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Donoso FS, Carver T, Ficorella L, Fennell N, Antoniou AC, Easton DF, Tischkowitz M, Walter FM, Usher-Smith JA, Archer S. Improving the communication of multifactorial cancer risk assessment results for different audiences: a co-design process. J Community Genet 2024:10.1007/s12687-024-00729-4. [PMID: 39320563 DOI: 10.1007/s12687-024-00729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/21/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Multifactorial cancer risk prediction tools, such as CanRisk, are increasingly being incorporated into routine healthcare. Understanding risk information and communicating risk is challenging and healthcare professionals rely substantially on the outputs of risk prediction tools to communicate results. This work aimed to produce a new CanRisk report so users can directly access key information and communicate risk estimates effectively. METHODS Over a 13-month period, we led an 8-step co-design process with patients, the public, and healthcare professionals. Steps comprised 1) think aloud testing of the original CanRisk report; 2) structured feedback on the original report; 3) literature review; 4) development of a new report prototype; 5) first round of structured feedback; 6) updating the new report prototype; 7) second round of structured feedback; and 8) finalising and publishing the new CanRisk report. RESULTS We received 56 sets of feedback from 34 stakeholders. Overall, the original CanRisk report was not suitable for patients and the public. Building on the feedback, the new report has an overview of the information presented: section one summarises key information for individuals; sections two and three present information for healthcare professionals in different settings. New features also include explanatory text, definitions, graphs, keys and tables to support the interpretation of the information. DISCUSSION This co-design experience shows the value of collaboration for the successful communication of complex health information. As a result, the new CanRisk report has the potential to better support shared decision-making processes about cancer risk management across clinical settings.
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Affiliation(s)
| | - Tim Carver
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lorenzo Ficorella
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nichola Fennell
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F Easton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
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El-Shafei DA, Said RM. Sun Safety: Knowledge and Behavior among Egyptian Farmers-a Multicomponent Intervention Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1042-1049. [PMID: 36280650 PMCID: PMC10234846 DOI: 10.1007/s13187-022-02230-3] [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] [Accepted: 10/10/2022] [Indexed: 06/02/2023]
Abstract
The purpose of study was to screen for health hazards related to sun exposure and to examine the effectiveness of a sun safety multicomponent intervention designed specifically for the Egyptian farmers. A multicomponent interventional study was conducted among 128 farmers from three villages in Zagazig district, Sharkia Governorate, Egypt, from January to July 2022. It passed through three phases: phase 1: assessment of participants' risk of skin cancer and vision screening; phase 2: filling a semi-structured questionnaire assessing sun exposure hazards and sun safety knowledge, behavior, and barriers; and phase 3: conducting multicomponent intervention composed of education session, providing sun safety supplies and reminders then evaluate the effect of this intervention after one month. Most of participants had moderate risk for skin cancer (69.0%), history of photokeratitis (77.3%), cataract (15.6%), and bad/very bad self-reported overall eyesight (43.0%). After intervention, there was a statistically significant improvement in the participants' awareness regarding sun exposure-related hazards, all knowledge items about sun safety measures (p < 0.01) and some sun safety behaviors (p < 0.05) including wearing protective clothing, minimization of direct sunlight exposure, taking breaks, plentiful water intake, regular self-checking of skin, wearing wide brimmed hats, and job rotation. Furthermore, there was a statistically significant improvement in all sun protection barriers (p < 0.01) except sunscreen and sunglasses related barriers (p ˃ 0.05). The multicomponent intervention composed of education session, providing sun safety supplies and reminders was effective in increasing awareness of farmers with sun exposure hazards and improving their knowledge and behavior towards sun safety measures.
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Affiliation(s)
- Dalia A El-Shafei
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
- Department of Family Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Randa M Said
- Department of Family Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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3
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Fazel SS, Fenton S, Braun N, Forsman-Phillips L, Linn Holness D, Kalia S, Arrandale VH, Tenkate T, Peters CE. Tailored Sun Safety Messages for Outdoor Workers. Saf Health Work 2023; 14:43-49. [PMID: 36941943 PMCID: PMC10024223 DOI: 10.1016/j.shaw.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/25/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Background Messaging surrounding skin cancer prevention has previously focused on the general public and emphasized how or when activities should be undertaken to reduce solar ultraviolet radiation (UVR) exposure. Generic messages may not be applicable to all settings, and should be tailored to protect unique and/or highly susceptible subpopulations, such as outdoor workers. The primary objective of this study was to develop a set of tailored, practical, harm-reducing sun safety messages that will better support outdoor workers and their employers in reducing the risk of solar UVR exposure and UVR-related occupational illnesses. Methods We adapted a core set of sun safety messages previously developed for the general population to be more applicable and actionable by outdoor workers and their employers. This study used an integrated knowledge translation approach and a modified Delphi method (which uses a survey-based consensus process) to tailor the established set of sun safety messages for use for outdoor worker populations. Results The tailored messages were created with a consideration for what is feasible for outdoor workers, and provide users with key facts, recommendations, and tips related to preventing skin cancer, eye damage, and heat stress, specifically when working outdoors. Conclusion The resulting tailored messages are a set of evidence-based, expert- approved, and stakeholder-workshopped messages that can be used in a variety of work settings as part of an exposure control plan for employers with outdoor workers.
