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Vogel RI, Luo X, Brown K, Jewett P, Dona AC, Nagler RH, Ahmed RL, Martinson BC, Lazovich D. A UVR-sensor wearable device intervention to reduce sun exposure in melanoma survivors: Results from a randomized controlled trial. PLoS One 2023; 18:e0281480. [PMID: 36763627 PMCID: PMC9916644 DOI: 10.1371/journal.pone.0281480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/12/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Melanoma survivors are at increased risk of developing a second primary melanoma; however, some report sub-optimal sun behaviors and sunburns. We tested the effectiveness of a wearable device with ultraviolet radiation (UVR)-sensing technology to improve sun behaviors and reduce sunburns in cutaneous melanoma survivors. MATERIALS AND METHODS We conducted a randomized controlled trial using Shade 2, a commercially available wrist device that measures UVR. The intervention group received the device and mobile application notifications about their exposure and prompts to use sunscreen. The control group received the device and a separate research mobile application without information about their exposure or notifications. Participants wore the device for 12 weeks and self-reported sun behaviors before, during, and after the intervention. The primary outcome was a composite score of sun protection behaviors at week 12. RESULTS 386 participants were randomized (186 control, 182 intervention). Most were female and 5+ years past their first melanoma diagnosis. The average age was 56 years. Most (93%) completed the study, though 40% experienced device issues. No meaningful differences were observed in self-reported sun protection behaviors at week 12 (controls 3.0±0.5 vs. intervention 2.9±0.5, p = 0.06), any sunburn during the intervention period (controls 14.4% vs. intervention 12.7%, p = 0.75), or average daily objective UVR exposure (controls median 87 vs. intervention 83 J/m2, p = 0.43). CONCLUSION Wearing a device that measured and alerted melanoma survivors to UVR exposure did not result in different sun behaviors, exposure, or sunburns relative to controls. The technology needs refinement before further attempts to assess the effectiveness of self-monitoring UVR exposure. CLINICAL TRIALS REGISTRATION NCT03927742.
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Affiliation(s)
- Rachel Isaksson Vogel
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Katherine Brown
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Patricia Jewett
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Allison C. Dona
- Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rebekah H. Nagler
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Hubbard School of Journalism & Mass Communication, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rehana L. Ahmed
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Brian C. Martinson
- HealthPartners Institute, Bloomington, Minnesota, United States of America
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health System, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis. Cancer Causes Control 2021; 32:1333-1345. [PMID: 34313875 DOI: 10.1007/s10552-021-01481-7] [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] [Received: 12/21/2020] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. METHODS iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. RESULTS Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. CONCLUSION NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.
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Taber JM, Aspinwall LG, Drummond DM, Stump TK, Kohlmann W, Champine M, Cassidy P, Leachman SA. Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma. Ann Behav Med 2021; 55:24-40. [PMID: 32415830 PMCID: PMC7880221 DOI: 10.1093/abm/kaaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. PURPOSE To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. METHODS A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. RESULTS Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. CONCLUSIONS Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Tammy K Stump
- Department of Preventive Medicine, Northwestern University, Evanston, IL
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Tamminga MA, Lipoff JB. Understanding sunscreen and photoprotection misinformation on parenting blogs: A mixed-method study. Pediatr Dermatol 2021; 38:88-91. [PMID: 33063890 DOI: 10.1111/pde.14411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND/OBJECTIVES Sun exposure during childhood is a modifiable risk factor for skin cancer. Social media (including parenting blogs) represent promising platforms for understanding misinformation about pediatric photoprotection. This study's objective was to qualitatively and quantitatively evaluate the digital social context of parenting blogs that shape parents' decisions about children's photoprotection. METHODS Mixed-method analysis was conducted of the 25 most popular parenting blogs in the USA, including 56 blog posts addressing photoprotection and 2661 comments. An inductive method was used to code and identify key themes associated with blog post categorization as sunscreen-encouraging, -discouraging, and -ambivalent. The qualitative analysis program NVivo was used to calculate descriptive statistics for comment codes based on co-occurrence with blog post category. RESULTS Sunscreen-discouraging posts addressed natural remedies, sunscreen recipes, and vitamin D. Sunscreen-encouraging posts focused on skin cancer and protective clothing. Sunscreen-ambivalent posts were associated with scientific studies. Sunscreen-discouraging posts received more comments (mean 124) than encouraging (31) or ambivalent posts (8). Discouraging (65%) and ambivalent posts (75%) cited scientific literature more often than encouraging posts (14%). Comments were twice as likely to discourage photoprotection as to encourage it (1340 vs 447 comments). CONCLUSIONS Parenting blogs are a substantial resource of both information and misinformation on pediatric photoprotection. However, misinformation receives substantially more engagement. The themes revealed in this study may help physicians and public health officials in developing interventions to target misinformation around pediatric photoprotection.
