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Friday S, Salisbury K, Snyder S, Strowd L. Evaluating How a School-Based Skin Cancer Prevention Program Can Change Behavior Among North Carolina Highschoolers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:174-179. [PMID: 38062342 DOI: 10.1007/s13187-023-02391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 04/05/2024]
Abstract
The incidence of skin cancer has risen steadily over recent decades. Childhood and adolescent sun exposure remains a critical risk factor in skin cancer development, making education of high schoolers imperative for promoting sun-safe behaviors. Medical students in North Carolina recognized this need and designed a skin cancer education program focused on portraying skin cancer in individuals with all Fitzpatrick skin phototypes. Eighty-seven students completed the pre-survey, and 84 completed the post-session survey. In the post-survey, 88% of students listed actionable behavioral changes they plan to make following the presentation. Following an educational session, students were able to demonstrate their new knowledge and provide meaningful behavioral changes. This program navigated challenges posed by COVID-19 and addressed the need for more inclusive skin cancer educational material.
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Affiliation(s)
- Sarah Friday
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Katherine Salisbury
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Stephanie Snyder
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Lindsay Strowd
- Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
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Feng YR, Ward S, Lopez D, Minto C, Blane S, Preen DB. Evaluation of the awareness of Western Australian SunSmart campaigns between 2008 and 2022. Health Promot J Austr 2024. [PMID: 38402863 DOI: 10.1002/hpja.851] [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: 08/29/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
ISSUE ADDRESSED It is unknown whether SunSmart health promotion campaigns in Western Australia are still effectively reaching their target audience of young people (under 45 years). This study examined trends over time in awareness, relevancy and believability of SunSmart advertisements and identified socio-demographic characteristics and risk factors associated with campaign awareness. METHOD Linear regression and log-binomial modelling were undertaken using data from the annual SunSmart post-campaign evaluation surveys between 2008/2009 and 2021/2022. SunSmart campaigns were analysed and categorised into the following themes: (1) personal real-life stories; (2) daily activities/sun exposure leads to skin cancer; or (3) cartoon/animated. RESULTS Between 2008 and 2022, there were declines in total awareness (74.2% to 20.4%), unprompted awareness (33.7% to 4.9%) and relevancy (89.5% to 54.8%) of SunSmart advertisements (representing annual percent decreases of 3.6%, 3.1% and 1.8%, respectively). However, believability remained high over time (>94% in each annual survey). Trends were inconsistent between the awareness of campaign themes and socio-demographic characteristics and risk factors. Several campaigns had greater awareness in their subsequent years, compared with the first campaign year. CONCLUSION In more recent years, SunSmart advertisements and campaigns may not have reached their target audience. In addition to socio-demographic characteristics, particularly age, advertisement factors may also affect the awareness of specific campaigns. SO WHAT?: Given the changing advertising landscape and its rising costs, ongoing funding is pertinent to increase the reach of future SunSmart campaigns. Increasing advertisements on alternative platforms and designing campaigns which separately target adolescents and adults need to be considered.
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Affiliation(s)
- Ying Ru Feng
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Ward
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Carolyn Minto
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Sally Blane
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Proesmans K, Van Vaerenbergh F, Lahousse L. The role of community pharmacists in primary and secondary prevention of skin cancer: an evaluation of a Flemish skin cancer prevention campaign. BMC Public Health 2023; 23:2490. [PMID: 38087215 PMCID: PMC10717840 DOI: 10.1186/s12889-023-17429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Skin cancer is a leading form of cancer in Belgium. Prevention of skin cancer by community pharmacists can play a role in increasing awareness and promoting sun protection. However, which persons could be reached by community pharmacists for skin cancer awareness in Belgium and whether this increased awareness is associated with increased sun protection and early detection remains unclear. METHODS Demographics of approached persons in Flemish community pharmacies during the months of May-June 2022 and the content of the skin cancer counseling were retrieved from the pharmacy database. Sunscreen purchases and dermatologist visits were evaluated up to 180 days after the skin cancer counseling. RESULTS Community pharmacists provided skin cancer counseling to a broad population of visitors (n = 822, 69% females, median age of 59 years Q1-Q3: 44-71 years). During the campaign, 822 visitors received a leaflet with skin cancer prevalence and sunscreen importance. On top of that, 335 visitors (41%) received additional counseling: skin type sensitivity was checked for 198 visitors (24%), typical characteristics of melanoma were discussed with 100 visitors (12%) and 37 visitors (5%) were referred to a physician for further information or concerns regarding a skin spot. Overall, one out of three visitors purchased sunscreen on the day of the counseling (33%, increasing up to 38% after 180 days). Among people under 20 years, this was even higher (51%). Additional counseling increased the likelihood of a dermatologist visit within 180 days (OR = 1.80; 95%CI: 1.12-2.88). CONCLUSIONS By providing skin cancer counseling in Belgian community pharmacies, a broad range of citizens was reached and triggered to purchase sunscreen, often on the same day as the counseling. Notably, young people were likely to purchase sunscreen. Citizens receiving additional counseling were more likely to visit a dermatologist within 180 days.
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Affiliation(s)
- Kristiaan Proesmans
- Faculty of Pharmaceutical Sciences, Department of Bio-analysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, Ghent, 9000, Belgium
| | - Frauke Van Vaerenbergh
- Faculty of Pharmaceutical Sciences, Department of Bio-analysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, Ghent, 9000, Belgium
| | - Lies Lahousse
- Faculty of Pharmaceutical Sciences, Department of Bio-analysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, Ghent, 9000, Belgium.
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Etoori D, Desai M, Mandal S, Rosenberg W, Sabin CA. A scoping review of media campaign strategies used to reach populations living with or at high risk for Hepatitis C in high income countries to inform future national campaigns in the United Kingdom. BMC Infect Dis 2023; 23:629. [PMID: 37752434 PMCID: PMC10523688 DOI: 10.1186/s12879-023-08603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND With the advent of direct acting antivirals, the World Health Organisation proposed eliminating Hepatitis C as a public health threat by 2030. To achieve this, countries need to diagnose, engage in care and treat their undiagnosed populations. This will require sensitisation campaigns. However previous media campaigns have had mixed impact. We conducted a scoping review to identify and understand the impact of previous Hepatitis C media campaigns. These findings could inform the delivery of future campaigns. METHODS We searched five electronic databases for published literature on media campaigns conducted for Hepatitis C awareness, testing, and treatment in Organisation for Economic Co-operation and Development (OECD) countries since 2010. Two independent reviewers screened citations for inclusion. Additionally, we spoke to stakeholders in the Hepatitis C field in the UK and conducted a Google search to identify any unpublished literature. A quantitative synthesis was conducted to identify targeted populations, strategies and media used, aims and impact of the campaigns. RESULTS A title and year of publication screening of 3815 citations resulted in 113 papers that had a full abstract screen. This left 50 full-text papers, 18 were included of which 9 (50%) were from Europe. 5 (27.8%) of campaigns targeted minority ethnicities, and 9 (50%) aimed to increase testing. A Google search identified 6 grey literature sources. Most campaigns were not evaluated for impact. Discussions with stakeholders identified several barriers to successful campaigns including lack of targeted messaging, stigmatising or accusatory messaging, and short-lived or intermittent campaign strategies. CONCLUSION Future campaigns will likely need to be multifaceted and have multiple tailored interventions. Campaigns will need to be sizeable and robust, integrated into health systems and viewed as an ongoing service rather than one-offs.
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Affiliation(s)
- David Etoori
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - William Rosenberg
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at UCL in partnership with the UK Health Security Agency (UKHSA), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Thoonen K, Woodhouse S, Minto C, Blane S, Talati Z. Patterns of Sun Protection Behaviours among Australian Adolescents and Adults over a Six-Year Period. Curr Oncol 2023; 30:7178-7188. [PMID: 37623001 PMCID: PMC10453427 DOI: 10.3390/curroncol30080520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The major cause for skin cancer is the excessive and unprotected exposure to ultraviolet radiation (UVR), which can be prevented by engaging in sun protection behaviours. As longitudinal studies on both adolescents' and adults' performances of sun protection behaviours are limited, the current study aimed to investigate changes in sun protection in these population segments in Western Australia, a region with high annual UVR. During six summer seasons (2015/16 to 2020/21), cross-sectional surveys were conducted among 1806 adolescents (14 to 17 years old) and 1808 adults (18-45 years old), investigating the frequency of five sun protection behaviours (wearing clothing, applying sunscreen, wearing a hat, wearing sunglasses, and seeking shade) and sun avoidance (staying indoors). Over the six-year period, staying indoors increased in both groups. Among adolescents, a decrease in wearing clothing and sunglasses and an increase in seeking shade was demonstrated, and hat and sunscreen use remained relatively stable. Among adults, an increase in sunscreen use was shown, whereas all other sun-related behaviours remained consistent over the six-year period. The results from this study can provide directions for health communications focusing on improving sun protection behaviours among both adolescent and adult populations.
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Affiliation(s)
- Karlijn Thoonen
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne 3010, Australia
| | - Sade Woodhouse
- School of Population Health, Curtin University, Perth 6845, Australia (Z.T.)
| | - Carolyn Minto
- Cancer Council Western Australia, Perth 6008, Australia;
| | - Sally Blane
- Cancer Council Western Australia, Perth 6008, Australia;
| | - Zenobia Talati
- School of Population Health, Curtin University, Perth 6845, Australia (Z.T.)