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Affiliation(s)
- Sajjad S. Fazel
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N2, Canada
| | - Shelby Fenton
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N2, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Nicole Braun
- Saskatchewan Cancer Agency, Regina, SK, S4W 0G3, Canada
| | - Lindsay Forsman-Phillips
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - D. Linn Holness
- Occupational Medicine Division, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, M5T 3M7, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
| | - Sunil Kalia
- BC Cancer, Vancouver, BC, V5Z 1G1, Canada
- Department of Dermatology and Skin Science, Faculty of Medicine, University of British Columbia, Vancouver, BC, V5Z 4E8, Canada
| | - Victoria H. Arrandale
- Dalla Lana School of Public Health, University of Toronto, ON, M5T 3M7, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, ON, M5G 1X3, Canada
| | - Thomas Tenkate
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, ON, M5B 2K3, Canada
| | - Cheryl E. Peters
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N2, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- BC Cancer, Vancouver, BC, V5Z 1G1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
- Corresponding author. Cumming School of Medicine, University of Calgary, CAREX Canada, University of British Columbia, BC Cancer and BC CDC, 655 W 12th Ave, Vancouver, BC, V5Z4R4, Canada.
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Ackermann DM, Bracken K, Janda M, Turner RM, Hersch JK, Drabarek D, Bell KJL. Strategies to Improve Adherence to Skin Self-examination and Other Self-management Practices in People at High Risk of Melanoma: A Scoping Review of Randomized Clinical Trials. JAMA Dermatol 2023; 159:432-440. [PMID: 36857048 DOI: 10.1001/jamadermatol.2022.6478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Importance Adherence, both in research trials and in clinical practice, is crucial to the success of interventions. There is limited guidance on strategies to increase adherence and the measurement and reporting of adherence in trials of melanoma self-management practices. Objective This scoping review aimed to describe (1) strategies to improve adherence to self-management practices in randomized clinical trials of people at high risk of melanoma and (2) measurement and reporting of adherence data in these trials. Evidence Review Four databases, including MEDLINE, Embase, CENTRAL, and CINAHL, were searched from inception to July 2022. Eligible studies were randomized clinical trials of self-monitoring interventions for early detection of melanoma in people at increased risk due to personal history (eg, melanoma, transplant, dysplastic naevus syndrome), family history of melanoma, or as determined by a risk assessment tool or clinical judgment. Findings From 939 records screened, 18 eligible randomized clinical trials were identified, ranging in size from 40 to 724 participants, using a range of adherence strategies but with sparse evidence on effectiveness of the strategies. Strategies were classified as trial design (n = 15); social and economic support (n = 5); intervention design (n = 18); intervention and condition support (n = 10); and participant support (n = 18). No strategies were reported for supporting underserved groups (eg, people who are socioeconomically disadvantaged, have low health literacy, non-English speakers, or older adults) to adhere to self-monitoring practices, and few trials targeted provider (referring to both clinicians and researchers) adherence (n = 5). Behavioral support tools included reminders (n = 8), priority-setting guidance (n = 5), and clinician feedback (n = 5). Measurement of adherence was usually by participant report of skin self-examination practice with some recent trials of digital interventions also directly measuring adherence to the intervention through website or application analytic data. Reporting of adherence data was limited, and fewer than half of all reports mentioned adherence in their discussion. Conclusions and Relevance Using an adaptation of the World Health Organization framework for clinical adherence, this scoping review of randomized clinical trials identified key concepts as well as gaps in the way adherence is approached in design, conduct, and reporting of trials for skin self-examination and other self-management practices in people at high risk of melanoma. These findings may usefully guide future trials and clinical practice; evaluation of adherence strategies may be possible using a Study Within A Trial (SWAT) framework within host trials.
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Affiliation(s)
- Deonna M Ackermann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Bracken
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Jolyn K Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Leung T, Eysenbach G, Peterson S, Heckman C, Kashy D, Berger A, Studts C, Negrón R, Buller D, Paddock L, Gallo J, Kulik A, Frederick S, Pesanelli M, Domider M, Grosso M. Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e39640. [PMID: 36692933 PMCID: PMC9906316 DOI: 10.2196/39640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors. OBJECTIVE We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. METHODS Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors' SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating. RESULTS This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates. CONCLUSIONS The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention's delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others. TRIAL REGISTRATION ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39640.
