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Asadi LK, Khalili A, Wang SQ. The sociological basis of the skin cancer epidemic. Int J Dermatol 2023; 62:169-176. [PMID: 35020194 DOI: 10.1111/ijd.15987] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/09/2021] [Accepted: 11/06/2021] [Indexed: 01/20/2023]
Abstract
Given the precipitous rise in its incidence in recent decades, skin cancer has been recognized as a growing epidemic. We explore the sociological underpinnings of this epidemic, including: (1) aging of the demographic; (2) human ecologic factors (residing in areas with high ambient ultraviolet levels and a depleted ozone layer); (3) large-scale European migration to more equatorial latitudes; (4) social structures that for centuries minimized miscegenation and maximized segregation; (5) gender-based differences in sunbathing, tanning, sunscreen use, and clothing choice; (6) occupational ultraviolet exposure; (7) the complex interplay of socioeconomic status, race, and urbanization on skin cancer incidence and mortality; (8) the effects of war on skin cancer incidence; (9) cultural shifts in clothing, travel, outdoor sports, recreation, and attitudes towards being tan; and (10) the indirect effects of religion. We show that without these sociological factors, the most common type of cancer would not be nearly as common.
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Affiliation(s)
- Leila K Asadi
- Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, New Jersey, USA
| | - Ahmad Khalili
- Professor Emeritus of Sociology, Department of Interdisciplinary Programs, Slippery Rock University, Slippery Rock, Pennsylvania, USA
| | - Steven Q Wang
- Division of Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, New Jersey, USA
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2
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Karlsson O, Hagberg O, Nielsen K, Paoli J, Ingvar Å. Difference in Sun Exposure Habits Between Individuals with High and Low Risk of Skin Cancer. Dermatol Pract Concept 2021; 11:e2021090. [PMID: 34631260 DOI: 10.5826/dpc.1104a90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 10/31/2022] Open
Abstract
Background Skin cancer incidence is rapidly increasing. The main risk factor, sun exposure, can be modified. Informational campaigns can be effective in raising skin cancer awareness and target the high-risk population. Still, sun exposure habits in people at high risk of skin cancer are not well-known. Objective To investigate if and how sun exposure habits differ between low-risk and high-risk individuals. Methods During the Swedish Euromelanoma campaign of 2018, questionnaires were collected containing information regarding sun exposure habits and risk factors for skin cancer. Data on 4,141 participants was used to investigate the association between risk factors and sun exposure habits. Results A fair skin type and a previous history of skin cancer were significantly associated with enhanced sun protective behavior. Family history of skin cancer, childhood sunburns and the presence of large/atypical nevi had no effect on sun exposure habits. Going on sunny holidays were particularly unaffected by being at high risk of skin cancer. Conclusion Individuals at high risk of developing skin cancer showed suboptimal sun exposure habits and harmful traveling behaviors. We suggest that future skin cancer campaigns inform on accurate sun protection behavior during sunny holidays and associated risk factors. Risk factors such as childhood sunburns, numerous common and large/atypical nevi, as well as family history of skin cancer seem to be less recognized by the population.
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Affiliation(s)
- Oskar Karlsson
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Kari Nielsen
- Department of Dermatology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund, Division of Dermatology, Lund University, Sweden
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Åsa Ingvar
- Department of Dermatology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund, Division of Dermatology, Lund University, Sweden
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3
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García-Montero P, Blázquez-Sánchez N, Rivas-Ruíz F, Millán-Cayetano JF, Fernández-Canedo I, de Troya-Martín M. Preventing Skin Cancer Among Staff and Guests at Seaside Hotels. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:501-508. [PMID: 30756322 DOI: 10.1007/s13187-019-01488-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Beach users and outdoor workers in resort areas are major risk groups for skin cancer, and therefore seaside hotels constitute a strategic area in which to conduct awareness-raising campaigns and interventions. The main aim of the present study is to describe habits, attitudes and knowledge related to sun exposure, the sunburn events experienced and potentially malignant skin lesions observed among hotel staff and guests recruited during a skin cancer prevention campaign at seaside hotels in the western Costa del Sol (southern Spain). This descriptive cross-sectional study was conducted at four seaside hotels in the western Costa del Sol. An 8-day awareness-raising campaign on skin cancer was conducted for hotel guests and staff, who were invited to complete a questionnaire about their habits, attitudes and knowledge regarding photoprotection, and to receive a comprehensive skin examination. The questionnaire on habits, attitudes and knowledge related to sun exposure was completed by 542 participants. The most common photoprotection practice was the use of sunglasses (79.3%). Potentially dangerous lesions were identified in 39 persons (14%). In addition, 94.0% reported having gained new knowledge, 89.6% had changed their attitudes towards sun tanning and 94.7% intended to improve their photoprotection practices in the future. Seaside hotels are an optimal scenario for conducting studies aimed at skin cancer prevention and reduction. Further studies should be carried out in other geographical areas to confirm our results, to evaluate the costs and benefits of such interventions and determine their long-term impact on health.
