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Akerlof KL, Loevenich J, Melena S, Lipsky CA. Behaviorally segmented audiences for managing sunscreen chemical pollution risk in protected coastal natural resource areas. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024; 44:349-365. [PMID: 37188329 DOI: 10.1111/risa.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
This audience segmentation of visitors at coastal parks in Hawaii and North Carolina addresses an emergent natural resource management concern and risk to aquatic ecosystems: sunscreen chemical pollution. Four audiences were identified that correspond to different behavioral profiles: sunscreen protection tourists, multimodal sun protection tourists, in-state frequent park visitors, and frequent beachgoers who skip sunscreen. The second-largest audience, sunscreen protection tourists, represents 29% of visitors at Cape Lookout National Seashore and 25% at Kaloko-Honokōhau National Historical Park. This group ranks of most concern for chemical pollution because they use sunscreen, but not typically mineral formulations or other methods such as protective clothing, and they have lower levels of sunscreen chemical issue awareness. The identification of similar audience segments across regions with differing cultural characteristics and sunscreen regulation status suggests the robustness of the model and its indicator variables, with implications for both environmental protection and public health. Further, coastal visitors' interest in enacting pro-environmental sun protection behaviors during their next park or beach visit indicates the potential for natural resource managers to holistically address risks in both domains through targeted interventions with audiences of most concern.
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Affiliation(s)
- K L Akerlof
- Department of Environmental Science and Policy, George Mason University, Fairfax, Virginia, USA
| | - Jacqueline Loevenich
- Department of Aquatic Animal Health, University of Florida, Gainesville, Florida, USA
| | - Sara Melena
- Natural Resource Stewardship & Science Directorate, National Park Service, Fort Collins, Colorado, USA
| | - Christine A Lipsky
- Natural Resource Stewardship & Science Directorate, National Park Service, Fort Collins, Colorado, USA
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Cole SE, Hawkins M, Miller KA, Allen MW, Cockburn M. Correlation Between Objective Measures of Sun Exposure and Self‐reported Sun Protective Behavior and Attitudes in Predominantly Hispanic Youth. Photochem Photobiol 2022; 99:1037-1046. [DOI: 10.1111/php.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah E. Cole
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
| | - Makenzie Hawkins
- Department of Pediatrics University of Utah Salt Lake City UT United States
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles CA United States
| | - Martin W. Allen
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Department of Electrical and Computer Engineering University of Canterbury Christchurch New Zealand
| | - Myles Cockburn
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles CA United States
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Miller KA, Huh J, Piombo SE, Richardson JL, Harris SC, Peng DH, Cockburn MG. Sun protection changes among diverse elementary schoolchildren participating in a sun safety intervention: A latent transition analysis of a randomized controlled trial. Prev Med 2021; 149:106601. [PMID: 33971211 PMCID: PMC8195865 DOI: 10.1016/j.ypmed.2021.106601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
Children are a priority population for skin cancer prevention as excessive sun exposure in childhood increases the risk of melanoma in adulthood. The complexity of sun protective behaviors has posed measurement challenges for trials testing intervention efficacy. The current study evaluated a sun safety intervention for schoolchildren using latent transition analysis (LTA) to examine patterns of sun protection behaviors over time. A three-armed randomized controlled trial was conducted between 2012 and 2016 with two intervention groups (N = 3368) and an observation-only control group (N = 342) among 4th and 5th graders from 24 public schools in Los Angeles County. Both interventions conditions were grouped and compared to controls. Five self-reported sun protective behaviors were measured at baseline and three-month follow-up: use of sunscreen, long sleeves, long pants, hats, and shade seeking. Participants comprised 3710 schoolchildren, mean age 9 years, 47% female and 69% Latino. At baseline, four patterns of sun protection behaviors were found: children who engaged in 1) all sun protective behaviors; 2) few protective behaviors; 3) protective clothing and shade only; and 4) hats only. Children in the control group were likely to remain in their baseline status or transition to a less protective status at three-month follow-up. By contrast, 30% of children in the intervention group transitioned to a more protective status at follow-up. In this RCT of a sun safety intervention, children in the intervention transitioned to more protective behaviors compared to controls. Using LTA enriches understanding of intervention efficacy by modeling the complexity of sun protection behaviors over time. TRIAL REGISTRATION: School-based Randomized Trial of SunSmart Interventions, ClinicalTrials.gov Identifier: NCT04176237 https://clinicaltrials.gov/ct2/show/NCT04176237?cond=School-based+Randomized+Trial+of+SunSmart+Interventions&draw=2&rank=1.
