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Davis AE, Kennelley GE, Amaye-Obu T, Jowdy PF, Ghadersohi S, Nasir-Moin M, Paragh G, Berman HA, Huss WJ. The phenomenon of phototoxicity and long-term risks of commonly prescribed and structurally diverse drugs. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2024; 19:100221. [PMID: 38389933 PMCID: PMC10883358 DOI: 10.1016/j.jpap.2023.100221] [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] [Indexed: 02/24/2024] Open
Abstract
Photosensitivity to structurally diverse drugs is a common but under-reported adverse cutaneous reaction and can be classified as phototoxic or photoallergic. Phototoxic reactions occur when the skin is exposed to sunlight after administering topical or systemic medications that exhibit photosensitizing activity. These reactions depend on the dose of medication, degree of exposure to ultraviolet light, type of ultraviolet light, and sufficient skin distribution volume. Accurate prediction of the incidence and phototoxic response severity is challenging due to a paucity of literature, suggesting that phototoxicity may be more frequent than reported. This paper reports an extensive literature review on phototoxic drugs; the review employed pre-determined search criteria that included meta-analyses, systematic reviews, literature reviews, and case reports freely available in full text. Additional reports were identified from reference sections that contributed to the understanding of phototoxicity. The following drugs and/or drug classes are discussed: amiodarone, voriconazole, chlorpromazine, doxycycline, fluoroquinolones, hydrochlorothiazide, nonsteroidal anti-inflammatory drugs, and vemurafenib. In reviewing phototoxic skin reactions, this review highlights drug molecular structures, their reactive pathways, and, as there is a growing association between photosensitizing drugs and the increasing incidence of skin cancer, the consequential long-term implications of photocarcinogenesis.
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Affiliation(s)
- Anna E Davis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gabrielle E Kennelley
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- College of Medicine, Central Michigan University, Mt. Pleasant, MI 48858, USA
| | - Tatiana Amaye-Obu
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter F Jowdy
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sarah Ghadersohi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mehr Nasir-Moin
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Harvey A Berman
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Romanell Center for the Philosophy of Medicine and Bioethics, Park Hall University at Buffalo, Buffalo, NY 14260, USA
| | - Wendy J Huss
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Lacson JCA, Soto-Torres B, Sutton SK, Doyle SH, Kim Y, Roetzheim RG, Vadaparampil ST, Kanetsky PA. Skin cancer prevention behaviors, beliefs, distress, and worry among hispanics in Florida and Puerto Rico. BMC Public Health 2023; 23:2234. [PMID: 37957686 PMCID: PMC10644628 DOI: 10.1186/s12889-023-17039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Incidence of skin cancer has been increasing among U.S. Hispanics, who often are diagnosed with larger lesions and at later stage disease. Behaviors to decrease exposure to ultraviolet radiation can reduce risk of skin cancer. We describe skin cancer prevention behaviors and psychosocial variables among Hispanic participants recruited into a skin cancer prevention trial. METHODS Self-reported Hispanic participants from eight primary care clinics in Tampa, Florida and Ponce, Puerto Rico were recruited into a randomized controlled prevention trial. Information on demographics, sun-related behaviors, and psychosocial variables were collected before intervention materials were provided. Multivariable regression models were used to compare baseline sun-related behaviors and psychosocial variables across groups defined by geographic location and language preference. RESULTS Participants reported low levels of intentional outdoor tanning, weekday and weekend sun exposure, and very low levels of indoor tanning. However, only a minority of participants practiced sun-protective behaviors often or always, and about 30% experienced a sunburn in the past year. Participants had low levels of recent worry and concern about skin cancer, modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy. When comparing across groups defined by geographic location and language preference, English-preferring Tampa residents (hereafter referred to as Tampeños) had the highest proportion who were sunburned (35.9%) and tended toward more risky behavior but also had higher protective behavior than did Spanish-preferring Tampeños or Puerto Ricans. Spanish-preferring Puerto Ricans had higher recent concern about skin cancer, comparative chance of getting skin cancer, and response efficacy compared to either English- or Spanish-preferring Tampeños. Spanish-preferring Tampeños had the highest levels of familism and recent distress about skin cancer. CONCLUSIONS Our results mirror previous observations of low levels of sun-protective behavior among U.S. Hispanics compelling the need for culturally appropriate and translated awareness campaigns targeted to this population. Because Hispanics in Tampa and Puerto Rico reported modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy, interventions aiming to improve skin cancer prevention activities that are anchored in Protection Motivation Theory may be particularly effective in this population subgroup.