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Affiliation(s)
- Pablo García-Montero
- Dermatology Department, Hospital Costa del Sol, Autovía A7 - Km 187, Marbella, Málaga, Spain.
| | - Nuria Blázquez-Sánchez
- Dermatology Department, Hospital Costa del Sol, Autovía A7 - Km 187, Marbella, Málaga, Spain
| | - Francisco Rivas-Ruíz
- Research Unit, Hospital Costa del Sol, Marbella, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | | | - Inés Fernández-Canedo
- Dermatology Department, Hospital Costa del Sol, Autovía A7 - Km 187, Marbella, Málaga, Spain
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4
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Kluger N, Bouchard L. A Comparative Study of Google Search Trends for Melanoma, Breast Cancer and Prostate Cancer in Finland. Dermatology 2019; 235:346-347. [DOI: 10.1159/000498987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
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5
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Køster B, Meyer MKH, Andersson TML, Engholm G, Dalum P. Skin cancer projections and cost savings 2014-2045 of improvements to the Danish sunbed legislation of 2014. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:78-86. [PMID: 30198585 PMCID: PMC7379953 DOI: 10.1111/phpp.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sunbed use increases the risk of skin cancer. The Danish sunbed legislation (2014) did not include an age limit. AIM To model skin cancer incidences and saved costs from potential effects of structural interventions on prevalence of sunbed use. MATERIALS AND METHODS Survey data from 2015 were collected for 3999 Danes, representative for the Danish population in regards to age, gender and region. Skin cancer incidences were modelled in the Prevent program, using population projections, historic cancer incidence, sunbed use exposure and relative risk of sunbed use on melanoma. RESULTS If structural interventions like an age limit of 18 years for sunbed use or complete ban had been included in the Danish sunbed legislation in 2014, it would have reduced the annual number of skin cancer cases with 455 or 4177, respectively, while for the entire period, 2014-2045 the total reductions would be 3730 or 81 887 fewer cases, respectively. The cost savings from an age limit or ban, respectively, are 9 and 129 millions € during 2014-2045. CONCLUSION Legislative restrictive measures which could reduce the sunbed use exists. Danish politicians have the opportunity, supported by the population, to reduce the skin cancer incidence and thereby to reduce the future costs of skin cancer.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Maria K H Meyer
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Therese M-L Andersson
- Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
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6
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Køster B, Meyer M, Andersson T, Engholm G, Dalum P. Development in sunburn 2007-2015 and skin cancer projections 2007-2040 of campaign results in the Danish population. Medicine (Baltimore) 2018; 97:e12738. [PMID: 30313078 PMCID: PMC6203499 DOI: 10.1097/md.0000000000012738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/14/2018] [Indexed: 01/15/2023] Open
Abstract
Exposure to ultraviolet radiation is the main risk factor for skin cancer. Denmark has one of the highest incidences of skin cancer in the world. In 2007, a long-term sun safety campaign was launched in Denmark. We have evaluated the effects on prevalence of sunburn and modeled the effects on future melanoma incidence.Sunburn was evaluated by annual cross-sectional surveys representative for the Danish population on age, gender, and region. During 2007-2015, survey data were collected for 33.315 Danes. Cutaneous Melanoma incidences were modeled in the Prevent program, using population projections, historic incidence, sunburn exposure, and relative risk of sunburn on melanoma.The prevalence of sunburn in Denmark was reduced with 1% annually during 2007 to 2015. The campaign is estimated to have reduced the number of skin cancer cases with 664 annually in 2040 and 14.326 totally during 2007 to 2040. If the campaign was terminated in 2015 and sunburn rates return to precampaign level there would be no annual reduction in 2040 while in total the reduction would be 4.024 cases for 2007 to 2040. A continuous campaign until 2040 would yield annual reductions of 2.121 cases by 2040 and a total of 29.729 cases for the entire period.We have showed the value of prevention and the value of long-term planning in prevention campaigning. Sunburn use was reduced significantly during 2007-2015 and further reductions are possible. Consequently, we predict significant fewer skin cancer cases as anticipated.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
| | - Maria Meyer
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
| | - Therese Andersson
- Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden Copenhagen Ø, Denmark
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7
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Køster B, Meyer MKH, Andersson TML, Engholm G, Dalum P. Sunbed use 2007-2015 and skin cancer projections of campaign results 2007-2040 in the Danish population: repeated cross-sectional surveys. BMJ Open 2018; 8:e022094. [PMID: 30158228 PMCID: PMC6119446 DOI: 10.1136/bmjopen-2018-022094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the effect of the Danish Sun Safety Campaign 2007-2015 on the prevalence of sunbed use and to model future effects on the skin cancer incidences 2007-2040. DESIGN The study has a repeated, cross-sectional design. SETTING Exposure to ultraviolet radiation is the main risk factor for skin cancer. Denmark has the highest prevalence of sunbed use reported and one of the highest incidences of skin cancer worldwide. PARTICIPANTS During 2007-2015, survey data were collected for 37 766 Danes, representative of the Danish population with regards to age, gender and region. INTERVENTIONS In 2007, an ongoing long-term antisunbed campaign was launched in Denmark. PRIMARY AND SECONDARY OUTCOME MEASURES Sunbed use was evaluated by annual cross-sectional surveys. Skin cancer incidence was modelled in the Prevent programme, using population projections, historic cancer incidence, sunbed use exposure and relative risk of sunbed use on melanoma. RESULTS The prevalence of recent sunbed use in Denmark was reduced from 32% and 18% to 13% and 8% for women and men, respectively. The campaigns results during 2007-2015 are estimated to reduce the number of skin cancer cases from more than 5000 (746malignant melanoma, 1562 SCC, 2673 BCC) totally during 2007-2040. Keeping the 2015 level of sunbed use constant by continued campaign pressure or introduction of structural interventions would potentially prevent more than 750 skin cancer cases annually in 2040 and 16 000 skin cancer cases in total during 2007-2040. CONCLUSION We have shown the value of prevention and of long-term planning in prevention campaigning. Sunbed use was reduced significantly during 2007-2015 and further reductions are possible by structural interventions. Consequently, significantly fewer skin cancer cases are anticipated during 2007-2040. The Danish Parliament has population support to enforce structural interventions to avoid a large burden of this disease.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Maria KH Meyer
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Therese M-L Andersson
- Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
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8
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Køster B, Søndergaard J, Nielsen JB, Olsen A, Bentzen J. Reliability and consistency of a validated sun exposure questionnaire in a population-based Danish sample. Prev Med Rep 2018; 10:43-48. [PMID: 29552457 PMCID: PMC5852403 DOI: 10.1016/j.pmedr.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/26/2017] [Accepted: 02/05/2018] [Indexed: 12/27/2022] Open
Abstract
An important feature of questionnaire validation is reliability. To be able to measure a given concept by questionnaire validly, the reliability needs to be high. The objectives of this study were to examine reliability of attitude and knowledge and behavioral consistency of sunburn in a developed questionnaire for monitoring and evaluating population sun-related behavior. Sun related behavior, attitude and knowledge was measured weekly by a questionnaire in the summer of 2013 among 664 Danes. Reliability was tested in a test-retest design. Consistency of behavioral information was tested similarly in a questionnaire adapted to measure behavior throughout the summer. The response rates for questionnaire 1, 2 and 3 were high and the drop out was not dependent on demographic characteristic. There was at least 73% agreement between sunburns in the measurement week and the entire summer, and a possible sunburn underestimation in questionnaires summarizing the entire summer. The participants underestimated their outdoor exposure in the evaluation covering the entire summer as compared to the measurement week. The reliability of scales measuring attitude and knowledge was high for majority of scales, while consistency in protection behavior was low. To our knowledge, this is the first study to report reliability for a completely validated questionnaire on sun-related behavior in a national random population based sample. Further, we show that attitude and knowledge questions confirmed their validity with good reliability, while consistency of protection behavior in general and in a week's measurement was low. Objectively validated questionnaires tested for reliability/behavioral consistency. Strong reliability of the knowledge and attitude items was shown. Knowledge about behavioral consistency between questionnaire measurement periods A recommendable design for short term evaluation of skin cancer prevention campaigns
