. Participants with complete information were 3692. Sunbed users aged > 15 years were significantly more frequently females, young, living in Northern Italy, highly educated, and current or former smokers. They had darker phototype, more common nevi, had used sunbeds more frequently before the age of 15, reported a history of sunburns, and use of sunscreens. Indoor tanning is an important public health issue and a relevant target for primary prevention. However, not all countries have adopted the recommendations issued by the World Health Organization (WHO) on health risks associated with artificial tanning. A deeper insight into the topic may contribute to identify the best prevention strategies.
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Affiliation(s)
- Simona Mastroeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
| | - Francesca Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy.
| | - Nidia Melo Salcedo
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
| | | | - Luca Fania
- Dermatology Department, IDI-IRCCS, Rome, Italy
| | - Flaminia Antonelli
- Dermatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta 104, 00167, Rome, Italy
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18
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Laughter MR, Anderson JB, Aguilera MN, Sadeghpour M, Pugliano-Mauro M. Indoor tanning: Evidence surrounding advertised health claims. Clin Dermatol 2021; 39:865-872. [PMID: 34785014 DOI: 10.1016/j.clindermatol.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Indoor tanning continues to remain common, despite evidence of an increased risk of skin cancer from artificial ultraviolet (UV) radiation. In the hopes of gaining customers, the tanning bed industry has marketed health benefits of indoor tanning such as increased vitamin D production, development of a base tan, enhanced mood, and treatment of certain dermatologic conditions. To better educate their patients, providers need a comprehensive reference reviewing the evidence that support or oppose these claims. In this work, we conducted an evidence-based review of the literature to identify and grade studies that investigate health claims related to UV exposure. Results indicate that there is little evidence to support each of these proposed health benefits. Tanning beds emit primarily UVA radiation, which is relatively ineffective at activating vitamin D or mood enhancing pathways, and the effects are minimal in regard to tanning beds generating a protective base tan or treating dermatologic conditions compared with the increased risk of skin cancer. Health care providers must continue to warn and educate patients about the misleading information propagated by the tanning bed industry as well as about the dangers of artificial UV radiation.
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Affiliation(s)
| | - Jaclyn B Anderson
- University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Megan N Aguilera
- University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | | | - Melissa Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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19
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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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20
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Muzumdar S, Lin G, Kerr P, Grant-Kels JM. Evidence concerning the accusation that melanoma is overdiagnosed. J Am Acad Dermatol 2021; 85:841-846. [PMID: 34116095 DOI: 10.1016/j.jaad.2021.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Melanoma is one of the most commonly diagnosed malignancies in the United States and is responsible for the majority of deaths from skin cancer. OBJECTIVE Since the 1970s, the incidence of melanoma has risen appreciably while melanoma-specific mortality has remained stable. This has raised a debate about potential overdiagnosis of melanoma. Herein, we review temporal trends in melanoma incidence and mortality and explore factors that may contribute to observed trends, including an aging population in the United States, ultraviolet exposure, increased numbers of biopsies by dermatologists and physician extenders, skin cancer screenings, histopathology criteria, and historic underdiagnosis. Additionally, we discuss melanoma overdiagnosis and the extent to which it may contribute to current trends. METHODS The literature was reviewed. RESULTS Several factors may contribute to an increased incidence of melanoma, including an aging population, ultraviolet exposure, increased skin biopsies, skin cancer screenings, histopathologic criteria, historic underdiagnosis, and current overdiagnosis. LIMITATIONS Further studies are required to determine exactly which tumors are being overdiagnosed, and how to improve patient outcomes with adjustment to physician's practice. CONCLUSION The rise in the incidence of melanoma observed since the 1970s is likely multifactorial.
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Affiliation(s)
- Sonal Muzumdar
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Gloria Lin
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Philip Kerr
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut; University of Florida Dermatology Department, Gainesville, Florida.
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21
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Qutob SS, McNamee JP, Brion O. Prevalence of tanning equipment use among Canadians. Prev Med Rep 2021; 22:101356. [PMID: 33850696 PMCID: PMC8022241 DOI: 10.1016/j.pmedr.2021.101356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to collect prevalence estimates of indoor tanning usage and associated injuries in Canada. The rapid response component of the 2019 Canadian Community Health Survey collected data on the use of tanning equipment in the previous 12 months, including reasons for use, frequency/duration of use, precautions taken and adverse reactions or injuries. The 2019 research findings were as follows, an estimated 3.0% (95% CI: 2.5-3.4%) of Canadians reported that they had used indoor tanning equipment in the past year. Among users, 71.1% (95% CI: 63.9-78.3%) were female and females aged 18-34 were significantly more prevalent users compared to females aged 45 or older. The prevalence of indoor tanning was higher among people without a university degree; however, there were no differences in prevalence by household income or region. Most users indicated they used indoor tanning equipment within a tanning salon (75.3%: 95% CI: 69.1-81.6%) and the most common reason for usage was to develop a "protective" base tan (72.1%: 95% CI: 65.2-78.9%). Over one third (39.2%: 95% CI: 31.1-47.2%) of all users reported 10 or more sessions in the past year. The prevalence of indoor UV tanning usage is declining in Canada. Similar to results in 2014, the majority of users continue to be female, with a large number in the 18 to 34 age group.
