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Vasudevan S, Vogt WC, Weininger S, Pfefer TJ. Melanometry for objective evaluation of skin pigmentation in pulse oximetry studies. COMMUNICATIONS MEDICINE 2024; 4:138. [PMID: 38992188 PMCID: PMC11239860 DOI: 10.1038/s43856-024-00550-7] [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: 03/09/2023] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Pulse oximetry enables real-time, noninvasive monitoring of arterial blood oxygen levels. However, results can vary with skin color, thus detecting disparities during clinical validation studies requires an accurate measure of skin pigmentation. Recent clinical studies have used subjective methods such as self-reported color, race/ethnicity to categorize skin. Melanometers based on optical reflectance may offer a more effective, objective approach to assess pigmentation. Here, we review melanometry approaches and assess evidence supporting their use as clinical research tools. We compare performance data, including repeatability, robustness to confounders, and compare devices to each other, to subjective methods, and high-quality references. Finally, we propose best practices for evaluating melanometers and discuss alternate optical approaches that may improve accuracy. Whilst evidence indicates that melanometers can provide superior performance to subjective approaches, we encourage additional research and standardization efforts, as these are needed to ensure consistent and reliable results in clinical studies.
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Affiliation(s)
- Sandhya Vasudevan
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
| | - William C Vogt
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Sandy Weininger
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - T Joshua Pfefer
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
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Bieliauskiene G, Philipsen PA, Ørsted-Jordy L, Køster B, Wulf HC. Visual scales are superior to questionnaires in skin phototype self-assessment by children. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:238-245. [PMID: 30809865 DOI: 10.1111/phpp.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE There are no suitable methods for skin phototype self-assessment by children. Our study investigated several skin phototype self-assessment methods in children to identify the best correlation to objectively measure skin phototype. METHODS Danish schoolchildren (ages 6-19) participated in a nation-wide study that assessed skin, eye, hair colour and sun behaviour. Skin phototype self-assessment was performed by children using two visual colour scales (cartoon faces and colour cards), question-based colour scale and questions about tendency to burn and ability to tan. For objective skin phototype measurements, 483 children from all age groups were selected and their pigment protection factor (PPF) was measured at three skin sites using a skin reflectance spectrophotometer. RESULTS Cartoon faces (r2 = 0.654) and colour cards (r2 = 0.659) were better at predicting PPF on the inner forearm than the question-based colour method (r2 = 0.520). PPF prediction from questions on skin reaction to sun exposure was markedly inferior (r2 ≤ 0.142) to both visual colour scales and question-based colour method. CONCLUSION Both visual colour scales proved to be superior to question-based skin phototype self-assessment in schoolchildren. In contrast, questions on skin reaction to sun exposure were shown to be an unsuitable tool for self-assessment of skin phototype in children.
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Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Le Clair MZ, Cockburn MG. Tanning bed use and melanoma: Establishing risk and improving prevention interventions. Prev Med Rep 2016; 3:139-44. [PMID: 27419006 PMCID: PMC4929140 DOI: 10.1016/j.pmedr.2015.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Exposure to ultraviolet radiation (UVR) from indoor tanning devices is thought to cause melanoma and other negative health consequences. Despite these findings, the practice of indoor tanning in the United States remains prevalent. In this paper we aim to present a clear discussion of the relationship between indoor tanning and melanoma risk, and to identify potential strategies for effective melanoma prevention by addressing indoor tanning device use. BASIC PROCEDURES We reviewed relevant literature on the risks of indoor tanning, current indoor tanning legislation, and trends in indoor tanning and melanoma incidence. Study was conducted at the University of Southern California, Los Angeles, CA between the years of 2014 and 2015. MAIN FINDINGS Our findings reaffirm the relationship between indoor tanning and melanoma risk, and suggest a widespread public misunderstanding of the negative effects of indoor tanning. PRINCIPAL CONCLUSIONS This review argues for an aggressive initiative to reduce indoor tanning in the United States, to design prevention efforts tailored towards specific high risk groups, and the need to better inform the public of the risks of indoor tanning.