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Affiliation(s)
- John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US
| | | | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Scarlet H Doyle
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, US
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US.
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Görig T, Apfelbacher C, Drewitz KP, Reimers AK, Breitbart EW, Diehl K. Sunburn and sun protection during recreational outdoor sport in summer: Findings from the German general population aged 16-65 years. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:589-597. [PMID: 37409508 DOI: 10.1111/phpp.12898] [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: 11/18/2022] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Sunburn can increase one's risk of developing skin cancer. We aimed to quantify the prevalence of sunburn during recreational outdoor sport (ROS) in summer, to explore the use of different sun protection measures, and to examine factors associated with sunburn during ROS using a population-based sample from Germany. METHODS For this cross-sectional study, 2081 individuals aged 16-65 years who reported being engaged in ROS in summer were surveyed via standardized telephone interviews in 2020 (National Cancer Aid Monitoring, NCAM). RESULTS Overall, 16.7% reported experiencing at least one sunburn during ROS in the past twelve months. Sunburn occurrence was negatively associated with the age of the participants (e.g. OR = 0.49 in 56-65 year-olds, p < .001), and positively associated with skin type I/II (OR = 1.55, p < .001) and with having a higher number of nevi (OR = 1.42, p = .005). While wearing sleeved shirts was the most frequently-used sun protection measure during ROS (74.9%), wearing headgear was least common in our sample (29.0%). In multivariate analyses, sunburn was positively associated with the use of sun protection measures (e.g. OR = 1.32 for wearing sleeved shirts, p = .02). CONCLUSIONS Our nationwide data show that ROS is one of the settings where sun protection should play a greater role. Especially in organized sports, particular attention should be devoted to organizational (e.g. exercise outside peak hours) or contextual measures (e.g. shade by the natural or built environment) to prevent skin cancer in later life.
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Affiliation(s)
- Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Professorship of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karl Philipp Drewitz
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Anne Kerstin Reimers
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Professorship of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Bae PhD BJ, Heald PhD G. Non-linear effects of absolute risk information on individuals'self-evaluation, affective responses, and behavioral intentionsof precautionary actions against skin cancer. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1259-1269. [PMID: 34242548 DOI: 10.1080/07448481.2021.1926266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/01/2021] [Accepted: 04/25/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The current study explores non-linear effects of absolute risk and effects of comparative risk information about skin cancer on individuals' safety ratings, affective responses and behavioral intentions. METHOD An experimental survey was conducted among college students (N = 563) to test the effects of absolute and comparative risk information across a range of risk levels from 3.7% to 60%. RESULTS The non-linear model of absolute risk effect was confirmed by the data. Absolute risk information had detectable effects at low levels of risk, but the effects did not change appreciably at the highest absolute risk levels. Regarding comparative risk, the data did not support its effects on individuals' safety ratings, affective responses and behavioral intentions. CONCLUSION The study found the non-linear model fits well to the skin cancer related feelings and behavioral intentions. It suggests future research apply non-linear models to a variety of health communication areas.