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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, United States of America; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America.
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Sarah E Piombo
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Susan C Harris
- Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States of America
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
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Huh J, Lee KJ, Roldan W, Castro Y, Kshirsagar S, Rastogi P, Kim I, Miller KA, Cockburn M, Yip J. Making of Mobile SunSmart: Co-designing a Just-in-Time Sun Protection Intervention for Children and Parents. Int J Behav Med 2021; 28:768-778. [PMID: 33846955 PMCID: PMC8041475 DOI: 10.1007/s12529-021-09987-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/02/2022]
Abstract
Background In this study, we describe a participatory design process to develop a technology-based intervention for sun protection for children and their parents. Our methodology embraces and leverages the expert knowledge of the target users, children and their parents, about their sun protection practices to directly influence the design of our mobile just-in-time adaptive intervention (JITAI). The objectives of this paper are to describe our research procedures and summarize primary findings incorporated into developing our JITAI modules. Methods We conducted 3 rounds of iterative co-design workshops with design expert KidsTeam UW children (N: 11–12) and subject expert children and their parents from local communities in California (N: 22–48). Iteratively, we thematically coded the qualitative data generated by participants in the co-design sessions to directly inform design specifications. Results Three themes emerged: (1) preference for non-linear educational format with less structure,; (2) situations not conducive for prioritizing sun protection; and (3) challenges, barriers, and ambiguity relating to sun protection to protect oneself and one’s family. Based on the design ideas and iterative participant feedback, three categories of modules were developed: personalized and interactive data intake module, narrative-education module with augmented reality experiment, person/real-time tailored JITAI, and assessment modules. Conclusions This is one of the first projects that maximally engage children and parents as co-designers to build a technology to improve sun protection with iterative and intentional design principles. Our scalable approach to design a mobile JITAI to improve sun protection will lay the foundation for future public health investigators with similar endeavors. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-09987-9.
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Affiliation(s)
- Jimi Huh
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA.
| | - Kung Jin Lee
- Information School, University of Washington, Seattle, WA, USA
| | - Wendy Roldan
- Human Centered Design & Engineering, University of Washington, Seattle, WA 98105, USA
| | - Yasmine Castro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Saurabh Kshirsagar
- School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Pankhuri Rastogi
- School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Ian Kim
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA.,Department of Dermatology, University of Southern California, Los Angeles, CA 90033, USA
| | - Myles Cockburn
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA.,Department of Dermatology, University of Southern California, Los Angeles, CA 90033, USA
| | - Jason Yip
- Information School, University of Washington, Seattle, WA, USA
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Truong A, Forbes B, Zhang M, McFadden M, Klein S. A Sun Safety Pilot Program Using a Tanning Myths–Focused Video Contest for Utah Adolescents: Cross-sectional Analysis. JMIR DERMATOLOGY 2021. [DOI: 10.2196/20192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Adolescents are susceptible to excessive ultraviolet exposure due to intentional tanning, outdoor lifestyles, and poor sunscreen adherence. As skin cancer incidence continues to rise in the United States, effective and focused interventions are needed to encourage photoprotective behaviors.
Objective
This study seeks to determine poor photoprotective behavior risk factors in adolescents residing in Utah and whether video contest participants have increased sun-protective knowledge and intentions.
Methods
In this cross-sectional study, we surveyed Utah high school students (n=20) who participated in a tanning myths-themed public service announcement video contest. A control cohort of students who did not participate in the video contest were also surveyed (n=89). Demographics, sun exposure history, intentions to tan, and intentions to use sunscreen were documented. Knowledge of tanning myths was assessed with a 7-question sun safety quiz.