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Affiliation(s)
| | | | - Susan Peterson
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, The University of Texas, San Antonio, TX, United States
| | - Carolyn Heckman
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Deborah Kashy
- College of Social Science, Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Adam Berger
- Division of Surgical Oncology, Department of Surgery, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Christina Studts
- Pediatrics - General Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rosalyn Negrón
- College of Liberal Arts, University of Massachusetts Boston, Boston, MA, United States
| | | | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Joseph Gallo
- Hackensack Meridian Jersey Shore Medical Center, Hackensack Meridian Health, Neptune City, NJ, United States
| | - Alexandria Kulik
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Sara Frederick
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Morgan Pesanelli
- School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Mara Domider
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Marissa Grosso
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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6
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Conahan LJ, Robertson S. Sun-Protective Behaviors in Patients with Melasma. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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7
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Alhabash S, Dong Y, Moureaud C, Muraro IS, Hertig JB. Effects of Fear and Humor Appeals in Public Service Announcements (PSAs) on Intentions to Purchase Medications via Social Media. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12340. [PMID: 36231640 PMCID: PMC9564852 DOI: 10.3390/ijerph191912340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
The increasing prevalence of online purchase of medications, specifically via social media platforms, poses significant health risks due to high chances of such medications being substandard and falsified (SF). The current study uses a 2 (persuasive appeal: fear vs. humor) x 3 (message repetition) mixed factorial experiment to investigate the effectiveness of persuasive appeals (on intentions to purchase medications online via social media referrals, mediated by psychological reactance (threat to freedom and anger), attitudes toward the public service announcements (PSAs), and viral behavioral intentions. ANOVA results showed the superiority of humor appeals compared to fear appeals in (1) reducing psychological reactance, (2) igniting favorable responses to the PSA, and (3) marginally reducing the intentions to purchase medications vial social media despite lower online engagement intentions (viral behavioral intentions). Pre-existing risk perceptions moderated these differences. A moderated serial mediation model, conducted using PROCESS models, was examined to assess the mechanism by which persuasive appeals and risk perceptions interact in influencing purchase intentions. Findings are discussed theoretically in regard to extending the psychological reactance model within the digital environment and practically in terms of public health, brand protection, and law enforcement recommendations.
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Affiliation(s)
- Saleem Alhabash
- Department of Advertising and Public Relations, College of Communication Arts, Michigan State University, East Lansing, MI 48824, USA
| | - Yao Dong
- Department of Advertising and Public Relations, College of Communication Arts, Michigan State University, East Lansing, MI 48824, USA
| | | | - Iago S. Muraro
- Department of Advertising and Public Relations, College of Communication Arts, Michigan State University, East Lansing, MI 48824, USA
| | - John B. Hertig
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN 46208, USA
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8
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Effectiveness of a tailored web app on sun protection intentions and its implications for skin cancer prevention: A randomized controlled trial. PLOS DIGITAL HEALTH 2022; 1:e0000032. [PMID: 36812525 PMCID: PMC9931317 DOI: 10.1371/journal.pdig.0000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/20/2022]
Abstract
Skin cancers related to sunexposure are rising globally, yet largely preventable. Digital solutions enable individually tailored prevention and may play a crucial role in reducing disease burden. We developed SUNsitive, a theory-guided web app to facilitate sun protection and skin cancer prevention. The app collected relevant information through a questionnaire and provided tailored feedback on personal risk, adequate sun protection, skin cancer prevention, and overall skin health. SUNsitive's effect on sun protection intentions and a set of secondary outcomes was evaluated with a two-arm randomized controlled trial (n = 244). At 2 weeks post-intervention, we did not find any statistical evidence for the intervention's effect on the primary outcome or any of the secondary outcomes. However, both groups reported improved intentions to sun protect compared to their baseline values. Furthermore, our process outcomes suggest that approaching sun protection and skin cancer prevention with a digital tailored "questionnaire-feedback" format is feasible, well-perceived, and well accepted. Trial registration: Protocol registration: ISRCTN registry (ISRCTN10581468).
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9
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Potjer TP, van der Grinten TWJ, Lakeman IMM, Bollen SH, Rodríguez-Girondo M, Iles MM, Barrett JH, Kiemeney LA, Gruis NA, van Asperen CJ, van der Stoep N. Association between a 46-SNP Polygenic Risk Score and melanoma risk in Dutch patients with familial melanoma. J Med Genet 2021; 58:760-766. [PMID: 32994281 PMCID: PMC8551976 DOI: 10.1136/jmedgenet-2020-107251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Familial clustering of melanoma suggests a shared genetic predisposition among family members, but only 10%-40% of familial cases carry a pathogenic variant in a known high-risk melanoma susceptibility gene. We investigated whether a melanoma-specific Polygenic Risk Score (PRS) is associated with melanoma risk in patients with genetically unexplained familial melanoma. METHODS Dutch familial melanoma cases (n=418) were genotyped for 46 SNPs previously identified as independently associated with melanoma risk. The 46-SNP PRS was calculated and standardised to 3423 healthy controls (sPRS) and the association between PRS and melanoma risk was modelled using logistic regression. Within the case series, possible differences were further explored by investigating the PRS in relation to (1) the number of primary melanomas in a patient and (2) the extent of familial clustering of melanoma. RESULTS The PRS was significantly associated with melanoma risk, with a per-SD OR of 2.12 (95% CI 1.90 to 2.35, p<0.001), corresponding to a 5.70-fold increased risk (95% CI 3.93 to 8.28) when comparing the top 90th to the middle 40-60th PRS percentiles. The mean PRS was significantly higher in cases with multiple primary melanomas than in cases with a single melanoma (sPRS 1.17 vs 0.71, p=0.001). Conversely, cases from high-density melanoma families had a lower (but non-significant) mean PRS than cases from low-density families (sPRS 0.60 vs 0.94, p=0.204). CONCLUSION Our work underlines the significance of a PRS in determining melanoma susceptibility and encourages further exploration of the diagnostic value of a PRS in genetically unexplained melanoma families.