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Lagacé F, Noorah BN, Conte S, Mija LA, Chang J, Cattelan L, LeBeau J, Claveau J, Turchin I, Gulliver W, Gniadecki R, Netchiporouk E, Miller Jr. WH, Salopek TG, Rahme E, Peláez S, Litvinov IV. Assessing Skin Cancer Risk Factors, Sun Safety Behaviors and Melanoma Concern in Atlantic Canada: A Comprehensive Survey Study. Cancers (Basel) 2023; 15:3753. [PMID: 37568569 PMCID: PMC10417242 DOI: 10.3390/cancers15153753] [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: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma (CM) is increasing at an alarming rate in Canada and elsewhere around the world. Significant regional differences in CM incidence have been identified in Atlantic provinces. The goal of this study is to compare ultraviolet exposure, sun protective behaviours, level of worry and baseline CM knowledge in provinces with a high versus low incidence of CM as well, as between various demographic groups. METHODS A cross-sectional survey study was conducted in Atlantic provinces between July 2020 and August 2022. All participants aged ≥ 16 years with a completed survey were eligible. Survey responses were summarized using frequency counts, percentages, and means. Two-sided Z-tests for equality of proportions and logistic regression models were used to compare the survey results between geographic and demographic groups. RESULTS In total, 7861 participants were included (28.0% men; mean age 61.3 years; response rate 28%). Our results (gender- and age-adjusted odds ratio, 95% confidence interval) show that high-incidence provinces for CM (Prince Edward Island and Nova Scotia) had significantly more sunburns (OR 2.00, 1.72-2.31), total sun exposure (OR 2.05, 1.68-2.50), recreational sun exposure (OR 1.95, 1.61-2.35) and tans (OR 1.77, 1.53-2.05) than individuals in low-incidence provinces (Newfoundland and Labrador). However, individuals in high-incidence provinces displayed more protective behaviors: there were less tanning bed users (OR 0.82, 0.71-0.95), they checked their skin more frequently for new moles (OR 1.26, 1.06-1.51) and practiced more sun protection overall. Additional analyses are presented based on education, income, sexual orientation and gender. DISCUSSION These findings suggest that future efforts aimed at reducing the CM burden in Atlantic Canada should be tailored for target geographic and/or demographic groups. LIMITATIONS the study participants are not representative of the population in Atlantic Canada due to recruitment strategies.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Bibi Nuzha Noorah
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Santina Conte
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada
| | | | - Jasmine Chang
- Department of Family Medicine, McGill University, Montréal, QC H4A 3J1, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Jonathan LeBeau
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada
| | - Joël Claveau
- Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Melanoma and Skin Cancer Clinic, Québec City, QC G1R 4H6, Canada
| | - Irina Turchin
- Division of Dermatology, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Wayne Gulliver
- Division of Dermatology, Department of Medicine, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Wilson H. Miller Jr.
- Department of Medicine and Oncology, McGill University, Montréal, QC H3T 1J4, Canada
| | - Thomas G. Salopek
- Division of Dermatology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montréal, QC H3T 1J4, Canada
| | - Sandra Peláez
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, Montréal, QC H3C 3J7, Canada;
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
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Trenerry C, Fletcher C, Wilson C, Gunn K. "She'll Be Right, Mate": A Mixed Methods Analysis of Skin Cancer Prevention Practices among Australian Farmers-An At-Risk Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052940. [PMID: 35270633 PMCID: PMC8910209 DOI: 10.3390/ijerph19052940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/23/2022]
Abstract
This study examined Australian farmers’ engagement with skin cancer prevention behaviours and explored what made it hard for them to be ‘SunSmart’ (barriers), and what could be done to make prevention easier (facilitators). In total, 498 farmers (83.1% male, 22–89 years, 50.8% grain, sheep, or cattle farmers) participated. The least frequently performed SunSmart behaviours (reported as never practiced during summer) were using SPF 30+ sunscreen (16.6%), wearing protective sunglasses (10.5%), and wearing protective clothing (8.6%). Greater engagement (i.e., higher scores on scale from Never to Always) with SunSmart behaviours was explained by gender (female), educational attainment (trade or technical college certificate vs. high school), personal skin cancer history, and skin sun sensitivity. Barriers reported by farmers related to personal preferences (e.g., short-sleeved rather than long-sleeved clothing), comfort, and perceived impracticality of sun protection. Farmers’ solutions included making protective clothing and sunscreen more appropriate for farm work (e.g., by making clothing more breathable). A personal health scare was the most reported motivation for skin cancer prevention. Findings highlight the need for increased access to sun-protective clothing and sunscreen that is suitable for wearing when working on farms, complemented by culturally appropriate health education messaging, to encourage more farmers to perform SunSmart behaviours.
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Affiliation(s)
- Camilla Trenerry
- School of Psychology, The University of Adelaide, Adelaide, SA 5000, Australia;
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA 5000, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Chloe Fletcher
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
| | - Carlene Wilson
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
- Olivia Newton John Cancer Wellness Research Centre, Austin Health, Heidelberg, VIC 3084, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3083, Australia
| | - Kate Gunn
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA 5000, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
- Correspondence:
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Saginala K, Barsouk A, Aluru JS, Rawla P, Barsouk A. Epidemiology of Melanoma. Med Sci (Basel) 2021; 9:63. [PMID: 34698235 PMCID: PMC8544364 DOI: 10.3390/medsci9040063] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
Melanoma accounts for 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. Melanoma incidence is rising in developed, predominantly fair-skinned countries, growing over 320% in the US since 1975. However, US mortality has fallen almost 30% over the past decade with the approval of 10 new targeted or immunotherapy agents since 2011. Mutations in the signaling-protein BRAF, present in half of cases, are targeted with oral BRAF/MEK inhibitor combinations, while checkpoint inhibitors are used to restore immunosurveillance likely inactivated by UV radiation. Although the overall 5-year survival has risen to 93.3% in the US, survival for stage IV disease remains only 29.8%. Melanoma is most common in white, older men, with an average age of diagnosis of 65. Outdoor UV exposure without protection is the main risk factor, although indoor tanning beds, immunosuppression, family history and rare congenital diseases, moles, and obesity contribute to the disease. Primary prevention initiatives in Australia implemented since 1988, such as education on sun-protection, have increased sun-screen usage and curbed melanoma incidence, which peaked in Australia in 2005. In the US, melanoma incidence is not projected to peak until 2022-2026. Fewer than 40% of Americans report practicing adequate protection (sun avoidance from 10 a.m.-4 p.m. and regular application of broad-spectrum sunscreen with an SPF > 30). A 2-4-fold return on investment is predicted for a US sun-protection education initiative. Lesion-directed skin screening programs, especially for those at risk, have also cost-efficiently reduced melanoma mortality.
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Affiliation(s)
- Kalyan Saginala
- Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA;
| | - Adam Barsouk
- Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - John Sukumar Aluru
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02212, USA;
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Haynes A, Nathan A, Maitland C, Dixon H, Nicholson A, Wakefield M, Dobbinson S. Prevalence and Correlates of Observed Sun Protection Behaviors Across Different Public Outdoor Settings in Melbourne, Australia. HEALTH EDUCATION & BEHAVIOR 2021; 49:405-414. [PMID: 34238043 DOI: 10.1177/10901981211026535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Skin cancer prevention efforts in Australia have increasingly incorporated a focus on protection during incidental sun exposure. This complements the long-present messages promoting protection in high-risk settings and avoidance of acute intense bouts of sun exposure. Data from two waves of a cross-sectional direct observational survey was used to assess the prevalence and correlates of N = 12,083 adolescents' and adults' sun protection behavior (arm and leg cover, hat, sunglasses, and shade cover). Individuals were observed in public outdoor settings in Melbourne, Australia during peak ultraviolet (UV) times (11 a.m.-3 p.m.) on summer weekends. Settings included pools and beaches, parks and gardens, and for the first time in 2018, outdoor streets and cafés which may capture more incidental forms of sun exposure and represent another public setting where Australians commonly spend time outdoors. Females and older adults were consistently better protected than males and adolescents. Physical activity was strongly associated with low shade cover across settings. Weather was more strongly associated with sun protection at outdoor streets/cafes and parks/gardens than at pools/beaches but use of observed sun protection (particularly arm cover and covering hat) was low across settings. Continued public education about UV risk and its relation to weather and the seasons is needed to promote the routine use of multiple forms of sun protection during outdoor activities in peak UV times, especially among males and adolescents. Findings also highlight the importance of considering activity demands of public spaces in shade planning to optimize sun protection during outdoor activities in public spaces.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Andrea Nathan
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia
| | - Clover Maitland
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anna Nicholson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Suzanne Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
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10
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Correia O, Correia J, Correia B, Duarte AF. Outdoor advertising as a way of skin cancer prevention. Int J Dermatol 2020; 60:e235-e236. [PMID: 33332612 DOI: 10.1111/ijd.15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Osvaldo Correia
- Portuguese Skin Cancer Association, Porto, Portugal.,Centro Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,Basic and Clinical Immunology Unit, Faculty of Medicine, University do Porto, Porto, Portugal
| | | | | | - Ana F Duarte
- Portuguese Skin Cancer Association, Porto, Portugal.,Centro Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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11
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Prichard I, Kneebone A, Hutchinson AD, Wilson C. The relationship between skin tone dissatisfaction and sun tanning behaviour. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ivanka Prichard
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
| | - Anna Kneebone
- Cancer Council South Australia, Adelaide, South Australia, Australia,
| | - Amanda D. Hutchinson
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
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12
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Morris K, Swinbourne A. Identifying prototypes associated with sun‐related behaviours in North Queensland. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kayla Morris
- Department of Psychology, School of Arts and Social Sciences, James Cook University, Townsville, Queensland, Australia,
| | - Anne Swinbourne
- Department of Psychology, School of Arts and Social Sciences, James Cook University, Townsville, Queensland, Australia,
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Leske S, Young RM, White KM, Hawkes AL. A Qualitative Exploration of Sun Safety Beliefs Among Australian Adults. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stuart Leske
- School of Psychology and Counselling, Queensland University of Technology,
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
| | - Ross Mcd Young
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
- Faculty of Health, Queensland University of Technology,
| | - Katherine Marie White
- School of Psychology and Counselling, Queensland University of Technology,
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
| | - Anna L Hawkes
- Faculty of Health, Queensland University of Technology,
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland,
- School of Public Health and Social Work, Queensland University of Technology,
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Haynes A, Nathan A, Dixon H, Wakefield M, Dobbinson S. Sun-protective clothing and shade use in public outdoor leisure settings from 1992 to 2019: Results from cross-sectional observational surveys in Melbourne, Australia. Prev Med 2020; 139:106230. [PMID: 32768510 DOI: 10.1016/j.ypmed.2020.106230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/11/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
Skin cancer presents a significant public health burden in Australia. The present study aimed to supplement population-based estimates of sun protection behaviour by examining setting-specific trends in directly observed sun protection in public outdoor leisure settings. Repeated cross-sectional observational surveys of adolescents and adults were conducted on summer weekends between 11 am and 3 pm from 1992 to 2002, 2006 to 2012, and 2018 to 2019 (N = 44,979) at pools/beaches and parks/gardens within 25 km of the centre of Melbourne, Victoria. The primary outcome was a binary index representing individuals having above or below the median level of body surface covered by hat, shirt, and leg garments in each setting type. The prevalence of above-median body coverage increased between 1992 and 2002 in both settings. At pools/beaches, a slight decline in above-median body coverage between 2006 and 2019 in males and females (adjusted odds ratio, AOR = 0.96 [0.94, 0.97]; 0.94 [0.93, 0.95]) appeared to be driven by a decline in leg coverage, while arm coverage, hat, sunglasses, and shade use remained stable. At parks/gardens, a decline in above-median body coverage between 2006 and 2019 (AOR = 0.90 [0.89, 0.91]; 0.94 [0.93, 0.95]) was accompanied by small declines across other protective behaviours that varied between males and females. Patterns in protective behaviours observed in outdoor leisure settings may reflect the changing composition of individuals choosing to remain outdoors during peak UV times and highlight the importance of continued promotion and monitoring of the use of multiple measures to protect against UV damage in Australia.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia.