Results
The survey response rate was 93.2% (109/117). Two-thirds reported at least one sunburn, and 47.7% (52/109) reported intentional tanning within the past 2 years. Higher tanning intentions were associated with a personal (P<.001), family (P=.001), and peer (P<.001) history of tanning. Video contest participants had higher sun safety quiz scores (P<.001) and higher sunscreen use intentions (P=.01), but did not have decreased tanning intentions (P=.47) compared to non–video contest participants. Hispanic and Black students were less likely to participate in the video contest (P<.001 and P=.04, respectively). In a comparison of White students to students of color, there were no differences in sun exposure history, but students of color had lower sun safety knowledge (P=.01) and lower sunscreen use intention (P=.02).
Conclusions
Sun safety educational disparities exist, and targeted efforts are needed to encourage photoprotective behaviors in high-risk populations. Our findings suggest that video contest participation may encourage sunscreen use and sun protection awareness.
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Janjani H, Nedjat S, MasoudYunesian, Nasseri S, Haghighat Doost F, Nabizadeh R. Sun exposure and health safety practices of high school students in an urban population of Iran. BMC Public Health 2019; 19:1736. [PMID: 31878908 PMCID: PMC6933744 DOI: 10.1186/s12889-019-8100-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Skin cancer attributed to sunlight exposure has an increasing trend worldwide, resulting in increased problems for healthcare services. This study aimed to evaluate the health safety practices of high school students in Saveh, Iran according to a sun protection guideline produced locally for Iran. Method This cross-sectional study was done in 31 government and private high schools of Saveh, a central city of Iran. A sun protection questionnaire was designed in accordance with Iran sun protection guideline which has been developed based on the World Health Organization and US Environmental Protection Agency guidelines. The questionnaire consists of four sections of demographic information, knowledge, attitude, and protection behavior. A total of 504 students were selected by simple random sampling method. Pearson correlation coefficient and multiple linear regression analysis were used to assess the correlation between knowledge, attitude and behavior of the participants. Results The mean score of the students’ knowledge, attitude, and behavior regarding harmfulness of ultraviolet radiation was 50.79 ± 14.64, 60.41 ± 15.04, and 45 ± 11.59, respectively. A significant association was observed between attitude and knowledge, behavior and knowledge as well as attitude. There was a significant correlation between sex and protective behaviors, sex and knowledge (p ≤ 0.001), and education level and knowledge (p = 0.002). Conclusion students who protected themselves from sunlight less than others believed that their protection level was adequate. Health concerns related to sun exposure suggest the need for increasing the student’s awareness in sun protection area. As behavior is influenced by cultural aspects, implementation of the current guideline can be effective in reducing the health effects of sun exposure.
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Affiliation(s)
- Hosna Janjani
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - MasoudYunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Nasseri
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Haghighat Doost
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Wojcik KY, Escobedo LA, Wysong A, Heck JE, Ritz B, Hamilton AS, Milam J, Cockburn MG. High Birth Weight, Early UV Exposure, and Melanoma Risk in Children, Adolescents, and Young Adults. Epidemiology 2019; 30:278-284. [PMID: 30499783 PMCID: PMC6435257 DOI: 10.1097/ede.0000000000000963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Melanoma, the deadliest form of skin cancer, is the second most common cancer diagnosed before age 30. Little is known about potentially modifiable or intervenable risk factors specific to developing melanoma at a young age. The objective was to determine if high birth weight or higher early-life ultraviolet (UV) radiation exposure would be associated with increased risk of melanoma in young patients. METHODS Population-based, case-control study of 1,396 cases of melanoma diagnosed before age 30 in 1988-2013 and 27,920 controls, obtained by linking cancer registry data to birth records in California. RESULTS High birth weight (>4,000 g) was associated with 19% higher risk of melanoma (OR = 1.19; 95% CI = 1.02, 1.39), while low birth weight (<2,500 g) was associated with 41% lower risk (OR = 0.59; 95% CI = 0.43, 0.82), compared with normal birth weight (2,500-4,000 g); dose-response per 1,000 g increase was also evident (OR = 1.24; 95% CI = 1.13, 1.36). All quartiles of birthplace UV greater than the lowest quartile were associated with increased melanoma risk. The strongest relation between birthplace UV and melanoma was for 15-19 years of age at diagnosis. CONCLUSIONS High birth weight and high early-life UV exposure may be important independent risk factors for melanoma diagnosis before age 30. The implication is that adopting skin-protective behaviors as early as infancy could be important for primary prevention of melanoma in younger people. However, research that accounts for early-life behavioral patterns of skin protection during infancy is needed to advance our understanding of how birth weight and early-life UV may influence the development of early-onset melanoma.
