Skin Cancer Prevention Behaviors Research Articles

Melanoma Genetic Testing, Counseling, and Adherence to Skin Cancer Prevention and Detection Behaviors

Little is known about the impact of knowledge of CDKN2A and MC1R genotype on melanoma prevention behaviors like sun avoidance and skin examination in the context of familial melanoma. Seventy-three adults with a family history of melanoma were randomly assigned to be offered individualized CDKN2A and MC1R genotyping results in the context of a genetic counseling session, or the standard practice of not being offered counseling or disclosure of genotyping results. Mixed effects or longitudinal logistic models were used to determine whether the intervention affected change in sun protection habits, skin examinations, and perception and beliefs related to melanoma risk, prevention, and genetic counseling. All participants in the intervention group who attended genetic counseling sessions chose to receive their test results. From baseline to follow-up, participants in the intervention group reported an increase in the frequency of skin self-examinations compared with a slight decrease in the control group (P = 0.002). Participants in the intervention group reported a smaller decrease in frequency of wearing a shirt with long sleeves than did participants in the control group (P = 0.047). No effect of the intervention was noted for other outcomes. Feedback of CDKN2A and MC1R genotype among families without known pathogenic CDKN2A mutations does not seem to decrease sun protection behaviors. While disclosure of CDKN2A and MC1R genotype did not have negative effects on prevention, the benefits of communicating this information remain unclear. The small number of families who tested positive for CDKN2A mutations in this study is a limitation.

Skin cancer screening in the homeless population

The homeless population is a medically vulnerable patient population in our communities. Of particular concern to dermatologists is the risk for the development of skin cancer in the homeless, in light of their chronic sun exposure and suboptimal sun protection behaviors. Two free skin cancer screenings conducted at the Fourth Street Clinic in Salt Lake City, Utah, in 2011 and 2012, resulted in the diagnosis of 13 skin cancers in 62 patients. These events also highlighted that many homeless patients had suboptimal skin cancer prevention behaviors. We believe that education, awareness, and disease prevention can be relatively easily accomplished by local homeless clinics as a first line of defense against skin cancer in the homeless population.

Cancer Prevention and Screening Practices of Siblings of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

To compare the skin and breast/cervical cancer prevention/screening practices of adult siblings of childhood cancer survivors with controls and to identify modifying factors for these practices. Cross-sectional, self-report data from 2,588 adult siblings of 5+ year survivors of childhood cancer were analyzed to assess cancer prevention/screening practices. Two age, sex, and race/ethnicity-matched samples (N = 5,915 and N = 37,789) of the Behavioral Risk Factor Surveillance System participants served as the comparison populations. Sociodemographic and cancer-related data were explored as modifying factors for sibling cancer prevention/screening practices through multivariable logistic regression. Compared with controls, siblings were more likely to practice skin cancer prevention behaviors: use of protective clothing [OR, 2.85; 95% confidence interval (CI), 2.39-3.39], use of shade (OR, 2.11; 95% CI, 1.88-2.36), use of sunscreen (OR, 1.27; 95% CI, 1.14-1.40), and wearing a hat (OR, 1.77; 95% CI, 1.58-1.98). No differences were noted for breast/cervical cancer screening including mammography and Pap testing. Having less than a high school education and lack of health insurance were associated with diminished cancer prevention/screening behaviors. Survivor diagnosis, treatment intensity, adverse health, chronic health conditions, and second cancers were not associated with sibling cancer prevention/screening behaviors. Siblings of cancer survivors report greater skin cancer prevention practices when compared with controls; however, no differences were noted for breast/cervical cancer screening practices. Access to care and lack of education may be associated with decreased cancer prevention/screening behaviors. Interventions are needed to address these barriers. Research should be directed at understanding the impact of the cancer experience on sibling health behaviors.

A profile of skin cancer prevention media coverage in 2009

Little is known about the coverage of skin cancer prevention messages in news print media. To perform a content analysis of mass-media articles from newspaper and magazines pertaining to skin cancer prevention in 4 specific months (January, May, July, and October) in 2009 and assess the extent of coverage of skin cancer prevention messages. We conducted a content analysis of 144 articles related to skin cancer prevention extracted from strategic media scans of selected months in 2009. We sought to provide the frequency of mass-media content categorized by theme and focus related to ultraviolet radiation (UVR) protection and risk-reducing behaviors. The audience for the vast majority (78%) of the articles was the general public. Among the assessed articles, more were published in May (49%) and July (35%) than in the remaining other months. The two most frequent themes focused on 'protection of the skin' (32%) and on 'skin cancer prevention' (23%) via risk reduction behavioral practices. Analysis of message content regarding UVR reduction practices showed that many mentioned 'use of sunscreen' (65% of messages) with the least-often mentioned behaviors being 'seek shade' (6.3%) and 'do not burn' (1.4%). In addition, a quarter of the articles lacked any content mentioning recommended UVR reduction behaviors. This study was limited to the narrow scope of articles published in 2009 and for selected months. This profile of mass-media content regarding skin cancer prevention revealed gaps in coverage of UVR reduction behaviors with possible room for improvement. Strategies for improving and comprehensiveness of coverage of recommended skin cancer prevention behaviors in the media are discussed.

