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Hagerman CJ, Stock ML, Jobe MC, Dwyer LA, Houlihan AE, Yeung EW. Ethnic and Gender Differences in Sun-Related Cognitions Among College Students: Implications for Intervention. Int J Behav Med 2024:10.1007/s12529-024-10257-7. [PMID: 38360939 DOI: 10.1007/s12529-024-10257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Skin cancer incidence and prognosis vary by ethnicity and gender, and previous studies demonstrate ethnic and gender differences in sun-related cognitions and behaviors that contribute to this disease. The current study sought to inform skin cancer interventions tailored to specific demographic groups of college students. The study applied the prototype willingness model (PWM) to examine how unique combinations of ethnic and gender identities influence sun-related cognitions. METHOD Using data from a survey of 262 college students, the study tested whether self-reported sun-related cognitions were different for White women, Hispanic women, White men, and Hispanic men. Path modeling was also used to identify which PWM cognitions (e.g., prototypes, norms) were the strongest predictors of risk and protection intentions and willingness in each demographic group. RESULTS Several differences in sun-related cognitions and PWM pathways emerged across groups, emphasizing the need for tailored skin cancer education and interventions. Results suggest that, for White women, interventions should primarily focus on creating less favorable attitudes toward being tan. CONCLUSION Interventions for Hispanic women may instead benefit from manipulating perceived similarity to sun-related prototypes, encouraging closer personal identification with images of women who protect their skin and encouraging less identification with images of women who tan. For White men, skin cancer interventions may focus on creating more favorable images of men who protect their skin from the sun. Lastly, interventions for Hispanic men should increase perceived vulnerability for skin cancer.
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Affiliation(s)
- Charlotte J Hagerman
- Weight, Eating, and Lifestyle Science (WELL) Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle L Stock
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
| | - Mary C Jobe
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA.
| | - Laura A Dwyer
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
| | | | - Ellen W Yeung
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
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2
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Diehl K, Thoonen K, Breitbart EW, Pfahlberg AB, Görig T. Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116876. [PMID: 35682459 PMCID: PMC9180203 DOI: 10.3390/ijerph19116876] [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: 05/09/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022]
Abstract
The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children’s behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1−10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers’ sun protection behaviors were positively associated with children’s behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers’ risk behavior was associated with children’s reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today’s children from developing skin cancer in later life.
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Affiliation(s)
- Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
- Correspondence:
| | - Karlijn Thoonen
- Centre for Environmental Safety and Security, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands;
| | | | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
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3
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Kuo A, Silverberg N, Fernandez Faith E, Morgan R, Todd P. A systematic scoping review of racial, ethnic, and socioeconomic health disparities in pediatric dermatology. Pediatr Dermatol 2021; 38 Suppl 2:6-12. [PMID: 34409633 DOI: 10.1111/pde.14755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES Health disparities encompass a wide range of personal, societal, environmental, and system-based factors that contribute to inequitable health and health outcomes in vulnerable patient populations. The goal of this work was to scientifically summarize the existing published North American research on disparity as it pertains to pediatric dermatology. METHODS A systematic review was performed according to PRISMA guidelines. A medical librarian performed electronic searches from multiple electronic databases from their dates of inception to March 2021. Title and abstracts were reviewed by authors, identifying articles for full review. Data on article characteristics and identified disparities were then extracted and collected in a spreadsheet. RESULTS Fifty-one articles met final inclusion criteria, of which 25 highlighted disparities due to race/ethnicity, 13 highlighted disparities due to socioeconomic (SES), and 13 highlighted disparities due to both race/ethnicity and SES. The most frequent study designs were cross-sectional or survey, followed by retrospective cohort. Only two were prospective cohort studies. Disparities reported included reduced access to care and medications, increased school absenteeism, reduced knowledge about skin care including sun protection, increased hospitalizations and emergency department visits, and severe and persistent disease in the setting of minority race and poverty, among other indicators. CONCLUSIONS There are few, scattered research studies addressing disparity in pediatric dermatology. Greater focus will be needed in the future to improve knowledge of sources of disparity and its detrimental effects on the health of children, to rectify the notable disparity under-reporting of disparity research.