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Affiliation(s)
- Katherine Y Wojcik
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Loraine A Escobedo
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Ann S Hamilton
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joel Milam
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Myles G Cockburn
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Yan S, Kwan YH, Tan CS, Thumboo J, Low LL. A systematic review of the clinical application of data-driven population segmentation analysis. BMC Med Res Methodol 2018; 18:121. [PMID: 30390641 PMCID: PMC6215625 DOI: 10.1186/s12874-018-0584-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Data-driven population segmentation analysis utilizes data analytics to divide a heterogeneous population into parsimonious and relatively homogenous groups with similar healthcare characteristics. It is a promising patient-centric analysis that enables effective integrated healthcare interventions specific for each segment. Although widely applied, there is no systematic review on the clinical application of data-driven population segmentation analysis. METHODS We carried out a systematic literature search using PubMed, Embase and Web of Science following PRISMA criteria. We included English peer-reviewed articles that applied data-driven population segmentation analysis on empirical health data. We summarized the clinical settings in which segmentation analysis was applied, compared and contrasted strengths, limitations, and practical considerations of different segmentation methods, and assessed the segmentation outcome of all included studies. The studies were assessed by two independent reviewers. RESULTS We retrieved 14,514 articles and included 216 articles. Data-driven population segmentation analysis was widely used in different clinical contexts. 163 studies examined the general population while 53 focused on specific population with certain diseases or conditions, including psychological, oncological, respiratory, cardiovascular, and gastrointestinal conditions. Variables used for segmentation in the studies are heterogeneous. Most studies (n = 170) utilized secondary data in community settings (n = 185). The most common segmentation method was latent class/profile/transition/growth analysis (n = 96) followed by K-means cluster analysis (n = 60) and hierarchical analysis (n = 50), each having its advantages, disadvantages, and practical considerations. We also identified key criteria to evaluate a segmentation framework: internal validity, external validity, identifiability/interpretability, substantiality, stability, actionability/accessibility, and parsimony. CONCLUSIONS Data-driven population segmentation has been widely applied and holds great potential in managing population health. The evaluations of segmentation outcome require the interplay of data analytics and subject matter expertise. The optimal framework for segmentation requires further research.
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Affiliation(s)
- Shi Yan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549 Singapore
| | - Julian Thumboo
- Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Lian Leng Low
- Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Bowyer Block, Block A, Level 2, Singapore, 169608 Singapore
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Brinker TJ, Heckl M, Gatzka M, Heppt MV, Resende Rodrigues H, Schneider S, Sondermann W, de Almeida E Silva C, Kirchberger MC, Klode J, Enk AH, Knispel S, von Kalle C, Stoffels I, Schadendorf D, Nakamura Y, Esser S, Assis A, Bernardes-Souza B. A Skin Cancer Prevention Facial-Aging Mobile App for Secondary Schools in Brazil: Appearance-Focused Interventional Study. JMIR Mhealth Uhealth 2018. [PMID: 29523502 PMCID: PMC5866300 DOI: 10.2196/mhealth.9794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. Southeast Brazil has especially high incidences of melanoma, and early detection is low. Exposure to ultraviolet (UV) radiation is a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation among adolescents for tanning. A medical student-delivered intervention that takes advantage of the broad availability of mobile phones and adolescents’ interest in their appearance indicated effectiveness in a recent study from Germany. However, the effect in a high-UV index country with a high melanoma prevalence and the capability of medical students to implement such an intervention remain unknown. Objective In this pilot study, our objective was to investigate the preliminary success and implementability of a photoaging intervention to prevent skin cancer in Brazilian adolescents. Methods We implemented a free photoaging mobile phone app (Sunface) in 15 secondary school classes in southeast Brazil. Medical students “mirrored” the pupils’ altered 3-dimensional (3D) selfies reacting to touch on tablets via a projector in front of their whole grade accompanied by a brief discussion of means of UV protection. An anonymous questionnaire capturing sociodemographic data and risk factors for melanoma measured the perceptions of the intervention on 5-point Likert scales among 356 pupils of both sexes (13-19 years old; median age 16 years) in grades 8 to 12 of 2 secondary schools in Brazil. Results We measured more than 90% agreement in both items that measured motivation to reduce UV exposure and only 5.6% disagreement: 322 (90.5%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 321 (90.2%) that it motivated them to improve their sun protection; 20 pupils (5.6%) disagreed with both items. The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in females vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in females vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence. Conclusions The photoaging intervention was effective in changing behavioral predictors for UV protection in Brazilian adolescents. The predictors measured indicated an even higher prospective effectiveness in southeast Brazil than in Germany (>90% agreement in Brazil vs >60% agreement in Germany to both items that measured motivation to reduce UV exposure) in accordance with the theory of planned behavior. Medical students are capable of complete implementation. A randomized controlled trial measuring prospective effects in Brazil is planned as a result of this study.