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Affiliation(s)
- Beom Jun Bae PhD
- Communication Arts Department, Georgia Southern University, Statesboro, Georgia, USA
| | - Gary Heald PhD
- School of Communication, Florida State University, Tallahassee, Florida, USA
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Validity of a Self-Assessment Skin Tone Palette Compared to a Colorimeter for Characterizing Skin Color for Skin Cancer Research. Curr Oncol 2023; 30:3189-3200. [PMID: 36975454 PMCID: PMC10047066 DOI: 10.3390/curroncol30030241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/28/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Our goal is to determine whether our objective 9-point Self-Assessment Skin Tone Palette (SASTP) is correlated with a colorimeter’s assessment of a melanin index, so that Hispanic and Black people can be included in skin cancer research where scales were developed for White populations. Subjects were asked to self-identify their skin tones using the SASTP. This study assessed the criterion validity of the SASTP by measuring a range of skin colors compared to a melanin index reported from a colorimeter for the upper-inner arm (non-sun-exposed skin color), and the outer forearm (sun-exposed). Among 188 non-artificial tanners, 50% were White, 30% were Hispanic or White-Hispanic, and 20% were other racial categories. Meanwhile, 70% were female (30% male) and 81% were age 18–29 (19% age 30+). The mean melanin of the upper-inner arm decreased with lighter skin color and stronger tendency to burn. The SASTP in comparison to melanin index values was correlated for both the upper-inner arm (r = 0.81, p < 0.001) and the outer forearm (r = 0.77, p < 0.001). The SASTP provides a 9-point scale that can be considered as an alternative, less expensive method that is comparable to the objective colorimeter melanin index, which may be useful in studies on skin cancer among White, non-White, and Hispanic peoples.
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Muacevic A, Adler JR, Helmy ZA, Alsifri SS, Bondagji MF, Alshehri AM, Alzahrani EA. Behaviors and Knowledge Related to Intentional Outdoor Tanning Among Adults in the Western Region of Saudi Arabia. Cureus 2022; 14:e33140. [PMID: 36726884 PMCID: PMC9886412 DOI: 10.7759/cureus.33140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Intentional outdoor tanning is the process through which people expose their skin to ultraviolet (UV) radiation to darken their skin color toward brown or bronze. UV radiation is a well-known modifiable risk factor for photoaging, photoallergic reactions, and phototoxicity. OBJECTIVE The aim of this study was to assess the behaviors and knowledge of intentional outdoor tanning among adults in the western region of Saudi Arabia. METHODS A cross-sectional study was conducted among 1023 adults from the general population who met the eligibility criteria. Data were collected in October and November 2022 using an electronic questionnaire to assess the sociodemographic data, behaviors, and knowledge of the participants related to intentional outdoor tanning. RESULTS Overall, 24.5% of the participants intentionally tanned outdoors, the majority of which (203, 80.9%) were exposed to the sun for more than 20 minutes. The participants who intentionally tan outdoors were significantly younger than those who do not (32 ± 10.7 vs. 38.4 ± 13.9, respectively, P <0.001). Most of the participants had good knowledge of the disadvantages of sun exposure on the skin (61.3%). Additionally, good knowledge was significantly more prevalent in women (70.3%) than men (48.6%) (P <0.001). CONCLUSION Individuals who intentionally tan outdoors engage in other behaviors or beliefs that increase exposure to UV rays. This points to the need for comprehensive interventions such as community-counseling campaigns to address these new trends and their relationship with photoaging and skin cancer.