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Affiliation(s)
- Alyce Kuo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Esteban Fernandez Faith
- Department of Pediatrics, Division of Dermatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rebecca Morgan
- Kornhauser Health Science Library, University of Louisville, Louisville, Kentucky, USA
| | - Patricia Todd
- Department of Pediatrics, Division of Pediatric Dermatology, Norton Children's Medical Group and University of Louisville School of Medicine, Louisville, Kentucky, USA
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4
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Zarins A, Huang JW, Ramien ML. Photoprotection in the Immunosuppressed Pediatric Population. J Cutan Med Surg 2018; 22:639-642. [PMID: 30322295 DOI: 10.1177/1203475418782151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Zarins
- 1 Division of Rheumatology and Dermatology, Department of Pediatrics, Children's Hospital of Eastern Ontario Division of Dermatology, Ottawa, ON, Canada.,2 Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Johnny W Huang
- 3 University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Michele L Ramien
- 1 Division of Rheumatology and Dermatology, Department of Pediatrics, Children's Hospital of Eastern Ontario Division of Dermatology, Ottawa, ON, Canada.,2 Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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5
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Cao H, Brehm M, Hynan L, Goff HW. Wrinkles, brown spots, and cancer: Relationship between appearance- and health-based knowledge and sunscreen use. J Cosmet Dermatol 2018; 18:558-562. [PMID: 30009555 DOI: 10.1111/jocd.12712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/15/2018] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is increasing understanding that sunscreen use is associated with reduced photoaging and that appearance-based messages are more effective than health-based messages in promoting daily sunscreen use. We hypothesized that persons with greater awareness of the effects of photoaging use sunscreen more consistently. METHODS Cross-sectional survey of adults in Dallas, TX, assessing sunscreen-related knowledge, behavior, and information source. RESULTS Each respondent averaged 2.5 ± 1.7 hours of self-reported sun exposure daily with the least reported time being 0.15 hours. Eighty-eight percent reported that sun exposure caused skin cancer "a lot." Eighty-nine percent "agreed" or "strongly agreed" that "sun exposure causes most signs of skin aging." Over 70% "agreed" or "strongly agreed" to an appearance-based reason for their sunscreen use. Sixty-six percent reported they would consider using sunscreen if anticipating sun exposure lasting 2 hours or less. Only 30% reported using sunscreen daily. Greater photoaging knowledge was positively associated with sunscreen adherence (at least P < 0.05 with each knowledge item). Those with darker complexions or skin less likely to burn reported less knowledge of photoaging (ρ = -0.219, P ≤ 0.001) and had lower sunscreen use (ρ = 0.301, P < 0.001). CONCLUSION Despite most respondents reporting knowledge of health and appearance risks of sun exposure and a motivation to prevent them with sunscreen, most do not use sunscreen adequately. This discrepancy could be due to people perceiving risks of sun exposure based on duration of continuous exposure. There may be misconceptions that short-interval sun exposure that does not result in sunburn is less harmful than extended exposure.
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Affiliation(s)
| | - Mary Brehm
- UT Southwestern Medical Center, Dallas, Texas
| | - Linda Hynan
- UT Southwestern Medical Center, Dallas, Texas
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6
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Miller KA, In GK, Jiang SY, Ahadiat O, Higgins S, Wysong A, Cockburn MG. Skin Cancer Prevention Among Hispanics: a Review of the Literature. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Miller KA, Huh J, Unger JB, Richardson JL, Allen MW, Peng DH, Cockburn MG. Correlates of sun protection behaviors among Hispanic children residing in a high UVR environment. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 33:75-83. [PMID: 27995652 DOI: 10.1111/phpp.12287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND/PURPOSE Rates of melanoma are rising in Hispanics in the United States. Excessive sun exposure in childhood increases the risk of melanoma in adulthood, and little is known about the factors motivating sun protection behaviors among Hispanic youth. METHODS Correlates of sun protection were examined among Hispanic children residing in Los Angeles, California (N = 1891). Associations between multiple constructs (psychosocial, familial, and cultural) and sun protection outcomes (use of sunscreen, protective clothing, and shade seeking/sun avoidance) were examined. RESULTS Family variables were associated with more frequent sun protection among Hispanic children across outcomes, as were perceived peer norms, perceived self-efficacy, and fewer sun protection barriers. Skin cancer risk factors such as lighter skin and sunburn experience, and level of acculturation were not associated with greater sun protection. CONCLUSION Family sun protection habits are instrumental to Hispanic children's sun safe behaviors, and interventions that engage the family may be most effective. Increasing risk communication to high-risk subgroups of Hispanic children (those with lighter, more sun reactive skin) is important when developing intervention strategies. However, there is overlap between Hispanic children's sun protection correlates and those observed among non-Hispanic white children, suggesting that interventions to improve sun protection may generalize across cultural contexts.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Martin W Allen
- Department of Electrical and Computer Engineering, MacDiarmid Institute for Advanced Materials and Nanotechnology, University of Canterbury, Christchurch, New Zealand