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Affiliation(s)
- Sami S. Qutob
- Consumer and Clinical Radiation Protection Bureau, Health Effects and Assessment Division at Health Canada, Canada
| | - James P. McNamee
- Consumer and Clinical Radiation Protection Bureau, Health Effects and Assessment Division at Health Canada, Canada
| | - Orly Brion
- Environmental Health Science and Research Bureau, Population Studies Division at Health Canada, Canada
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22
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De La Garza H, Maymone MBC, Vashi NA. Impact of Social Media on Skin Cancer Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095002. [PMID: 34065061 PMCID: PMC8125878 DOI: 10.3390/ijerph18095002] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 12/04/2022]
Abstract
Despite the increasing prevalence of social media usage in health care contexts, its impact on skin cancer prevention and awareness has not been largely investigated. We conducted a review of literature on this topic with the objective of summarizing and analyzing the role of social media in skin cancer and sun damage awareness and to identify the uses, benefits, and limitations of different social media platforms on skin cancer prevention. In today’s technological society, it is critical to understand and study the best form of communication. Specific platforms like Instagram, Twitter, Facebook, YouTube, and TikTok vary in originators of material, target demographics, messaging strategies, and reliability of information with regards to skin cancer, sun, and indoor tanning damage. Our results demonstrate that social media interventions have shown promise in skin cancer prevention and continue to escalate by the day. Dermatologists should keep pace with the latest dermatological content on social media and examine its evolution to target the right audience with the proper messages. Further research is needed to evaluate the effectiveness and true impact of social media on meaningful and lasting behavior change for skin cancer prevention.
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Affiliation(s)
- Henriette De La Garza
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Mayra B. C. Maymone
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Neelam A. Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA;
- Correspondence:
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23
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Heckman CJ, Buller DB, Stapleton JL. A Call to Action to Eliminate Indoor Tanning: Focus on Policy. JAMA Dermatol 2021; 157:767-768. [PMID: 33909017 DOI: 10.1001/jamadermatol.2021.0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Carolyn J Heckman
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick
| | | | - Jerod L Stapleton
- Cancer Prevention and Control Program, Markey Cancer Center, University of Kentucky, Lexington
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24
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Abstract
Cutaneous malignancy is becoming an increasing public health burden in terms of morbidity and cost, associated with changing environmental exposures and increased longevity of the general and the immunosuppressed population. Yet the understanding of the scope of this problem is hindered by lack of robust registries for nonmelanoma skin cancer. The risk factor responsible for most of these cancers, exposure to ultraviolet radiation, can be mitigated. However, greater consensus is necessary to enact effective prevention and screening programs. New developments, including identification of biomarkers and use of artificial intelligence, show promise for targeting screening efforts.
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Affiliation(s)
- Miriam A O'Leary
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Box #850, 800 Washington Street, Boston, MA 02111, USA.
| | - Steven J Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Room 5401, Tucson, AZ 85724, USA
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25
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The current burden of non-melanoma skin cancer attributable to ultraviolet radiation and related risk behaviours in Canada. Cancer Causes Control 2021; 32:279-290. [PMID: 33394206 DOI: 10.1007/s10552-020-01382-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/04/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Ultraviolet radiation (UVR) is an established cause of non-melanoma skin cancer (NMSC)-basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The aim of this study was to estimate the current burden of BCC and SCC associated with UVR and modifiable UVR behaviours (sunburn, sunbathing, and indoor tanning) in Canada in 2015. METHODS The current burden of BCC and SCC associated with UVR was estimated by comparing 2015 incidence rates with rates of less exposed body sites (trunk and lower limbs) after adjusting for estimated surface areas. The burden associated with modifiable UVR behaviours was estimated by using prevalence estimates among Caucasians from the Second National Sun Survey, and relative risks that are generalizable to Canadians from conducting meta-analyses of relevant studies. RESULTS We estimated that 80.5% of BCCs and 83.0% of SCCs were attributable to UVR. Adult sunburn was associated with relative risks of 1.85 (95% CI 1.15-3.00) for BCC and 1.41 (95% CI 0.91-2.18) for SCC, while adult sunbathing was associated with relative risks of 1.82 (95% CI 1.52-2.17) for BCC and 1.14 (95% CI 0.53-2.46) for SCC. We estimated that 18.6% of BCCs and 9.9% of SCCs were attributable to adult sunburn, while 28.1% of BCCs were attributable to adult sunbathing. We estimated that 46.2% of BCCs and 17.3% of SCCs were attributable to modifiable UVR behaviours combined. CONCLUSION Our results provide quantifiable estimates of the potentially avoidable burden of NMSCs among Canadians. These estimates can be used to motivate prevention efforts in Canada.
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26
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Gordon LG, Rodriguez-Acevedo AJ, Køster B, Guy GP, Sinclair C, Van Deventer E, Green AC. Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe. JAMA Dermatol 2020; 156:401-410. [PMID: 32074257 DOI: 10.1001/jamadermatol.2020.0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Importance UV radiation emissions from indoor tanning devices are carcinogenic. Regulatory actions may be associated with reduced exposure of UV radiation at a population level. Objective To estimate the long-term health and economic consequences of banning indoor tanning devices or prohibiting their use by minors only in North America and Europe compared with ongoing current levels of use. Design, Setting, and Participants This economic analysis modeled data for individuals 12 to 35 years old in North America and Europe, who commonly engage in indoor tanning. A Markov cohort model was used with outcomes projected during the cohort's remaining life-years. Models were populated by extracting data from high-quality systematic reviews and meta-analyses, epidemiologic reports, and cancer registrations. Main Outcomes and Measures Main outcomes were numbers of melanomas and deaths from melanoma, numbers of keratinocyte carcinomas, life-years, and health care and productivity costs. Extensive sensitivity analyses were performed to assess the stability of results. Results In an estimated population of 110 932 523 in the United States and Canada and 141 970 492 in Europe, for the next generation of youths and young adults during their remaining lifespans, regulatory actions that ban indoor tanning devices could be expected to gain 423 000 life-years, avert 240 000 melanomas (-8.2%), and avert 7.3 million keratinocyte carcinomas (-7.8%) in North America and gain 460 000 life-years, avert 204 000 melanomas (-4.9%), and avert 2.4 million keratinocyte carcinomas (-4.4%) in Europe compared with ongoing current levels of use. Economic cost savings of US $31.1 billion in North America and €21.1 billion (US $15.9 billion) in Europe could occur. Skin cancers averted and cost savings after prohibiting indoor tanning by minors may be associated with one-third of the corresponding benefits of a total ban. Conclusions and Relevance Banning indoor tanning may be associated with reduced skin cancer burden and health care costs. Corresponding gains from prohibiting indoor tanning by minors only may be smaller.