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Diehl K, Breitbart EW, Greinert R, Hillhouse J, Stapleton JL, Görig T. Nationwide Analysis on Intentional Indoor and Outdoor Tanning: Prevalence and Correlates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12309. [PMID: 36231611 PMCID: PMC9564845 DOI: 10.3390/ijerph191912309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Outdoor and indoor tanning are considered as risk factors for the development of skin cancer. The aims of this nationwide representative study were to quantify both behaviors in a sample with a wide age range, to identify those showing both behaviors and to explore and compare determinants of both behaviors. We used data from the fifth wave (2019) of the National Cancer Aid Monitoring (NCAM). We surveyed the representative sample including 4000 individuals, aged 16-65 years, living in Germany. Data were collected through telephone interviews. In addition to descriptive statistics, we used logistic regression analyses to identify determinants. The one-year-prevalence of tanning bed use was 7.5%, while 31.9% tanned (very) often intentionally outdoors in at least one situation (weekdays, holidays, and weekends). A total of 3.2% reported both risk behaviors. Regression analyses revealed that tanning bed use is associated with employment, an increased number of naevi, and lack of risk awareness. Intentional outdoor tanning was associated with male sex, younger age, past tobacco use, and low risk awareness of UV radiation. Our findings suggest that only a minority of subjects showed both risk behaviors. This implies that individuals seem to perform either one behavior or the other. In addition, the associated determinants differed between both behaviors, implying that specific preventive measures tailored to address to each tanning behavior are needed.
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Affiliation(s)
- Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | | | - Rüdiger Greinert
- Arbeitsgemeinschaft Dermatologische Prävention, 21614 Buxtehude, Germany
| | - Joel Hillhouse
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Jerod L. Stapleton
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY 40506, USA
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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Braun HA, Adler CH, Goodman M, Yeung H. Sunburn frequency and risk and protective factors: a cross-sectional survey. Dermatol Online J 2021; 27:13030/qt6qn7k2gp. [PMID: 33999575 PMCID: PMC8281353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023] Open
Abstract
Skin cancer prevention is at the forefront of public health as morbidity increases. Limited data exists on effective interventions to reduce sunburn frequency and modifiable risk factors. This research aims to determine an association between 1) demographic characteristics and outdoor sunburn frequency, and 2) sunburn frequency and sun-related risk and protective factors in a nationally representative, cross-sectional household survey. Of 23,430 surveys sent, 4,883 respondents reported sunburn-related data. Association between sunburns and demographic, risk, and protective factors were examined. When assessing demographic factors, potential confounding was addressed using multivariable analysis. In multivariable models, younger, non-Hispanic White respondents were more likely to report sunburn. Those with higher income were more likely to report any sunburn, but less likely to sunburn frequently. Females were less likely to report frequent sunburns. Engagement in sporting events, outdoor events, and day-to-day activities during the most recent sunburn was more commonly reported by those with frequent sunburns as compared with those with infrequent sunburns. Sun-protection interventions targeting higher-risk demographics during time spent outdoors, at sporting events, and during other day-to-day activities may be beneficial. Further insight into risk and protective behaviors for those who did not burn could be useful to guide public health interventions.
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Affiliation(s)
| | | | | | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA Regional Telehealth Service, VA Southeast Network VISN 7, Decatur, GA.
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9
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Bowers JM, Nosek S, Moyer A. Young adults' stigmatizing perceptions about individuals with skin cancer: the influence of potential cancer cause, cancer metaphors, and gender. Psychol Health 2021; 37:615-632. [PMID: 33405966 DOI: 10.1080/08870446.2020.1869738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: This study examined the influence of three potential predictors of stigmatising cancer perceptions: the controllability of the cancer cause, metaphors used to describe the cancer experience, and the target's gender.Method: 306 undergraduates (Mage = 20) were recruited via subject pool, balancing males and females. Participants read a fictitious post by a patient/blogger with skin cancer that described different potential causes for their cancer varying with respect to its controllability, used varying types of commonly invoked cancer metaphors, and indicated their gender with names.Main outcome measures: Potential stigmatisation of the blogger in the form of negative affective responses, perceptions of flawed character, desired social distance and expectations for post-traumatic growth were assessed using mixed methods. The perceived age of the blogger and expectations for their survival were also explored.Results: More blame, less sympathy, and less favourable perceptions of character were ascribed to the hypothetical blogger when their cancer was described as due to their lifestyle rather than genetics and thus potentially construed as more controllable. Females using a war metaphor resulted in more positive responses compared to a female using no metaphorical language.Conclusion: Stigmatisation of individuals with skin cancer may depend on the potential cause of cancer, and to some extent, metaphors and gender.