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Affiliation(s)
- Marie Z. Le Clair
- Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90089, USA
| | - Myles G. Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90089, USA
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Jacobs LC, Hamer MA, Verkouteren JAC, Pardo LM, Liu F, Nijsten T. Perceived skin colour seems a swift, valid and reliable measurement. Br J Dermatol 2015; 173:1084-6. [PMID: 25940018 DOI: 10.1111/bjd.13888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L C Jacobs
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - M A Hamer
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - J A C Verkouteren
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - L M Pardo
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - F Liu
- Department of Forensic Molecular Biology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - T Nijsten
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
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Cust AE, Pickles KM, Goumas C, Vu T, Schmid H, Nagore E, Kelly J, Aitken JF, Giles GG, Hopper JL, Jenkins MA, Mann GJ. Accuracy of self-reported nevus and pigmentation phenotype compared with clinical assessment in a population-based study of young Australian adults. Cancer Epidemiol Biomarkers Prev 2015; 24:736-43. [PMID: 25628333 DOI: 10.1158/1055-9965.epi-14-1203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/17/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Awareness of individual risk may encourage improved prevention and early detection of melanoma. METHODS We evaluated the accuracy of self-reported pigmentation and nevus phenotype compared with clinical assessment, and examined agreement between nevus counts from selected anatomical regions. The sample included 456 cases with invasive cutaneous melanoma diagnosed between ages 18 to 39 years and 538 controls from the population-based Australian Melanoma Family Study. Participants completed a questionnaire about their pigmentation and nevus phenotype, and attended a dermatologic skin examination. RESULTS There was strong agreement between self-reported and clinical assessment of eye color [κ, = 0.78; 95% confidence interval (CI), 0.74-0.81]; and moderate agreement for hair color (κ = 0.46; 95% CI, 0.42-0.50). Agreement between self-reported skin color and spectrophotometer-derived measurements was poor (κ = 0.12; 95% CI, 0.08-0.16) to moderate (Spearman correlation rs = -0.37; 95% CI, -0.32 to -0.42). Participants tended to underestimate their nevus counts and pigmentation; men were more likely to underreport their skin color. The rs was 0.43 (95% CI, 0.38-0.49) comparing clinical total body nevus counts with self-reported nevus categories. There was good agreement between total body nevus counts and site-specific nevus counts, particularly on both arms. CONCLUSIONS Young adults have suboptimal accuracy when assessing important risk characteristics including nevus numbers and pigmentation. Measuring nevus count on the arms is a good predictor of full body nevus count. IMPACT These results have implications for the likely success of targeted public health programs that rely on self-assessment of these factors.
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Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Kristen M Pickles
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Chris Goumas
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Thao Vu
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helen Schmid
- Centre for Cancer Research, University of Sydney at Westmead Millennium Institute for Medical Research and Melanoma Institute Australia, Sydney, Australia
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - John Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - Joanne F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Graham J Mann
- Centre for Cancer Research, University of Sydney at Westmead Millennium Institute for Medical Research and Melanoma Institute Australia, Sydney, Australia
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Reeder AI, Iosua E, Gray AR, Hammond VA. Validity and Reliability of the Munsell Soil Color Charts for Assessing Human Skin Color. Cancer Epidemiol Biomarkers Prev 2014; 23:2041-7. [DOI: 10.1158/1055-9965.epi-14-0269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Smith A, Harrison S, Nowak M, Buettner P, MacLennan R. Changes in the pattern of sun exposure and sun protection in young children from tropical Australia. J Am Acad Dermatol 2013; 68:774-83. [DOI: 10.1016/j.jaad.2012.10.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/25/2012] [Accepted: 10/27/2012] [Indexed: 10/27/2022]
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Uter W, Benz M, Mayr A, Gefeller O, Pfahlberg A. Assessing skin pigmentation in epidemiological studies: The reliability of measurements under different conditions. Skin Res Technol 2012; 19:100-6. [DOI: 10.1111/srt.12013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2012] [Indexed: 02/07/2023]
Affiliation(s)
- W. Uter
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen; Erlangen Germany
| | - M. Benz
- Fraunhofer Institute for Integrated Circuits; Erlangen Germany
| | - A. Mayr
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen; Erlangen Germany
| | - O. Gefeller
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen; Erlangen Germany
| | - A. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology; University of Erlangen; Erlangen Germany
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Falk M. Differences in sun exposure habits between self-reported skin type and ultraviolet sensitivity measured by phototest. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:190-5. [PMID: 21729167 DOI: 10.1111/j.1600-0781.2011.00599.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Traditionally, classification of skin reactivity to ultraviolet (UV) light is based on self-estimation of tendency to burn and tan (Fitzpatrick's classification). Although widely accepted, the model has shown to correlate poorly with actual UV sensitivity, measured by phototest. The aim of the present study was to investigate how self-estimated skin type, according to Fitzpatrick, and actual UV sensitivity measured by phototest correlate with sun exposure and protection. METHODS One hundred and sixty-six voluntary patients visiting their general practitioner for investigation of suspicious skin tumours were recruited for the study, and filled out a questionnaire, mapping sun habits and sun protection behaviour, based on five-point Likert responses. The patients reported their skin type (I-VI) according to Fitzpatrick, and a phototest was performed to determine the minimal erythema dose. RESULTS For most of the questions, high self-estimated UV sensitivity, according to Fitzpatrick, appeared to be associated with a higher level of sun avoidance/protection (P<0.05). For actual UV sensitivity, however, the difference in response distribution was only significant for sunscreen use, and did not show a similar apparent association related to the degree of UV sensitivity. CONCLUSION Self-estimated skin UV sensitivity, according to Fitzpatrick's classification, appears to be a stronger predictor of sun exposure and protection than actual UV sensitivity measured by phototest.