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Affiliation(s)
- Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology School of Nursing, Brisbane, Queensland, Australia.,The University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Astrid J Rodriguez-Acevedo
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Manchester Academic Health Science Centre, CRUK Manchester Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
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Stapleton JL, Ray AE, Glenn SD, McLouth LE, Parmar V, Manne SL. A randomized controlled trial of a web-based personalized feedback intervention targeting frequent indoor tanning bed users: Engagement, acceptability, and preliminary behavioral outcomes. J Health Psychol 2020; 27:923-935. [PMID: 33353412 DOI: 10.1177/1359105320982038] [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: 11/15/2022] Open
Abstract
Frequent indoor tanning bed use is an established public health concern, yet research on tanning cessation interventions for frequent tanners is lacking. We describe the protocol for a brief, web-based tanning behavior change intervention and present evidence that it is acceptable and engaging to frequent indoor tanners. Lower tanning rates were not observed among participants receiving the intervention in a randomized controlled trial but participants' interest in changing tanning increased. This intervention could be a useful approach to increasing frequent tanners' interest in behavior change and openness to engaging within a more intensive, multi-component tanning cessation program.Trial Registration: NCT03448224 Clinical Trials.gov (https://clinicaltrials.gov/ct2/show/NCT03448224?cond=NCT03448224&draw=2&rank=1).
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Affiliation(s)
| | - Anne E Ray
- University of Kentucky College of Public Health, USA
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Burgard B, Reichrath J. Solarium Use and Risk for Malignant Melanoma: Many Open Questions, Not the Time to Close the Debate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1268:155-170. [PMID: 32918218 DOI: 10.1007/978-3-030-46227-7_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To shed further light on the ongoing debate whether sunbed use may increase melanoma risk, we have critically assessed the scientific literature that is at present available, focussing on a meta-analysis that we published recently. Our literature search identified several meta-analyses that report a weak association for ever-exposure to UV radiation from a solarium with melanoma risk. However, the quality of studies included in these meta-analyses and the resulting evidence levels and grades of recommendation were very low due to the lack of interventional trials and because of severe limitations of many of the observational studies. The results of cohort and case-control studies published until today do not prove causality, not even by the Hill criteria. The overall quality of these observational studies and the resulting evidence levels are low due to severe limitations (including unobserved or unrecorded confounding), which leads to bias. It must be recognized that in the majority of studies, published to date, many of the confounding factors, including sun exposure, sunburns and skin type, have not been adequately and systematically recorded and adjusted for. We conclude that the many limitations of the individual studies and the resulting low levels of evidence and grades of recommendation do at present not allow postulation of a causal relationship between solarium use and melanoma risk. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.
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Affiliation(s)
- Barbara Burgard
- Center for Clinical and Experimental Photodermatology, The Saarland University Hospital, Homburg, Germany.,Center for Clinical and Experimental Photodermatology and Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | - Jörg Reichrath
- Center for Clinical and Experimental Photodermatology and Department of Dermatology, Saarland University Medical Center, Homburg, Germany.
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Køster B, Meyer MKH, Søgaard J, Dalum P. Benefit-Cost Analysis of the Danish Sun Safety Campaign 2007-2015: Cost Savings from Sunburn and Sunbed Use Reduction and Derived Skin Cancer Reductions 2007-2040 in the Danish Population. PHARMACOECONOMICS - OPEN 2020; 4:419-425. [PMID: 31617085 PMCID: PMC7426353 DOI: 10.1007/s41669-019-00182-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ninety percent of skin cancers are avoidable. In Denmark, 16,500 cases of melanoma and keratinocyte cancers were registered in 2015. The Danish Sun Safety Campaign has campaigned since 2007, targeting overexposure to ultraviolet radiation. During 2007-2015, the key indicators of skin cancer, i.e. sunbed use and sunburn, showed annual reductions of 6% and 1%, respectively. OBJECTIVES We aimed to examine the financial savings to society as a result of the campaign reductions in skin cancer cases (2007-2040), and to examine the campaign's cost-benefit and return on investment (ROI). METHODS The analysis is based on existing data: (1) annual population-based surveys regarding the Danish population's behavior in the sun; (2) skin cancer projections; (3) relative risks of skin cancers from sunburn and sunbed use and (4) historical cancer incidences, combined with new data; (5) benefits from the avoided costs of skin cancer reductions; and (6) the costs of the Danish Sun Safety Campaign. RESULTS The results were based on a reduction of 9000 skin cancer cases, saving €29 million of which €13 million were derived from sunburn reductions and €16 million from reductions in sunbed use. The ROI was €2.18. CONCLUSION Skin cancer prevention in Denmark is cost effective. Every Euro spent by the Danish Sun Safety Campaign saved the Danish health budget €2.18 in health expenses.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Maria K. H. Meyer
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Jes Søgaard
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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Banerjee SC, Rodríguez VM, Greene K, Hay JL. Trending on Pinterest: an examination of pins about skin tanning. Transl Behav Med 2020; 9:737-748. [PMID: 29648613 DOI: 10.1093/tbm/iby036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rates of melanoma and nonmelanoma skin cancers are on the rise in the USA with data revealing disproportionate increase in female young adults. The popularity of intentional skin tanning among U.S. adolescents is attributed to several factors, including prioritization of physical appearance, media images of tanned celebrities, ease of availability of artificial tanning facilities, and more recently, the prevalence and celebration of tanned skin on social media. Pinterest, as the third most popular social media platform, was searched for "pins" about skin tanning. The resultant "pins" were examined to understand the extent and characteristics of skin tanning portrayed on Pinterest. We analyzed pins on Pinterest about skin tanning (n = 501) through a quantitative content analysis. Overall, results indicated an overwhelmingly protanning characteristic of pins about skin tanning on Pinterest, with over 85% of pins promoting tanning behavior. The pins were generally characterized by the portrayal of a female subject (61%) and provided positive reinforcement for tanning (49%). Use of tanning for enhancing appearance was the main positive outcome expectancy portrayed in the pins (35%), and nudity or exposure of skin on arms (32%) and legs (31%) was evident in about a third of pins. With overwhelmingly positive pins promoting tanning, use of female subjects, exhibiting nudity, and appearance enhancement, there seems be to a consistent targeting of female users to accept tanning as a socially acceptable and popular behavior. The findings indicate a need for developing sun protection messages and the leveraging of social media for dissemination of skin cancer prevention and detection messages.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kathryn Greene
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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31
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Fischbach L, Faramawi MF, Girard D, Thapa S, Travers R. Training cosmetology students in Arkansas to help dermatologists find skin cancers earlier: results of a cluster-randomized controlled trial. J Public Health (Oxf) 2020; 43:789-796. [DOI: 10.1093/pubmed/fdaa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We tested an educational video in cosmetology schools to increase students’ knowledge about skin cancer, sun-safety practices, identifying suspicious lesions and recommending clients consult a dermatologist when a suspicious lesion is observed.