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Affiliation(s)
- Jennifer M Bowers
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Sarah Nosek
- Department of Psychology, Saint Michael's College, Colchester, Vermont, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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10
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Banerjee SC, Rodríguez VM, Greene K, Hay JL. Trending on Pinterest: an examination of pins about skin tanning. Transl Behav Med 2020; 9:737-748. [PMID: 29648613 DOI: 10.1093/tbm/iby036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rates of melanoma and nonmelanoma skin cancers are on the rise in the USA with data revealing disproportionate increase in female young adults. The popularity of intentional skin tanning among U.S. adolescents is attributed to several factors, including prioritization of physical appearance, media images of tanned celebrities, ease of availability of artificial tanning facilities, and more recently, the prevalence and celebration of tanned skin on social media. Pinterest, as the third most popular social media platform, was searched for "pins" about skin tanning. The resultant "pins" were examined to understand the extent and characteristics of skin tanning portrayed on Pinterest. We analyzed pins on Pinterest about skin tanning (n = 501) through a quantitative content analysis. Overall, results indicated an overwhelmingly protanning characteristic of pins about skin tanning on Pinterest, with over 85% of pins promoting tanning behavior. The pins were generally characterized by the portrayal of a female subject (61%) and provided positive reinforcement for tanning (49%). Use of tanning for enhancing appearance was the main positive outcome expectancy portrayed in the pins (35%), and nudity or exposure of skin on arms (32%) and legs (31%) was evident in about a third of pins. With overwhelmingly positive pins promoting tanning, use of female subjects, exhibiting nudity, and appearance enhancement, there seems be to a consistent targeting of female users to accept tanning as a socially acceptable and popular behavior. The findings indicate a need for developing sun protection messages and the leveraging of social media for dissemination of skin cancer prevention and detection messages.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kathryn Greene
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Bowers JM, Geller AC, Schofield E, Li Y, Hay JL. Indoor Tanning Trends Among US Adults, 2007-2018. Am J Public Health 2020; 110:823-828. [PMID: 32298165 DOI: 10.2105/ajph.2020.305605] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine indoor tanning trends among US adults, and the relation to indoor tanning youth access legislation.Methods. This study analyzed the Health Information National Trends Survey (HINTS), a mailed survey, from the years 2007, 2011, 2013, 2014, 2017, and 2018 (combined n = 20 2019).Results. Indoor tanning prevalence decreased significantly over time among all US adults from 2007 (10%) to 2018 (4%; P < .001), among young adults aged 18 to 34 years (14% to 4%; P < .001), and among both women (14% to 4%; P < .001) and men (5% to 4%; P < .05). Indoor tanning significantly decreased in states that enacted youth access legislation by 2018, but did not significantly decrease for other states. Frequent indoor tanning was common in 2018; about one quarter of respondents who reported any indoor tanning did so 25 times or more in the past year.Conclusions. This study identifies several challenges in continuing to reduce indoor tanning in the United States. Youth access legislation may be effective for reducing tanning among the broader population of tanners; however, there remains a need for focus on highly frequent tanners, as well as men.