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Affiliation(s)
- Mila A Tamminga
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Vogel RI, Nagler RH, Ahmed RL, Brown K, Luo X, Martinson BC, Lazovich D. UVR-sensor wearable device intervention to improve sun behaviors and reduce sunburns in melanoma survivors: study protocol of a parallel-group randomized controlled trial. Trials 2020; 21:959. [PMID: 33228807 PMCID: PMC7682122 DOI: 10.1186/s13063-020-04881-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Background Individuals who have been diagnosed with melanoma have more than a 9-fold increased risk of developing another melanoma. Ultraviolet radiation (UVR) exposure following a melanoma diagnosis can be modified to reduce risk of a new melanoma diagnosis. Yet research shows that many melanoma survivors do not report optimal sun protection practices. The objective of this study is to evaluate the effectiveness of a UVR-sensor wearable device to improve sun protection behaviors and reduce sunburns in a randomized controlled trial (RCT) in melanoma survivors. Methods We will conduct an RCT among 368 melanoma survivors in two waves (Summer 2020, Summer 2021). This approach allows for adequate recruitment of the required sample and potential improvements to recruitment, compliance, and retention strategies between waves. The intervention includes an informational brochure about sun protection behaviors and a commercially available UVR-sensor wearable device (Shade), which accurately measures UVR. The device, along with its associated mobile application, measures and stores UVR exposure. As UVR exposure accumulates, the device provides notifications to increase sun protection action. Survivors in the control group receive the device and a separate mobile application that does not provide notifications or summary UVR exposure data. Participants will be asked to wear the device for 12 weeks. They will complete surveys about their sun behaviors at study entry, every 4 weeks during the intervention, and 1 year later. At the end of the intervention period, intervention and control groups will be compared for differences in a summary measure of sun protection habits and experience of a sunburn. We will also measure self-reported physical activity, depression, and anxiety to examine potential unintended negative consequences of the intervention. Discussion The study intervention will be completed Fall 2021, with anticipated results available in 2022. If this intervention improves sun protection behaviors in melanoma survivors, these findings would support expanding the use of this technology with other populations at high risk for melanoma. Trial registration ClinicalTrials.gov NCT03927742. Registered on April 15, 2019.