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Affiliation(s)
- Magnus Falk
- Research and Development Unit for Local Health Care, County of Östergötland, Linköping, Sweden.
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Nowak M, Harrison SL, Buettner PG, Kimlin M, Porter D, Kennedy L, Speare R. Vitamin D status of adults from tropical Australia determined using two different laboratory assays: implications for public health messages. Photochem Photobiol 2011; 87:935-43. [PMID: 21534976 DOI: 10.1111/j.1751-1097.2011.00941.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We measured serum 25 hydroxyvitamin D [25(OH)D] levels of ambulatory adults in tropical Australia to determine whether it is appropriate to continue promoting sun-safety in this population. In August 2006 (winter), self-administered questionnaires were completed by 145 Meals-on-Wheels volunteers (49.3% male; mean age 57.8 ± 14.7 years; 76.6% response) from Townsville, Queensland (Latitude 19(o) S). Serum 25(OH)D was analyzed using two common assays. Mean levels were 68.3 (SD ± 18.7; range 26-142) by DiaSorin Radioimmunoassay and 83.0 (SD ± 30.8; range 30-184) by DiaSorin Liaison® one. No participants were 25(OH)D deficient (<25 nmol L(-1)). Nine participants (6.2%) had 25(OH)D levels between 25 and 50 nmol L(-1) (insufficient), by both methods (seven with a BMI ≥ 25). Twenty-eight participants (19.3%) had one result in the insufficient range and the other in the adequate range. Thus, almost all of these free-living adults in tropical Australia had adequate vitamin D levels at the end of winter. There was poor agreement between the two 25(OH)D assays. These results suggest it is appropriate to continue promoting sun-safe messages to the ambulatory Caucasian adult population of North Queensland, which has an extremely high incidence of skin cancer. The lack of agreement between the two assays is a concern. Few doctors are aware of this measurement issue.
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Affiliation(s)
- Madeleine Nowak
- North Queensland Centre for Cancer Research, School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
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Reeder AI, Hammond VA, Gray AR. Questionnaire items to assess skin color and erythemal sensitivity: reliability, validity, and "the dark shift". Cancer Epidemiol Biomarkers Prev 2010; 19:1167-73. [PMID: 20447914 DOI: 10.1158/1055-9965.epi-09-1300] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Skin pigmentation is a key factor for UV radiation exposure related cancers. To appropriately target cancer control activities related to this exposure and for better representation in epidemiologic studies, a valid and reliable assessment of skin color is required. METHODS The validity and reliability of two self-report measures were assessed: skin color and erythemal sensitivity. A sample of 289 university students categorized their unexposed skin color and photosensitivity via a questionnaire. Skin color was also measured by spectrophotometer. After 7 days, participants repeated the self-report assessment. RESULTS Significant correlations were found for both self-report items with objective measures, indicating that these items may be valid assessment tools (color: Spearman's rho=-0.75, P<0.001; photosensitivity: Spearman's rho=-0.64, P<0.001). No sex differences in validity were evident. Stronger correlations were found among those of European than those of non-European ethnicity (color: Spearman's rho=-0.78 versus -0.59, bootstrap P=0.007; photosensitivity: Spearman's rho=-0.63 versus -0.28, bootstrap P=0.001). Strong biases toward overestimation of skin pigmentation were evident, ranging from 36% in the self-identified fair skin group to 77% in the medium skin color group. Intrarater reliability of the questionnaire items was high (color: k=0.78, P<0.001; photosensitivity: k=0.77, P<0.001). CONCLUSIONS Study findings suggest that self-report may be a valid measurement strategy when assessing skin type, but there is a bias toward overestimation of skin color and, potentially, UV radiation resilience. IMPACT This bias has the potential to undermine the effectiveness of skin cancer prevention efforts and needs to be addressed in health promotion programs.