| | - Andrea Nathan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia
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Bolick NL, Huang L, Mostaghimi A, Hartman RI. Temporal trends in primary and secondary skin cancer prevention in the United States. J Am Acad Dermatol 2020; 83:1191-1192. [DOI: 10.1016/j.jaad.2020.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 11/25/2022]
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16
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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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Greco SL, MacIntyre E, Young S, Warden H, Drudge C, Kim J, Candido E, Demers P, Copes R. An approach to estimating the environmental burden of cancer from known and probable carcinogens: application to Ontario, Canada. BMC Public Health 2020; 20:1017. [PMID: 32590953 PMCID: PMC7320572 DOI: 10.1186/s12889-020-08771-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantifying the potential cancer cases associated with environmental carcinogen exposure can help inform efforts to improve population health. This study developed an approach to estimate the environmental burden of cancer and applied it to Ontario, Canada. The purpose was to identify environmental carcinogens with the greatest impact on cancer burden to support evidence-based decision making. METHODS We conducted a probabilistic assessment of the environmental burden of cancer in Ontario. We selected 23 carcinogens that we defined as "environmental" (e.g., pollutants) and were relevant to the province, based on select classifications provided by the International Agency for Research on Cancer. We evaluated population exposure to the carcinogens through inhalation of indoor/outdoor air; ingestion of food, water, and dust; and exposure to radiation. We obtained or calculated concentration-response functions relating carcinogen exposure and the risk of developing cancer. Using both human health risk assessment and population attributable fraction models in a Monte Carlo simulation, we estimated the annual cancer cases associated with each environmental carcinogen, reporting the simulation summary (e.g., mean and percentiles). RESULTS We estimated between 3540 and 6510 annual cancer cases attributable to exposure to 23 environmental carcinogens in Ontario. Three carcinogens were responsible for over 90% of the environmental burden of cancer: solar ultraviolet (UV) radiation, radon in homes, and fine particulate matter (PM2.5) in outdoor air. Eight other carcinogens had an estimated mean burden of at least 10 annual cancer cases: acrylamide, arsenic, asbestos, chromium, diesel engine exhaust particulate matter, dioxins, formaldehyde, and second-hand smoke. The remaining 12 carcinogens had an estimated mean burden of less than 10 annual cancer cases in Ontario. CONCLUSIONS We found the environmental burden of cancer in Ontario to fall between previously estimated burdens of alcohol and tobacco use. These results allow for a comparative assessment across carcinogens and offer insights into strategies to reduce the environmental burden of cancer. Our analysis could be adopted by other jurisdictions and repeated in the future for Ontario to track progress in reducing cancer burden, assess newly classified environmental carcinogens, and identify top burden contributors.
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Affiliation(s)
- Susan Lavinia Greco
- Public Health Ontario, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Elaina MacIntyre
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Hunter Warden
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | - JinHee Kim
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elisa Candido
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paul Demers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ray Copes
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Bleakley A, Jordan AB, Strasser AA, Lazovich D, Glanz K. Testing General Versus Specific Behavioral Focus in Messaging for the Promotion of Sun Protection Behaviors. Ann Behav Med 2020; 54:108-118. [PMID: 31586204 DOI: 10.1093/abm/kaz032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recommendations for skin cancer prevention include behaviors such as using sunscreen, seeking shade, and wearing a shirt with sleeves, but the best way to persuasively communicate this information to the public is not clear. PURPOSE To test whether a messaging strategy using videos that focus on one specific behavior at a time versus a more general or multibehavior sun protection message is effective at changing attitudinal beliefs and intention with regard to sun protection behaviors. METHODS Online experiment among non-Hispanic white 18-49 year old adults in the USA. Participants were randomly assigned to one of four conditions, each one with health messages on a different sun protection prevention behavior: "using sunscreen" (Condition 1, n = 259), "seeking shade" (Condition 2, n = 245), or "covering up" (Condition 3, n = 289). Condition 4 (the control, n = 251) is a multibehavior message that equally promotes sunscreen, seeking shade, and covering up and features a general message on sun safety. RESULTS ANOVA and path analysis results suggest that messages which emphasize a single sun protection behavior compared with general sun safety messaging could potentially be a promising approach. The effectiveness of the videos in influencing attitudinal beliefs varied by behavior, with some gender and age moderation. There was an indirect effect on intention to use sunscreen. CONCLUSIONS This study advances our understanding of strategies for skin cancer prevention campaigns. Specifically, it suggests that focusing on a single sun protection behavior with targeted beliefs may be valuable as a first step in encouraging sun safety.
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Affiliation(s)
- Amy Bleakley
- Department of Communication, University of Delaware, Newark, DE
| | - Amy B Jordan
- School of Communication and Information, Rutgers the State University of New Jersey, New Brunswick, NJ
| | - Andrew A Strasser
- Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Deann Lazovich
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Karen Glanz
- Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.,School of Nursing, University of Pennsylvania, Philadelphia, PA
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Tabbakh T, Volkov A, Wakefield M, Dobbinson S. Implementation of the SunSmart program and population sun protection behaviour in Melbourne, Australia: Results from cross-sectional summer surveys from 1987 to 2017. PLoS Med 2019; 16:e1002932. [PMID: 31593565 PMCID: PMC6782093 DOI: 10.1371/journal.pmed.1002932] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Australia has one of the highest skin cancer rates in the world. 'SunSmart' is a multi-component, internationally recognised community-wide skin cancer prevention program implemented in Melbourne, Australia, since summer 1988-1989. Following recent reductions in melanoma rates among younger Australian cohorts, the extent of behaviour change and the potential contribution of prevention programs to this decline in melanoma rates are of interest. Sun protection is a multifaceted behaviour. Measures previously applied to monitor change over time in preventive behaviour for this population focused on individual behaviours. The omission of multiple behaviours that reduce exposure to ultraviolet radiation (UV) may have led to underestimates of behaviour change, meriting further analysis of long-term trends to contribute to this debate. METHODS AND FINDINGS A population-based survey was conducted in Melbourne in the summer before SunSmart commenced (1987-1988) and across summers in 3 subsequent decades (1988-2017). During summer months, residents (14-69 years) were recruited to cross-sectional weekly telephone interviews assessing their tanning attitudes, sun protection behaviour, and sunburn incidence on the weekend prior to interview. Quotas were used to ensure the sample was proportional to the population by age and sex, while younger respondents were oversampled in some years. The majority of the respondents reported their skin was susceptible to sunburn. Changes in sun protection behaviour were analysed for N = 13,285 respondents in multivariable models, cumulating surveys within decades (1987-1988: N = 1,655; 1990s: N = 5,258; 2000s: N = 3,385; 2010s: N = 2,987) and adjusting for relevant ambient weather conditions and UV levels on weekend dates. We analysed specific and composite behaviours including a novel analysis of the use of maximal sun protection, which considered those people who stayed indoors during peak UV hours together with those people well-protected when outdoors. From a low base, use of sun protection increased rapidly in the decade after SunSmart commenced. The odds of use of at least 1 sun protection behaviours on summer weekends was 3 times higher in the 1990s than pre-SunSmart (adjusted odds ratio [AOR] 3.04, 95% CI 2.52-3.68, p < 0.001). There was a smaller increase in use of maximal sun protection including shade (AOR = 1.68, 95% CI 1.44-1.97, p < 0.001). These improvements were sustained into the 2000s and continued to increase in the 2010s. Inferences about program effects are limited by the self-reported data, the absence of a control population, the cross-sectional study design, and the fact that the survey was not conducted in all years. Other potential confounders may include increasing educational attainment among respondents over time and exposure to other campaigns such as tobacco and obesity prevention. CONCLUSIONS With an estimated 20-year lag between sun exposure and melanoma incidence, our findings are consistent with SunSmart having contributed to the reduction in melanoma among younger cohorts.