Brief Report: Ultraviolet Radiation Exposure, Considering Acculturation Among Hispanics (Project URECAH)

Very few studies have examined acculturation of Hispanics as it relates to skin cancer prevention attitudes and behaviors. This pilot study used the Abbreviated Acculturation Rating Scale for Mexican Americans-II to classify 14-25-year-old Hispanics as traditional, bicultural, or acculturated. More acculturated individuals reported significantly higher perceived benefits of ultraviolet radiation exposure and lower worry about skin damage than traditional individuals. Bicultural individuals reported using sunscreen significantly more often than acculturated individuals. These preliminary data suggest that more acculturated Hispanic young adults may demonstrate riskier skin cancer-related attitudes and behaviors than others.

Physician sun protection counseling: Prevalence, correlates, and association with sun protection practices among US adolescents and their parents, 2004

ObjectiveTo assess the population prevalence and correlates of ever receiving physician advice to practice sun protection (i.e. sun protection counseling) and whether such counseling is associated with sun protection behaviors in adolescents and their parents. MethodAnalysis of a nationally representative cross-sectional telephone survey of ultraviolet radiation exposure behaviors among US adolescents ages 11 to 18 and their parents, conducted between August and November 2004. ResultsForty-four percent of US adolescents and their parents reported physician sun protection counseling. Counseling was more frequently reported by adolescents whose parents were also counseled, reported other sun protection information sources (skin cancer prevention media messages and school sun safety messages), had first degree relatives with skin cancer, and were white, non-Hispanic. Counseling was positively associated with regular sunscreen use, appropriate sunscreen application practices, and intermittent hat use, but not with other recommended behaviors. Sunscreen use rates were generally higher among adolescents reporting several sun protection information sources (counseling, media and school messages) than those with combinations of two or fewer of these sources. ConclusionsThe role of physicians, either independently or in concert with other information sources, should be explored in strategies promoting primary skin cancer prevention behaviors among adolescents and parents.

A Randomized Trial of Tailored Skin Cancer Prevention Messages for Adults: Project SCAPE

We evaluated the impact of a mailed, tailored intervention on skin cancer prevention and skin self-examination behaviors of adults at moderate and high risk for skin cancer. Adults at moderate and high risk for skin cancer were recruited in primary health care settings in Honolulu, HI, and Long Island, NY. After completing a baseline survey, participants were randomized to 2 groups. The treatment group received tailored materials, including personalized risk feedback, and the control group received general educational materials. Multivariate analyses compared sun protection and skin self-examination between groups, controlling for location, risk level, gender, and age. A total of 596 adults completed the trial. The tailored materials had a significant effect on overall sun-protection habits, the use of hats, the use of sunglasses, and the recency of skin self-examination. Some effects were moderated by location and risk level. Tailored communications including personalized risk feedback can improve sun-protection behaviors and skin self-examination among adults at increased risk for skin cancer. These convenient, low-cost interventions can be implemented in a variety of settings and should be tested further to assess their long-term effectiveness.

The Association between Skin Characteristics and Skin Cancer Prevention Behaviors

Behaviors such as sunscreen use and wearing sun-protective clothing are thought to prevent certain types of skin cancer and precancerous lesions, but few studies have examined differences in these prevention behaviors by skin type. We carried out a cross-sectional study (n = 6,858) nested within a community-based prospective cohort in Washington County, Maryland. We measured the associations between skin type, complexion, freckling, and eye color, and sunscreen and sun-protective clothing use. The prevalence of regular sunscreen use was 23% and regular sun-protective clothing use was 21%. There were consistent trends indicating those with the most sun-sensitive skin type were most likely to engage in prevention behaviors. For example, compared with those who tan without burning, those who develop blistering sunburns were more likely to use sunscreen [odds ratio (OR), 6.04; 95% confidence interval (95% CI), 2.82-12.95 men; OR, 4.89; 95% CI, 3.34-7.16 women] and sun-protective clothing (OR, 2.87; 95% CI, 1.71-4.80 men; OR, 4.44; 95% CI, 2.88-6.85 women). Health-related characteristics such as body mass index and cigarette smoking were also significantly inversely associated with prevention behaviors. The overall prevalence of prevention behaviors was low. Those with phenotypic risk factors for skin cancer were most likely to use sunscreen and sun-protective clothing. Those with high-risk skin cancer phenotypes may also be those who are most receptive to skin cancer prevention educational interventions.