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Affiliation(s)
- Anthony I Reeder
- Cancer Society of New Zealand Social & Behavioural Research Unit, Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin 9054, New Zealand.
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Assessment of a new questionnaire for self-reported sun sensitivity in an occupational skin cancer screening program. BMC DERMATOLOGY 2008; 8:4. [PMID: 18950496 PMCID: PMC2582222 DOI: 10.1186/1471-5945-8-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 10/24/2008] [Indexed: 11/10/2022]
Abstract
Background Sun sensitivity of the skin is a risk factor for the development of cutaneous melanoma and other skin cancers. Epidemiological studies on causal factors for the development of melanoma must control for sun sensitivity as a confounder. A standardized instrument for measuring sun sensitivity has not been established yet. It is assumed that many studies show a high potential of residual confounding for sun sensitivity. In the present study, a new questionnaire for the assessment of self-reported sun sensitivity is administered and examined. Methods Prior to an occupational skin cancer screening program, the 745 participating employees were asked to fill in a questionnaire for self-assessment of sun sensitivity. The questionnaire was developed by experts of the working group "Round Table Sunbeds" (RTS) to limit the health hazards of sunbed use in Germany. A sun sensitivity score (RTS-score) was calculated using 10 indicators. The internal consistency of the questionnaire and the agreement with other methods (convergent validity) were examined. Results The RTS-score was calculated for 655 study participants who were 18 to 65 years of age. The correlation of the items among each other was between 0.12 and 0.62. The items and the RTS-score correlated between 0.46 and 0.77. The internal consistency showed a reliability coefficient with 0.82 (Cronbach's alpha). The comparison with the Fitzpatrick classification, the prevailing standard, was possible in 617 cases with a rank correlation of rs = 0.65. The categorization of the RTS-score in four risk groups showed correct classification to the four skin types of Fitzpatrick in 75% of the cases. Other methods for the assessment of sun sensitivity displayed varying agreements with the RTS-score. Conclusion The RTS questionnaire showed a sufficient internal consistency. There is a good convergent validity between the RTS-score and the Fritzpatrick classification avoiding shortcomings of the prevailing standard. The questionnaire represents a simple, reliable and valid instrument for the assessment of sun sensitivity. The questionnaire can be useful for epidemiological studies as well as for skin cancer prevention. Further development and standardization of sun sensitivity assessments is necessary to strengthen the evidence of epidemiological studies on causal factors of melanoma and other skin cancers.
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Benvenuto-Andrade C, Zen B, Fonseca G, Villa D, Cestari T. Sun Exposure and Sun Protection Habits Among High-school Adolescents in Porto Alegre, Brazil¶. Photochem Photobiol 2007. [DOI: 10.1111/j.1751-1097.2005.tb00236.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Harrison SL, Buettner PG, Maclennan R. The North Queensland "Sun-Safe Clothing" study: design and baseline results of a randomized trial to determine the effectiveness of sun-protective clothing in preventing melanocytic nevi. Am J Epidemiol 2005; 161:536-45. [PMID: 15746470 DOI: 10.1093/aje/kwi081] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 1999, the authors began recruitment for a randomized controlled intervention trial aimed at preventing melanocytic nevi (moles) by minimizing sun exposure through the use of sun-protective clothing. The study involves 652 Caucasian children (75.6% response) aged 0-35 months from 25 child-care centers (n = 13 intervention and n = 12 control) living in the high-solar-irradiance environment of Townsville, Queensland, Australia. Children attending intervention centers wear investigator-provided garments made from fabrics with ultraviolet protection factors rated very good to excellent. Control centers continue to offer usual care. Three-year follow-up of all children will be completed in 2005. The main outcome measure is the number of new melanocytic nevi. At baseline, the two groups were similar with respect to nevi, phenotype, age, demographic characteristics, sun-protection habits, and history of sun exposure, except that more children from control versus intervention centers (2% and 0%, respectively; p = 0.006) had experienced painful sunburn with blistering. Higher melanocytic nevus counts were associated with more time spent outdoors and a history of sunburn, while sunscreen use, particularly during the mild winter months, appeared to have a protective effect. These findings further substantiate the hypothesis that nevus development in young children is related to sun exposure.
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Affiliation(s)
- Simone L Harrison
- Skin Cancer Research Group, North Queensland Center for Cancer Research, School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia 4811.