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Affiliation(s)
- B Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.,Research Unit of General Practice, University of Southern, Denmark
| | - J Søndergaard
- Research Unit of General Practice, University of Southern, Denmark
| | - J B Nielsen
- Research Unit of General Practice, University of Southern, Denmark
| | - A Olsen
- Research Centre, Danish Cancer Society, Denmark
| | - J Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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9
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Andersen PA, Buller DB, Walkosz BJ, Scott MD, Beck L, Liu X, Abbott A, Eye R, Cutter G. A Randomized Trial of an Advanced Sun Safety Intervention for Vacationers at 41 North American Resorts. JOURNAL OF HEALTH COMMUNICATION 2017; 22:951-963. [PMID: 29161214 PMCID: PMC6309206 DOI: 10.1080/10810730.2017.1382615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Taking vacations in sunny locations is associated with the development of skin cancer. This study tested a multi-component sun protection intervention based on diffusion of innovations theory and transportation theory designed to increase vacationers' comprehensive sun protection, i.e., use of clothing, hats, and shade, and use, pre-application, and reapplication of sunscreen. The trial enrolled 41 warm weather resorts in North America in a pair-matched group randomized pretest-posttest design and assessed samples of adult vacationers at resort outdoor recreation venues regarding sun protection at pretest (n = 3,531) and posttest (n = 3,226). While results showed no overall effect of the intervention on comprehensive sun protection across venues, the intervention produced statistically significant improvements in sun protection at waterside venues (pools and beaches). The intervention's overall effects may have been impeded by a lack of uniformly robust implementation, low interest in skin cancer prevention by guests, or shortcomings of the theories used to create prevention messages. The intervention may have worked best with guests in the highest-risk recreation venue, i.e., waterside recreation where they exposed the most skin. Alternative approaches that alter resort organizations, such as through changes in policy, environmental features, or occupational efforts might be more effective than targeting vacationers with behavior-change messages.
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Affiliation(s)
- Peter A. Andersen
- School of Communication, San Diego State University, San Diego, California, USA
| | | | | | | | - Larry Beck
- L. Robert Payne School of Hospitality and Tourism Management, San Diego State University, San Diego, California, USA
| | - Xia Liu
- Klein Buendel, Inc., Golden, Colorado, USA
| | - Allison Abbott
- School of Communication, San Diego State University, San Diego, California, USA
| | - Rachel Eye
- Klein Buendel, Inc., Golden, Colorado, USA
| | - Gary Cutter
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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10
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de Troya-Martín M, de Gálvez-Aranda MV, Rivas-Ruiz F, Blázquez-Sánchez N, Fernández-Morano MT, Padilla-España L, Herrera-Ceballos E. Prevalence and predictors of sunburn among beachgoers. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 34:122-129. [DOI: 10.1111/phpp.12354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Francisco Rivas-Ruiz
- Unidad de Investigación; Hospital Costa del Sol; Marbella Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)
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11
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Buller DB, Andersen PA, Walkosz BJ, Scott MD, Beck L, Cutter GR. Effect of an intervention on observed sun protection by vacationers in a randomized controlled trial at North American resorts. Prev Med 2017; 99:29-36. [PMID: 28189810 PMCID: PMC5432386 DOI: 10.1016/j.ypmed.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/05/2016] [Accepted: 01/29/2017] [Indexed: 11/15/2022]
Abstract
During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n=4347; posttest n=3986) at warm-weather destination resorts in North America (n=41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p>0.05) or intervention implementation (p>0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre=-22.74, post=-15.77; control pre=-27.24, post=-23.24) but not non-waterside venues (z-score composite: intervention pre=20.43, post=20.53; control pre=22.94, post=18.03, p<0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z=score composite: high implementation pre=-25.45, post=-14.05; low implementation pre=-24.70, post=-21.40) compared to non-waterside (z-score composite: high implementation pre=14.51, post=19.98; low implementation pre=24.03, post=18.98, p<0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity.