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20
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Nicholson A, Murphy M, Walker H, Tinker R, Dobbinson S. Not part of my routine: a qualitative study of use and understanding of UV forecast information and the SunSmart app. BMC Public Health 2019; 19:1127. [PMID: 31420026 PMCID: PMC6698026 DOI: 10.1186/s12889-019-7421-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/31/2019] [Indexed: 11/21/2022] Open
Abstract
Background The Ultraviolet (UV) Index provides a reliable means of monitoring the strength of UV radiation at the Earth’s surface, which can be used to indicate the potential for skin damage. This qualitative study aims to examine public understanding of the UV Index among Australians who routinely use UV forecast information as well as those who do not. Methods Recent use of the SunSmart app (a popular mobile and tablet app that provides UV forecast information) served as a proxy for use of UV forecast information. Six focus groups were conducted with ‘new users’, who trialled the SunSmart app for the first time in the two weeks preceding the group discussion. In addition, 15 in-depth interviews were conducted with ‘existing users’, who routinely used the SunSmart app. Thematic discourse analysis was undertaken to compare views and experiences. Results Misperceptions about UV radiation were common. Participants learnt new information about UV radiation, the UV Index, and the times of the day that sun protection is recommended. Among adults who were using UV forecast information for the first time, this learning rarely translated to new behaviours; for these participants, the UV Index forecast information and recommendations were inconsistent with their own observation of the weather and subsequent judgement about their propensity to burn. Thus new users considered the UV forecast information to be overly cautious. In contrast, existing users recognised their inability to judge the UV Index level; for these participants, UV forecast information provided by the SunSmart app was incorporated into their daily routines and used to inform their sun protection behaviours. Conclusions/implications No matter how broadly UV forecast information is promoted, it is unlikely to improve sun protection behaviours across the Victorian population due to the low level of basic understanding of UV radiation. Public education strategies that correct the commonly held misperception that temperature and/or sunshine can reliably predict the potential for UV damage are required. Improved public awareness about UV radiation and how the UV Index can be used to prevent skin cancer may help Australians to develop more effective sun protection habits.
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Affiliation(s)
- Anna Nicholson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Michael Murphy
- MMResearch, 9 School Lane, Ferny Creek, Victoria, 3786, Australia
| | - Heather Walker
- SunSmart Victoria, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Rick Tinker
- Australian Radiation Protection and Nuclear Safety Agency, 619 Lower Plenty Road, Yallambie, Victoria, 3085, Australia
| | - Suzanne Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
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Vuong K, Armstrong BK, McGeechan K, Cust AE. Personalized melanoma risk assessments and tailored prevention advice: a pragmatic randomized controlled trial in Australian general practice. Fam Pract 2019; 36:237-246. [PMID: 29800131 DOI: 10.1093/fampra/cmy040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Personalized risk assessments using prediction models that incorporate several melanoma risk factors may promote melanoma-prevention behaviours. OBJECTIVES To evaluate the effect on short-term melanoma-prevention behaviours of web-based, real-time, model-generated personalized melanoma risk information and tailored prevention advice, and its feasibility and clinician acceptability. METHODS Between February and April 2016, in an open randomized controlled trial across four general medical practices in New South Wales, Australia, 272 patients were randomly allocated to receive (i) real-time model-generated personalized melanoma risk assessment and tailored melanoma-prevention advice or (ii) generic melanoma-prevention advice. We measured self-reported melanoma-prevention behaviours at baseline and 6 weeks and the intervention's feasibility and acceptability. RESULTS Follow-up questionnaires were completed by 185 patients at 6 weeks: 174 assessed as average risk and 11 as high or very high risk. There were no statistically significant differences between intervention and control patients in sun protection, sun exposure or early diagnosis behaviours. When stratified by melanoma risk, average risk patients in the intervention group appeared to show greater sun protection at 6 weeks (mean difference = 0.23, on a scale of 1-5; 95% confidence interval: 0.01 to 0.45; P = 0.04) than patients in the control group; the P value for interaction between intervention and risk category was 0.10. There was favourable feedback from patients and general practitioners. CONCLUSIONS Web-based delivery in general practice of real-time, model-generated personalized melanoma risk prediction and tailored melanoma-prevention advice is feasible and acceptable. An apparent increase in sun protection behaviour in average risk patients warrants further evaluation in different risk groups.
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Affiliation(s)
- Kylie Vuong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Bruce K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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23
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Mingoia J, Hutchinson AD, Gleaves DH, Wilson C. The impact of a social media literacy intervention on positive attitudes to tanning: A pilot study. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2018.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dexter B, King R, Harrison SL, Parisi AV, Downs NJ. A Pilot Observational Study of Environmental Summertime Health Risk Behavior in Central Brisbane, Queensland: Opportunities to Raise Sun Protection Awareness in Australia's Sunshine State. Photochem Photobiol 2018; 95:650-655. [DOI: 10.1111/php.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/27/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Ben Dexter
- Faculty of Health, Engineering and Sciences University of Southern Queensland Toowoomba QLD Australia
| | - Rachel King
- Faculty of Health, Engineering and Sciences University of Southern Queensland Toowoomba QLD Australia
| | - Simone L. Harrison
- Faculty of Health, Engineering and Sciences University of Southern Queensland Toowoomba QLD Australia
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville QLD Australia
| | - Alfio V. Parisi
- Faculty of Health, Engineering and Sciences University of Southern Queensland Toowoomba QLD Australia
| | - Nathan J. Downs
- Faculty of Health, Engineering and Sciences University of Southern Queensland Toowoomba QLD Australia
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville QLD Australia
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25
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Nkogatse MM, Ramotsehoa MC, Eloff FC, Wright CY. Solar Ultraviolet Radiation Exposure and Sun Protection Behaviors and Knowledge Among a High-Risk and Overlooked Group of Outdoor Workers in South Africa. Photochem Photobiol 2018; 95:439-445. [PMID: 30183090 DOI: 10.1111/php.13008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
Abstract
The exposure of outdoor car guards to solar ultraviolet radiation (UVR), the majority with deeply pigmented skin, to solar UVR was measured for five consecutive days during early spring (September 2017) in South Africa using electronic UVR dosimeters attached to the upper arm of each participant. The exposure of the nape of the neck, forehead, nose, cheek and hand was extrapolated from the measurements. The onsite ambient solar UVR on a flat, horizontal, unshaded surface was measured concurrently. The sun-related knowledge, behavior and attitudes of the car guards were evaluated using questionnaires. Total personal daily solar UVR exposure as a percentage of the ambient solar UVR exposure was 24%. The exposure of car guards on several body sites was in excess of the occupational threshold limit value. Sleeved shirts and hats were the most commonly used sun protection measures (worn by 70% and 80%, respectively). Considering the high levels of solar UVR reported on most days throughout the year in South Africa, more studies quantifying the personal exposure of outdoor workers in both the informal and formal sectors are necessary.
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Affiliation(s)
- Mahlako Malesele Nkogatse
- Occupational Hygiene and Health Research Initiative (OHHRI), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Motsehoa Cynthia Ramotsehoa
- Occupational Hygiene and Health Research Initiative (OHHRI), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Frederick Christofel Eloff
- Occupational Hygiene and Health Research Initiative (OHHRI), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Caradee Yael Wright
- Environmental and Health Research Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa.,Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, Gauteng
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26
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Grandahl K, Ibler KS, Laier GH, Mortensen OS. Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers. Environ Health Prev Med 2018; 23:47. [PMID: 30285623 PMCID: PMC6169023 DOI: 10.1186/s12199-018-0736-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To prevent occupational skin cancer, it is essential that the sun-protective behavior of outdoor workers is adequate. The aim is to study the sun-protective behavior of Danish outdoor workers at work, at leisure, and on sun holiday and compare it to that of indoor workers. METHODS This is a cross-sectional study, based on a 53-item survey completed by Danish outdoor (n = 380) and indoor workers (n = 119) in 2016-2017. Status as outdoor or indoor worker was decided based on self-report and behavioral differences were tested using (paired) t tests and multiple regression adjusted for age, sex, educational level, history of smoking, and skin type. RESULTS Danish outdoor workers at work use sun protection less than they do at leisure and on sun holiday (α < .05) where their sun protection behavior is similar to that of indoor workers. The proportion of Danish outdoor workers that always/often use sun protection at work is for shade seeking around noon 4.2%, sunscreen 34.5%, wide-brimmed hat 25.3%, and long trousers and shirt with sleeves 42.4%. Of Danish outdoor workers, 49.5% do not think about the risk of occupational skin cancer and 11.8% think the risk is insignificant, 32.4% think that the use of sun protection is of low or no importance, 84.2% consider sunburn important as skin cancer risk factor still 88.9% have a history of sunburn at work, > 80.0% agree that risk of skin cancer is reduced by the use of sun protection, and only 4.0% dismiss the possibility of sun protection use at work. CONCLUSIONS Skin cancer risk and use of sun protection at work are largely neglected in Danish outdoor workers, more so than at leisure and on sun holiday where their risk behavior resembles that of indoor workers. This indicates an untapped workplace preventive potential.