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Affiliation(s)
- Thomas P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Inge M M Lakeman
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sander H Bollen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mar Rodríguez-Girondo
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark M Iles
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Jennifer H Barrett
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Lambertus A Kiemeney
- Department of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nelleke A Gruis
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke van der Stoep
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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10
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Allen N, Damian DL. Interventions to Increase Sunscreen Use in Adults: A Review of the Literature. HEALTH EDUCATION & BEHAVIOR 2021; 49:415-423. [PMID: 34636262 DOI: 10.1177/10901981211046534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Skin cancers are the most common malignancy in Australia. Regular sunscreen use can reduce the incidence of cutaneous squamous cell carcinomas and actinic keratoses and has been associated with reducing the incidence of basal cell carcinomas and melanomas. However, sunscreen effectiveness is limited by the failure of the population to use it routinely. Interventions that promote the daily application of sunscreen may reduce the morbidity, mortality, and economic burden associated with skin malignancies. We reviewed the literature that examines the effectiveness of interventions to increase routine sunscreen use and found that no one strategy has been shown to be clearly effective in adults and that relatively few studies have aimed to increase routine use in groups at extreme skin cancer risk. Future research should consider how interventions can be best designed and how sunscreen use is measured so that cost-effective, feasible strategies that result in improved sunscreen use in adults can be established.
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Affiliation(s)
- Nicholas Allen
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Diona L Damian
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Sydney, New South Wales, Australia
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11
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Smit AK, Allen M, Beswick B, Butow P, Dawkins H, Dobbinson SJ, Dunlop KL, Espinoza D, Fenton G, Kanetsky PA, Keogh L, Kimlin MG, Kirk J, Law MH, Lo S, Low C, Mann GJ, Reyes-Marcelino G, Morton RL, Newson AJ, Savard J, Trevena L, Wordsworth S, Cust AE. Impact of personal genomic risk information on melanoma prevention behaviors and psychological outcomes: a randomized controlled trial. Genet Med 2021; 23:2394-2403. [PMID: 34385669 PMCID: PMC8629758 DOI: 10.1038/s41436-021-01292-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose We evaluated the impact of personal melanoma genomic risk information on sun-related behaviors and psychological outcomes. Methods In this parallel group, open, randomized controlled trial, 1,025 Australians of European ancestry without melanoma and aged 18–69 years were recruited via the Medicare database (3% consent). Participants were randomized to the intervention (n = 513; saliva sample for genetic testing, personalized melanoma risk booklet based on a 40-variant polygenic risk score, telephone-based genetic counseling, educational booklet) or control (n = 512; educational booklet). Wrist-worn ultraviolet (UV) radiation dosimeters (10-day wear) and questionnaires were administered at baseline, 1 month postintervention, and 12 months postbaseline. Results At 12 months, 948 (92%) participants completed dosimetry and 973 (95%) the questionnaire. For the primary outcome, there was no effect of the genomic risk intervention on objectively measured UV exposure at 12 months, irrespective of traditional risk factors. For secondary outcomes at 12 months, the intervention reduced sunburns (risk ratio: 0.72, 95% confidence interval: 0.54–0.96), and increased skin examinations among women. Melanoma-related worry was reduced. There was no overall impact on general psychological distress. Conclusion Personalized genomic risk information did not influence sun exposure patterns but did improve some skin cancer prevention and early detection behaviors, suggesting it may be useful for precision prevention. There was no evidence of psychological harm.
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Affiliation(s)
- Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand
| | - Brooke Beswick
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Hugh Dawkins
- Division of Genetics, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,School of Medicine, The University of Notre Dame, Notre Dame, NSW, Australia
| | | | - Kate L Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Georgina Fenton
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - Peter A Kanetsky
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael G Kimlin
- Queensland University of Technology, School of Biomedical Sciences, Brisbane, QLD, Australia
| | - Judy Kirk
- Westmead Clinical School and Westmead Institute for Medical Research, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Cynthia Low
- Consumer representative, Brisbane, QLD, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, ANU, ACT, Canberra, Australia
| | - Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline Savard
- School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Wordsworth
- Health Economics Research Centre, The University of Oxford, Oxford, UK
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia. .,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
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12
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Miller CA, Lafata JE, Thomson MD. The Effects of Personalizing Colorectal Cancer Risk Communication on Risk Perceptions and Health Behavior Intentions: a Randomized Trial of Average-Risk Adults. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:719-727. [PMID: 31997146 PMCID: PMC7387146 DOI: 10.1007/s13187-020-01694-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Risk assessment tools may help individuals gauge cancer risk and motivate lifestyle and screening behavior changes. Despite the evermore common availability of such tools, little is known about their potential utility in average-risk population approaches to cancer prevention. We evaluated the effects of providing personalized (vs. generic) information concerning colorectal cancer (CRC) risk factors on average-risk individuals' risk perceptions and intentions to engage in three risk-reducing behaviors: CRC screening, diet, and physical activity. Further, we explored whether the receipt of CRC-specific risk assessment feedback influenced individuals' breast cancer risk perceptions and mammography intentions. Using an online survey, N = 419 survey respondents aged 50-75 with no personal or family history of CRC were randomized to receive an average estimate of CRC lifetime risk and risk factor information that was either personalized (treatment) or invariant/non-personalized (control). Respondent risk perceptions and behavioral intentions were ascertained before and after risk assessment administration. No differences were observed in risk perceptions or behavioral intentions by study arm. However, regardless of study arm, CRC screening intentions significantly increased after risk assessment feedback was provided. This occurred despite a significant reduction in risk perceptions. Results support the role simple cancer risk assessment information could play in promoting screening behaviors while improving the accuracy of cancer risk perceptions. Providing cancer risk assessment information may decrease individuals' perceptions of cancer risk to more realistic levels while simultaneously facilitating screening intentions among an average-risk population, regardless of whether provided risk information is personalized.
