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Skiba MB, Miller D, Stratton DB, Hall CA, McKenna S, Blair CK, Demark-Wahnefried W. Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer. Contemp Clin Trials Commun 2024; 39:101290. [PMID: 38595771 PMCID: PMC11002544 DOI: 10.1016/j.conctc.2024.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/16/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Background Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Few interventions exist to support health behaviors beyond U.V. exposure. We adapted Harvest for Health, a home-based mentored gardening intervention for cancer survivors, for implementation in Arizona as a community-based intervention. Methods Stakeholder-informed adaptations for Harvest for Health Together Arizona (H4H2-AZ) included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants will be enrolled in cohorts aligned with growing seasons (e.g., spring, monsoon, fall) and matched to an individual 30 ft2 community garden plot for two growing seasons (6 months). Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. This pilot six-month single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer as primary outcomes. Secondary outcomes are to explore the effects on cancer preventive health behaviors and health-related quality of life. Discussion This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers. Trial registration ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.
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Affiliation(s)
- Meghan B. Skiba
- Advanced Nursing Practice and Science Division, College of Nursing, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Dylan Miller
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Epidemiology, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Delaney B. Stratton
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Dermatology, Banner University Health, Tucson, AZ, USA
| | - Caitlyn A. Hall
- W.A. Franke Honors College, University of Arizona, Tucson, AZ, USA
- Department of Biosystems Engineering, College of Agricultural and Life Sciences, University of Arizona, Tucson, AZ, USA
| | - Sharon McKenna
- Melanoma Task Force, Arizona Department of Health Services, Phoenix, AZ, USA
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Domínguez Bueso DL, González Ruiz LM, Mondragón Márquez LI, Liu JJ. Skin cancer survivorship and sun protection behaviors in the United States. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12933. [PMID: 38288776 DOI: 10.1111/phpp.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Skin cancer survivors are more vulnerable to subsequent skin cancers and other malignancies, but previous studies have not examined in detail their sun protection behavior prevalence by sociodemographic factors. We aimed to understand the sociodemographic disparities in the prevalence of three important types of sun protection behaviors: using sunscreen, seeking shade, and wearing protective clothing, among skin cancer survivors and those without skin cancer history. METHODS We used the 2015 U.S. National Health Interview Survey to analyze 29,523 participants, of which 772 were skin cancer survivors and 28,751 were those without skin cancer history. We assessed overall and specific sun protection behavior prevalence based on using sunscreen, seeking shade, and wearing protective clothing. Weighted Poisson regression was used to estimate prevalence ratios. RESULTS Melanoma and nonmelanoma skin cancer survivors had similar overall sun protection behavior (p > .05). Among all skin cancer survivors, 36.0% infrequently used sunscreen, 50.2% infrequently wore protective clothing, 47.8% infrequently sought shade, and 30.0% lacked frequent overall sun protection, which significantly differed from those without skin cancer history (p < .0001). The prevalence of frequent overall sun protection behavior was lower for those who were younger at survey, males, less educated, single or never married, or lived in poverty, regardless of their skin cancer history (p < .01). CONCLUSIONS By identifying subpopulations with higher prevalence of infrequent sun protection among those with or without skin cancer history, our findings may encourage efforts to reduce sociodemographic disparities in sun protection behaviors and promote primary and tertiary skin cancer prevention.
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Affiliation(s)
| | - Liza M González Ruiz
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Jason J Liu
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Manne S, Wu Y, Buller D, Heckman C, Devine K, Frederick S, Solleder J, Schaefer A, Lu SE. The Effects of a Parent-Focused Social Media Intervention on Child Sun Safety: Pilot and Feasibility Study. JMIR Form Res 2023; 7:e48402. [PMID: 38064250 PMCID: PMC10746961 DOI: 10.2196/48402] [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: 04/21/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child's increasing independence while providing practical assistance to ensure sun protection is implemented. OBJECTIVE The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. METHODS The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. RESULTS Enrollment (64.3%, 92/143) and retention (94.6%, 87/92) were good. On average, participants viewed 67.6% (56.8/84) of posts, "liked" 16.4% (13.77/84) of posts, commented on 14.8% (12.43/84) of posts, and voted on 46% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). CONCLUSIONS This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted.
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Affiliation(s)
- Sharon Manne
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - Carolyn Heckman
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Katie Devine
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University 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
| | - Justin Solleder
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Alexis Schaefer
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Shou-En Lu
- Rutgers School of Public Health, New Brunswick, NJ, United States
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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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Mueller AM, Goessinger EV, Cerminara SE, Kostner L, Amaral M, Huber SM, Passweg LP, Moreno LG, Bodenmann D, Kunz M, Levesque MP, Maul JT, Cheng PF, Navarini AA, Maul LV. Educational level-dependent melanoma awareness in a high-risk population in Switzerland. Front Oncol 2023; 13:1174542. [PMID: 37207151 PMCID: PMC10189064 DOI: 10.3389/fonc.2023.1174542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction The worldwide incidence of melanoma has been increasing rapidly in recent decades with Switzerland having one of the highest rates in Europe. Ultraviolet (UV) radiation is one of the main risk factors for skin cancer. Our objective was to investigate UV protective behavior and melanoma awareness in a high-risk cohort for melanoma. Methods In this prospective monocentric study, we assessed general melanoma awareness and UV protection habits in at-risk patients (≥100 nevi, ≥5 dysplastic nevi, known CDKN2A mutation, and/or positive family history) and melanoma patients using questionnaires. Results Between 01/2021 and 03/ 2022, a total of 269 patients (53.5% at-risk patients, 46.5% melanoma patients) were included. We observed a significant trend toward using a higher sun protection factor (SPF) in melanoma patients compared with at-risk patients (SPF 50+: 48% [n=60] vs. 26% [n=37]; p=0.0016). Those with a college or university degree used a high SPF significantly more often than patients with lower education levels (p=0.0007). However, higher educational levels correlated with increased annual sun exposure (p=0.041). Neither a positive family history for melanoma, nor gender or Fitzpatrick skin type influenced sun protection behavior. An age of ≥ 50 years presented as a significant risk factor for melanoma development with an odd's ratio of 2.32. Study participation resulted in improved sun protection behavior with 51% reporting more frequent sunscreen use after study inclusion. Discussion UV protection remains a critical factor in melanoma prevention. We suggest that melanoma awareness should continue to be raised through public skin cancer prevention campaigns with a particular focus on individuals with low levels of education.