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Affiliation(s)
- Kasper Grandahl
- The Department of Occupational Medicine, Copenhagen University Holbaek, Gl. Ringstedvej 4B, 4300 Holbaek, Denmark
| | | | | | - Ole Steen Mortensen
- The Department of Occupational Medicine, Copenhagen University Holbaek, Gl. Ringstedvej 4B, 4300 Holbaek, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Køster B, Meyer M, Andersson T, Engholm G, Dalum P. Development in sunburn 2007-2015 and skin cancer projections 2007-2040 of campaign results in the Danish population. Medicine (Baltimore) 2018; 97:e12738. [PMID: 30313078 PMCID: PMC6203499 DOI: 10.1097/md.0000000000012738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/14/2018] [Indexed: 01/15/2023] Open
Abstract
Exposure to ultraviolet radiation is the main risk factor for skin cancer. Denmark has one of the highest incidences of skin cancer in the world. In 2007, a long-term sun safety campaign was launched in Denmark. We have evaluated the effects on prevalence of sunburn and modeled the effects on future melanoma incidence.Sunburn was evaluated by annual cross-sectional surveys representative for the Danish population on age, gender, and region. During 2007-2015, survey data were collected for 33.315 Danes. Cutaneous Melanoma incidences were modeled in the Prevent program, using population projections, historic incidence, sunburn exposure, and relative risk of sunburn on melanoma.The prevalence of sunburn in Denmark was reduced with 1% annually during 2007 to 2015. The campaign is estimated to have reduced the number of skin cancer cases with 664 annually in 2040 and 14.326 totally during 2007 to 2040. If the campaign was terminated in 2015 and sunburn rates return to precampaign level there would be no annual reduction in 2040 while in total the reduction would be 4.024 cases for 2007 to 2040. A continuous campaign until 2040 would yield annual reductions of 2.121 cases by 2040 and a total of 29.729 cases for the entire period.We have showed the value of prevention and the value of long-term planning in prevention campaigning. Sunburn use was reduced significantly during 2007-2015 and further reductions are possible. Consequently, we predict significant fewer skin cancer cases as anticipated.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
| | - Maria Meyer
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
| | - Therese Andersson
- Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
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Sun protective behaviours during maximum exposure to ultraviolet radiation when undertaking outdoor activities: an integrated literature review. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-0945-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Køster B, Søndergaard J, Nielsen JB, Olsen A, Bentzen J. Reliability and consistency of a validated sun exposure questionnaire in a population-based Danish sample. Prev Med Rep 2018; 10:43-48. [PMID: 29552457 PMCID: PMC5852403 DOI: 10.1016/j.pmedr.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/26/2017] [Accepted: 02/05/2018] [Indexed: 12/27/2022] Open
Abstract
An important feature of questionnaire validation is reliability. To be able to measure a given concept by questionnaire validly, the reliability needs to be high. The objectives of this study were to examine reliability of attitude and knowledge and behavioral consistency of sunburn in a developed questionnaire for monitoring and evaluating population sun-related behavior. Sun related behavior, attitude and knowledge was measured weekly by a questionnaire in the summer of 2013 among 664 Danes. Reliability was tested in a test-retest design. Consistency of behavioral information was tested similarly in a questionnaire adapted to measure behavior throughout the summer. The response rates for questionnaire 1, 2 and 3 were high and the drop out was not dependent on demographic characteristic. There was at least 73% agreement between sunburns in the measurement week and the entire summer, and a possible sunburn underestimation in questionnaires summarizing the entire summer. The participants underestimated their outdoor exposure in the evaluation covering the entire summer as compared to the measurement week. The reliability of scales measuring attitude and knowledge was high for majority of scales, while consistency in protection behavior was low. To our knowledge, this is the first study to report reliability for a completely validated questionnaire on sun-related behavior in a national random population based sample. Further, we show that attitude and knowledge questions confirmed their validity with good reliability, while consistency of protection behavior in general and in a week's measurement was low. Objectively validated questionnaires tested for reliability/behavioral consistency. Strong reliability of the knowledge and attitude items was shown. Knowledge about behavioral consistency between questionnaire measurement periods A recommendable design for short term evaluation of skin cancer prevention campaigns
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Affiliation(s)
- B Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.,Research Unit of General Practice, University of Southern, Denmark
| | - J Søndergaard
- Research Unit of General Practice, University of Southern, Denmark
| | - J B Nielsen
- Research Unit of General Practice, University of Southern, Denmark
| | - A Olsen
- Research Centre, Danish Cancer Society, Denmark
| | - J Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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Barrett F, Usher K, Woods C, Harrison SL, Nikles J, Conway J. Sun protective behaviors at an outdoor entertainment event in Australia. Nurs Health Sci 2017; 20:132-138. [DOI: 10.1111/nhs.12396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/19/2017] [Accepted: 09/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona Barrett
- School of Health; University of New England; Armidale New South Wales Australia
| | - Kim Usher
- School of Health; University of New England; Armidale New South Wales Australia
| | - Cindy Woods
- School of Health; University of New England; Armidale New South Wales Australia
| | - Simone L. Harrison
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences; James Cook University; Townsville Queensland Australia
| | - Jane Nikles
- Centre for Clinical Research, Faculty of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Jane Conway
- School of Health; University of New England; Armidale New South Wales Australia
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Buller DB, English DR, Buller MK, Simmons J, Chamberlain JA, Wakefield M, Dobbinson S. Shade Sails and Passive Recreation in Public Parks of Melbourne and Denver: A Randomized Intervention. Am J Public Health 2017; 107:1869-1875. [PMID: 29048958 DOI: 10.2105/ajph.2017.304071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To test whether shade sails will increase the use of passive recreation areas (PRAs). METHODS We conducted a stratified randomized pretest-posttest controlled design study in Melbourne, Australia, and Denver, Colorado, in 2010 to 2014. We randomized a sample of 144 public parks with 2 PRAs in full sun in a 1:3 ratio to treatment or control. Shade sails were built at 1 PRA per treatment park. The outcome was any use of the study PRA (n = 576 pretest and n = 576 posttest observations; 100% follow-up). RESULTS Compared with control PRAs (adjusted probability of use: pretest = 0.14, posttest = 0.17), use of treatment PRAs (pretest = 0.10, posttest = 0.32) was higher at posttest (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 1.71, 8.94). Shade increased use of PRAs in Denver (control: pretest = 0.18, posttest = 0.19; treatment: pretest = 0.16, posttest = 0.47) more than Melbourne (control: pretest = 0.11, posttest = 0.14; shaded: pretest = 0.06, posttest = 0.19; OR = 2.98; 95% CI = 1.09, 8.14). CONCLUSIONS Public investment in shade is warranted for skin cancer prevention and may be especially useful in the United States. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02971709.
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Affiliation(s)
- David B Buller
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
| | - Dallas R English
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
| | - Mary Klein Buller
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
| | - Jody Simmons
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
| | - James A Chamberlain
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
| | - Melanie Wakefield
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
| | - Suzanne Dobbinson
- David B. Buller and Mary Klein Buller are with Klein Buendel, Inc., Golden, CO. Dallas R. English is with the Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia. Jody Simmons, Melanie Wakefield, and Suzanne Dobbinson are with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne. James A. Chamberlain is with the Cancer Epidemiology Centre, Cancer Council Victoria
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Shih ST, Carter R, Heward S, Sinclair C. Skin cancer has a large impact on our public hospitals but prevention programs continue to demonstrate strong economic credentials. Aust N Z J Public Health 2017; 41:371-376. [DOI: 10.1111/1753-6405.12679] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/01/2017] [Accepted: 03/01/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sophy T.F. Shih
- Deakin Health Economics, Faculty of Health; Deakin University; Victoria
| | - Rob Carter
- Deakin Health Economics, Faculty of Health; Deakin University; Victoria
| | - Sue Heward
- SunSmart Program; Cancer Council Victoria
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Shih ST, Carter R, Heward S, Sinclair C. Economic evaluation of future skin cancer prevention in Australia. Prev Med 2017; 99:7-12. [PMID: 28131778 DOI: 10.1016/j.ypmed.2017.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/11/2016] [Accepted: 01/22/2017] [Indexed: 11/29/2022]
Abstract
Public health programs to reduce the significant burden of skin cancer have been implemented in Australia and around the world. The economic rationale for prevention needs to be kept up-to-date as relevant disease patterns, risk factors and expenditure patterns change through time. The aim of this study was to update and extend the economic credentials for skin cancer prevention in Australia. Economic evaluations were conducted in 2015 with multiple methods applied, including cost-effectiveness and cost-benefit analysis, multiple study perspectives ('societal', 'health sector', '3rd party funder') and counterfactual analysis sourced from cancer incidence between 1982 and 2011. Modelled outcomes included 'cases prevented', 'deaths averted' and 'health-adjusted life-years'. Cost-benefit Analysis, including productivity impacts in the general economy, was conducted. With an additional $AUD 0.16 ($USD 0.12) per capita investment into future skin cancer prevention across Australia, 140,000 skin cancer cases would be prevented over the 20year reference period (2011 to 2030). Depending on study perspective and method, the upgraded program is either dominant (achieving both health gains and cost offsets) or highly cost-effective (health gain at modest net cost). Return on investment (ROI) was $AUD 3.20 per dollar invested, with net social benefit of $AUD 1.43 billion. The study confirmed the strong economic credentials for skin cancer prevention and provided sound arguments for increased investment in Australia. The reference case analysis provides a useful benchmark for other countries to consider in the design and funding of their prevention programs.