Methods
We used a cluster-randomized controlled study design to randomize 22 cosmetology schools to receive our educational video or a publicly accessible healthy lifestyle video (control).
Results
Students who received the intervention were more likely than controls to increase their knowledge of skin cancer, risk factors and how to identify potential skin cancers (risk ratio [RR] and 95% confidence interval = 2.86 [1.58–5.20]). At follow-up, students in the intervention group were more likely than those in the control group to look for suspicious moles on their clients’ faces, scalps and necks (RRs = 1.75, 2.16 and 2.90, respectively). Additionally, students in the intervention group were more likely to communicate with clients about sun-safety practices (RR = 1.74 [1.11–2.73]) and consulting a dermatologist about suspicious moles (RR = 1.57 [1.03–2.41]).
Conclusions
Our educational video helped cosmetology students recognize potential skin cancers and talk with clients about sun safety and consulting a dermatologist about suspicious moles. Such videos may play a role in the public health surveillance of skin cancers in communities.
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Affiliation(s)
- Lori Fischbach
- Department of Epidemiology, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
| | - Mohammed F Faramawi
- Department of Epidemiology, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
| | | | - Susan Thapa
- Department of Epidemiology, University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA
| | - Robin Travers
- Skin Care Physicians of Chestnut Hill,Chestnut Hill,MA, USA
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32
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Huang CM, Kirchhof MG. Evaluation of Indoor Tanning Facilities in American Fitness Centers. J Cutan Med Surg 2020; 24:372-379. [PMID: 32441110 DOI: 10.1177/1203475420923645] [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: 11/17/2022]
Abstract
BACKGROUND Indoor tanning (IT) in fitness facilities encourages a misleading positive relationship between tanning and health. While IT in Canadian fitness facilities has been studied, American literature regarding this topic is lacking. OBJECTIVES The objective of this study is to evaluate availability, cost, reported risks, and adherence to legislation of IT in American fitness clubs. METHODS This was a cross-sectional study utilizing a telephone questionnaire to survey gyms across all 50 states. The key term "fitness club" was searched in the Yellow Pages and 20 facilities from each state were randomly included into the study. Data were described descriptively and Pearson χ2 tests were used to compare IT prevalence and rates of noncompliance between population groups. Regression analysis examined potential relationship between cost and prevalence of IT. RESULTS Of the 1000 fitness clubs surveyed, 44.4% (444/1000) offered IT. The overall noncompliance rates for age, rest time, and eye protection were 13.8% (54/390), 26.0% (20/77), and 27.8% (85/225), respectively. The most common risk reported was skin cancer (61.6%), but many facilities were unsure of risks (27.0%) and some described no risk associated with IT (3.2%). The average cost for monthly unlimited tanning was 33 ± 13.96 USD. A state-to-state comparison showed a statistically significant inverse relationship between mean cost and prevalence of IT (P = .013, [r]= -0.35). CONCLUSION The prevalence and noncompliance rates of IT in fitness clubs contradict the healthy lifestyles they are working to promote. To limit harms, legislations should be standardized and more strictly enforced. Additionally, public education on IT risks and the use of higher costs may help minimize IT use.
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Affiliation(s)
- Christina M Huang
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital, ON, Canada
| | - Mark G Kirchhof
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital, ON, Canada
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33
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Alberg AJ, LoConte NK, Foxhall L, Weinstock MA, Gomez SL, Francisco M, Moushey EA, Gershenwald JE. American Society of Clinical Oncology Policy Statement on Skin Cancer Prevention. JCO Oncol Pract 2020; 16:490-499. [PMID: 32374709 DOI: 10.1200/jop.19.00585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Lewis Foxhall
- The University of Texas MD Anderson Cancer Center, Houston, TX
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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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35
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Suozzi K, Turban J, Girardi M. Cutaneous Photoprotection: A Review of the Current Status and Evolving Strategies. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:55-67. [PMID: 32226337 PMCID: PMC7087054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ultraviolet radiation (UVR) exposure is well established as the major environmental risk factor for the development of melanoma, cutaneous squamous cell carcinoma (cSCC), and basal cell carcinoma (BCC). Additional risk factors including genetic mutations, other environmental agents, and immune status are important in modulating the effects of UVR. Dermatologists advocate a multi-pronged approach to minimizing UVR exposure including lifestyle modifications, UVR protective clothing, and topically applied sun-protective products, i.e. sunscreen. New Federal Drug Administration (FDA) regulations on sunscreen have brought certain long-standing ingredients in sunscreen products under scrutiny. The FDA's proposed rule for over the counter (OTC) monograph states that the inorganic sunscreens, zinc oxide and titanium dioxide, were found to be "generally recognized as safe and effective," but cite insufficient evidence to grant organic sunscreens the same designation. This proposed rule by the FDA and our increasing understanding of multifactorial mechanisms of UVR damage are an impetus for innovation and advances in sun protective technology. A complete set of strategies designed to limit the risk of UV-induced skin cell malignant transformation and tumor development must address the fuller consideration of genetic, environmental, and immune factors that cooperatively drive cutaneous carcinogenesis. Recent advances in our understanding of the biochemical processes underpinning UVR associated cutaneous cellular damage, genotoxicity, and clonal expansion provide investigators with a spectrum of opportunities for technologic innovation in the prevention of skin cancer. Strategies to improve upon current topical sunscreen formulations have strived for broader UVR spectral coverage, more favorable aesthetics, increased adherence, and minimal penetration into the living epidermis. In addition to improved sunscreens, future topical therapies may target processes within the epidermis that contribute to carcinogenesis. These include reactive species quenching, delivery of DNA repair enzymes, and targeting of cytokines essential to the proliferation of mutant keratinocytes.