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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de Troya-Martín M, Padilla-España L, Férnandez-Morano T, Delgado-Sánchez N, Blázquez Sánchez N, Rivas-Ruiz F, Herrera-Ceballos E, de Gálvez-Aranda MV. Sun Protection Habits and Attitudes Among Healthcare Personnel in a Mediterranean Population. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:789-795. [PMID: 26370806 DOI: 10.1007/s13187-015-0913-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health professionals are key agents in healthcare promotion. In the field of skin cancer, they play a crucial role in the development of prevention strategies in the community. This paper aims to describe the sun exposure attitudes and habits of public healthcare professionals in the western Costa del Sol (Spain). A cross-sectional descriptive study was conducted in the Costa del Sol healthcare district to analyse sun exposure and protection practices and habits, and attitudes to tanning and sun protection. The respondents, all healthcare personnel in various professional categories and workplace situations, were asked to complete a self-administered questionnaire. Six hundred forty-three workers in the Costa del Sol healthcare district took part in the study. Of these participants, 450 were healthcare professionals. Of the 450 health professionals, 226 (50.2 %) were nurses or auxiliary nursing staff, and the remaining 224 were doctors. These two groups presented differences regarding habits of sun exposure: 15.3 % of the doctors went to the beach at least 30 days a year, compared to 30.9 % of the nurses (p < 0.001). With respect to workplace situation, there were differences (p < 0.001) between the sunburn events reported by healthcare staff who worked in hospitals (52.4 %) compared to those working in primary healthcare (30.4 %); comparable differences were found with respect to attitudes toward the use of sunscreen creams (p = 0.014). This study identifies two distinct subgroups within healthcare personnel: on one hand, primary healthcare professionals, who are key agents for future policy strategies, and on the other, specialist healthcare professionals, who are more likely to suffer sunburn events and therefore toward whom strategies should be addressed to encourage them to change their sun exposure attitudes and habits and sun protection practices.
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Affiliation(s)
| | - Laura Padilla-España
- Dermatology Department, Costa del Sol Hospital, Autovia A-7, km 187, 29603, Marbella, Spain.
| | | | - Nuria Delgado-Sánchez
- Distrito Sanitario Costa del Sol, Hospital Costa del Sol, Autovia A-7, km 187, 29603, Marbella, Spain
| | - Nuria Blázquez Sánchez
- Dermatology Department, Costa del Sol Hospital, Autovia A-7, km 187, 29603, Marbella, Spain
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9
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Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now. CA Cancer J Clin 2016; 66:460-480. [PMID: 27232110 PMCID: PMC5124531 DOI: 10.3322/caac.21352] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.
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Affiliation(s)
- Mary K Tripp
- Instructor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meg Watson
- Epidemiologist, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sophie J Balk
- Attending Pediatrician, Children's Hospital at Montefiore, and Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Susan M Swetter
- Professor, Department of Dermatology, and Director, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA
- Professor and Assistant Chief, Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jeffrey E Gershenwald
- Dr. John M. Skibber Professor, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Professor, Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
- Co-Leader, Melanoma Moon Shot, The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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VanWormer JJ, Holsman RH, Petchenik JB, Dhuey BJ, Keifer MC. Epidemiologic trends in medically-attended tree stand fall injuries among Wisconsin deer hunters. Injury 2016; 47:220-5. [PMID: 26443558 PMCID: PMC4698102 DOI: 10.1016/j.injury.2015.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/02/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tree stand falls are the most common injury to hunters in the USA, but there is limited research on the topic. This study examined the 5-year trends in incident tree stand fall injuries in rural north-central Wisconsin and described patient demographics and injury features. METHODS A retrospective analysis was conducted on five prior hunting seasons, 2009-2013. Cases were ascertained from electronic health records via natural language processing that identified patients from the Marshfield Epidemiologic Study Area who received medical attention for a tree stand fall. Annual incidence rates were calculated using the number of hunting license holders in the target population, per administrative data from the Wisconsin Department of Natural Resources. RESULTS There were 16,556-16,902 deer hunters in any given year, with 39 (92% male) confirmed medically-attended tree stand fall injuries in 2009-2013. Injuries mainly occurred in the lower extremities (n=23), and included two fatalities and one paralysis case. The risk of tree stand fall injuries went from 6.0 (95% CI: 3.2, 11.1) per 10,000 hunters in 2009 to 3.6 (95% CI: 1.6, 7.9) per 10,000 hunters in 2013, which was not a significant change over 5 years (p=0.79). Most falls occurred among archery hunters, in the evening and when descending from a tree stand. Cases were demographically similar to the general population of Wisconsin deer hunters. CONCLUSIONS The current seasonal incidence rate of tree stand fall injuries is relatively low in rural Wisconsin, but with limited signs of improvement. Continued efforts are needed to promote the long-term safety of the hunting public.