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Affiliation(s)
- Titus Josef Brinker
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.,Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Marlene Heckl
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Martina Gatzka
- Department of Dermatology and Allergic Diseases, Ulm University Hospital, University of Ulm, Ulm, Germany
| | - Markus V Heppt
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | | | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Klode
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Sarah Knispel
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christof von Kalle
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Germany
| | - Stefan Esser
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aisllan Assis
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil
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Brinker TJ, Faria BL, Gatzka M, de Faria OM, Heppt MV, Kirchberger MC, Schadendorf D, Nakamura Y, Buslaff F, Lisboa OC, Oliveira ACC, Lino HA, Bernardes-Souza B. A skin cancer prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised controlled trial. BMJ Open 2018; 8:e018299. [PMID: 29511007 PMCID: PMC5855446 DOI: 10.1136/bmjopen-2017-018299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. The Southeast of Brazil has especially high incidences of melanoma, and early detection is low. Exposure to UV radiation represents a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation for adolescents for tanning. A medical student-delivered intervention that harnesses the broad availability of mobile phones as well as adolescents' interest in their appearance may represent a novel method to improve skin cancer prevention. METHODS AND ANALYSIS We developed a free mobile app (Sunface), which will be implemented in at least 30 secondary school classes, each with 21 students (at least 30 classes with 21 students for control) in February 2018 in Southeast Brazil via a novel method called mirroring. In a 45 min classroom seminar, the students' altered three-dimensional selfies on tablets are 'mirrored' via a projector in front of their entire class, showing the effects of unprotected UV exposure on their future faces. External block randomisation via computer is performed on the class level with a 1:1 allocation. Sociodemographic data, as well as skin type, ancestry, UV protection behaviour and its predictors are measured via a paper-pencil questionnaire before as well as at 3 and 6 months postintervention. The primary end point is the group difference in the 30-day prevalence of daily sunscreen use at a 6-month follow-up. Secondary end points include (1) the difference in daily sunscreen use at a 3-month follow-up, (2) if a self-skin examination in accordance with the ABCDE rule was performed within the 6-month follow-up and (3) the number of tanning sessions. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committee of the University of Itauna. Results will be disseminated at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03178240; Pre-results.