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Affiliation(s)
- Kathleen Suozzi
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Jack Turban
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT,To whom all correspondence should be addressed: Michael Girardi, MD, Yale Department of Dermatology, P.O. Box. 208059, New Haven, CT, 06520-8082; Tel: 203-785-4092, Fax: 203-776-6188,
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Adekunle L, Chen R, Morrison L, Halley M, Eng V, Hendlin Y, Wehner MR, Chren MM, Linos E. Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review. BMJ 2020; 368:m7. [PMID: 32019742 PMCID: PMC7190068 DOI: 10.1136/bmj.m7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature. DESIGN Systematic review. DATA SOURCES PubMed, Embase, and Web of Science, up to 15 February 2019. STUDY SELECTION CRITERIA Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded. RESULTS 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4). CONCLUSIONS Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123617.
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Affiliation(s)
- Lola Adekunle
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Rebecca Chen
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Lily Morrison
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Meghan Halley
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Victor Eng
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Yogi Hendlin
- School of Philosophy Erasmus University, Rotterdam, Netherlands
| | - Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Health Services Research and of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
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Bruce AF, Cowan T. Sun-Protective Behaviors: An Educational Intervention With Hospital Staff Aimed at Skin Cancer Prevention in Children. Clin J Oncol Nurs 2020; 24:75-80. [PMID: 31961833 DOI: 10.1188/20.cjon.75-80] [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: 11/17/2022]
Abstract
BACKGROUND Melanoma incidence and mortality rates are predicted to steadily increase. Sun protection is important during early development because of the potential for overexposure to ultraviolet radiation while outdoors. OBJECTIVES The purpose of this project was to design, implement, and evaluate an educational intervention provided to healthcare professionals (HCPs) with the intention of influencing the behaviors of child populations served. METHODS The project evaluated HCPs' baseline knowledge about sun-protective behaviors, their level of knowledge regarding sun-protective behaviors postintervention, their intent to change behavior, and the feasibility of implementing behavior change within the organization. FINDINGS Pre- to post-test knowledge significantly increased. All participants reported that they would encourage children's sunscreen usage, and 98% reported that they would support the behavior change; however, 35% indicated likeliness that they would personally use sunscreen or sun-protection methods.
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Gall Myrick J, Noar SM, Sontag JM, Kelley D. Connections between sources of health and beauty information and indoor tanning behavior among college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:163-168. [PMID: 30485157 DOI: 10.1080/07448481.2018.1536662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/02/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study tested how media, family, and peer sources of health and beauty information predict indoor tanning (IT) beliefs and behavior. Participants: 210 undergraduate women at a state university in the southeastern United States. Methods: Respondents completed a survey about sources of health and beauty information, IT beliefs, and IT behavior. Correlations and a path model were used to test associations between variables. Results: Friends were positively and family were negatively associated with positive outcome expectations, with mood enhancement beliefs positively predicting behavior. Reliance on news positively predicted appearance damage and immediate risk, which both predicted behavior. Reliance on social media was negatively associated with beliefs about immediate risks. Conclusion: Health and beauty information from social media and from friends may promote beliefs about tanning, while information from news or one's family may reduce risky beliefs. Prevention efforts could leverage information sources to shift tanning beliefs and behavior.
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Affiliation(s)
- Jessica Gall Myrick
- Department of Film/Video and Media Studies, Bellisario College of Communications, Pennsylvania State University, University Park, PA, USA
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina, Chapel Hill, NC, USA
| | - Jennah M Sontag
- Center for Tobacco Studies, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Dannielle Kelley
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
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Blue light-triggered photochemistry and cytotoxicity of retinal. Cell Signal 2020; 69:109547. [PMID: 31982549 DOI: 10.1016/j.cellsig.2020.109547] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 01/08/2023]
Abstract
The chemical- and photo- toxicity of chromophore retinal on cells have long been debated. Although we recently showed that retinal and blue light exposure interrupt cellular signaling, a comprehensive study examining molecular underpinnings of this perturbation and its consequences to cellular fate is lacking. Here, we report molecular evidence for blue light excited-retinal induced oxidative damage of polyunsaturated lipid anchors in membrane-interacting signaling molecules and DNA damage in cells using live-cell imaging and in vitro experimentation. The incurred molecular damage irreversibly disrupted subcellular localization of these molecules, a crucial criterion for their signaling. We further show retinal accumulation in lipid-bilayers of cell membranes could enhance the lifetime of retinal in cells. Comparative response-signatures suggest that retinal triggers reactions upon photoexcitation similar to photodynamic therapy agents and generate reactive oxygen species in cells. Additionally, data also shows that exposing retinal-containing cells to sunlight induces substantial cytotoxicity. Collectively, our results explain a likely in vivo mechanism and reaction conditions under which bio-available retinal in physiological light conditions damages cells.