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Affiliation(s)
- Carrie A Miller
- Department of Health Behavior and Policy, School of Medicine, and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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13
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Allen CG, Peterson S, Khoury MJ, Brody LC, McBride CM. A scoping review of social and behavioral science research to translate genomic discoveries into population health impact. Transl Behav Med 2021; 11:901-911. [PMID: 32902617 PMCID: PMC8240657 DOI: 10.1093/tbm/ibaa076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the completion of the Human Genome Project, progress toward translating genomic research discoveries to address population health issues has been limited. Several meetings of social and behavioral scientists have outlined priority research areas where advancement of translational research could increase population health benefits of genomic discoveries. In this review, we track the pace of progress, study size and design, and focus of genomics translational research from 2012 to 2018 and its concordance with five social and behavioral science recommended priorities. We conducted a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines for Scoping Reviews. Steps involved completing a search in five databases and a hand search of bibliographies of relevant literature. Our search (from 2012 to 2018) yielded 4,538 unique studies; 117 were included in the final analyses. Two coders extracted data including items from the PICOTS framework. Analysis included descriptive statistics to help identify trends in pace, study size and design, and translational priority area. Among the 117 studies included in our final sample, nearly half focused on genomics applications that have evidence to support translation or implementation into practice (Centers for Disease Control and Prevention Tier 1 applications). Common study designs were cross-sectional (40.2%) and qualitative (24.8%), with average sample sizes of 716 across all studies. Most often, studies addressed public understanding of genetics and genomics (33.3%), risk communication (29.1%), and intervention development and testing of interventions to promote behavior change (19.7%). The number of studies that address social and behavioral science priority areas is extremely limited and the pace of this research continues to lag behind basic science advances. Much of the research identified in this review is descriptive and related to public understanding, risk communication, and intervention development and testing of interventions to promote behavior change. The field has been slow to develop and evaluate public health-friendly interventions and test implementation approaches that could enable health benefits and equitable access to genomic discoveries. As the completion of the human genome approaches its 20th anniversary, full engagement of transdisciplinary efforts to address translation challenges will be required to close this gap.
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Affiliation(s)
- Caitlin G Allen
- Behavioral, Social and Health Education Sciences Department, Emory University, Atlanta, GA, USA
| | - Shenita Peterson
- Woodruff Health Science Center Library, Emory University, Atlanta, GA, USA
| | - Muin J Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lawrence C Brody
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, MD, USA
| | - Colleen M McBride
- Behavioral, Social and Health Education Sciences Department, Emory University, Atlanta, GA, USA
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14
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Kaiser I, Pfahlberg AB, Uter W, Heppt MV, Veierød MB, Gefeller O. Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217919. [PMID: 33126677 PMCID: PMC7662952 DOI: 10.3390/ijerph17217919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
The rising incidence of cutaneous melanoma over the past few decades has prompted substantial efforts to develop risk prediction models identifying people at high risk of developing melanoma to facilitate targeted screening programs. We review these models, regarding study characteristics, differences in risk factor selection and assessment, evaluation, and validation methods. Our systematic literature search revealed 40 studies comprising 46 different risk prediction models eligible for the review. Altogether, 35 different risk factors were part of the models with nevi being the most common one (n = 35, 78%); little consistency in other risk factors was observed. Results of an internal validation were reported for less than half of the studies (n = 18, 45%), and only 6 performed external validation. In terms of model performance, 29 studies assessed the discriminative ability of their models; other performance measures, e.g., regarding calibration or clinical usefulness, were rarely reported. Due to the substantial heterogeneity in risk factor selection and assessment as well as methodologic aspects of model development, direct comparisons between models are hardly possible. Uniform methodologic standards for the development and validation of risk prediction models for melanoma and reporting standards for the accompanying publications are necessary and need to be obligatory for that reason.
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Affiliation(s)
- Isabelle Kaiser
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (I.K.); (A.B.P.); (W.U.)
| | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (I.K.); (A.B.P.); (W.U.)
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (I.K.); (A.B.P.); (W.U.)
| | - Markus V. Heppt
- Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Marit B. Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway;
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (I.K.); (A.B.P.); (W.U.)