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Benvenuto-Andrade C, Zen B, Fonseca G, De Villa D, Cestari T. Sun Exposure and Sun Protection Habits Among High-school Adolescents in Porto Alegre, Brazil¶. Photochem Photobiol 2005. [DOI: 10.1562/2005-01-25-ra-428.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pfahlberg A, Uter W, Kraus C, Wienecke WR, Reulbach U, Kölmel KF, Gefeller O. Monitoring of nevus density in children as a method to detect shifts in melanoma risk in the population. Prev Med 2004; 38:382-7. [PMID: 15020171 DOI: 10.1016/j.ypmed.2003.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nevus density in children, a well-known risk factor for malignant melanoma, depends both on constitutional factors and on previous ultraviolet (UV) exposure. Secular trends of childhood UV exposure could thus be indirectly monitored by repeated standardized surveys assessing nevus density in children, such as the "childhood monitoring of nevus density (CMONDE-Study)". METHODS Two complete surveys comprising all children at the time of school enrolment were performed in the city and county of Göttingen, Germany, during the years 1999 and 2000. A total of 4252 children with a median age of 6.25 years were examined as part of the mandatory school enrolment health assessment, and complete data were available for 3881 children. RESULTS Median nevus density was 5.8/m(2) in the entire study group. The subgroup-specific median increased from "Fitzpatrick skin type" IV to II, but the density was not increased for the type I subgroup. Similarly, nevus density rose with increasing lightness of hair color, but was very low in red-haired individuals. While the number of freckles was also strongly associated with nevus density, the association between iris color and skin reflectance, respectively, was weak. The duration of the additional examination for CMONDE was on average 3-5 min per child. CONCLUSION We regard CMONDE as a highly feasible surveillance instrument, which should be implemented as an important addition to regular regional or national health reporting.
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Affiliation(s)
- A Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Boldeman C, Dal H, Kristjansson S, Lindelöf B. Is self-assessment of skin type a valid method for adolescents? J Am Acad Dermatol 2004; 50:447-9. [PMID: 14988689 DOI: 10.1016/j.jaad.2003.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Self-assessed sun sensitivity (skin type) according to Fitzpatrick's classification has been reported to have drawbacks. Data from a cross-sectional study of tanning habits in Stockholm, Sweden, showed an underestimation of sun sensitivity among adolescents. Cautionary advice regarding sun and sun bed exposure, and sunscreen use versus skin type may have to be revised.
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Affiliation(s)
- Cecilia Boldeman
- Center of Public Health, Stockholm County Council, Box 175 33, SE-119 81 Stockholm, Sweden.
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Fuchs SC, Guimarães SM, Sortica C, Wainberg F, Dias KO, Ughini M, Castro JAS, Fuchs FD. Reliability of race assessment based on the race of the ascendants: a cross-sectional study. BMC Public Health 2002; 2:1. [PMID: 11860611 PMCID: PMC65507 DOI: 10.1186/1471-2458-2-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2001] [Accepted: 01/16/2002] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Race is commonly described in epidemiological surveys based on phenotypic characteristics. Training of interviewers to identify race is time-consuming and self identification of race might be difficult to interpret. The aim of this study was to determine the agreement between race definition based on the number of ascendants with black skin colour, with the self-assessment and observer's assessment of the skin colour. METHODS In a cross-sectional study of 50 women aged 14 years or older, from an outpatient clinic of an University affiliated hospital, race was assessed through observation and the self-assignment of the colour of skin and by the number of black ascendants including parents and grandparents. Reliability was measured through Kappa coefficient. RESULTS Agreement beyond chance between self-assigned and observed skin colour was excellent for white (0.75 95% CI 0.72-0.78) and black women (0.89 95% CI 0.71-0.79), but only good for participants with mixed colour (0.61 95% CI 0.58-0.64), resulting in a global kappa of 0.75 (95% CI 0.71-0.79). However, only a good agreement for mixed women was obtained. The presence of 3 or more black ascendants was highly associated with observed and self-assessed black skin colour. Most women self-assigned or observed as white had no black ascendants. CONCLUSIONS The assessment of race based on the race of ascendants showed reasonable agreement with the ascertainment done by trained interviewers and with the self-report of race. This method may be considered for evaluation of race in epidemiological surveys, since it is less time-consuming than the evaluation by interviewers.
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Affiliation(s)
- Sandra C Fuchs
- Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Sylvia M Guimarães
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Cristine Sortica
- School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Fernanda Wainberg
- School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Karine O Dias
- School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Mariana Ughini
- School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - José Augusto S Castro
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Flavio D Fuchs
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
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