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Wu YP, Stump TK, Hay JL, Aspinwall LG, Boucher KM, Deboeck PR, Grossman D, Mooney K, Leachman SA, Smith KR, Wankier AP, Brady HL, Hancock SE, Parsons BG, Tercyak KP. The Family Lifestyles, Actions and Risk Education (FLARE) study: Protocol for a randomized controlled trial of a sun protection intervention for children of melanoma survivors. Contemp Clin Trials 2023; 131:107276. [PMID: 37393004 PMCID: PMC10529923 DOI: 10.1016/j.cct.2023.107276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Children of parents who had melanoma are more likely to develop skin cancer themselves owing to shared familial risks. The prevention of sunburns and promotion of sun-protective behaviors are essential to control cancer among these children. The Family Lifestyles, Actions and Risk Education (FLARE) intervention will be delivered as part of a randomized controlled trial to support parent-child collaboration to improve sun safety outcomes among children of melanoma survivors. METHODS FLARE is a two-arm randomized controlled trial design that will recruit dyads comprised of a parent who is a melanoma survivor and their child (aged 8-17 years). Dyads will be randomized to receive FLARE or standard skin cancer prevention education, which both entail 3 telehealth sessions with an interventionist. FLARE is guided by Social-Cognitive and Protection Motivation theories to target child sun protection behaviors through parent and child perceived risk for melanoma, problem-solving skills, and development of a family skin protection action plan to promote positive modeling of sun protection behaviors. At multiple assessments through one-year post-baseline, parents and children complete surveys to assess frequency of reported child sunburns, child sun protection behaviors and melanin-induced surface skin color change, and potential mediators of intervention effects (e.g., parent-child modeling). CONCLUSION The FLARE trial addresses the need for melanoma preventive interventions for children with familial risk for the disease. If efficacious, FLARE could help to mitigate familial risk for melanoma among these children by teaching practices which, if enacted, decrease sunburn occurrence and improve children's use of well-established sun protection strategies.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Tammy K Stump
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, New York 10021, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 North 1530 East, Salt Lake City, UT 84112, USA.
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Internal Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT, USA.
| | - Pascal R Deboeck
- Department of Psychology, University of Utah, 380 North 1530 East, Salt Lake City, UT 84112, USA.
| | - Douglas Grossman
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Kathi Mooney
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; College of Nursing, University of Utah, 10 North, 2000 E, Salt Lake City, UT 84112, USA.
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Ave; Suite 16D, Portland, OR 97239, USA.
| | - Ken R Smith
- Utah Population Database Pedigree and Population Resource, Department of Population Sciences, Huntsman Cancer Institute, University of Utah, 675 Arapeen Drive; Suite 200, Salt Lake City, UT 84112, USA.
| | - Ali P Wankier
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Hannah L Brady
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Samuel E Hancock
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Bridget G Parsons
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Washington, DC 20007, USA.
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Wu YP, Boucher K, Hu N, Hay J, Kohlmann W, Aspinwall LG, Bowen DJ, Parsons BG, Nagelhout ES, Grossman D, Mooney K, Leachman SA, Tercyak KP. A pilot study of a telehealth family-focused melanoma preventive intervention for children with a family history of melanoma. Psychooncology 2020; 29:148-155. [PMID: 31520429 PMCID: PMC6980884 DOI: 10.1002/pon.5232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Melanoma preventive interventions for children with familial risk are critically needed because ultraviolet radiation (UVR) exposure and sunburn occurrence early in life are the primary modifiable risk factors for melanoma. The current study examined the feasibility and acceptability of a new, family-focused telehealth intervention for children with familial risk for melanoma and their parents. The study also explored changes in child sun protection and risk behaviors, sunburn occurrence, and objectively measured UVR exposure. METHODS This was a prospective study with a single-group design (n = 21 parent-child dyads, children ages 8-17). Dyads were asked to participate in three in-person assessments and three live video teleconference intervention sessions. RESULTS The intervention was feasibly delivered, and the intervention content was acceptable to parents and children. The intervention was associated with improvements in child use of certain sun protection strategies over time and declines in child UVR exposure. CONCLUSIONS A telehealth-delivered,family-focused melanoma preventive intervention was feasibly delivered and was acceptable to parent-child dyads. Future melanoma preventive interventions for this at-risk population could incorporate eHealth technologies to facilitate improvements in use of sun protection and monitoring of UVR exposure. This trial was registered with Clinicaltrials.gov, number NCT02846714.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kenneth Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah
- Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Nan Hu
- Huntsman Cancer Institute, Salt Lake City, Utah
- Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jennifer Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | | | - Elizabeth S Nagelhout
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kathi Mooney
- Huntsman Cancer Institute, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kenneth P Tercyak