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Affiliation(s)
- Alina Miriam Mueller
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Elisabeth Victoria Goessinger
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sara Elisa Cerminara
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Lisa Kostner
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Margarida Amaral
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | | | | | | | | | - Michael Kunz
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Mitchell Paul Levesque
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil Fang Cheng
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Alexander Andreas Navarini
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- *Correspondence: Lara Valeska Maul,
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Sunburns and Sun Protection Behaviors among Male Hispanic Outdoor Day Laborers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052524. [PMID: 35270218 PMCID: PMC8909209 DOI: 10.3390/ijerph19052524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 12/10/2022]
Abstract
Individuals who work outside are at increased risk for skin cancer due to excessive exposure to ultraviolet (UV) radiation. Little is known about UV exposures and sun safety practices of outdoor day laborers, who are disproportionately Hispanic. This study identified the correlates of sunburn and sun protection behaviors in a sample of male, Hispanic day laborers (n = 175). More than half of the participants (54.9%) experienced one or more sunburns when working during the past summer, and 62.9% reported having one or more symptoms of heat illness. The frequency of engaging in sun protection behaviors was suboptimal, including sunglasses use (M = 2.68, SD = 1.71), staying in the shade (M = 2.30, SD = 0.94), wearing sunscreen (M = 2.10, SD = 1.39), and wearing a wide-brimmed hat (M = 1.75, SD = 1.32), based on a 5-point scale (1 = never; 5 = always). Lower education level, higher levels of skin sensitivity to the sun, any symptom of heat illness, fewer barriers to wearing a wide-brimmed hat, and not wearing a wide-brimmed hat were associated with a greater number of sunburns. Factors associated with each sun protection behavior varied. Implications and directions for future research are discussed.
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Kurz B, Berneburg M, Singer S. [Sun protection of human skin: from A to Z]. Hautarzt 2022; 73:251-256. [PMID: 35146544 DOI: 10.1007/s00105-022-04953-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Solar radiation contains about 6.8% ultraviolet (UV) radiation. UV radiation is still regarded as one of the most important risk factors for both nonmelanoma skin cancer (NMSC; predominantly basal cell carcinoma and squamous cell carcinoma) and malignant melanoma (MM). To avoid induction and persistence of UV-induced mutations, our skin is armed with an arsenal of endogenous protective mechanisms such as induction of cell cycle arrest, repair mechanisms, immunosurveillance and the initiation of various types of cell death. Exogenous sun protection includes a range of behaviors such as avoiding extensive sun exposure, wearing UV-proof clothing and appropriate application of topical sunscreens.
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Affiliation(s)
- B Kurz
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - M Berneburg
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - S Singer
- Klinik und Poliklinik für Dermatologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Manne S, Kashy DA, Pagoto S, Peterson SK, Heckman CJ, Gallo J, Berger A, Buller DB, Kulik A, Frederick S, Pesanelli M. Family Attitudes and Communication about Sun Protection and Sun Protection Practices among Young Adult Melanoma Survivors and Their Family Members. JOURNAL OF HEALTH COMMUNICATION 2021; 26:781-791. [PMID: 34844521 PMCID: PMC9270718 DOI: 10.1080/10810730.2021.2008552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Young melanoma survivors and their family are at increased risk for developing melanoma, but seldom engage in sun protection behaviors. Little is known about the role of family factors in sun protection. Our goals were: 1) examine correspondence between survivors and family sun protection, individual attitudes, and family attitudes and communication about risk-reducing behaviors, and; 2) evaluate the mediating role of family attitudes and communication in the association between individual sun protection attitudes and behavior. Measures of individual attitudes, family attitudes and communication, and sun protection behaviors were completed by 529 participants. Multilevel modeling assessed family correspondence in sun-related attitudes and behaviors and mediation. Families had varying levels of shared attitudes and behaviors, with higher correspondence for family norms. Survivors reported stronger family norms, greater family benefits, and more discussion than siblings. For both sexes, family discussion was associated with higher sun protection. For women only, more favorable attitudes were associated with sun protection partly because women discussed sun protection with family and held stronger norms. Because families' attitudes and practices correspond, family-focused interventions may prove effective. Among females, increasing risk awareness and sunscreen efficacy and overcoming barriers may foster enhanced normative standards, communication about, and engagement in sun protection.
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Affiliation(s)
- Sharon Manne
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Deborah A Kashy
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Susan K Peterson
- Department of Behavioral Science, Division of of Cancer Prevention and Population Sciences, University of Texas Md Anderson Cancer Center, USA
| | - Carolyn J Heckman
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Joseph Gallo
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Adam Berger
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | | | - Alexandria Kulik
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Sara Frederick
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
| | - Morgan Pesanelli
- Department of Medicine, Behavioral Sciences Section, Rutgers Cancer Institute of New Jersey, USA
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