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Affiliation(s)
- Jeffrey J VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, United States.
| | - Robert H Holsman
- Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States
| | - Jordan B Petchenik
- Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States
| | - Brian J Dhuey
- Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States
| | - Matthew C Keifer
- National Farm Medicine Center, Marshfield Clinic Research Foundation, United States
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11
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Voss RK, Woods TN, Cromwell KD, Nelson KC, Cormier JN. Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis. PATIENT-RELATED OUTCOME MEASURES 2015; 6:229-42. [PMID: 26609248 PMCID: PMC4644158 DOI: 10.2147/prom.s69351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new "apps" available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments).
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Affiliation(s)
- Rachel K Voss
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tessa N Woods
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Hingle MD, Snyder AL, McKenzie NE, Thomson CA, Logan RA, Ellison EA, Koch SM, Harris RB. Effects of a short messaging service-based skin cancer prevention campaign in adolescents. Am J Prev Med 2014; 47:617-23. [PMID: 25053602 PMCID: PMC4205167 DOI: 10.1016/j.amepre.2014.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/13/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages. PURPOSE To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents. METHODS The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11-14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety-themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests. RESULTS Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends. CONCLUSIONS A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects.
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Affiliation(s)
- Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona.
| | - Aimee L Snyder
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Naja E McKenzie
- Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | | | - Eden A Ellison
- College of Nursing, Marquette University, Milwaukee, Wisconsin
| | - Stephanie M Koch
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | - Robin B Harris
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Skin Cancer Institute at the University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
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13
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Mihalis EL, Wysong A, Boscardin WJ, Tang JY, Chren MM, Arron ST. Factors affecting sunscreen use and sun avoidance in a U.S. national sample of organ transplant recipients. Br J Dermatol 2013; 168:346-53. [PMID: 22880814 DOI: 10.1111/j.1365-2133.2012.11213.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Organ transplant recipients have an increased risk of nonmelanoma skin cancers due to immunosuppressive therapy following transplantation. Use of sunscreen has been shown to reduce this risk. OBJECTIVES To identify patient and healthcare factors associated with sun-protective behaviours in organ transplant recipients after transplantation with the goal of increasing overall sunscreen use. METHODS This study utilized a cross-sectional, retrospective survey from a national sample of 198 organ transplant recipients in the U.S.A. from 2004 to 2008 with no prior diagnosis of skin cancer. The main outcome measures were sunscreen use and sun avoidance before and after transplantation. Frequency of sunscreen use and sun exposure was obtained by self-report on Likert scales ranging from never to always, and these responses were converted to a numerical scale from 0 to 4. RESULTS Overall sunscreen use increased after transplantation (from a score of 1·4 to 2·1, P < 0·001). Sex, Fitzpatrick skin type, receiving advice to avoid sun from a healthcare provider, and pretransplantation sunscreen use were significantly associated with frequency of post-transplantation sunscreen use in multivariate models. Pretransplantation sun exposure, advice to avoid sun and pretransplantation sunscreen use were significantly associated with sun avoidance post-transplantation. CONCLUSIONS Both patient features and clinician advice are associated with sun-protective behaviours after organ transplantation. These results will help physicians target expanded sun-protection counselling to those patients most in need of such intervention.
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Affiliation(s)
- E L Mihalis
- Harvard Medical School, Harvard University, Boston, MA, USA
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