- Cancer Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C
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Tessier L, Brehaut JC, Potter BK, Chakraborty P, Carroll JC, Wilson BJ. Family History Taking in Pediatric Practice: A Qualitative Interview Study. Public Health Genomics 2019; 22:110-118. [PMID: 31661705 DOI: 10.1159/000503729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 09/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Family history (FH) is a risk factor for many conditions in pediatric practice. There is no standard of care regarding FH taking, and only a few published studies about current practice. OBJECTIVES To explore in depth pediatricians' perceptions, attitudes, beliefs, and practices regarding FH taking. METHODS The Theoretical Domains Framework (TDF) was used to develop a comprehensive interview scheme. Semi-structured interviews were conducted with community pediatricians. Interviews were audio-recorded, transcribed, and analyzed using a thematic approach and the constant comparison method. RESULTS Eleven pediatricians were interviewed. FH was found to be a firmly embedded, complex, and important aspect of pediatric practice. Participants described FH as part of regular holistic care. FH and social history were linked and often appeared to be part of the same concept to participants. FH was used for a range of purposes. In addition to risk assessment, FH information helped clarify diagnosis and select medication, tailor overall patient management based on family circumstance, and provide psychosocial support for parents. Participants expressed confidence in their FH skills and reported tailoring their approach with experience. Most were not concerned about formal evidence for FH and would not change their practice except for "good reason." CONCLUSIONS The use of the TDF helped ensure a comprehensive approach to FH taking in pediatric practice. The findings suggest that FH taking in this setting is a complex activity, embedded in routine care. Efforts to make FH taking more systematic may founder if they fail to take into account pediatricians' attitudes, perspectives, and practices.
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Affiliation(s)
- Laure Tessier
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada,
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University, St. John's, Newfoundland, Canada
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Wu YP, Parsons BG, Mooney R, Aspinwall LG, Cloyes K, Hay JL, Kohlmann W, Grossman D, Leachman SA. Barriers and Facilitators to Melanoma Prevention and Control Behaviors Among At-Risk Children. J Community Health 2019; 43:993-1001. [PMID: 29623503 DOI: 10.1007/s10900-018-0516-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Melanoma prevention is essential for children who are at elevated risk for the disease due to family history. However, children who carry a familial risk for the disease do not optimally adhere to recommended melanoma preventive behaviors. The current study sought to identify perceived barriers to and facilitators of children's engagement in melanoma preventive behaviors among children at elevated risk for melanoma due to family history of the disease (i.e., having a parent with a history of melanoma) from both parents' and childrens' perspectives. Qualitative methods were employed and consisted of separate focus group discussions with children (ages 8-17 years, n = 37) and their parents (n = 39). Focus group transcripts were coded using content analysis. Parents and children reported a number of barriers and facilitators, including on the individual (e.g., knowledge and awareness, preferences), social (e.g., peer influences, family modeling and communication), and contextual (e.g., healthcare provider communication) levels. The identified categories of barriers and facilitators both confirm and extend the literature documenting the reasons children who are at elevated risk for melanoma do not engage in melanoma prevention and control behaviors. Programs aiming to decrease melanoma risk among children of melanoma survivors could help families address their barriers to preventive behavior implementation and build on facilitators. Melanoma survivors and their children could benefit from support on their interactions with healthcare providers, schools, peers, and other caregivers about melanoma prevention.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Bridget G Parsons
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Ryan Mooney
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Kristin Cloyes
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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Wu YP, Parsons BG, Aspinwall LG, Hay JL, Boucher KM, Caputo H, Mooney R, Grossman D, Leachman SA. Parent and child perspectives on perceived barriers to child sun protection and their association with sun protection strategies among children of melanoma survivors. Pediatr Dermatol 2019; 36:317-323. [PMID: 30895676 PMCID: PMC6525049 DOI: 10.1111/pde.13796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Children with an elevated familial risk for melanoma inconsistently implement sun protection behaviors that could mitigate their melanoma risk. Little is known about perceived barriers to child sun protection among this at-risk group and their parents, and the extent to which perceived barriers are associated with child sun protection. The goal of this study was to examine, among children with a family history of melanoma, the frequency with which children and their parents reported barriers to child sun protection and the extent to which barriers were associated with reported use of sun protection among children. METHODS Children with a family history of melanoma and their parents completed questionnaires assessing perceived barriers and reported child use of sun protection. RESULTS Common barriers to child sun protection included being bothered by implementing the behavior or forgetting. A greater number of perceived barriers were associated with less frequent child use of sunscreen, long-sleeved shirts, long pants, and shade. CONCLUSIONS Children at elevated risk for melanoma due to a family history of the disease and their parents perceive multiple barriers to sun protection that are associated with children's use of these melanoma preventive behaviors. Sun protection interventions for this at-risk population could provide families with specific strategies to address common barriers to implementing child sun protection.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, Utah.,Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | | | | | - Ryan Mooney