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Affiliation(s)
- Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA. .,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| | - Rebekah H Nagler
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Hubbard School of Journalism & Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Rehana L Ahmed
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Brown
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brian C Martinson
- HealthPartners Institute, Bloomington, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Rowland JH, Gallicchio L, Mollica M, Saiontz N, Falisi AL, Tesauro G. Survivorship Science at the NIH: Lessons Learned From Grants Funded in Fiscal Year 2016. J Natl Cancer Inst 2020; 111:109-117. [PMID: 30657942 DOI: 10.1093/jnci/djy208] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/01/2018] [Accepted: 11/08/2018] [Indexed: 01/26/2023] Open
Abstract
Federal investment in survivorship science has grown markedly since the National Cancer Institute's creation of the Office of Cancer Survivorship in 1996. To describe the nature of this research, provide a benchmark, and map new directions for the future, a portfolio analysis of National Institutes of Health-wide survivorship grants was undertaken for fiscal year 2016. Applying survivorship-relevant terms, a search was conducted using the National Institutes of Health Information for Management, Planning, Analysis and Coordination grants database. Grants identified were reviewed for inclusion and categorized by grant mechanism used, funding agency, and principal investigator characteristics. Trained pairs of coders classified each grant by focus and design (observational vs interventional), population studied, and outcomes examined. A total of 215 survivorship grants were identified; 7 were excluded for lack of fit and 2 for nonresearch focus. Forty-one (19.7%) representing training grants (n = 38) or conference grants (n = 3) were not coded. Of the remaining 165 grants, most (88.5%) were funded by the National Cancer Institute; used the large, investigator-initiated (R01) mechanism (66.7%); focused on adult survivors alone (84.2%), often breast cancer survivors (47.3%); were observational in nature (57.3%); and addressed a broad array of topics, including psychosocial and physiologic outcomes, health behaviors, patterns of care, and economic/employment outcomes. Grants were led by investigators from diverse backgrounds, 28.4% of whom were early in their career. Present funding patterns, many stable since 2006, point to the need to expand research to include different cancer sites, greater ethnoculturally diverse samples, and older (>65 years) as well as longer-term (>5 years) survivors and address effects of newer therapies.
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Affiliation(s)
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Michelle Mollica
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Nicole Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Angela L Falisi
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Gina Tesauro
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Patterns of sun safety behaviors in parents: Associations with physical activity, sedentary behavior, and access to neighborhood physical activity resources. Prev Med 2020; 132:105976. [PMID: 31911162 PMCID: PMC7299179 DOI: 10.1016/j.ypmed.2019.105976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/26/2019] [Accepted: 12/28/2019] [Indexed: 12/15/2022]
Abstract
Exposure to ultraviolet rays is associated with increased risk of sunburn - a biomarker of skin cancer risk - and physical activity can increase exposure. Sun safety behaviors can mitigate the increased risk of skin cancer. The objective of this cross-sectional study was to determine associations between physical activity behaviors, access to neighborhood physical activity resources, and sunburn across different patterning of sun safety behaviors. Data collected in 2014 from parents in the United States were analyzed (N = 1680; 75% female, primarily between the ages of 35-44 and 45-59, and 67% White). Latent class analysis was conducted to identify classes of sun safety behaviors based on engagement in sun protective behaviors (wearing a hat, shirt with sleeves, and seeking shade) and sun exposure (tanning outdoors). The latent classes were then examined as moderators of the association between physical activity related variables and sunburn. Three classes were identified corresponding to Low, Moderate, and High Risk for sunburn. There was no evidence of moderation, so equality constraints were imposed across the classes. Moderate-to-vigorous physical activity (MVPA) (odds ratio [OR] = 1.09) and neighborhood environments favoring physical activity (OR = 1.39) were associated with an increased likelihood of sunburn. Greater engagement in physical activity and access to built environments that favour activity are associated with a higher likelihood of sunburn, regardless of sun safety behaviors. Physically active parents are a vulnerable population for melanoma, and cancer prevention efforts focused on physical activity should also address sun safety.