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Affiliation(s)
- David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA.
| | - Peter A Andersen
- School of Communication, San Diego State University, 5500 Campanille, San Diego, CA 92182-4560, USA
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Michael D Scott
- Department of Communication Arts and Sciences, 400 W 1st Street, California State University, Chico, CA 95929, USA
| | - Larry Beck
- L. Robert Payne School of Hospitality and Tourism Management, San Diego State University, San Diego, CA 92182, USA
| | - Gary R Cutter
- School of Public Health, University of Alabama, Birmingham, 1667 University Blvd, Ryals 410b, Birmingham, AL 35294, USA
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12
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Køster B, Søndergaard J, Nielsen JB, Allen M, Bjerregaard M, Olsen A, Bentzen J. Effects of smartphone diaries and personal dosimeters on behavior in a randomized study of methods to document sunlight exposure. Prev Med Rep 2016; 3:367-72. [PMID: 27419038 PMCID: PMC4929184 DOI: 10.1016/j.pmedr.2016.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 04/09/2016] [Accepted: 04/20/2016] [Indexed: 11/20/2022] Open
Abstract
Dosimeters and diaries have previously been used to evaluate sun-related behavior and UV exposure in local samples. However, wearing a dosimeter or filling in a diary may cause a behavioral change. The aim of this study was to examine possible confounding factors for a questionnaire validation study. We examined the effects of wearing dosimeters and filling out diaries, measurement period and recall effect on the sun-related behavior in Denmark in 2012. Our sample included 240 participants eligible by smartphone status and who took a vacation during weeks 26–32 in 2012, randomized by gender, age, education and skin type to six groups: 1) Control + diary, 2) Control, 3) 1-week dosimetry measurement, 4) 1-week dosimetry measurement + diary, 5) 3-week dosimetry measurement and 6) 1-week dosimetry measurement with 4 week delayed questionnaire. Correlation coefficients between reported outdoor time and registered outdoor time for groups 3–6 were 0.39, 0.45, 0.43 and 0.09, respectively. Group 6 was the only group not significantly correlated. Questionnaire reported outdoor exposure time was shorter in the dosimeter measurement groups (3–6) than in their respective controls. We showed that using a dosimeter or keeping a diary seems to increase attention towards the behavior examined and therefore may influence this behavior. Receiving the questionnaire with 4 week delay had a significant negative influence on correlation and recall of sunburn. When planning future UV behavior questionnaire validations, we suggest to use a 1-week interval for dosimetry measurements, no diary, and to minimize the time from end of measurement to filling out questionnaires. Personal UV dosimeters and diaries were previously applied in studies of UV radiation. Effects of using UV dosimeters and diaries on participants' behavior were not previously examined. Correlation between objective and subjective measures of outdoor exposure time was shown. Their correlation coefficient depends on length of recall (bias). The use of dosimeters and diaries increases attention towards the examined behavior.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
- Research Unit of General Practice, University of Southern, Denmark
- Corresponding author at: Strandboulevarden 49, DK-2100, Denmark.Strandboulevarden 49DK-2100Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, University of Southern, Denmark
| | | | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, New Zealand
| | - Mette Bjerregaard
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Anja Olsen
- Research Centre, Danish Cancer Society, Denmark
| | - Joan Bentzen
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
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13
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Andersen PA, Buller DB, Walkosz BJ, Scott MD, Beck L, Liu X, Abbott A, Eye R. Environmental variables associated with vacationers' sun protection at warm weather resorts in North America. ENVIRONMENTAL RESEARCH 2016; 146:200-206. [PMID: 26775001 DOI: 10.1016/j.envres.2015.12.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Vacationing at sunny, warm weather locations is a risk factor for excessive solar ultraviolet (UV) radiation exposure and skin cancer. OBJECTIVES This study examined the association of environmental variables related to UV levels with vacationers' sun protection. METHODS Vacationers at 41 summer resorts in 17 states and 1 Canadian Province were interviewed (n=3531) and observed (N=4347) during 2012 and 2013. Clothing coverage, sunglasses, and shade use were observed. Use of sunscreen and sunburns were self-reported. Environmental information was recorded by research staff or acquired from ground stations and the weather service. RESULTS Temperature was positively associated with sun protection behaviors; however clothing coverage was negatively associated with temperature. Cloud cover was negatively associated with sun protection, with the exception of clothing coverage which was positively associated with it. Elevation showed a mixed pattern of associations with vacationer's sun protection. Latitude of a resort was negatively associated with most sun protection behaviors, such that sun protection increased at more southerly resorts. Similarly, the farther south a vacationer traveled to the resort, the less sun protection they employed. The UV index showed a weak, positive relationship with some sun protection behaviors even when controlling for temperature. CONCLUSIONS Vacationers appeared aware that UV is higher at southern latitudes and may learn UV is intense when living in southern regions. However, many used temperature, an unreliable cue, to judge UV intensity and seemed to adjust clothing for warmth not UV protection. Efforts are needed to help individuals make more accurate sun safety decisions.