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, Utah.,Huntsman Cancer Institute, Salt Lake City, Utah
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
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Bieliauskiene G, Philipsen PA, Ørsted-Jordy L, Køster B, Wulf HC. Visual scales are superior to questionnaires in skin phototype self-assessment by children. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:238-245. [PMID: 30809865 DOI: 10.1111/phpp.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/25/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE There are no suitable methods for skin phototype self-assessment by children. Our study investigated several skin phototype self-assessment methods in children to identify the best correlation to objectively measure skin phototype. METHODS Danish schoolchildren (ages 6-19) participated in a nation-wide study that assessed skin, eye, hair colour and sun behaviour. Skin phototype self-assessment was performed by children using two visual colour scales (cartoon faces and colour cards), question-based colour scale and questions about tendency to burn and ability to tan. For objective skin phototype measurements, 483 children from all age groups were selected and their pigment protection factor (PPF) was measured at three skin sites using a skin reflectance spectrophotometer. RESULTS Cartoon faces (r2 = 0.654) and colour cards (r2 = 0.659) were better at predicting PPF on the inner forearm than the question-based colour method (r2 = 0.520). PPF prediction from questions on skin reaction to sun exposure was markedly inferior (r2 ≤ 0.142) to both visual colour scales and question-based colour method. CONCLUSION Both visual colour scales proved to be superior to question-based skin phototype self-assessment in schoolchildren. In contrast, questions on skin reaction to sun exposure were shown to be an unsuitable tool for self-assessment of skin phototype in children.
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Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Wu YP, Aspinwall LG, Nagelhout E, Kohlmann W, Kaphingst KA, Homburger S, Perkins RD, Grossman D, Harding G, Cassidy P, Leachman SA. Development of an Educational Program Integrating Concepts of Genetic Risk and Preventive Strategies for Children with a Family History of Melanoma. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:774-781. [PMID: 27889875 PMCID: PMC5446308 DOI: 10.1007/s13187-016-1144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Efforts to prevent melanoma, especially for those at elevated risk for the disease, should ideally begin during childhood. However, there are few preventive interventions targeting children who are at higher risk for melanoma due to a family history of the disease. Further, there are no educational interventions that aim to help these at-risk children understand their risk for melanoma and the ways in which preventive behaviors, such as sun protection, can mitigate their risk. The current paper describes a multidisciplinary team's process for creating a developmentally appropriate educational intervention about melanoma risk and prevention for children ages 8-17 years who have a family history of melanoma. Drawing from the fields of dermatology, health behavior change and education, genetic risk communication, science education, and graphic arts, the multimedia intervention created covers key learning points relevant to understanding melanoma, the role of DNA damage in melanoma development, inherited risk factors for melanoma, environmental factors causing DNA damage, and methods for preventing DNA damage, such as sun protective behaviors. Lessons learned during the development of the educational intervention, particularly relevant to multidisciplinary team interactions, are discussed. Implications for future testing and refinement of the novel educational content are also reviewed.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112, USA
| | - Elizabeth Nagelhout
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 S Central Campus Drive, Room 2400, Salt Lake City, UT, 84112, USA
| | - Sheila Homburger
- Genetic Science Learning Center, University of Utah, 515 100 S, Salt Lake City, UT, 84102, USA
| | - Ryan D Perkins
- Genetic Science Learning Center, University of Utah, 515 100 S, Salt Lake City, UT, 84102, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT, 84132, USA
| | - Garrett Harding
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
| | - Pamela Cassidy
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR, 97239, USA
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR, 97239, USA
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Kimball SM, Lee J, Vieth R. Sunbeds with UVB radiation can produce physiological levels of serum 25-Hydroxyvitamin D in healthy volunteers. DERMATO-ENDOCRINOLOGY 2017; 9:e1375635. [PMID: 29484099 PMCID: PMC5821157 DOI: 10.1080/19381980.2017.1375635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/01/2017] [Accepted: 08/31/2017] [Indexed: 12/02/2022]
Abstract