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Wu YP, Boucher K, Hu N, Hay J, Kohlmann W, Aspinwall LG, Bowen DJ, Parsons BG, Nagelhout ES, Grossman D, Mooney K, Leachman SA, Tercyak KP. A pilot study of a telehealth family-focused melanoma preventive intervention for children with a family history of melanoma. Psychooncology 2020; 29:148-155. [PMID: 31520429 PMCID: PMC6980884 DOI: 10.1002/pon.5232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Melanoma preventive interventions for children with familial risk are critically needed because ultraviolet radiation (UVR) exposure and sunburn occurrence early in life are the primary modifiable risk factors for melanoma. The current study examined the feasibility and acceptability of a new, family-focused telehealth intervention for children with familial risk for melanoma and their parents. The study also explored changes in child sun protection and risk behaviors, sunburn occurrence, and objectively measured UVR exposure. METHODS This was a prospective study with a single-group design (n = 21 parent-child dyads, children ages 8-17). Dyads were asked to participate in three in-person assessments and three live video teleconference intervention sessions. RESULTS The intervention was feasibly delivered, and the intervention content was acceptable to parents and children. The intervention was associated with improvements in child use of certain sun protection strategies over time and declines in child UVR exposure. CONCLUSIONS A telehealth-delivered,family-focused melanoma preventive intervention was feasibly delivered and was acceptable to parent-child dyads. Future melanoma preventive interventions for this at-risk population could incorporate eHealth technologies to facilitate improvements in use of sun protection and monitoring of UVR exposure. This trial was registered with Clinicaltrials.gov, number NCT02846714.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kenneth Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah
- Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Nan Hu
- Huntsman Cancer Institute, Salt Lake City, Utah
- Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jennifer Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | | | - Elizabeth S Nagelhout
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kathi Mooney
- Huntsman Cancer Institute, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kenneth P Tercyak
- Cancer Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C
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Morris KL, Perna FM. Decision Tree Model vs Traditional Measures to Identify Patterns of Sun-Protective Behaviors and Sun Sensitivity Associated With Sunburn. JAMA Dermatol 2019; 154:897-902. [PMID: 29955755 DOI: 10.1001/jamadermatol.2018.1646] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Understanding patterns of sun-protective behaviors and their association with sunburn can provide important insight into measurement approaches and intervention targets. Objective To assess whether decision-based modeling can be used to identify patterns of sun-protective behaviors associated with the likelihood of sunburn and to compare the predictive value of this method with traditional (ie, composite score) measurement approaches. Design, Setting, and Participants This cross-sectional study used a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey, consisting of household interviews conducted in person and completed by telephone when necessary. Participants included civilian noninstitutionalized US adults. Data were collected from January 1 through December 31, 2015. Main Outcomes and Measures The associations among sun sensitivity, multiple sun-protective behaviors (ie, using sunscreen, seeking shade, wearing a hat, and wearing protective clothing), and sunburn were examined using a χ2 automatic interaction detection method for decision tree analysis. Results were compared with a composite score approach. Results In our study population of 28 558 respondents with complete data (54.1% women; mean [SD] age, 49.0 [18.0] years), 20 patterns of sun protection were identified. Among 15 992 sun-sensitive individuals, those who used only sunscreen had the highest likelihood of sunburn (62.4%). The group with the lowest likelihood of sunburn did not report using sunscreen but engaged in the other 3 protective behaviors (24.3% likelihood of sunburn). Among 12 566 non-sun-sensitive individuals, those who engaged in all 4 protective behaviors had the lowest likelihood of sunburn (6.6%). The highest likelihood of sunburn was among those who only reported sunscreen use (26.2%). The decision tree model and the composite score approach correctly classified a similar number of cases; however, the decision tree model was superior in classifying cases with sunburn (44.3% correctly classified in the decision tree vs 25.9% with the composite score). Conclusions and Relevance This innovative application of a decision tree analytic approach demonstrates the interactive and sometimes counterintuitive effects of multiple sun-protective behaviors on likelihood of sunburn. These data show where traditional measurement approaches of behavior may fall short and highlight the importance of linking behavior to a clinically relevant outcome. Given the scope of those affected and enormous associated health care costs, improving efforts in skin cancer prevention has the potential for a significant effect on public health.
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Affiliation(s)
- Kasey L Morris
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Frank M Perna
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Holman DM, Ding H, Guy GP, Watson M, Hartman AM, Perna FM. Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults. JAMA Dermatol 2019. [PMID: 29541756 DOI: 10.1001/jamadermatol.2018.0028] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts. Objective To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population. Design, Setting, and Participants In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey-Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017. Main Outcomes and Measures The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling. Results A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non-aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non-binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non-overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups. Conclusions and Relevance Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.