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Affiliation(s)
- Sophy Tf Shih
- Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, VIC 3025, Australia.
| | - Rob Carter
- Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, VIC 3025, Australia.
| | - Sue Heward
- SunSmart Program, Cancer Council Victoria, WHO Collaborative Centre for UV Radiation, 615 St Kilda Road, Melbourne, VIC 3004, Australia.
| | - Craig Sinclair
- Prevention Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia.
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Køster B, Søndergaard J, Nielsen JB, Christensen KB, Allen M, Olsen A, Bentzen J. Knowledge deficit, attitude and behavior scales association to objective measures of sun exposure and sunburn in a Danish population based sample. PLoS One 2017; 12:e0178190. [PMID: 28542543 PMCID: PMC5444774 DOI: 10.1371/journal.pone.0178190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/08/2017] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to develop new scales measuring knowledge and attitude about UVR and sun related behavior, and to examine their association to sun related behavior objectively measured by personal dosimetry. During May-August 2013, 664 Danes wore a personal electronic UV-dosimeter for one week that measured their UVR exposure. Afterwards, they answered a questionnaire on sun-related items. We applied descriptive analysis, linear and logistic regression analysis to evaluate the associations between the questionnaire scales and objective UVR measures. Perceiving protection as routine and important were positively correlated with protective behavior. Knowledge deficit of UV and risk of melanoma, perceived benefits and importance of protection behavior was also correlated with use of protection. ‘Knowledge deficit of UV and risk of melanoma and Perceived barrier towards sun avoidance between 12 and 15’ were both associated with increased risk of sunburn. Attitude towards tan was associated to both outdoor time and exposure as well as use of protection, but not to sunburn. The results regarding Knowledge deficit of UV and risk of melanoma associated to UVR exposure and Perceived barrier towards sun avoidance between 12 and 15 emphasize the importance of awareness of melanoma risk and the priority of the skin cancer prevention advice. Shifting activities to outside the suns peak-hours could be an approach for structural and campaign preventive measures. Knowledge of items predicting exposure to UVR, use of protection and sunburn are important for planning of preventive interventions and melanoma research.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, Copenhagen Ø, Denmark
- Research Unit of General Practice, University of Southern Denmark,Odense, Denmark
- * E-mail:
| | - Jens Søndergaard
- Research Unit of General Practice, University of Southern Denmark,Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, University of Southern Denmark,Odense, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand
| | - Anja Olsen
- Research Centre, Danish Cancer Society, Copenhagen, Denmark
| | - Joan Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, Copenhagen Ø, Denmark
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Deo RC, Downs N, Parisi AV, Adamowski JF, Quilty JM. Very short-term reactive forecasting of the solar ultraviolet index using an extreme learning machine integrated with the solar zenith angle. ENVIRONMENTAL RESEARCH 2017; 155:141-166. [PMID: 28222363 DOI: 10.1016/j.envres.2017.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 06/06/2023]
Abstract
Exposure to erythemally-effective solar ultraviolet radiation (UVR) that contributes to malignant keratinocyte cancers and associated health-risk is best mitigated through innovative decision-support systems, with global solar UV index (UVI) forecast necessary to inform real-time sun-protection behaviour recommendations. It follows that the UVI forecasting models are useful tools for such decision-making. In this study, a model for computationally-efficient data-driven forecasting of diffuse and global very short-term reactive (VSTR) (10-min lead-time) UVI, enhanced by drawing on the solar zenith angle (θs) data, was developed using an extreme learning machine (ELM) algorithm. An ELM algorithm typically serves to address complex and ill-defined forecasting problems. UV spectroradiometer situated in Toowoomba, Australia measured daily cycles (0500-1700h) of UVI over the austral summer period. After trialling activations functions based on sine, hard limit, logarithmic and tangent sigmoid and triangular and radial basis networks for best results, an optimal ELM architecture utilising logarithmic sigmoid equation in hidden layer, with lagged combinations of θs as the predictor data was developed. ELM's performance was evaluated using statistical metrics: correlation coefficient (r), Willmott's Index (WI), Nash-Sutcliffe efficiency coefficient (ENS), root mean square error (RMSE), and mean absolute error (MAE) between observed and forecasted UVI. Using these metrics, the ELM model's performance was compared to that of existing methods: multivariate adaptive regression spline (MARS), M5 Model Tree, and a semi-empirical (Pro6UV) clear sky model. Based on RMSE and MAE values, the ELM model (0.255, 0.346, respectively) outperformed the MARS (0.310, 0.438) and M5 Model Tree (0.346, 0.466) models. Concurring with these metrics, the Willmott's Index for the ELM, MARS and M5 Model Tree models were 0.966, 0.942 and 0.934, respectively. About 57% of the ELM model's absolute errors were small in magnitude (±0.25), whereas the MARS and M5 Model Tree models generated 53% and 48% of such errors, respectively, indicating the latter models' errors to be distributed in larger magnitude error range. In terms of peak global UVI forecasting, with half the level of error, the ELM model outperformed MARS and M5 Model Tree. A comparison of the magnitude of hourly-cumulated errors of 10-min lead time forecasts for diffuse and global UVI highlighted ELM model's greater accuracy compared to MARS, M5 Model Tree or Pro6UV models. This confirmed the versatility of an ELM model drawing on θsdata for VSTR forecasting of UVI at near real-time horizon. When applied to the goal of enhancing expert systems, ELM-based accurate forecasts capable of reacting quickly to measured conditions can enhance real-time exposure advice for the public, mitigating the potential for solar UV-exposure-related disease.
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Affiliation(s)
- Ravinesh C Deo
- School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences (ICACS), Institute of Agriculture and Environment (IAg&E), University of Southern Queensland, QLD 4300, Australia.
| | - Nathan Downs
- School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences (ICACS), Institute of Agriculture and Environment (IAg&E), University of Southern Queensland, QLD 4300, Australia
| | - Alfio V Parisi
- School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences (ICACS), Institute of Agriculture and Environment (IAg&E), University of Southern Queensland, QLD 4300, Australia
| | - Jan F Adamowski
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Science, McGill University, Québec H9X 3V9, Canada
| | - John M Quilty
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Science, McGill University, Québec H9X 3V9, Canada
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Leung VKY, Dobbinson SJ, Goodman DJ, Kanellis J, Chong AH. Skin cancer history, sun-related attitudes, behaviour and sunburn among renal transplant recipients versus general population. Australas J Dermatol 2017; 59:e106-e113. [PMID: 28332195 DOI: 10.1111/ajd.12591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Renal transplant recipients (RTR) have both an excessive skin cancer incidence and a high mortality rate. In Australia RTR receive extensive public education on skin cancer and many undergo further education pre/post-transplant. This study examines whether RTR have sufficiently rigorous sun protection behaviour compared with the general population. METHODS Altogether 179 RTR from two large Melbourne hospitals involving skin clinic teams in patient care were recruited to undergo cross-sectional telephone interviews. Comparisons were made with residents (25-69 years) surveyed using equivalent measures and methods in adjacent summers (2006-2007, n = 904; 2010-2011, n = 942) for regular population monitoring surveys. Multivariate analyses of weekend behaviour were adjusted for related ambient temperature records. RESULTS RTR were more compliant with sun protection behaviour on the weekend prior to interview than the residents surveyed. For example, for 2006-2007 and 2010-2011, the odds ratio and confidence intervals (CI 95%) were respectively: used sunscreen: 2.0 (1.1-3.8) and 2.8 (1.4-5.3); wore a long-sleeved top: 4.5 (2.4-8.5) and 3.6 (1.9-7.0). RTR sunburn prevalence (5%) appeared similar to that of residents (odds ratios comparing 2006-2007 and 2010-2011 0.6 [95% CI, 0.2-1.6] and 0.7 [95% CI, 0.3-1.9]). Despite generally good sun protection behaviour, many RTR (47%) had skin cancers treated. CONCLUSION The intensive education of RTR may have contributed to their better sun protection. Some RTR with excessive exposure to UV radiation introduction of may benefit from implementation of further photoprotection strategies. These findings may be particularly relevant to other RTR groups receiving education about sun protection.
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Affiliation(s)
- Vivian Ka Ying Leung
- Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Suzanne Jane Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David Josef Goodman
- Department of Nephrology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - John Kanellis
- Department of Nephrology, Monash University Department of Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Alvin Heong Chong
- Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
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Buller DB, Dobbinson S, English DR, Wakefield M, Buller MK. Rationale, design, and baseline data of a cross-national randomized trial on the effect of built shade in public parks for sun protection. Contemp Clin Trials 2017; 55:47-55. [PMID: 28185996 DOI: 10.1016/j.cct.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 02/03/2023]
Abstract
Environments can be structured to reduce solar ultraviolet radiation (UV) exposure to prevent skin cancer. A prospective randomized trial is being conducted to test whether introducing shade sails in passive recreation areas (PRAs) in public parks will increase use and decrease UV exposure in the shaded compared to unshaded PRAs. Shade effects will be compared between Melbourne, Australia and Denver, USA. The trial enrolled 145 public parks with PRAs suitable for shade construction and randomized parks to intervention or control in a 1:3 ratio. Use of PRAs and UV levels were recorded at each park by trained observers during 30-minute periods on four weekend days in each of two summers (pretest and posttest). Shade sails were constructed between the summers. Given low numbers of users at pretest, the outcome measure was modified to use of the PRA (use vs. no use) and unit of analysis to the individual observation. Observations (n=580) occurred on average 29days from the summer solstice and 55min from solar noon in warm weather (mean=26.2°C) with some cloud cover but only slight or no wind. Typically, PRAs had benches and picnic tables and were located near playgrounds. PRAs were in use during 13.3% of observations (mean=0.41 users). UV over 30-minutes at the PRA boundary (mean=3.2 standard erythemal dose [SED]) and center (mean=3.3 SED) was high. Shade for skin cancer prevention has been understudied. This study will address this gap by determining whether purpose-built shade structures promote greater use of shaded areas within public parks.