- Correspondence:
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15
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Coroiu A, Moran C, Bergeron C, Thombs BD, Geller AC, Kingsland E, Körner A. Operationalization of skin self-examination in randomized controlled trials with individuals at increased risk for melanoma: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1013-1026. [PMID: 31917011 DOI: 10.1016/j.pec.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/25/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate how skin self-examination was operationalized and the psychometric properties of the scales used to assess this behavior in randomized controlled trials (RCTs) testing interventions that promote SSE among individuals at increased risk for melanoma. METHOD Eight scientific databases (e.g., Medline, EMBASE, CINAHL, PsycINFO) and four trial registries (e.g., Clinicaltrials.gov, UK Clinical Trails Gateway) were searched from inception through April 2, 2019. Three reviewers carried out the selection of relevant trials and conducted data extraction. RESULTS The review identified 13 unique RCT's. The definition of skin self-exams, extrapolated from instructions provided to participants during the trials and reported in only 6/13 trials, included periodically checking the skin of the entire body, individually or with partners/mirrors, with or without tracking or monitoring tools, and using the ABCDE criteria to identify early signs of melanoma. There was variability in how skin self-examination behavior was measured with respect to item content, number of items, response format, and type of outcome variable used: continuous or binary). No validity evidence and minimal reliability evidence for the measures were identified. CONCLUSIONS AND PRACTICE IMPLICATIONS Future studies are needed to establish the psychometric properties of measures assessing skin self-examination.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Brett D Thombs
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Quebec, Canada; Department of Psychology, McGill University, Montréal, Quebec, Canada
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Emily Kingsland
- McGill Library and Archives, McGill University, Montréal, Canada
| | - Annett Körner
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Montreal, Canada; Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
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16
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Ersser S, Effah A, Dyson J, Kellar I, Thomas S, McNichol E, Caperon E, Hewitt C, Muinonen‐Martin A. Effectiveness of interventions to support the early detection of skin cancer through skin self‐examination: a systematic review and meta‐analysis. Br J Dermatol 2019; 180:1339-1347. [DOI: 10.1111/bjd.17529] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 02/05/2023]
Affiliation(s)
- S.J. Ersser
- Department of Health Sciences University of York YorkU.K
| | - A. Effah
- School of Healthcare University of Leeds LeedsU.K
| | - J. Dyson
- School of Health & Social Work University of Hull Hull U.K
| | - I. Kellar
- School of Psychology University of Leeds LeedsU.K
| | - S. Thomas
- Faculty of Health & Social Sciences Bournemouth University Bournemouth U.K
| | - E. McNichol
- School of Healthcare University of Leeds LeedsU.K
| | - E. Caperon
- Leeds Institute of Health Sciences University of Leeds Leeds U.K
| | - C. Hewitt
- Department of Health Sciences University of York YorkU.K
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17
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Ziehfreund S, Schuster B, Zink A. Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019. J Eur Acad Dermatol Venereol 2019; 33:1477-1495. [PMID: 30801774 DOI: 10.1111/jdv.15525] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
Worldwide 2-3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun-related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer-related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between 1 January 2012 and 31 December 2018. We identified 51 relevant cross-sectional studies and 22 interventional studies. Sun-related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun protection programmes using new technologies seem to have great potential to increase sun-related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by healthcare institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.
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Affiliation(s)
- S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - B Schuster
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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18
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Cust AE, Drummond M, Kanetsky PA, Goldstein AM, Barrett JH, MacGregor S, Law MH, Iles MM, Bui M, Hopper JL, Brossard M, Demenais F, Taylor JC, Hoggart C, Brown KM, Landi MT, Newton-Bishop JA, Mann GJ, Bishop DT. Assessing the Incremental Contribution of Common Genomic Variants to Melanoma Risk Prediction in Two Population-Based Studies. J Invest Dermatol 2018; 138:2617-2624. [PMID: 29890168 PMCID: PMC6249137 DOI: 10.1016/j.jid.2018.05.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/02/2023]
Abstract
It is unclear to what degree genomic and traditional (phenotypic and environmental) risk factors overlap in their prediction of melanoma risk. We evaluated the incremental contribution of common genomic variants (in pigmentation, nevus, and other pathways) and their overlap with traditional risk factors, using data from two population-based case-control studies from Australia (n = 1,035) and the United Kingdom (n = 1,460) that used the same questionnaires. Polygenic risk scores were derived from 21 gene regions associated with melanoma and odds ratios from published meta-analyses. Logistic regression models were adjusted for age, sex, center, and ancestry. Adding the polygenic risk score to a model with traditional risk factors increased the area under the receiver operating characteristic curve (AUC) by 2.3% (P = 0.003) for Australia and by 2.8% (P = 0.002) for Leeds. Gene variants in the pigmentation pathway, particularly MC1R, were responsible for most of the incremental improvement. In a cross-tabulation of polygenic by traditional tertile risk scores, 59% (Australia) and 49% (Leeds) of participants were categorized in the same (concordant) tertile. Of participants with low traditional risk, 9% (Australia) and 21% (Leeds) had high polygenic risk. Testing of genomic variants can identify people who are susceptible to melanoma despite not having a traditional phenotypic risk profile.