Vitamin D3 is produced in the skin in response to UVB irradiation, from either sun exposure or UVB sunbeds. The objective of the current study was to characterize serum 25(OH)D response to regular sunbed use from several lamp outputs following their respective time exposure recommendations. There were three groups that tanned over 12 weeks during the winter months in dedicated sunbeds based on lamp outputs (100 W and 160 W low pressure fluorescent and 700 W high pressure filtered metal halide lamps) and a control group provided serum 25(OH)D samples at baseline and end-of-study. Tanning session lengths were calculated based on Health Canada guidelines to stay below the erythema levels. Mean 25(OH)D were increased by an average of 42 nmol/L in the sunbeds that used 100 W and 160 W fluorescents. Change in 25(OH)D was dependent on baseline 25(OH)D levels and sunbed (p = 0.003) and age (p = 0.03), but was not affected by gender, BMI, Fitzpatrick type or cumulative length of tanning sessions. There was no significant increase in 25(OH)D levels in participants using the 700 W filtered metal halide lamp sunbed or in the control participants. Skin pigmentation, ITA°, was markedly increased in all tanners and skin lightness, L*, significantly decreased at 12 weeks. Both L* and ITA° were significantly correlated with 25(OH)D concentrations for the sunbeds with fluorescent lamps emitting UVB (100 W and 160W). Participants following standardized exposure schedules meeting Health Canada regulations in sunbeds irradiating adequate UVB showed continuous increases of 25(OH)D to physiological levels even after producing a tan in a controlled manner. ClinicalTrials.gov Registration: NCT02334592
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Affiliation(s)
- Samantha M Kimball
- Department of Research Pure North S'Energy Foundation, 800 - 326 11th Avenue SW, Calgary, AB, Canada
| | - Jasmine Lee
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 326.75 - 209 Victoria St. Toronto ON, Canada
| | - Reinhold Vieth
- Departments of Laboratory Medicine, and Pathobiology and Nutritional Sciences, University of Toronto, Medical Sciences Building, 6th Floor, 1 King's College Circle, Toronto, ON, Canada
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Wu YP, Mays D, Kohlmann W, Tercyak KP. Pediatric Predispositional Genetic Risk Communication: Potential Utility for Prevention and Control of Melanoma Risk as an Exemplar. J Genet Couns 2017; 26:887-893. [PMID: 28547663 PMCID: PMC5702278 DOI: 10.1007/s10897-017-0105-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/25/2017] [Indexed: 12/20/2022]
Abstract
Predispositional genetic testing among minor children is intensely debated due to the potential benefits and harms of providing this type of genetic information to children and their families. Existing guidelines on pediatric genetic testing state that predispositional testing could be appropriate for minors if preventive services exist that mitigate children's risk for or severity of the health condition in question. We use the example of hereditary melanoma to illustrate the rationale for and potential application of genetic risk communication for an adult-onset cancer to a pediatric population where childhood behaviors may reduce risk of disease later in life. We draw from the adult melanoma genetic risk communication and pediatric health behavior change literatures to suggest ways in which genetic test reporting and complementary education could be delivered to children who carry a hereditary risk for melanoma and their families in order to foster children's engagement in melanoma preventive behaviors. Genetic discoveries will continue to yield new opportunities to provide predispositional genetic risk information to unaffected individuals, including children, and could be delivered within programs that provide personalized and translational approaches to cancer prevention.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
- Huntsman Cancer Institute, Salt Lake City, UT, USA.
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA
| | | | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA
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College Students' Perceptions of Worry and Parent Beliefs: Associations with Behaviors to Prevent Sun Exposure. J Skin Cancer 2017; 2017:4985702. [PMID: 28804653 PMCID: PMC5540521 DOI: 10.1155/2017/4985702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/26/2017] [Accepted: 06/18/2017] [Indexed: 11/17/2022] Open
Abstract
More research is needed to understand how attitudes impact behaviors that afford sun protection. The current study examined the impact of students' perceptions of parental beliefs about sun exposure and its influence on their practiced sun protection behaviors and worry about sun exposure. Participants were college students (N = 462) at a large Midwestern university. They completed a survey to examine their perceptions of risks and messages about sun exposure and sun exposure behaviors. Results indicated that gender and students' perceptions of parental beliefs about sun exposure were related to sun protection behaviors and their own worry over sun exposure. Specifically, males showed lower levels of sun protection behaviors, with the exception of wearing a hat with a brim, and lower levels of worry about sun exposure compared to females. Roughly a third of our sample had a family history of skin cancer, and this variable was related to worry about sun exposure and parental beliefs. Prevention messages and interventions to reduce sun risk for college students should address risks of sun exposure as well as educating young adults about the importance of wearing sunscreen, protective clothing, and hats to improve sun protection.
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Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol 2017; 76:S110-S121. [PMID: 28038884 DOI: 10.1016/j.jaad.2016.09.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation. Therefore, personalized photoprotection recommendations concerning skin cancer risk factors, desired treatment outcomes, health needs (eg, vitamin D), and photoaging based on the needs and preferences of the patient are essential. It is clear that additional research is needed on optimal levels of protection against ultraviolet radiation for people of color.