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Abstract
Skin color is one of the major attributes that defines both individual distinctiveness and differences between groups. There is a preference for lighter skin world-wide, among both light- and dark-skinned individuals, further leading to skin-color bias based upon skin-color hierarchy within certain ethnoracial groups. The psychiatric and psychosocial ramifications of skin color are important in several situations, including (1) disorders of skin discoloration (eg, vitiligo), which can significantly affect the psychosocial development of the patient especially when it has its first onset during adolescence; (2) widespread use of skin-lightening products, which are used despite knowledge about serious toxicity from inorganic mercury and potent corticosteroids that are some of their main constituents; (3) indoor tanning, which is a recognized carcinogen and practiced by over 50% of university-age adults and 20% of adolescents. Educating about photocarcinogenicity does not change tanning behaviors, which is strongly driven by peer pressure; and (4) when a psychiatric disorder, such as body dysmorphic disorder or major depressive disorder, is the primary basis for skin color dissatisfaction. Despite the role of complex sociocultural and psychiatric factors in clinical manifestations involving skin color, a supportive relation with the dermatologist can significantly aid the patient in managing their disease burden.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Psychmed Research, London, Ontario, Canada.
| | - Aditya K Gupta
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Mediprobe Research, London, Ontario, Canada
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Mays D, Ahn J, Zhang B, Atkins MB, Goerlitz D, Tercyak KP. Genetic Associations with Indoor Tanning Addiction among non-Hispanic White Young Adult Women. Ann Behav Med 2020; 54:1-9. [PMID: 31185074 DOI: 10.1093/abm/kaz021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some young people may become addicted to indoor tanning in a manner similar to other forms of addiction, but research on genetic associations with indoor tanning addiction remains limited. PURPOSE To examine if liabilities in genetic addiction reward pathways and psychiatric comorbidity influence the risk of indoor tanning addiction. METHODS This was a cross-sectional study with a community sample of 292 non-Hispanic white young adult women aged 18-30 years who reported indoor tanning in the past year. Self-report measures included indoor tanning frequency, appearance orientation, depressive symptoms, and two screeners of tanning addiction. DNA samples were analyzed for 34 single nucleotide polymorphisms (SNPs) in candidate genes in addiction reward pathways. RESULTS No SNPs were significantly associated with tanning addiction in univariate analyses after multiplicity adjustment. In multivariable analyses adjusting for indoor tanning frequency, appearance orientation, and depressive symptoms, variant genotypes (CC or CT) in two DRD2 dopamine receptor gene SNPs were associated with increased odds of indoor tanning addiction (rs4436578, odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.11-4.77; rs4648318, OR: 1.95, 95% CI: 1.02-3.72). Variant SNP genotypes interacted with depressive symptoms to increase the risk of indoor tanning addiction: OR: 10.79, 95% CI: 3.25, 35.80, OR: 13.60, 95% CI: 4.13, 44.78, respectively. CONCLUSIONS This study provides preliminary evidence that DRD2 dopamine receptor gene SNPs are associated with indoor tanning addiction and young women with variant genotypes and elevated depressive symptoms may be at higher risk. These preliminary results support a reward-based model for indoor tanning addiction and warrant further investigation.
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Affiliation(s)
- Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Bingsong Zhang
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Michael B Atkins
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - David Goerlitz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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42
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Wehner MR. WHO can decrease indoor tanning? Br J Dermatol 2019; 182:824. [PMID: 31849050 DOI: 10.1111/bjd.18725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M R Wehner
- Department of Health Services Research , The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
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Abstract
The incidence of melanoma continues to increase worldwide. In the United States, melanoma is the fifth most common cancer in men and the sixth most common cancer in women. The risk factors contributing to melanoma have largely remained unchanged, but there is a new focus on modifiable risk factors including sun exposure and ultraviolet light. A large public initiative supported by the Centers for Disease Control focuses on educating the public on the risks of sun exposure and indoor tanning. Early detection and resection of melanoma lesions is necessary to prevent metastasis and reduce medical costs.
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Affiliation(s)
- Stephanie Carr
- General Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Christy Smith
- General Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Jessica Wernberg
- General Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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Rodriguez-Acevedo AJ, Green AC, Sinclair C, van Deventer E, Gordon LG. Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta-analysis. Br J Dermatol 2019; 182:849-859. [PMID: 31381131 DOI: 10.1111/bjd.18412] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Exposure to artificial tanning devices is carcinogenic to humans, and government regulations to restrict or ban indoor tanning appear to be increasing. OBJECTIVES We evaluated changes in the international prevalence of indoor tanning among adolescents and adults after artificial tanning devices were classified as carcinogenic by the International Agency for Research on Cancer (IARC) in 2009. METHODS Systematic searches in PubMed and Web of Science databases were undertaken. Overall, 43 studies reporting 'ever' or 'past-year' indoor tanning exposure after 2009 were identified. We used metaregression analysis to evaluate the prevalence of indoor tanning over time. Random effects meta-analysis was used to summarize the prevalence of indoor tanning in adolescents and adults according to sex, region and presence of age prohibitions. RESULTS Global prevalence of indoor tanning in adolescents for 2013-2018 was 6·5% [95% confidence interval (CI) 3·3-10·6], 70% lower than the 22·0% (95% CI 17·2-26·8) prevalence for 2007-2012. Among adults, the prevalence was 10·4% (95% CI 5·7-16·3) for 2013-2018, a decrease of 35% from 18·2% for 2007-2012. Since 2009, the overall past-year prevalence among adolescents was 6·7% (95% CI 4·4-9·6) and 12·5% (95% CI 9·5-15·6) among adults. The prevalence of tanning indoors in the past year was similar in North America (adults, 12·5%; adolescents, 7·6%) and Europe (adults, 11·1%; adolescents, 5·1%). In 2009, three countries had regulations restricting indoor tanning, compared with 26 countries today. CONCLUSIONS Prevalence of indoor tanning has declined substantially and significantly in adolescents and adults since the 2009 IARC statement, reflecting the rise in regulations that limit this source of unnecessary exposure to carcinogenic ultraviolet radiation. What is already known about this topic? Indoor tanning is associated with an increased risk of melanoma. A meta-analysis of worldwide indoor tanning prevalence for 1986-2012 found a past-year prevalence of 18% in adolescents and 14% in adults, with higher prevalences during the period 2007-2012. Policies to regulate indoor tanning began to be implemented across the globe in 2009. Only one study carried out in the U.S.A. has evaluated the efficacy of such policies in reducing indoor tanning prevalence. What does this study add? For the period 2013-2018, we found indoor tanning prevalences of 6·7% in adolescents and 11·9% in adults. This implies a reduction in indoor tanning use of 70% in adolescents and 35% in adults during the last 10 years. Our study encourages policy makers to strengthen indoor tanning regulations that reduce sunbed use among the general population in order to produce maximum public health benefit.