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Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
| | - Martin Drummond
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Alisa M Goldstein
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jennifer H Barrett
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Stuart MacGregor
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Matthew H Law
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Mark M Iles
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, University of Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, University of Melbourne, Australia
| | - Myriam Brossard
- INSERM, UMR 946, Genetic Variation and Human Diseases Unit, Paris, France; Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Florence Demenais
- INSERM, UMR 946, Genetic Variation and Human Diseases Unit, Paris, France; Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - John C Taylor
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Clive Hoggart
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Kevin M Brown
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Maria Teresa Landi
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Julia A Newton-Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - D Timothy Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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19
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Kinney AY, Howell R, Ruckman R, McDougall JA, Boyce TW, Vicuña B, Lee JH, Guest DD, Rycroft R, Valverde PA, Gallegos KM, Meisner A, Wiggins CL, Stroup A, Paddock LE, Walters ST. Promoting guideline-based cancer genetic risk assessment for hereditary breast and ovarian cancer in ethnically and geographically diverse cancer survivors: Rationale and design of a 3-arm randomized controlled trial. Contemp Clin Trials 2018; 73:123-135. [PMID: 30236776 PMCID: PMC6214814 DOI: 10.1016/j.cct.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although national guidelines for cancer genetic risk assessment (CGRA) for hereditary breast and ovarian cancer (HBOC) have been available for over two decades, less than half of high-risk women have accessed these services, especially underserved minority and rural populations. Identification of high-risk individuals is crucial for cancer survivors and their families to benefit from biomedical advances in cancer prevention, early detection, and treatment. METHODS This paper describes community-engaged formative research and the protocol of the ongoing randomized 3-arm controlled Genetic Risk Assessment for Cancer Education and Empowerment (GRACE) trial. Ethnically and geographically diverse breast and ovarian cancer survivors at increased risk for hereditary cancer predisposition who have not had a CGRA are recruited through the three statewide cancer registries. The specific aims are to: 1) compare the effectiveness of a targeted intervention (TP) vs. a tailored counseling and navigation(TCN) intervention vs. usual care (UC) on CGRA utilization at 6 months post-diagnosis (primary outcome); compare the effectiveness of the interventions on genetic counseling uptake at 12 months after removal of cost barriers (secondary outcome); 2) examine potential underlying theoretical mediating and moderating mechanisms; and 3) conduct a cost evaluation to guide dissemination strategies. DISCUSSION The ongoing GRACE trial addresses an important translational gap by developing and implementing evidence-based strategies to promote guideline-based care and reduce disparities in CGRA utilization among ethnically and geographically diverse women. If effective, these interventions have the potential to reach a large number of high-risk families and reduce disparities through broad dissemination. TRIAL REGISTRATION NUMBER NCT03326713; clinicaltrials.gov.
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Affiliation(s)
- Anita Y Kinney
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey.
| | - Rachel Howell
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Rachel Ruckman
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Tawny W Boyce
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Belinda Vicuña
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico; Department of Psychology, University of New Mexico, Albuquerque, Mexico
| | - Ji-Hyun Lee
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Dolores D Guest
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Randi Rycroft
- Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, CO, United States
| | - Patricia A Valverde
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | - Angela Meisner
- New Mexico Tumor Registry, University of New Mexico, Albuquerque, Mexico
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico; New Mexico Tumor Registry, University of New Mexico, Albuquerque, Mexico
| | - Antoinette Stroup
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey
| | - Lisa E Paddock
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey
| | - Scott T Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX, United States
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20
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Pratt H, Hassanin K, Troughton LD, Czanner G, Zheng Y, McCormick AG, Hamill KJ. UV imaging reveals facial areas that are prone to skin cancer are disproportionately missed during sunscreen application. PLoS One 2017; 12:e0185297. [PMID: 28968413 PMCID: PMC5624581 DOI: 10.1371/journal.pone.0185297] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/08/2017] [Indexed: 01/01/2023] Open
Abstract
Application of sunscreen is a widely used mechanism for protecting skin from the harmful effects of UV light. However, protection can only be achieved through effective application, and areas that are routinely missed are likely at increased risk of UV damage. Here we sought to determine if specific areas of the face are missed during routine sunscreen application, and whether provision of public health information is sufficient to improve coverage. To investigate this, 57 participants were imaged with a UV sensitive camera before and after sunscreen application: first visit; minimal pre-instruction, second visit; provided with a public health information statement. Images were scored using a custom automated image analysis process designed to identify areas of high UV reflectance, i.e. missed during sunscreen application, and analysed for 5% significance. Analyses revealed eyelid and periorbital regions to be disproportionately missed during routine sunscreen application (median 14% missed in eyelid region vs 7% in rest of face, p<0.01). Provision of health information caused a significant improvement in coverage to eyelid areas in general however, the medial canthal area was still frequently missed. These data reveal that a public health announcement-type intervention could be effective at improving coverage of high risk areas of the face, however high risk areas are likely to remain unprotected therefore other mechanisms of sun protection should be widely promoted such as UV blocking sunglasses.