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Affiliation(s)
- Dawn M Holman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Ding
- DB Consulting Group Inc, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne M Hartman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Frank M Perna
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Pugh G, Hough R, Hubbard G, Banks E, Fisher A. Sun exposure among teenage and young adult cancer survivors in the United Kingdom. Pediatr Blood Cancer 2019; 66:e27424. [PMID: 30209864 DOI: 10.1002/pbc.27424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/07/2022]
Abstract
Skin cancers are a common form of second malignant neoplasm among teenage and young adult cancer survivors (TYACS). The Children's Oncology Group specifies that TYACS should adhere to safe sun practices and be screened for skin cancer annually. Cross-sectional self-report data collected by our group indicate over a third of TYACS (n = 229; mean age: 19.8 years) intentionally sunbathe, with many reporting sunburn. TYACS sunbathing, sunburn, and sunbed use are similar to the general population (P > 0.05). These data suggest TYACS require intervention to limit sun exposure and improve their sun safety habits.
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Affiliation(s)
- Gemma Pugh
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Rachael Hough
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Gill Hubbard
- Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Inverness, United Kingdom
| | - Elspeth Banks
- National Cancer Research Institute, London, United Kingdom
| | - Abigail Fisher
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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12
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Jiang QQ, Liu WB. miR-25 Promotes Melanoma Progression by regulating RNA binding motif protein 47. Med Sci (Paris) 2018; 34 Focus issue F1:59-65. [PMID: 30403177 DOI: 10.1051/medsci/201834f111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Melanoma is the most aggressive skin cancer, and accounts for the major part of skin cancer-related deaths in the world. In addition, the underlying mechanism of tumor progression in melanoma remains far from being elucidated. In this study, we have evaluated the function of miR-25 in melanoma. First, we examined the expression of miR-25 in four melanoma cell lines (A875, MV3, M14 and uacc-257) and in a normal melanocyte cell line (HEM-a). Then, we overexpressed miR-25 in M14 cells. Our results show that miR-25 promotes M14 cell proliferation and migration. We found that miR-25 up-regulates the PI3K/Akt/mTOR signaling pathway in these tumor cells. Furthermore, a luciferase-based reporter gene assay showed that miR-25 could directly target the RNA-binding motif protein 47 (RBM47). Taken together, our findings suggest that RBM47 is a promising target for the treatment of melanoma.
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Affiliation(s)
- Qun-Qun Jiang
- Department of Dermatology, 404 Hospital of People's Liberation Army, No.8 of Baoquan Street, Huancui District, Weihai, 264200, Shandong Province, China
| | - Wei-Bing Liu
- Department of Dermatology, 404 Hospital of People's Liberation Army, No.8 of Baoquan Street, Huancui District, Weihai, 264200, Shandong Province, China
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13
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Singh N, Gupta SK. Recent advancement in the early detection of melanoma using computerized tools: An image analysis perspective. Skin Res Technol 2018; 25:129-141. [PMID: 30030916 DOI: 10.1111/srt.12622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The paper reviews the advancement of tools and current technologies for the detection of melanoma. We discussed several computational strategies from pre- to postprocessing image operations, descriptors, and popular classifiers to diagnose a suspected skin lesion based on its virtual similarity to the malignant lesion with known histopathology. We reviewed the current state of smart phone-based apps as diagnostic tools for screening. METHODS A literature survey was conducted using a combination of keywords in the bibliographic databases: PubMed, AJCC, PH2, EDRA, and ISIC melanoma project. A number of melanoma detection apps were downloaded for two major mobile operating systems, iOS and Android; their important uses, key challenges, and various expert opinions were evaluated and also discussed. RESULTS We have provided an overview of research on the computer-aided diagnosis methods to estimate melanoma risk and early screening. Dermoscopic images are the most viable option for the advent of new image processing technologies based on which many of the skin cancer detection apps are being developed recently. We have categorized and explored their potential uses, evaluation criteria, limitations, and other details. CONCLUSION Such advancements are helpful in the sense they are raising awareness. Diagnostic accuracy is the major issue of smart phone-based apps and it cannot replace an adequate clinical experience and biopsy procedures.