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Affiliation(s)
| | - A C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, U.K
| | - C Sinclair
- Cancer Council Victoria, Melbourne, Victoria, 3004, Australia
| | - E van Deventer
- Department of Public Health, Environmental and Social Determinants of Health (PHE), CH1211 Geneva 27, Switzerland
| | - L G Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia.,Queensland University of Technology, School of Nursing, Kelvin Grove, Brisbane, Q4059, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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Chen R, Hipp JA, Morrison L, Henriksen L, Swetter SM, Linos E. Association of Number of Indoor Tanning Salons With Neighborhoods With Higher Concentrations of Male-Male Partnered Households. JAMA Netw Open 2019; 2:e1912443. [PMID: 31584678 PMCID: PMC6784810 DOI: 10.1001/jamanetworkopen.2019.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Both indoor tanning and skin cancer are more common among sexual-minority men, defined as gay and bisexual men, than among heterosexual men. Convenient access to indoor tanning salons may influence use patterns. OBJECTIVE To investigate whether indoor tanning salons are disproportionately located in areas with higher concentrations of gay men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used geographic information systems to integrate census data and business location data obtained from ArcGIS and Google Maps for the 10 US cities with the largest lesbian, gay, bisexual, and transgender populations in 2010, ie, Los Angeles, California; Chicago, Illinois; San Francisco, California; Seattle, Washington; San Diego, California; Dallas, Texas; Phoenix, Arizona; Washington, DC; Portland, Oregon; and Denver, Colorado. The association of indoor tanning salon locations with proportions of gay men, using the concentration of male-male partnered households as a proxy measure for the latter, was examined. Data analysis was performed in October 2018. EXPOSURES Census tracts with at least 1%, 5%, or 10% male-male partnered households, adjusting for median household income, percentage young women, and percentage non-Hispanic white residents. MAIN OUTCOMES AND MEASURES Presence of 1 or more indoor tanning salons within census tracts. RESULTS Across the 10 cities and 4091 census tracts in this study, there were 482 823 unmarried partnered households, of which 35 164 (7.3%) were male-male. The median (interquartile range) percentage of male-male partnered households per census tract was 0% (0%-10.6%). Odds of indoor tanning salon presence in areas with at least 10% male-male households were more than twice those of areas with less than 10% male-male households (odds ratio, 2.17; 95% CI, 1.59-2.97). When sensitivity analyses using a 1-mile euclidian buffer around each tanning salon were conducted, this association remained significant (odds ratio, 2.48; 95% CI, 2.14-2.88). After adjusting for median household income, percentage young women, and percentage non-Hispanic white residents, the odds of an indoor tanning salon being within 1 mile of a census tract with at least 10% male-male households remained twice that of census tracts with less than 10% male-male households (odds ratio, 2.00; 95% CI, 1.71-2.35). CONCLUSIONS AND RELEVANCE In this study, indoor tanning salons were more likely to be located near neighborhoods with higher concentrations of male-male partnered households, possibly contributing to the disproportionate use of indoor tanning by sexual-minority men.
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Affiliation(s)
- Rebecca Chen
- Weill Cornell Medical College, New York, New York
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
| | - J. Aaron Hipp
- Center for Geospatial Analytics, North Carolina State University, Raleigh
| | - Lily Morrison
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford School of Medicine, Palo Alto, California
| | - Susan M. Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eleni Linos
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
- Stanford Health Research and Policy, Stanford School of Medicine, Palo Alto, California
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46
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Aluma-Tenorio MS, Osorio-Ciro JA, Muñoz-Monsalve AM, Jaimes N, Ávila-Álvarez A, Tamayo-Betancur MC. Evaluación de la exposición solar y las medidas de fotoprotección en deportistas del Valle de Aburrá en el 2018. IATREIA 2019. [DOI: 10.17533/udea.iatreia.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Antecedentes: el cáncer de piel es el más común en humanos y su incidencia continúa en aumento. La radiación ultravioleta (RUV) es el principal factor ambiental asociado con este cáncer. Los deportistas presentan un mayor riesgo para desarrollar cáncer de piel; sin embargo en nuestro país, hasta el momento, no se ha estudiado esta población.Objetivo general: describir las conductas de riesgo del cáncer de piel en deportistas del Valle de Aburrá, a través de una encuesta realizada en los centros más importantes de la región.Materiales y métodos: estudio de corte transversal descriptivo; se evaluaron variables sociodemográficas, clínicas y relacionadas con hábitos de fotoprotección. Según el tipo de variable, se usó media y desviación estándar o conteos absolutos y relativos.Resultados: se incluyeron 122 deportistas, la edad promedio del grupo estudiado fue de 20 años, el 56 % de los incluidos fueron hombres. El 74 % de los deportes se realizaban al aire libre, el fútbol fue el deporte más frecuente. El 75 % de los participantes entrenaba cuatro o más veces por semana y el 55 % lo hacía en horas con muy alta RUV. El 27 % de los deportistas reportó de 1 a 3 insolaciones en la infancia. La fotoprotección química se utilizaba con más frecuencia que la física.Conclusiones: este es el primer estudio realizado en Colombia que evidencia la necesidad de mejorar la educación en prevención primaria y secundaria sobre el cáncer de piel en esta población.