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Affiliation(s)
- Harry Pratt
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Kareem Hassanin
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Lee D. Troughton
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Gabriela Czanner
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Yalin Zheng
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Austin G. McCormick
- Department of Opthalmology, Aintree University Teaching hospital, Liverpool, United Kingdom
| | - Kevin J. Hamill
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
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21
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Berg SA, Ming ME. Recent Advances in Our Understanding of the Epidemiology of Melanoma. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Hay JL, Shuk E, Schofield E, Loeb R, Holland S, Burkhalter J, Li Y. Real-time sun protection decisions in first-degree relatives of melanoma patients. Health Psychol 2017; 36:907-915. [PMID: 28846008 DOI: 10.1037/hea0000523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Melanoma is the most serious skin cancer, and consistent use of sun protection is recommended to reduce risk. Yet sun protection use is generally inconsistent. Understanding the decisional factors driving sun protection choices could aid in intervention development to promote sun protection maintenance. METHOD In 59 first-degree relatives of melanoma patients, an interactive voice response system (IVRS) on participants' cell phones was used to assess twice daily (morning, afternoon) real-time sun protection usage (sunscreen, shade, hats, protective clothing) and decision factors (weather, type of activity, convenience, social support) over a 14-day summer interval where morning and afternoon outdoor exposures were anticipated. Generalized estimating equations and hierarchical linear models were used to examine the effect of demographics and decisional factors on sun protection choices over time. RESULTS Sun protection use was inconsistent (e.g., 61% used sunscreen inconsistently). Most strategies were used independently, with the exception of moderate overlap of sunscreen and hat usage. Decision factors were highly relevant for sun protection. For instance, sunscreen use was related to the perception of having adequate time to apply it, whereas shade and hat usage were each related to convenience. Few findings emerged by gender, age, time of day, or year. Significant within-subject variation remained, however. CONCLUSIONS The findings support continued examination of decision factors in understanding sun protection consistency in real time. Interventions where cues to action and environmental supports work together in varied settings can be developed to improve sun protection maintenance in populations at risk for this common disease. (PsycINFO Database Record
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Elyse Shuk
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Elizabeth Schofield
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Rebecca Loeb
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Susan Holland
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Jack Burkhalter
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
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Santiago-Rivas M, Schnur JB, Jandorf L. Sun Protection Belief Clusters: Analysis of Amazon Mechanical Turk Data. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:673-678. [PMID: 26194777 PMCID: PMC4723289 DOI: 10.1007/s13187-015-0882-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This study aimed (i) to determine whether people could be differentiated on the basis of their sun protection belief profiles and individual characteristics and (ii) explore the use of a crowdsourcing web service for the assessment of sun protection beliefs. A sample of 500 adults completed an online survey of sun protection belief items using Amazon Mechanical Turk. A two-phased cluster analysis (i.e., hierarchical and non-hierarchical K-means) was utilized to determine clusters of sun protection barriers and facilitators. Results yielded three distinct clusters of sun protection barriers and three distinct clusters of sun protection facilitators. Significant associations between gender, age, sun sensitivity, and cluster membership were identified. Results also showed an association between barrier and facilitator cluster membership. The results of this study provided a potential alternative approach to developing future sun protection promotion initiatives in the population. Findings add to our knowledge regarding individuals who support, oppose, or are ambivalent toward sun protection and inform intervention research by identifying distinct subtypes that may best benefit from (or have a higher need for) skin cancer prevention efforts.
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Affiliation(s)
- Marimer Santiago-Rivas
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, Medical Institute, 1425 Madison Ave, Suite 3-50, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA.
| | - Julie B Schnur
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, Medical Institute, 1425 Madison Ave, Suite 3-50, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, Medical Institute, 1425 Madison Ave, Suite 3-50, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA
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Zamoiski RD, Cahoon EK, Michal Freedman D, Linet MS. Self-reported sunscreen use and urinary benzophenone-3 concentrations in the United States: NHANES 2003-2006 and 2009-2012. ENVIRONMENTAL RESEARCH 2015; 142:563-7. [PMID: 26298557 PMCID: PMC4609273 DOI: 10.1016/j.envres.2015.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/21/2015] [Accepted: 08/07/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Sunscreens protect against skin cancer and other harmful effects of solar ultraviolet radiation (UVR). Epidemiologic and public health surveys often rely on self-reported sunscreen use to estimate sun exposure and avoidance, but questions remain about the validity of self-reports. Benzophenone-3 (BP-3), a common sunscreen ingredient, can be detected in the urine. Prior studies suggest that BP-3 concentrations increase after application of sunscreen. OBJECTIVES The goal of this study was to assess the validity of self-reported frequency of sunscreen use in relation to urinary BP-3 concentrations in a representative sample of the general US population, including in sub-groups defined by age, sex and race/ethnicity. METHODS To assess the relationship between categorical self-reported sunscreen use and creatinine-corrected urinary BP-3 concentrations, we conducted a linear regression adjusted for age, sex, race/ethnicity, six-month time period, body mass index, education, and sun avoidance behaviors. We tested for effect modification by age, sex, ethnicity and time period of measurement using multiplicative interaction terms and a F test. RESULTS BP-3 was positively associated with self-reported frequency of sunscreen use across all ages, sexes, race/ethnicities, and time periods. Crude and multivariate adjusted models were all statistically significant. R-square was relatively low for all models, ranging from 0.15 to 0.43. CONCLUSIONS Urinary BP-3 is positively associated with self-reported frequency of sunscreen use in the general US population, even in groups with overall low sunscreen use. These results suggest that self-report is a valid, although weak, way of assessing relative frequencies of sunscreen usage in a population-based study.
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Affiliation(s)
- Rachel D Zamoiski
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States.
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - D Michal Freedman
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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Santiago-Rivas M, Velicer WF, Redding C. Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection. Psychol Health 2015; 30:1433-49. [PMID: 26040293 DOI: 10.1080/08870446.2015.1056791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant. DESIGN Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention. MAIN OUTCOME MEASURES Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use. RESULTS With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126-.614), and the pros predicted the outcomes (r = .181-.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes. CONCLUSION In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.
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Affiliation(s)
- Marimer Santiago-Rivas
- a Department of Oncological Sciences , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Wayne F Velicer
- b Cancer Prevention Research Center , University of Rhode Island , Kingston , RI , USA
| | - Colleen Redding
- b Cancer Prevention Research Center , University of Rhode Island , Kingston , RI , USA
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