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Affiliation(s)
- Tania Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul, School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Kesha Buster
- Buster Dermatology, Tulsa, Oklahoma; University of Alabama at Birmingham, Birmingham, Alabama
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Tripp MK, Peterson SK, Prokhorov AV, Shete SS, Lee JE, Gershenwald JE, Gritz ER. Correlates of Sun Protection and Sunburn in Children of Melanoma Survivors. Am J Prev Med 2016; 51:e77-85. [PMID: 27067306 PMCID: PMC5482415 DOI: 10.1016/j.amepre.2016.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/04/2016] [Accepted: 02/26/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sunburns during childhood increase melanoma risk. Children of melanoma survivors are at higher risk, but little is known about their sunburn and sun protection. One study showed that almost half of melanoma survivors' children experienced sunburn in the past year. This study evaluated sunburn and sun protection in melanoma survivors' children, and relevant survivor characteristics from Social Cognitive Theory and the Health Belief Model. METHODS Melanoma survivors (N=340) were recruited from a comprehensive cancer center. Survivors completed a baseline questionnaire administered by telephone to report on the behavior of their children (N=340) as part of an RCT of a sun protection intervention. Data were collected in 2008 and analyzed in 2015. RESULTS In the prior 6 months, 28% of children experienced sunburn. "Always" or "frequent" sun protection varied by behavior: sunscreen, 69%; lip balm, 15%; wide-brimmed hats, 9%; sleeved shirts, 28%; pants, 48%; sunglasses, 10%; shade, 33%; and limiting time outdoors, 45%. Survivors' sunburn and sun protection were positively associated with these outcomes in children. Correlates of sunburn also included older child age and higher risk perceptions. Correlates of sun protection behaviors included younger child age; stronger intentions, higher self-efficacy, and more positive outcome expectations about sun protection; and greater number of melanomas in survivors. CONCLUSIONS Melanoma survivors may have a heightened awareness of the importance of their children's sun protection, but their children are not routinely protected. Correlates of children's sunburn and sun protection suggest subgroups of survivors to target with interventions to improve sun protection.
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Affiliation(s)
- Mary K Tripp
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander V Prokhorov
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjay S Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey E Gershenwald
- Departments of Surgical Oncology and Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Glenn BA, Lin T, Chang LC, Okada A, Wong WK, Glanz K, Bastani R. Sun protection practices and sun exposure among children with a parental history of melanoma. Cancer Epidemiol Biomarkers Prev 2015; 24:169-77. [PMID: 25587110 DOI: 10.1158/1055-9965.epi-14-0650] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation (UVR) is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. METHODS The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0-17 years; N = 324). RESULTS Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average-risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn, whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. CONCLUSIONS Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed. IMPACT Intervening in high-risk populations may help reduce the burden of melanoma in the United States.
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Affiliation(s)
- Beth A Glenn
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.
| | - Tiffany Lin
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - L Cindy Chang
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Ashley Okada
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Weng Kee Wong
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roshan Bastani
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
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15
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Fitzpatrick L, Hay JL. Barriers to risk-understanding and risk-reduction behaviors among individuals with a family history of melanoma. Melanoma Manag 2014; 1:185-191. [PMID: 30190823 DOI: 10.2217/mmt.14.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Family members of melanoma patients are often called upon to provide support, ranging from monetary to medical assistance. Consanguineal relatives of melanoma patients are also at greater risk of developing the disease themselves. However, as a group, they have limited understanding of their melanoma risk and they demonstrate inadequate primary and secondary prevention behaviors. The optimal intervention strategies for improving the consistent use of such behaviors (i.e., improving rates of sun-protection behaviors and screening) remains unclear, necessitating further research.
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Affiliation(s)
- Laura Fitzpatrick
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.,Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Jennifer L Hay
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.,Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY 10022, USA.,Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.,Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY 10022, USA
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16
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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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17
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Diao DY, Lee TK. Sun-protective behaviors in populations at high risk for skin cancer. Psychol Res Behav Manag 2013; 7:9-18. [PMID: 24379732 PMCID: PMC3873203 DOI: 10.2147/prbm.s40457] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Over 3 million new cases of skin cancer are diagnosed in the US annually. Melanoma, a subtype of skin cancer that can be fatal if the disease is not detected and treated at an early stage, is the most common cancer for those aged 25–29 years and the second most common cancer in adolescents and young adults aged 15–29 years. The primary carcinogen for the genesis of skin cancers is ultraviolet light from solar radiation and tanning beds. In spite of massive health campaigns to raise public awareness on ultraviolet radiation, sun-protective practices still fall behind. A plausible explanation is the lack of behavioral change in the populations at risk; in this review article, we examine sun-protective behavior in the four high-risk skin cancer groups: skin cancer survivors, individuals with a family history of melanoma, individuals with physical characteristics associated with skin cancer risk, and organ transplantation patients. Findings in the literature demonstrate that increased knowledge and awareness does not consequently translate into behavioral changes in practice. Behavior can differ as a result of different attitudes and beliefs, depending on the population at risk. Thus, intervention should be tailored to the population targeted. A multidisciplinary health team providing consultation and education is required to influence these much needed changes.