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Affiliation(s)
- Titus Josef Brinker
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Martina Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | | | - Markus V Heppt
- Department of Dermatology and Allergology, University Medical Center Munich, Munich, Germany
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Fabian Buslaff
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
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11
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Brinker TJ, Brieske CM, Schaefer CM, Buslaff F, Gatzka M, Petri MP, Sondermann W, Schadendorf D, Stoffels I, Klode J. Photoaging Mobile Apps in School-Based Melanoma Prevention: Pilot Study. J Med Internet Res 2017; 19:e319. [PMID: 28887295 PMCID: PMC5610355 DOI: 10.2196/jmir.8661] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Around 90% of melanomas are caused by exposure to ultraviolet (UV) radiation and are therefore eminently preventable. Tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to malignant melanoma and other skin cancers are too far in the future to fathom. Given the substantial amount of time children and adolescents spend in schools, as well as with their mobile phones, addressing melanoma prevention via both of these ways is crucial. However, no school-based intervention using mobile apps has been evaluated to date. We recently released a photoaging mobile app, in which a selfie is altered to predict future appearance dependent on UV protection behavior and skin type. OBJECTIVE In this pilot study, we aimed to use mobile phone technology to improve school-based melanoma prevention and measure its preliminary success in different subgroups of students with regard to their UV protection behavior, Fitzpatrick skin type and age. METHODS We implemented a free photoaging mobile phone app (Sunface) in 2 German secondary schools via a method called mirroring. We "mirrored" the students' altered 3-dimensional (3D) selfies reacting to touch on mobile phones or tablets via a projector in front of their whole grade. Using an anonymous questionnaire capturing sociodemographic data as well as risk factors for melanoma we then measured their perceptions of the intervention on a 5-point Likert scale among 205 students of both sexes aged 13-19 years (median 15 years). RESULTS We measured more than 60% agreement in both items that measured motivation to reduce UV exposure and only 12.5% disagreement: 126 (63.0%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 124 (61.7%) to increase use of sun protection. However, only 25 (12.5%) disagreed with both items. The perceived effect on motivation was increased in participants with Fitzpatrick skin types 1-2 in both tanning bed avoidance (n=74, 71.8% agreement in skin types 1-2 vs n=50, 53.8% agreement in skin types 3-6) and increased use of sun protection (n=70, 68.0% agreement in skin types 1-2 vs n=52, 55.3% agreement in skin types 3-6), and also positively correlated with higher age. CONCLUSIONS We present a novel way of integrating photoaging in school-based melanoma prevention that affects the students' peer group, considers the predictors of UV exposure in accordance with the theory of planned behavior, and is particularly effective in changing behavioral predictors in fair-skinned adolescents (Fitzpatrick skin types 1-2). Further research is required to evaluate the intervention's prospective effects on adolescents of various cultural backgrounds.
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Affiliation(s)
- Titus Josef Brinker
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christian Martin Brieske
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Christoph Matthias Schaefer
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Fabian Buslaff
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martina Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | - Maximilian Philip Petri
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,West German Cancer Center, University Duisburg-Essen, Essen, Germany
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12
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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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13
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Day AK, Stapleton JL, Natale-Pereira AM, Goydos JS, Coups EJ. Parent and Child Characteristics Associated with Child Sunburn and Sun Protection Among U.S. Hispanics. Pediatr Dermatol 2017; 34:315-321. [PMID: 28523887 DOI: 10.1111/pde.13136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Skin cancer incidence has been increasing in U.S. Hispanics over several decades and the postdiagnosis outcomes are worse for Hispanics than for non-Hispanic whites. Parents are influential in children's health preventive behaviors, but little is known about parental factors associated with children's skin cancer-related behaviors in the U.S. Hispanic population. The present study examined parental and child correlates of skin cancer-related behaviors (sunburns, sunbathing, sun-protective clothing use, and sunscreen use) of children of Hispanic parents. METHODS This survey study included a population-based sample of 360 U.S. Hispanic parents (44.8% male) who had a child 14 years of age or younger. Measures included parental reports of parent and child demographic characteristics, parent skin cancer knowledge and linguistic acculturation, and parent and child skin cancer-related behaviors. RESULTS Approximately 28% of children and 31.9% of parents experienced at least one sunburn in the past year and approximately 29% of children and 36.7% of parents were reported to sunbathe. Moderate use of sun-protective clothing and sunscreen was reported for parents and their children. Child sun-protective clothing use and sunscreen use, sunburns, and sunbathing were associated with the corresponding behaviors of their parents. CONCLUSIONS Future research should consider the role of acculturation and perceived risk in the sun protection behaviors of U.S. Hispanic children, particularly in those who report a fair skin type. Hispanic parents should be included in interventions targeting their children's skin cancer-related behaviors, and it is suggested that such interventions could also encourage parents to improve their own behaviors.