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Affiliation(s)
- Peter A Andersen
- School of Communication, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Michael D Scott
- Mikonics, Inc., 40 B Old Road South, Santa Fe, NM 87540, USA
| | - Larry Beck
- L. Robert Payne School of Hospitality and Tourism Management, San Diego State University, Room PSFA 445, San Diego, CA 92182, USA
| | - Xia Liu
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Allison Abbott
- School of Communication, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Rachel Eye
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
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Køster B, Søndergaard J, Nielsen JB, Allen M, Bjerregaard M, Olsen A, Bentzen J. Feasibility of smartphone diaries and personal dosimeters to quantitatively study exposure to ultraviolet radiation in a small national sample. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 31:252-60. [DOI: 10.1111/phpp.12179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Jens Søndergaard
- Research Unit of General Practice; University of Southern Denmark; Odense Denmark
| | - Jesper B. Nielsen
- Research Unit of General Practice; University of Southern Denmark; Odense Denmark
| | - Martin Allen
- Electrical and Computer Engineering; University of Canterbury; Christchurch New Zealand
| | | | - Anja Olsen
- Danish Cancer Society; Copenhagen Ø Denmark
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15
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Lucas RM, Norval M, Neale RE, Young AR, de Gruijl FR, Takizawa Y, van der Leun JC. The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochem Photobiol Sci 2015; 14:53-87. [DOI: 10.1039/c4pp90033b] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ozone depletion, climate and human health.
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Affiliation(s)
- R. M. Lucas
- National Centre for Epidemiology and Population Health
- The Australian National University
- Canberra 2601
- Australia
- Telethon Kids Institute
| | - M. Norval
- Biomedical Sciences
- University of Edinburgh Medical School
- Edinburgh EH8 9AG
- UK
| | - R. E. Neale
- QIMR Berghofer Medical Research Institute
- Brisbane 4029
- Australia
| | - A. R. Young
- King's College London (KCL)
- St John's Institute of Dermatology
- London SE1 9RT
- UK
| | - F. R. de Gruijl
- Department of Dermatology
- Leiden University Medical Centre
- NL-2300 RC Leiden
- The Netherlands
| | - Y. Takizawa
- Akita University Graduate School of Medicine
- Akita Prefecture
- Japan
- National Institute for Minamata Diseases
- Kumamoto Prefecture
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16
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Bay C, Kejs AMT, Storm HH, Engholm G. Incidence and survival in patients with cutaneous melanoma by morphology, anatomical site and TNM stage: a Danish Population-based Register Study 1989-2011. Cancer Epidemiol 2014; 39:1-7. [PMID: 25468643 DOI: 10.1016/j.canep.2014.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/28/2014] [Accepted: 10/07/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The incidence of melanoma of the skin has risen in Denmark in recent decades, the increase being steeper from 2004. It is unclear whether this represents a true rise in incidence or whether it is caused by an increased awareness of the condition. METHODS To assess whether the increase was characterised by early-stage melanomas and a higher proportion of melanomas with superficial spreading morphology, we studied all skin melanoma patients registered in the Danish Cancer Register 1989-2011 (n=27,010) and followed up for death through 2013. Trends in age-standardised incidence by sex, subsite and morphology, relative survival, TNM stage distribution and stage-specific relative survival from 2004 were analysed. RESULTS The incidence of melanoma more than doubled over 23 years. A steeper increase from 2004 was driven mainly by superficial spreading tumours, but the proportion of nodular melanomas in patients 50 years of age and over also increased significantly. The largest increase occurred for stage I tumours and for tumours on the trunk. From 1989-1993 to 2009-2011 the 5-year relative survival increased at 12% and 6% points for male and female patients, respectively. INTERPRETATION Greater awareness, and thus lower stage at diagnosis (mediated by a large skin cancer prevention campaign from 2007), might explain part of the increase, but the increase in nodular melanoma also points to a genuine increase in the risk of melanoma.