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Affiliation(s)
- Nivedita Singh
- Department of Bioinformatics, Systems Toxicology Group, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India.,Department of Biochemistry, Babu Banarasi Das University, Lucknow, Uttar Pradesh, India
| | - Shailendra K Gupta
- Department of Bioinformatics, Systems Toxicology Group, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India.,Department of Systems Biology and Bioinformatics, University of Rostock, Rostock, Germany.,Chhattisgarh Swami Vivekanand Technical University, Bhilai, Chhattisgarh, India
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14
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Taber JM, Dickerman BA, Okhovat JP, Geller AC, Dwyer LA, Hartman AM, Perna FM. Skin cancer interventions across the cancer control continuum: Review of technology, environment, and theory. Prev Med 2018; 111:451-458. [PMID: 29277407 PMCID: PMC5949070 DOI: 10.1016/j.ypmed.2017.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/11/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.
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Affiliation(s)
- Jennifer M Taber
- Behavioral Research Program, National Cancer Institute, United States.
| | | | | | - Alan C Geller
- Harvard TH Chan School of Public Health, United States
| | | | - Anne M Hartman
- Behavioral Research Program, National Cancer Institute, United States
| | - Frank M Perna
- Behavioral Research Program, National Cancer Institute, United States
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15
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Geller AC, Jablonski NG, Pagoto SL, Hay JL, Hillhouse J, Buller DB, Kenney WL, Robinson JK, Weller RB, Moreno MA, Gilchrest BA, Sinclair C, Arndt J, Taber JM, Morris KL, Dwyer LA, Perna FM, Klein WMP, Suls J. Interdisciplinary Perspectives on Sun Safety. JAMA Dermatol 2018; 154:88-92. [PMID: 29117315 PMCID: PMC5839662 DOI: 10.1001/jamadermatol.2017.4201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Overexposure to the sun is associated with an increased risk of melanoma and nonmelanoma skin cancer, but indications of improvements in sun protection behavior are poor. Attempts to identify emerging themes in skin cancer control have largely been driven by groups of experts from a single field. In December 2016, 19 experts from various disciplines convened for Interdisciplinary Perspectives on Skin Cancer, a 2-day meeting hosted by the National Academy of Sciences. The group discussed knowledge gaps, perspectives on sun exposure, implications for skin cancer risk and other health outcomes, and new directions. Five themes emerged from the discussion: (1) The definition of risk must be expanded, and categories for skin physiology must be refined to incorporate population diversities. (2) Risky sun exposure often co-occurs with other health-related behaviors. (3) Messages must be nuanced to target at-risk populations. (4) Persons at risk for tanning disorder must be recognized and treated. (5) Sun safety interventions must be scalable. Efficient use of technologies will be required to sharpen messages to specific populations and to integrate them within multilevel interventions. Further interdisciplinary research should address these emerging themes to build effective and sustainable approaches to large-scale behavior change.
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Affiliation(s)
- Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nina G. Jablonski
- Department of Anthropology, The Pennsylvania State University, University Park
| | - Sherry L. Pagoto
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Jennifer L. Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joel Hillhouse
- Community and Behavioral Health, East Tennessee State University, Johnson City
| | | | - W. Larry Kenney
- Department of Kinesiology, The Pennsylvania State University
| | - June K. Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Chief Editor, JAMA Dermatology
| | - Richard B. Weller
- MRC Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland
| | - Megan A. Moreno
- Division of General Pediatrics, University of Washington, Seattle
| | - Barbara A. Gilchrest
- Department of Dermatology, Harvard Medical School and Massachusetts General Hospital, Boston
| | | | - Jamie Arndt
- Department of Psychological Sciences, University of Missouri, Columbia
| | - Jennifer M. Taber
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | | | | | | | | - Jerry Suls
- National Cancer Institute, Rockville, Maryland
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