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Affiliation(s)
- Ashley K Day
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey
| | | | - James S Goydos
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey
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14
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kelati A, Baybay H, Atassi M, Elfakir S, Gallouj S, Meziane M, Mernissi FZ. Skin cancer knowledge and attitudes in the region of Fez, Morocco: a cross-sectional study. BMC DERMATOLOGY 2017; 17:2. [PMID: 28212650 PMCID: PMC5316218 DOI: 10.1186/s12895-017-0055-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of skin cancers is constantly increasing in Morocco, and they have gradually become more aggressive due to a significant delay in the diagnosis. Our aim was to assess the levels of awareness and the influencing factors related to skin cancer knowledge in Morocco. METHODS This cross-sectional study was carried out in Morocco through the medium of a validated questionnaire, which contained several items - demographics, skin cancer knowledge and attitudes towards skin cancer patients- during a period of 1 year (2014). RESULTS Out of the 700 participants enrolled in the study, 17.9% had never heard of skin cancer, 32.5% had a low score of skin cancer knowledge, 66.7% had a moderate score, and only 0.85% had a high score of skin cancer knowledge. Further, 15.1% of the participants were under the assumption that this cancer is contagious. The sun was the most incriminated risk factor in skin cancer occurrence by 74.3% of the participants, and 57.9% of them believed that prevention is important through using various means of photoprotection. After univariate and multivariate analysis, the influencing factors related to the skin cancer knowledge in Morocco were: the socioeconomic status (P = 0.003, OR = 7. 3) and the educational level (p < 0.001, OR = 20. 9). CONCLUSIONS Due to the lack of knowledge or the underestimation of skin cancer in our study population, efforts are needed to promote skin cancer surveillance behaviors in Morocco.
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Affiliation(s)
- Awatef kelati
- Department of dermatology, University Hospital Hassan II, 202 Hay Mohamadi, Fez, Morocco
| | - Hanane Baybay
- Department of dermatology, University Hospital Hassan II, 202 Hay Mohamadi, Fez, Morocco
| | - Mariam Atassi
- Department of clinical epidemiology and scientific research, University Hospital Hassan II, Fez, Morocco
| | - Samira Elfakir
- Department of clinical epidemiology and scientific research, University Hospital Hassan II, Fez, Morocco
| | - Salim Gallouj
- Department of dermatology, University Hospital Hassan II, 202 Hay Mohamadi, Fez, Morocco
| | - Mariame Meziane
- Department of dermatology, University Hospital Hassan II, 202 Hay Mohamadi, Fez, Morocco
| | - Fatima Zahra Mernissi
- Department of dermatology, University Hospital Hassan II, 202 Hay Mohamadi, Fez, Morocco
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15
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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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16
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Wu YP, Aspinwall LG, Conn BM, Stump T, Grahmann B, Leachman SA. A systematic review of interventions to improve adherence to melanoma preventive behaviors for individuals at elevated risk. Prev Med 2016; 88:153-67. [PMID: 27090434 PMCID: PMC4902721 DOI: 10.1016/j.ypmed.2016.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine the effectiveness of behavioral interventions for melanoma prevention targeted to individuals at elevated risk due to personal and/or family history. METHODS Through literature searches in 5 search databases (through July 2014), 20 articles describing 14 unique interventions focused on melanoma prevention among individuals at elevated risk for the disease were identified. Interventions targeting only patients undergoing active treatment for melanoma were excluded. RESULTS The average study quality was moderate. The majority of interventions (6 out of 9, 66% of studies) led to improvements in one or more photoprotective behaviors, particularly for improvements in use of protective clothing (3 out of 5, 60% of studies), and frequency and/or thoroughness of skin self-examinations (9 out of 12, 75%). Fewer interventions (5 out of 14, 36%) targeted uptake of total body skin examinations (60% led to improvements). Also, fewer interventions targeted all three preventive behaviors (5 out of 14, 36%). CONCLUSIONS Findings suggest that future interventions should aim to improve adherence across multiple preventive behaviors, over a longer time period (past 8months post-intervention), and target high-risk children. Studies should include adequate sample sizes to investigate moderators and mediators of intervention effectiveness. Interventions may be strengthened by new techniques, such as incorporating family members (e.g., to improve thoroughness of skin self-examinations) and eHealth technology.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, USA; Huntsman Cancer Institute, USA.
| | - Lisa G Aspinwall
- Huntsman Cancer Institute, USA; Department of Psychology, University of Utah, USA
| | - Bridgid M Conn
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, USA
| | - Tammy Stump
- Department of Psychology, University of Utah, USA
| | - Bridget Grahmann
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, USA
| | - Sancy A Leachman
- Huntsman Cancer Institute, USA; Department of Dermatology, Oregon Health & Science University, USA
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