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Affiliation(s)
| | - Suzanne Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Dallas R English
- Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
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Bryant J, Zucca A, Brozek I, Rock V, Bonevski B. Sun protection attitudes and behaviours among first generation Australians with darker skin types: results from focus groups. J Immigr Minor Health 2016; 17:248-54. [PMID: 23963873 DOI: 10.1007/s10903-013-9900-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite residing in a country that has the highest rates of skin cancer in the world, little is known about the knowledge, attitudes and sun protection practices of first generation Australian-born individuals with olive and darker skin types. Six focus groups with first generation Australian-born individuals of Asian, Mediterranean, Middle Eastern and Indian background were conducted. Participants had good knowledge of the dangers of skin cancer. Most correctly perceived darker skin types as protective and believed they were at low risk of skin cancer. Most participants could recall high profile mass media sun protection campaigns. Several participants suggested that greater representation of ethnic minorities and/or individuals with darker skin types would increase the personal relevance of campaigns. Beliefs that sun protection is not necessary on the basis of skin type highlights the need for further studies to explore fundamental differences in attitudes and practices between those with olive and darker skin and the general Australian population.
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Affiliation(s)
- Jamie Bryant
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle and Hunter Medical Research Institute, Public Health/HBRG, HMRI Building, Callaghan, NSW, 2308, Australia,
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39
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Sex Differences in the Relationship Between Socio-Cultural Norms and Sunbathing. Int J Behav Med 2016; 24:428-437. [DOI: 10.1007/s12529-016-9606-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Sandhu PK, Elder R, Patel M, Saraiya M, Holman DM, Perna F, Smith RA, Buller D, Sinclair C, Reeder A, Makin J, McNoe B, Glanz K. Community-wide Interventions to Prevent Skin Cancer: Two Community Guide Systematic Reviews. Am J Prev Med 2016; 51:531-9. [PMID: 27647053 PMCID: PMC5031485 DOI: 10.1016/j.amepre.2016.03.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 12/31/2022]
Abstract
CONTEXT Skin cancer is a preventable and commonly diagnosed cancer in the U.S. Excessive ultraviolet radiation exposure is a known cause of skin cancer. This article presents updated results of two types of interventions evaluated in a previously published Community Guide systematic review: multicomponent community-wide interventions and mass media interventions when used alone. EVIDENCE ACQUISITION Studies assessing multicomponent community-wide and mass media interventions to prevent skin cancer by reducing ultraviolet radiation exposure were evaluated using Community Guide systematic review methods. Relevant studies published between 1966 and 2013 were included and analyzed for this review. EVIDENCE SYNTHESIS Seven studies evaluating the effectiveness of multicomponent community-wide interventions showed a median increase in sunscreen use of 10.8 (interquartile interval=7.3, 23.2) percentage points, a small decrease in ultraviolet radiation exposure, a decrease in indoor tanning device use of 4.0 (95% CI=2.5, 5.5) percentage points, and mixed results for other protective behaviors. Four studies evaluating the effectiveness of mass media interventions found that they generally led to improved ultraviolet protection behaviors among children and adults. CONCLUSIONS The available evidence showed that multicomponent community-wide interventions are effective in reducing the deleterious effects of ultraviolet radiation exposure by increasing sunscreen use. There was, however, insufficient evidence to determine the effectiveness of mass media interventions alone in reducing ultraviolet radiation exposure and increasing ultraviolet protection behaviors, indicating a continuing need for more research in this field to improve assessment of effectiveness.
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Affiliation(s)
- Paramjit K Sandhu
- Community Guide Branch, Division of Public Health Information Dissemination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Randy Elder
- Community Guide Branch, Division of Public Health Information Dissemination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mona Patel
- Community Guide Branch, Division of Public Health Information Dissemination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Dawn M Holman
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Frank Perna
- National Institutes of Health, National Cancer Institute, Bethesda, Maryland
| | | | | | - Craig Sinclair
- Cancer Council Victoria, Centre for Behavioural Research in Cancer, Victoria, Australia
| | - Anthony Reeder
- Cancer Society Social & Behavioral Research Unit, Department of Prevention & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jennifer Makin
- University of Tasmania, Menzies Research Institute, Tasmania, Australia
| | - Bronwen McNoe
- Cancer Society Social & Behavioral Research Unit, Department of Prevention & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Karen Glanz
- University of Pennsylvania Perelman School of Medicine and School of Nursing, Philadelphia, Pennsylvania
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Community-wide Interventions to Prevent Skin Cancer: Recommendation of the Community Preventive Services Task Force. Am J Prev Med 2016; 51:540-1. [PMID: 27647054 DOI: 10.1016/j.amepre.2016.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 11/19/2022]
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Bruine de Bruin W, Lefevre CE, Taylor AL, Dessai S, Fischhoff B, Kovats S. Promoting protection against a threat that evokes positive affect: The case of heat waves in the United Kingdom. J Exp Psychol Appl 2016; 22:261-71. [PMID: 27268282 PMCID: PMC5015596 DOI: 10.1037/xap0000083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heat waves can cause death, illness, and discomfort, and are expected to become more frequent as a result of climate change. Yet, United Kingdom residents have positive feelings about hot summers that may undermine their willingness to protect themselves against heat. We randomly assigned United Kingdom participants to 1 of 3 intervention strategies intended to promote heat protection, or to a control group. The first strategy aimed to build on the availability heuristic by asking participants to remember high summer temperatures, but it elicited thoughts of pleasantly hot summer weather. The second strategy aimed to build on the affect heuristic by evoking negative affect about summer temperatures, but it evoked thoughts of unpleasantly cold summer weather. The third strategy combined these 2 approaches and succeeded in evoking thoughts of unpleasantly hot summer weather. Across 2 experiments, the third (combined) strategy increased participants' expressed intentions to protect against heat compared with the control group, while performing at least as well as the 2 component strategies. We discuss implications for developing interventions about other "pleasant hazards." (PsycINFO Database Record
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Affiliation(s)
| | - Carmen E Lefevre
- Centre for Decision Research, Leeds University Business School, University of Leeds
| | - Andrea L Taylor
- Centre for Decision Research, Leeds University Business School, University of Leeds
| | | | - Baruch Fischhoff
- Department of Engineering and Public Policy, Carnegie Mellon University
| | - Sari Kovats
- NIHR Health Protection Research Unit in Environmental Change and Health, London School of Hygiene and Tropical Medicine
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Køster B, Thorgaard C, Philip A, Clemmensen H. Sunbed use and campaign initiatives in the Danish population, 2007-2009: a cross-sectional study. J Eur Acad Dermatol Venereol 2016; 25:1351-5. [PMID: 21711466 DOI: 10.1111/j.1468-3083.2010.03960.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Denmark has experienced an increase in melanoma incidence since the 1960s. In 2007, a skin cancer prevention campaign was launched, one of the targets being the widespread use of sunbeds in Denmark. The antisunbed campaign comprised public affairs initiatives and campaign activities, which included the social media, with young people as the main target. OBJECTIVE The aim of this study was to describe the development in sunbed use after the start of the campaign in the period 2007-2009. METHODS A population-based sample of 14,514 respondents aged 15-59 years completed four questionnaires in 2007-2009 on artificial exposure to ultraviolet radiation. We examined the relations between sunbed use, time and demographic factors using logistic regression analysis. RESULTS The odds ratio (OR) for being a sunbed user in 2009 when compared with 2007 was 0.61 (0.54-0.69); in the age group of 15-19 years, the OR was 0.42 (0.30-0.69). In 2009, however, 23% of Danes (33% of 15-19-year-olds) still reported sunbed use within the past 12 months, and more than 50% had experienced sunburn caused by a sunbed. In 2009, the majority of the population, including the age group of 15-19 years, was in favour of restricting admission to sunbed parlours for children under 18 years. CONCLUSIONS Sunbed use in Denmark decreased concurrently with the campaign activities, with the largest change in the youngest age group, which was a prioritized target of the campaign. Results suggest that a legislative solution should be found to avoid exposure of a large proportion of children to ultraviolet radiation and to reduce future melanoma incidence.
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Affiliation(s)
- B Køster
- Department of Prevention and Documentation, Danish Cancer Society, Strandboulevarden, Copenhagen, Denmark
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Doran CM, Ling R, Byrnes J, Crane M, Shakeshaft AP, Searles A, Perez D. Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia. PLoS One 2016; 11:e0147665. [PMID: 26824695 PMCID: PMC4732951 DOI: 10.1371/journal.pone.0147665] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/06/2016] [Indexed: 11/22/2022] Open
Abstract
Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer.