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Affiliation(s)
- Jennifer M Bowers
- Jennifer M. Bowers, Elizabeth Schofield, Yuelin Li, and Jennifer L. Hay are with the Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY. Jennifer M. Bowers is also with the Department of Psychology, Stony Brook University, Stony Brook, NY. Alan C. Geller is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Alan C Geller
- Jennifer M. Bowers, Elizabeth Schofield, Yuelin Li, and Jennifer L. Hay are with the Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY. Jennifer M. Bowers is also with the Department of Psychology, Stony Brook University, Stony Brook, NY. Alan C. Geller is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Elizabeth Schofield
- Jennifer M. Bowers, Elizabeth Schofield, Yuelin Li, and Jennifer L. Hay are with the Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY. Jennifer M. Bowers is also with the Department of Psychology, Stony Brook University, Stony Brook, NY. Alan C. Geller is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yuelin Li
- Jennifer M. Bowers, Elizabeth Schofield, Yuelin Li, and Jennifer L. Hay are with the Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY. Jennifer M. Bowers is also with the Department of Psychology, Stony Brook University, Stony Brook, NY. Alan C. Geller is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jennifer L Hay
- Jennifer M. Bowers, Elizabeth Schofield, Yuelin Li, and Jennifer L. Hay are with the Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY. Jennifer M. Bowers is also with the Department of Psychology, Stony Brook University, Stony Brook, NY. Alan C. Geller is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
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12
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Rocholl M, Ludewig M, John SM, Bitzer EM, Wilke A. Outdoor workers' perceptions of skin cancer risk and attitudes to sun-protective measures: A qualitative study. J Occup Health 2020; 62:e12083. [PMID: 31478315 PMCID: PMC6970388 DOI: 10.1002/1348-9585.12083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/11/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Since January 2015, squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural ultraviolet irradiation (UVR) is recognized as occupational disease in Germany. Interventions which improve the sun protection behavior of outdoor workers are urgently needed. When developing preventive interventions, the attitudes of target groups need to be taken into consideration. Therefore, outdoor workers' perceptions and attitudes were investigated. METHODS Seven guided, problem-centered qualitative interviews with healthy male outdoor workers were conducted. A qualitative content analysis was used to analyze the data. RESULTS We found an underestimation of the perceived skin cancer risk in the seven outdoor workers and heterogeneous attitudes toward the usage of sun-protective measures. Participants stated that the feasibility of technical sun-protective measures depends on the size of the working area. While using a headgear seemed common, none of the participants stated using additional neck protection. Wearing long-sleeved shirts and long trousers were considered problematic. The interviews revealed important requirements for sun-protective clothes, especially in terms of different materials. Although the usage of sunscreen was common, our interviewees seemed to apply it wrongly. CONCLUSION Risk perceptions of outdoor workers and their attitudes toward sun protection measures may influence the factual UV protection behavior in the workplace. Structures to facilitate the implementation of technical and organizational sun-protective measures seem to be necessary. Educational interventions and clear instructions which are tailored to the individual needs and attitudes of outdoor workers are required to improve the UV protection behavior and to avoid common mistakes.
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Affiliation(s)
- Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Michaela Ludewig
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Eva Maria Bitzer
- Public Health and Health Education, University of Education Freiburg, Freiburg im Breisgau, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
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13
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Schneiderbanger CK, Schuler G, Heinzerling L, Kirchberger MC. Characterization of tanning behavior assessed via online survey: Attitudes, habits, and preventive measures with focus on sunscreen use. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:268-274. [PMID: 30854722 DOI: 10.1111/phpp.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND/PURPOSE Incidence of melanoma is increasing globally. Exposure to ultraviolet radiation (UVR) as important risk factor for developing skin cancer can be influenced by tanning behavior. Only a few studies are available concerning sun tanning behavior and protective measures. METHODS An online survey was distributed via social media to assess tanning habits and examine associated demographic and behavioral factors. RESULTS In total, 403 questionnaires were distributed, and mean age of respondents was 32. Having a tanned skin, feeling warm and relaxed were the most common motivations for tanning. The use of sunscreen varied and seemed to depend on the occasion of UVR exposure, constantly applied during vacation and during tanning, less commonly applied in daily life and during work. Avoiding painful solar dermatitis was more important as motivation for the use of sunscreen than skin cancer prevention. Skin aging as reason for the use of sunscreen was especially important for females younger than 26 years. The most common applied sun protection factor was 16-49. The main reason opposing the use of sunscreen was a too laborious usage, which was significantly associated with male. Beauty was the only association related to tanned skin the majority (62%) agreed with. CONCLUSION The motivation for tanning and reasons for avoiding sunscreen strongly varies. Knowledge about these factors could be used for improving campaigns with respect to target groups. Clarifying the appropriate application of sunscreen, developing convenient sunscreen formulations and providing information about UVR-induced skin aging could lead to an increased usage of sunscreen and therefore to an improved UVR protection.