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Affiliation(s)
- Diana Y Diao
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim K Lee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada ; Cancer Control Research Program, BC Cancer Agency, Vancouver, British Columbia, Canada
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18
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Foote JA, Poole CM. Brief questions highlight the need for melanoma information campaigns. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:611-616. [PMID: 23996205 DOI: 10.1007/s13187-013-0537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Melanoma awareness was briefly assessed at walk/runs held simultaneously in Philadelphia PA, Phoenix AZ, and Seattle WA. Of the participants, 75 % (1521) answered short questions during event registration. Among 1,036 respondents aged 14 years and older, 66 % reported knowing melanoma warning signs. Significantly more respondents with melanoma family history reported having a physician-administered skin exam and knowing warning signs. More than one third of walk/run participants reported no definitive melanoma warning sign knowledge. Self-reported melanoma awareness and detection indices were lowest among Phoenix participants; the event city with the greatest annual sun exposure. Educational efforts for melanoma awareness are critically needed. Selected results of this project were presented in a poster forum at the 2006 Congress for Epidemiology meeting held in Seattle, WA (June 2006).
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Affiliation(s)
- Janet A Foote
- Arizona Cancer Center, Skin Cancer Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA,
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19
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Glenn BA, Bastani R, Chang LC, Khanna R, Chen K. Sun protection practices among children with a family history of melanoma: a pilot study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:731-737. [PMID: 22610837 DOI: 10.1007/s13187-012-0377-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The goal of this pilot study was to assess sun protection practices and correlates among children with a family history of melanoma, a high risk and understudied group. Sixty-eight melanoma cases, recruited through the Los Angeles County cancer registry, completed a survey. Survivors provided data on 110 children (mean age = 8.11 years). Although most children used sunscreen (79 %), half experienced a recent sunburn. The mean sun protection level for the sample was similar to levels observed among average risk children. Efforts to reduce sunburn frequency and improve sun protection among these vulnerable children appear warranted.
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Affiliation(s)
- Beth A Glenn
- Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, CHS, Los Angeles, CA 90095-6900, USA.
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20
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Abstract
PURPOSE Genetic testing of minors is controversial, as ethical considerations depend on multiple aspects of the particular disease and familial context. For melanoma, there is a well-established and avoidable environmental influence and a documented benefit of early detection. METHODS We surveyed 61 CDKN2A/p16 mutation-tested adults from two kindreds about their attitudes toward genetic testing of minors immediately posttesting and 2 years later. RESULTS Overall, 86.9% expressed support of melanoma genetic testing of minors, with the importance of risk awareness (77.4%) and the likelihood of improved prevention and screening behaviors (69.8%) as the most frequently cited potential benefits. Among mutation carriers, 82.6% wanted genetic testing for their own children. These preferences remained stable over a 2-year period. Most respondents (62.3%) favored complete involvement of their children in genetic counseling and test reporting; 19.7% suggested that children be tested but not informed of the results. Concerns about inducing psychological distress or compromising children's decision autonomy were infrequently cited. Testing preferences did not vary by respondent age, gender, or melanoma history. CONCLUSION Respondents strongly supported melanoma genetic testing of minors, with most citing improved health behavior as a likely outcome. We discuss options for melanoma genetic counseling and testing of minors.
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21
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Gillespie HS, Watson T, Emery JD, Lee AJ, Murchie P. A questionnaire to measure melanoma risk, knowledge and protective behaviour: assessing content validity in a convenience sample of Scots and Australians. BMC Med Res Methodol 2011; 11:123. [PMID: 21867531 PMCID: PMC3236020 DOI: 10.1186/1471-2288-11-123] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/25/2011] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was to assess the content validity of a questionnaire to measure melanoma risk, knowledge and protective behaviour in a convenience sample of Scots and Australians. Australia has the highest melanoma incidence worldwide but has developed a culture of skin cancer avoidance with a long history of skin cancer primary prevention campaigns of proven effectiveness. Scotland has lower incidence, but has shown a greater rate of increase between 1985 and 2007. There is an urgent need in Scotland, therefore, to identify those groups at greatest risk and provide them with effective preventative advice. Method A self-administered postal survey was completed by four groups formed from convenience samples in two geographical locations (Northeast Scotland and Western Australia). In univariate analysis scores on personal risk, level of concern, protective behaviour, and knowledge were compared by nationality, previous skin cancer diagnosis and personally knowing someone with melanoma. Multivariate linear regression analysis modelled the influence of potential predictor variables upon each of the scores. Results 540 people completed the questionnaire, 273 Scots (50.6%). 133 (24.6%) Scots and 83 (15.4%) Australians previously had melanoma or non-melanoma skin cancer, whilst 120 (22.2%) Scots and 190 (35.2%) Australians personally knew someone with melanoma. Australians had higher knowledge (p < 0.001), level of concern (p < 0.001) and protective behaviour (p < 0.001) scores than the Scottish. Australian nationality was the strongest independent predictor of a higher knowledge score (p < 0.001), followed by a previous skin cancer diagnosis (p = 0.003), personal knowledge of someone with melanoma (p = 0.011), female gender (p = 0.005) and higher education status (p < 0.001) (R2 = 0.163). Conclusion The questionnaire detected higher levels of knowledge and skin cancer protective behaviours in Australians than in Scottish people. This was expected and supports the content validity of the questionnaire and its value as a future research tool in the Scottish population.