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Affiliation(s)
- Christiane Bay
- The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hans H Storm
- The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark.
| | - Gerda Engholm
- The Danish Cancer Society, Department of Cancer Prevention & Documentation, Denmark.
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17
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Hansen M, Bentzen J. High-risk sun-tanning behaviour: a quantitative study in Denmark, 2008–2011. Public Health 2014; 128:777-83. [DOI: 10.1016/j.puhe.2014.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/08/2014] [Accepted: 07/04/2014] [Indexed: 10/24/2022]
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18
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Reinau D, Achermann C, Arnet N, Meier C, Hatz C, Surber C. Sun protective behaviour of vacationers spending holidays in the tropics and subtropics. Br J Dermatol 2014; 171:868-74. [DOI: 10.1111/bjd.12995] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D. Reinau
- Basel Pharmacoepidemiology Unit Division of Clinical Pharmacy and Epidemiology Department of Pharmaceutical Sciences University of Basel Basel Switzerland
- Hospital Pharmacy University Hospital Basel CH‐4031 Basel Switzerland
| | - C. Achermann
- Hospital Pharmacy University Hospital Basel CH‐4031 Basel Switzerland
| | - N. Arnet
- Hospital Pharmacy University Hospital Basel CH‐4031 Basel Switzerland
| | - C.R. Meier
- Basel Pharmacoepidemiology Unit Division of Clinical Pharmacy and Epidemiology Department of Pharmaceutical Sciences University of Basel Basel Switzerland
- Hospital Pharmacy University Hospital Basel CH‐4031 Basel Switzerland
- Boston Collaborative Drug Surveillance Program Boston University School of Public Health Lexington MA U.S.A
| | - C. Hatz
- Swiss Tropical and Public Health Institute Basel Switzerland
- Institute of Social and Preventive Medicine University of Zurich Zurich Switzerland
| | - C. Surber
- Department of Dermatology University Hospital Basel CH‐4031 Basel Switzerland
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Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014; 70:847-57.e1-18. [PMID: 24629998 DOI: 10.1016/j.jaad.2013.11.050] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 11/05/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tanning beds are associated with increased risk of melanoma. OBJECTIVE We sought to update the evidence of the association of melanoma and indoor tanning focusing on frequency of use and exposure to newer tanning beds. METHODS We searched Scopus, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature on August 14, 2013. We included all observational studies that included patients with melanoma who had indoor tanned. Odds ratios (OR) with 95% confidence intervals (CI) were extracted and combined using generic inverse variance methods assuming a random effects model. RESULTS In all, 31 studies were included with data available on 14,956 melanoma cases and 233,106 controls. Compared with never using, the OR for melanoma associated with ever using indoor tanning beds was 1.16 (95% CI 1.05-1.28). Similar findings were identified in recent studies with enrollment occurring in the year 2000 onward (OR 1.22, 95% CI 1.03-1.45) and in subjects attending more than 10 tanning sessions (OR 1.34, 95% CI 1.05-1.71). LIMITATIONS The quality of evidence contributing to review results ranges from poor to mediocre. CONCLUSION Using tanning beds is associated with a subsequent melanoma diagnosis. Exposure from more than 10 tanning sessions is most strongly associated and there was no statistically significant difference in this association before and after 2000, suggesting that newer tanning technology is not safer than older models.
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Affiliation(s)
| | - Michael B Bracken
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut.
| | - Jennifer Beecker
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Environmental effects of ozone depletion and its interactions with climate change: progress report, 2011. Photochem Photobiol Sci 2012; 11:13-27. [DOI: 10.1039/c1pp90033a] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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