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Pierret L, Suppa M, Gandini S, Del Marmol V, Gutermuth J. Overview on vitamin D and sunbed use. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:28-33. [PMID: 30811696 DOI: 10.1111/jdv.15316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022]
Abstract
Vitamin D seems to be associated with a protective effect in a vast range of diseases, including cardiovascular, autoimmune and oncologic conditions. Since ultraviolet (UV) B light is the most important prerequisite for the cutaneous synthesis of vitamin D, sunbeds are able to increase serum vitamin D levels, although only transiently in most cases. In this scenario, the artificial tanning industry relentlessly tries to promote the use of sunbeds as a 'safe' therapeutic measure to achieve an adequate serum vitamin D status. The World Health Organization classified UV-emitting tanning devices, as well as the whole UV spectrum, as group-1 carcinogens, as they significantly increase the risk of melanoma and non-melanoma skin cancer. In case of vitamin D deficiency or insufficiency, the current risk-benefit ratio is therefore in favour of vitamin D supplementation instead of sunbed use. Artificial tanning devices should never be considered as an option to achieve an appropriate vitamin D status. Their supposedly beneficial effects, vastly publicised by the artificial tanning industry, are not worth the carcinogenic risk associated with sunbed use.
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Affiliation(s)
- L Pierret
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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48
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Suppa M, Gandini S, Njimi H, Bulliard JL, Correia O, Duarte AF, Peris K, Stratigos AJ, Nagore E, Longo MI, Bylaite-Bucinskiene M, Karls R, Helppikangas H, Del Marmol V. Prevalence and determinants of sunbed use in thirty European countries: data from the Euromelanoma skin cancer prevention campaign. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:13-27. [PMID: 30811698 DOI: 10.1111/jdv.15311] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although considered as a first-group carcinogen, indoor tanning is a common practice in Europe. Euromelanoma is a pan-European skin cancer prevention campaign. OBJECTIVES To compare several European countries in terms of the prevalence and determinants of sunbed use. METHODS Participants in the Euromelanoma campaigns filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for age, gender, education, skin type and year of survey were employed to assess factors independently associated with sunbed use in each country. RESULTS In total, 227 888 individuals (67.4% females, median age 44, 63.4% highly educated, 71.9% skin types III-VI) from 30 countries participated. Overall, the prevalence of sunbed ever use was 10.6% (≤19-year-olds: 5.9%; 20 to 35-year-olds: 17.0%; >35-year-olds: 8.3%). Females displayed a higher prevalence than males in all countries. Balkan countries displayed the highest female/male ratios (≥4). Sunbed use was significantly more prevalent among skin type III-VI (14/30 countries) and highly educated participants (11/30 countries). Significant correlations were found between sunbed use prevalence and countries' latitude (P < 0.001) and sunshine (P = 0.002); Italy and Spain represented exceptions towards excessive exposure. Very different prevalence rates were found for Spain (19.3%) and Portugal (2.0%). Scandinavian countries ranked highest in sunbed use among ≤19-year-olds, Baltic countries among 20 to 35-year-olds. CONCLUSIONS Sunbed use prevalence was higher in northern, sun-deprived countries, with the exception of Italy and Spain. The main determinants of sunbed use were age (young adults) and gender (females), whereas education and skin type had a less relevant effect. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults) and Scandinavian (highest prevalence among adolescents). These data have public health relevance for future interventions aimed at reducing sunbed use in Europe.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J L Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Center for Health Technology and Services Research (CINTESIS), Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - K Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - A J Stratigos
- First Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Universidad Católica de València San Vicente Ferrer, Valencia, Spain
| | - M I Longo
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Bylaite-Bucinskiene
- Clinic of Infectious, Chest Diseases, Dermatovenereology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Karls
- Department of Infectiology and Dermatology, Riga Stradins University, Riga, Latvia
| | - H Helppikangas
- Dermatology Department, Clinical Center, University of Sarajevo, Sarajevo, Bosnia & Herzegovina
| | | | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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49
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Suppa M, Gandini S, Njimi H, Bulliard JL, Correia O, Duarte AF, Peris K, Stratigos AJ, Nagore E, Longo MI, Bylaite-Bucinskiene M, Karls R, Helppikangas H, Del Marmol V. Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:76-88. [PMID: 30811689 DOI: 10.1111/jdv.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires. OBJECTIVES To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. METHODS To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. RESULTS Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I-II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01-1.10)], atypical nevi [SOR = 1.04 (1.00-1.09)], lentigines [SOR = 1.16 (1.04-1.29)] and suspicion of melanoma [SOR = 1.13 (1.00-1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91-1.10)]. CONCLUSIONS Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J L Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - K Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - A J Stratigos
- First Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.,Universidad Católica de València San Vicente Ferrer, Valencia, Spain
| | - M I Longo
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Bylaite-Bucinskiene
- Clinic of Infectious, Chest diseases, Dermatovenereology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Karls
- Department of Infectiology and Dermatology, Riga Stradins University, Riga, Latvia
| | - H Helppikangas
- Dermatology Department, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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50
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Suppa M, Gandini S, Bulliard JL, Daxhelet M, Zamagni M, Forsea AM, Longo MI, Del Marmol V. Who, why, where: an overview of determinants of sunbed use in Europe. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:6-12. [PMID: 30811690 DOI: 10.1111/jdv.15318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/20/2018] [Indexed: 12/28/2022]
Abstract
Although exposure to indoor tanning has been established as a clear risk factor for skin cancer, sunbeds are still commonly used in Europe. Understanding the determinants of sunbed use in Europe is key to plan educational interventions, behavioural strategies and legislative measures, which should be tailored to subgroups with different risk profiles. Evidences show that the typical sunbed users in Europe are young-adult women, with intermediate skin type, a current employment and a medium/high socio-economic status. Typical users display sun-seeking behaviours and other risky behaviours such as smoking. Indoor tanning seems more common in northern than southern Europe. However, sunbed use remains common in fair-skinned individuals and among adolescents/pre-adolescents. Commonly reported reasons for sunbed use in Europe include aesthetic motives (i.e. looking attractive), the pursue of a prevacation tan, the influence of peers/parents engaging in the same habit, and the treatment of health conditions. The most commonly reported places to get an artificial tan in Europe are tanning studios and beauty salons. However, sunbeds are also available in sport venues, such as swimming pools and gyms, hotels and private houses. All these factors should be taken into account when planning educational, behavioural and legislative interventions to reduce the popularity of artificial tanning in Europe.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - J L Bulliard
- Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | - M Daxhelet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M Zamagni
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A M Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - M I Longo
- Department of Dermatology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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