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Affiliation(s)
- Helen S Gillespie
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill, Scotland
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22
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Manne SL, Coups EJ, Jacobsen PB, Ming M, Heckman CJ, Lessin S. Sun protection and sunbathing practices among at-risk family members of patients with melanoma. BMC Public Health 2011; 11:122. [PMID: 21338483 PMCID: PMC3050750 DOI: 10.1186/1471-2458-11-122] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/21/2011] [Indexed: 01/22/2023] Open
Abstract
Background Despite the increased level of familial risk, research indicates that family members of patients with melanoma engage in relatively low levels of sun protection and high levels of sun exposure. The goal of this study was to evaluate a broad range of demographic, medical, psychological, knowledge, and social influence correlates of sun protection and sunbathing practices among first-degree relatives (FDRs) of melanoma patients and to determine if correlates of sun protection and sunbathing were unique. Methods We evaluated correlates of sun protection and sunbathing among FDRs of melanoma patients who were at increased disease risk due to low compliance with sun protection and skin surveillance behaviors. Participants (N = 545) completed a phone survey. Results FDRs who reported higher sun protection had a higher education level, lower benefits of sunbathing, greater sunscreen self-efficacy, greater concerns about photo-aging and greater sun protection norms. FDRs who reported higher sunbathing were younger, more likely to be female, endorsed fewer sunscreen barriers, perceived more benefits of sunbathing, had lower image norms for tanness, and endorsed higher sunbathing norms. Conclusion Interventions for family members at risk for melanoma might benefit from improving sun protection self-efficacy, reducing perceived sunbathing benefits, and targeting normative influences to sunbathe.
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Affiliation(s)
- Sharon L Manne
- Cancer Prevention and Control Program, The Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA.
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23
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24
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Woo DK, Eide MJ. Tanning beds, skin cancer, and vitamin D: an examination of the scientific evidence and public health implications. Dermatol Ther 2010; 23:61-71. [DOI: 10.1111/j.1529-8019.2009.01291.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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Dennis LK, Kancherla V, Snetselaar LG. Adolescent attitudes towards tanning: does age matter? PEDIATRIC HEALTH 2009; 3:565-578. [PMID: 22707979 PMCID: PMC3374604 DOI: 10.2217/phe.09.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Adolescents seem to be obsessed with tanning. One third of both adolescents and adults report sunbathing. On average, about 20% of adolescents report ever-using of artificial UV tanning devices with 15% currently using them. Tanning attitudes appear similar for adolescents and adults. The top three reasons for tanning included beliefs that a tan makes them more comfortable socializing with friends, looks better and is attractive. The top reason for using artificial UV tanning devices is also aesthetics, followed by relaxation. Other reasons for using artificial UV tanning devices include vacation preparation and to gain a protective base. Attitudes related to appearance that result in more frequent tanning may be difficult to change.
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Affiliation(s)
- Leslie K Dennis
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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26
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Mahé E, Qattini S, Beauchet A, Saiag P. Web-based resources for sun protection information – A French-language evaluation. Eur J Cancer 2009; 45:2160-7. [DOI: 10.1016/j.ejca.2009.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/07/2009] [Accepted: 02/11/2009] [Indexed: 11/30/2022]
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Youl PH, Janda M, Kimlin M. Vitamin D and sun protection: The impact of mixed public health messages in Australia. Int J Cancer 2009; 124:1963-70. [DOI: 10.1002/ijc.24154] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Aspinwall LG, Leaf SL, Kohlmann W, Dola ER, Leachman SA. Patterns of photoprotection following CDKN2A/p16 genetic test reporting and counseling. J Am Acad Dermatol 2009; 60:745-57. [PMID: 19278751 DOI: 10.1016/j.jaad.2008.12.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/12/2008] [Accepted: 12/18/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The impact of melanoma genetic testing and counseling on photoprotective behaviors is unknown. OBJECTIVE To determine if genetic testing and counseling alter compliance with photoprotection recommendations. METHODS Reported use of sunscreen, protective clothing, and sun avoidance by 59 members of CDKN2A/p16-mutation positive pedigrees was assessed as a function of mutation status and melanoma history, before, immediately after, and 1 month following test reporting. RESULTS Intentions to practice all photoprotective behaviors increased in all participant groups (P < .0001). At 1 month, 33% of participants reported the adoption of a new photoprotective behavior. Subpopulation analyses identified different patterns of change in photoprotection relative to baseline (P < .005), with no net decline in any group. LIMITATIONS This initial study of CDKN2A/p16 families is small and awaits replication in a larger sample. CONCLUSION Melanoma genetic testing and counseling enhanced intentions to implement photoprotective strategies and did not result in reduced compliance in the CDKN2A/p16-subpopulation.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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29