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Affiliation(s)
- Christopher M. Doran
- School of Human Health and Social Sciences, Central Queensland University, Brisbane, Queensland, Australia
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- * E-mail:
| | - Rod Ling
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Melanie Crane
- Cancer Institute New South Wales, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony P. Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Donna Perez
- Cancer Institute New South Wales, Sydney, New South Wales, Australia
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Koch S, Pettigrew S, Minto C, Slevin T, Strickland M, Lin C, Jalleh G. Trends in sun-protection behaviour in Australian adults 2007-2012. Australas J Dermatol 2016; 58:111-116. [PMID: 26776445 DOI: 10.1111/ajd.12433] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/08/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Almost all skin cancers are the result of overexposure to UV radiation and could be prevented by adhering to a number of simple behavioural guidelines to minimise exposure to the sun. The present study examined trends in sun-protection behaviour among adults living in Western Australia, a region with high levels of UV radiation. METHODS During five summers from 2008 to 2012, 2076 Western Australian adults participated in annual, cross-sectional telephone surveys that assessed how often they engaged in a range of sun-protection behaviour (seeking shade, staying inside and wearing a hat, protective clothing, sunscreen or sunglasses). RESULTS Apart from an increase in sunscreen use and a consistently high use of sunglasses, most sun-protection behaviour remained stable at moderate levels during the 5-year period. Seeking shade, staying inside and wearing a hat were all practised at levels ranging between 'sometimes' and 'usually' on sunny days in summer during peak UV hours, with little to no variability across the survey years. Wearing protective clothing was the least frequent behaviour across all survey years and was significantly lower in the most recent survey year relative to baseline. CONCLUSIONS Further efforts are required to encourage greater enactment of sun-protection behaviour, especially on the use of protective clothing and seeking shade during periods of high UV radiation.
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Affiliation(s)
- Severine Koch
- Curtin University, Perth, Western Australia, Australia.,Cancer Council Western Australia, Perth, Western Australia, Australia
| | | | - Carolyn Minto
- Cancer Council Western Australia, Perth, Western Australia, Australia
| | - Terry Slevin
- Curtin University, Perth, Western Australia, Australia.,Cancer Council Western Australia, Perth, Western Australia, Australia
| | - Mark Strickland
- Cancer Council Western Australia, Perth, Western Australia, Australia
| | - Chad Lin
- Curtin University, Perth, Western Australia, Australia
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Berwick M, Buller DB, Cust A, Gallagher R, Lee TK, Meyskens F, Pandey S, Thomas NE, Veierød MB, Ward S. Melanoma Epidemiology and Prevention. Cancer Treat Res 2016; 167:17-49. [PMID: 26601858 DOI: 10.1007/978-3-319-22539-5_2] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as high-penetrant genes, moderate-risk genes, or low-risk genetic polymorphisms. Subtypes of tumors, such as BRAF-mutated tumors, have different risk factors as well as different therapies. Prevention of melanoma has been attempted using various strategies in specific subpopulations, but to date optimal interventions to reduce incidence have not emerged.
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Affiliation(s)
- Marianne Berwick
- Department of Internal Medicine, University of New Mexico, MSC10-5550, Albuquerque, NM, 87131-0001, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO, 80401, USA.
| | - Anne Cust
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Richard Gallagher
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Tim K Lee
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Frank Meyskens
- Public Health and Epidemiology, University of California, Irvine, USA.
| | - Shaily Pandey
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nancy E Thomas
- University of North Carolina, 413 Mary Ellen Jones Bldg. CB#7287, Chapel Hill, NC, 275992, USA.
| | - Marit B Veierød
- Department of Biostatistics, Institute of Basic Medical Sciences, P.O. Box 1122 Blindern, 0317, Oslo, Norway.
| | - Sarah Ward
- Centre for Genetic Origins of Health and Disease (GOHaD), The University of Western Australia, M409, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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García-Romero MT, Geller AC, Kawachi I. Using behavioral economics to promote healthy behavior toward sun exposure in adolescents and young adults. Prev Med 2015; 81:184-8. [PMID: 26361753 DOI: 10.1016/j.ypmed.2015.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/17/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
Skin cancer represents an important public health problem, and it is associated with ultraviolet radiation exposure, particularly at early ages. Unhealthy sun exposure and intentional tanning continue to be the trend among young people. Multiple interventions to raise awareness of the risks of sun exposure have been implemented, without necessarily translating into decreased unhealthy behaviors or skin cancer incidence rates. Behavioral economics adds a set of concepts and tools to potentially boost the efficacy of existing approaches to decrease unhealthy sun exposure. This paper reviews public health interventions that have been based in behavioral economics concepts and their results, and provides examples of new and creative ways physicians and health professionals can actively apply insights from behavioral economics to counsel teenagers and young adults about skin cancer prevention.
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Affiliation(s)
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States; Melanoma Epidemiology, Massachusetts General Hospital, Boston, MA, United States
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
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Abstract
OBJECTIVE Sustainability of prevention programs is a public health goal. METHODS The effectiveness of Go Sun Smart, an occupational skin cancer prevention program, was evaluated 5 to 7 years out from the conclusion of a controlled randomized dissemination trial that compared an enhanced versus basic dissemination strategy at 53 ski areas enrolled in the trial. RESULTS Employees (n = 2940) at ski areas in the enhanced condition reported fewer sunburns but did not differ from employees in the basic condition on other sun-protection measures. Significant differences for all sun-protection practices were identified at ski areas that displayed nine or more Go Sun Smart materials or a combined total of nine or more Go Sun Smart and other sun safety messages. CONCLUSIONS Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.
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Sánchez-Quiles D, Tovar-Sánchez A. Are sunscreens a new environmental risk associated with coastal tourism? ENVIRONMENT INTERNATIONAL 2015; 83:158-70. [PMID: 26142925 DOI: 10.1016/j.envint.2015.06.007] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 05/26/2023]
Abstract
The world coastal-zone population and coastal tourism are expected to grow during this century. Associated with that, there will be an increase in the use of sunscreens and cosmetics with UV-filters in their formulation, which will make coastal regions worldwide susceptible to the impact of these cosmetics. Recent investigations indicate that organic and inorganic UV-filters, as well as many other components that are constituents of the sunscreens, reach the marine environment--directly as a consequence of water recreational activities and/or indirectly from wastewater treatment plants (WWTP) effluents. Toxicity of organic and inorganic UV filters has been demonstrated in aquatic organism. UV-filters inhibit growth in marine phytoplankton and tend to bioaccumulate in the food webs. These findings together with coastal tourism data records highlight the potential risk that the increasing use of these cosmetics would have in coastal marine areas. Nevertheless, future investigations into distribution, residence time, aging, partitioning and speciation of their main components and by-products in the water column, persistence, accumulation and toxicity in the trophic chain, are needed to understand the magnitude and real impact of these emerging pollutants in the marine system.
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Affiliation(s)
- David Sánchez-Quiles
- Department of Global Change Research, Mediterranean Institute for Advanced Studies, IMEDEA (CSIC-UIB), Miguel Marqués 21, 07190 Esporles, Balearic Island, Spain.
| | - Antonio Tovar-Sánchez
- Department of Global Change Research, Mediterranean Institute for Advanced Studies, IMEDEA (CSIC-UIB), Miguel Marqués 21, 07190 Esporles, Balearic Island, Spain; Department of Ecology and Coastal Management, Andalusian Institute for Marine Science, ICMAN (CSIC), Campus Universitario Río San Pedro, 11510 Puerto Real, Cádiz, Spain
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50
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Dixon H, Scully M, Durkin S, Brennan E, Cotter T, Maloney S, O'Hara BJ, Wakefield M. Finding the keys to successful adult-targeted advertisements on obesity prevention: an experimental audience testing study. BMC Public Health 2015; 15:804. [PMID: 26290169 PMCID: PMC4546051 DOI: 10.1186/s12889-015-2159-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Mass media communications are an important component of comprehensive interventions to address population levels of overweight and obesity, yet we have little understanding of the effective characteristics of specific advertisements (ads) on this topic. This study aimed to quantitatively test audience reactions to existing adult-focused public health television ads addressing overweight and obesity to determine which ads have the highest levels of message acceptance, argument strength, personalised perceived effectiveness and negative emotional impact. Methods 1116 Australian adults aged 21-55 years recruited from a national online panel participated in this web-based study. Quotas were applied to achieve even numbers of males and females, those aged 21-29 years and 30-55 years, and those with a healthy weight (BMI = 18.5-24.9) and overweight/obesity (BMI = 25+). Participants were randomly assigned to view and rate four of eight ads that varied in terms of message content (health consequences, supportive/encouraging or social norms/acceptability) and execution style (graphic, simulation/animation, positive or negative testimonial, or depicted scene). Results Toxic fat (a graphic, health consequences ad) was the top performing ad on all four outcome measures and was significantly more likely than the other ads tested to promote strong responses in terms of message acceptance, argument strength and negative emotional impact. Measure up (a negative testimonial, health consequences ad) performed comparably on personalised perceived effectiveness. Most ads produced stronger perceptions of personalised perceived effectiveness among participants with overweight/obesity compared to participants with healthy weight. Some ads were more likely to promote strong negative emotions among participants with overweight/obesity. Conclusions Findings provide preliminary evidence of the most promising content and executional styles of ads that could be pursued as part of obesity prevention campaigns. Ads emphasising the negative health consequences of excess weight appear to elicit stronger cognitive and emotional responses from adults with overweight/obesity. However, careful pre-testing of these types of ads is needed prior to their inclusion in actual campaigns to ensure they do not have unintended negative impacts such as increased stigmatisation of vulnerable individuals and increased levels of body dissatisfaction and/or eating-disordered behaviour among at-risk population sub-groups. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2159-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Sarah Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Trish Cotter
- World Lung Foundation, 61 Broadway, Suite 2800, New York, NY, 10006, USA.
| | - Sarah Maloney
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Blythe J O'Hara
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Level 2, Medical Foundation Building, K25, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia.
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