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Affiliation(s)
- Constanze K Schneiderbanger
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Gerold Schuler
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael C Kirchberger
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
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14
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Bleakley A, Lazovich D, B Jordan A, Glanz K. Compensation Behaviors and Skin Cancer Prevention. Am J Prev Med 2018; 55:848-855. [PMID: 30344038 DOI: 10.1016/j.amepre.2018.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/16/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Skin cancer prevention guidelines recommend practicing multiple behaviors to protect against harmful ultraviolet rays, yet few adults report practicing more than one recommended behavior. This study examines the extent to which skin cancer prevention behaviors are combined and may follow a pattern of compensation in which an individual's performance of one behavior (e.g., wearing sunscreen) precludes performing other protective behaviors (e.g., wearing a hat). METHODS Data from qualitative semi-structured interviews (n=80) in 2015 and a quantitative online national survey (n=940) in 2016 with non-Hispanic white adults aged 18-49 years from the U.S. were used to examine combinations of skin cancer prevention behaviors. Data were analyzed in 2017. RESULTS Protective behaviors like wearing sunglasses and sunscreen were a common approach to prevention, but protective, avoidant (i.e., seeking shade, avoiding outdoor tanning), and covering-up (i.e., wearing a hat, shirt) strategies were rarely used in combination. Regression analyses to determine correlates of protection, avoidance, and covering-up showed that age was positively associated with practicing each strategy; positive attitudes about tanning were negatively associated with avoidance and covering-up; and positive body image was positively associated with protection and negatively associated with avoidance. Demographics such as education, employment, and gender, but not skin cancer risk, were also related to the various strategies. CONCLUSIONS Although a full evaluation of compensation theory and skin cancer prevention was limited by the available data, the results suggest that application of the theory may yield clues for how to improve sun protection behaviors.
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Affiliation(s)
- Amy Bleakley
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Amy B Jordan
- School of Communication and Information, Rutgers the State University of New Jersey, New Brunswick, New Jersey
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Niu Z, Parmar V, Xu B, Coups EJ, Stapleton JL. Prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States: Findings from the FLASHE survey. Prev Med Rep 2018; 11:187-190. [PMID: 29992085 PMCID: PMC6034571 DOI: 10.1016/j.pmedr.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/13/2018] [Accepted: 06/24/2018] [Indexed: 01/03/2023] Open
Abstract
A body of research has focused on adolescents' indoor tanning behaviors but relatively little is known about the prevalence of adolescents' intentional outdoor tanning (time spent outdoors to get a tan). The present study used data from the National Cancer Institute's 2014 Family Life, Activity, Sun, Health and Eating (FLASHE) cross-sectional survey to examine the prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States. Both unadjusted (bivariate) and adjusted (multi-variate) logistic regressions were performed to test the associations between demographic variables, time spent on media (e.g., using computers), emotional status and outdoor or indoor tanning. The overall prevalence of frequent outdoor tanning among adolescents in the U.S. was 15.6% (95% CI 13.8-17.4%) and the rate of indoor tanning in the past 12 months was 3% (95% CI 2.2-3.9). The adjusted odds of intentional outdoor tanning were significantly higher among girls (AOR 2.39, 95% CI 1.75-3.27), Non-Hispanic Whites (AOR 2.85, 95% CI 1.99-4.07), and those who spent more time on cell phones (AOR 1.40, 95% CI 1.25-1.57). The adjusted odds of indoor tanning were significantly higher among those who spent more time on computers (AOR 1.38, 95% CI 1.09-1.74) and cell phones (AOR 1.49, 95% CI 1.19-1.87). This study provides evidence for the relationship between media use and tanning behaviors among adolescents.
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Affiliation(s)
- Zhaomeng Niu
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, United States of America
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