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Abstract
Ultraviolet radiation is a carcinogen that also compromises skin appearance and function. Because the ultraviolet action spectra for DNA damage, skin cancer, and vitamin D(3) photosynthesis are identical and vitamin D is readily available from oral supplements, why has sun protection become controversial? First, the media and, apparently, some researchers are hungry for a new message. Second, the controversy is fueled by a powerful special interest group: the tanning industry. This industry does not target the frail elderly or inner-city ethnic minorities, groups for whom evidence of vitamin D(3) insufficiency is strongest, but rather fair-skinned teenagers and young adults, who are at highest risk of ultraviolet photodamage. Third, evolution does not keep pace with civilization. When nature gave humans the appealing capacity for cutaneous vitamin D(3) photosynthesis, life expectancy was <40 y; long-term photodamage was not a concern; and vitamin D(3) deficiency, with its resulting skeletal abnormalities (rickets), was likely to be fatal in early life. In the 21st century, life expectancy approaches 80 y in developed countries, vitamin D(3) is available at the corner store, and the lifetime risk of skin cancer is 1 in 3 among white Americans. Medical and regulatory groups should avoid poorly reasoned, sensationalistic recommendations regarding unprotected ultraviolet exposure. Instead, they should rigorously explore possible cause-and-effect relations between vitamin D(3) status and specific diseases while advocating the safest possible means of ensuring vitamin D(3) sufficiency.
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Affiliation(s)
- Barbara A Gilchrest
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.
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30
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31
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Abstract
BACKGROUND Exposure to ultraviolet radiation (UVR) results in a darkening of the skin known as tanning. Recently, it has been shown that tanning is a response to UVR-induced DNA damage and represents the skin's efforts to protect itself against further injury. Despite the link between UVR and cutaneous malignancy, people continue to pursue tanning from natural and artificial sources. This trend is reflected in the exponential rise in skin cancer incidence. OBJECTIVE The objective of this study was to review our current understanding of the factors controlling the tanning response and the relationship to cutaneous carcinogenesis, as well as the impact that the multibillion dollar tanning industry has had on the practice of dermatology. MATERIALS AND METHODS Extensive literature review was conducted in subjects related to tanning and the relationship to cutaneous malignancy. RESULTS Our knowledge of tanning and its effects on the skin has increased tremendously. It is clear that tanning contributes to the development of skin cancer. Despite this information, the incidence of skin cancer continues to increase exponentially. CONCLUSIONS Skin cancer poses a major public health concern and tanning remains the most modifiable risk factor in its etiology. Social, economic, and legislative issues have become tightly intertwined with the complex nature of human behavior in the continued pursuit of an activity that clearly has detrimental effects on one's health.
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Affiliation(s)
- Sherrif F Ibrahim
- Department of Dermatology, University of Rochester, Rochester, New York 60612-7300, USA.
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34
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Abstract
Ultraviolet (UV) radiation is a proven carcinogen, responsible for more than half of all human malignancies. It also compromises skin appearance and function. Since the UV action spectra for DNA damage, skin cancer and Vitamin D(3) (vit D) photosynthesis are identical and vit D is readily available from oral supplements, why has sun protection become controversial, now that some data suggest conventionally "sufficient" levels of vit D may be less than optimal for at least some population groups? First, the media and apparently some researchers are hungry for a new message. Nevertheless, after 50 years, UV exposure is still a major avoidable health hazard. Second, the controversy is fueled by a powerful special interest group: the indoor tanning industry. They target not the frail elderly or inner-city ethnic minorities, groups for whom evidence of vit D insufficiency is strongest, but rather fair-skinned teenagers and young adults, those at highest risk of UV photodamage. Third, evolution does not keep pace with civilization. When nature gave man the appealing capacity for vit D photosynthesis, the expected lifespan was far less than 40 years. Long-term photodamage was not a concern, and vit D was not available at the corner store. The medical community should avoid sensationalism and instead rigorously explore possible cause-and-effect relationships between vit D status and specific diseases while advocating the safest possible means of assuring vit D sufficiency.
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Affiliation(s)
- Barbara A Gilchrest
- Department of Dermatology, Boston University School of Medicine, 609 Albany Street-J507, Boston, MA 02118, USA.
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35
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Geller AC, Halpern AC. The benefits of skin cancer prevention counseling for parents and children. J Am Acad Dermatol 2006; 55:506-8. [PMID: 16908359 DOI: 10.1016/j.jaad.2006.05.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 05/26/2006] [Accepted: 05/30/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Alan C Geller
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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