Skin Cancer Knowledge and Preventive Behaviors among Patients with a Recent History of Cutaneous Squamous Cell Carcinoma

Aims: To evaluate skin cancer knowledge and preventive behaviors of patients recently treated for cutaneous squamous cell carcinoma (SCC) and to examine the factors associated with the adoption of preventive behaviors. Methods: Telephone survey on 315 SCC patients treated at a large dermatological hospital in Italy, evaluating skin cancer knowledge, sun protection and skin examination practices as well as medical recommendations received after SCC removal. Results: Skin cancer knowledge was fair/low for 48.9% of the participants. Doctors were the main source of skin cancer information for 24.4% of the patients. Of the patients assessed ≧12 months after SCC removal, 32.7% reported a total skin examination after removal. Of the participants, 41.6% never/rarely used sunscreens. In a multivariate analysis, the likelihood of having complete skin examinations was associated with a doctor’s advice to have an examination (odds ratio, OR = 2.29; 95% confidence interval, CI = 1.2–4.4), a higher knowledge level (OR = 2.05; 95% CI = 1.1–3.8) and past skin examinations (OR = 3.62; 95% CI = 1.9–7.0). Doctor’s recommendations increased the likelihood of adopting preventive behaviors. Conclusions: We found substantial knowledge gaps and limited adoption of skin cancer prevention, highlighting the need for interventions promoting knowledge and preventive behaviors, particularly among higher-risk patients.

The Relative Persuasiveness of Gain-Framed Loss-Framed Messages for Encouraging Disease Prevention Behaviors: A Meta-Analytic Review

A meta-analytic review of 93 studies (N = 21,656) finds that in disease prevention messages, gain-framed appeals, which emphasize the advantages of compliance with the communicator's recommendation, are statistically significantly more persuasive than loss-framed appeals, which emphasize the disadvantages of noncompliance. This difference is quite small (corresponding to r = .03), however, and appears attributable to a relatively large (and statistically significant) effect for messages advocating dental hygiene behaviors. Despite very good statistical power, the analysis finds no statistically significant differences in persuasiveness between gain- and loss-framed messages concerning other preventive actions such as safer-sex behaviors, skin cancer prevention behaviors, or diet and nutrition behaviors.

Skin cancer prevention behaviours during summer holidays in 14 and 18-year-old Belgian adolescents

A cross-sectional study was conducted among 602 Belgian adolescents to analyse their sun protection habits. The results show that Belgian adolescents stay in the sun for a long time, even in periods when ultraviolet radiation is very damaging. Of all respondents, 70% exposed themselves for at least 3 h to the sun on sunny days. Most respondents (49%) exposed themselves between 1200 and 1500 h. Almost two-thirds of the respondents (59.3%) reported at least one sunburn in the past year and 26.5% got sunburnt at least twice; 24% used sunbeds more than 6 times per year. Applying sunscreen every 2 h was the most commonly used method by adolescents to protect themselves, although 70% did not use sunscreen regularly. Female students used sunscreen more regularly than male students, and sunbed use was higher among 18-year-olds than 14-year-olds. Our results clearly suggest that respondents with fair skin types are at increased risk of developing skin cancer, because of various high exposure activities accompanied by relatively few protection behaviours. A second risk group consists of students from the two lower educational levels, again because of high exposure levels and less frequent protection behaviours. The risks of sunbed use should be communicated clearly to older adolescents. Hence, these two groups need to receive high priority for cancer prevention activities in Belgium.

Fear Appeals for Individuals in Different Stagesof Change: Intended and Unintended Effectsand Implications on Public Health Campaigns

This study represents an initial attempt to examine the intended and unintended effects of fear appeals among individuals in different stages of change. Toward this end, a pilot study investigated the effects of fear appeals promoting skin cancer preventive behavior among college students. After being exposed to fear appeals, individuals who were in the precontemplation stage indicated a greater likelihood of thinking defensively and fatalistically regarding the facts on health risk than those who had intended to engage in or who had previously engaged in preventive behavior. Concurrently, after being exposed to fear appeals, those who were in the precontemplation stage reported less favorable attitudes toward message recommendations, weaker intentions to engage in recommended behavior, and less performance of preventive behavior than those who had contemplated or had previously engaged in preventive behavior. Implications of these results on future public health campaigns are discussed.

Awareness, knowledge and attitudes to non-melanoma skin cancer and actinic keratosis among the general public

The incidence of nonmelanoma skin cancer (NMSC) has dramatically increased worldwide. In areas of high incidence this will place a significant burden on the health system. Objectives To establish the awareness, knowledge and attitudes of the general public to NMSC and provide an overview on their level of understanding and knowledge of preventative measures. Two thousand and one hundred Caucasian and Hispanic individuals, aged 40-75 years, from the UK, Italy, Germany, Spain, France, the USA and Australia were randomly selected to participate in this market research survey. In a structured telephone interview lasting approximately 10 min, respondents answered questions on NMSC, specifically actinic keratosis (AK) and basal cell carcinoma (BCC). Overall, 6% of respondents had been diagnosed with NMSC, of which the incidence was highest in Australia and the USA. The frequency of skin cancer detection examinations was also greater within these populations. Countries with a high incidence of NSMC had greater awareness of the condition, with more awareness of BCC than AK. The majority of respondents believed there was a correlation between skin cancer and sun exposure, however, a minority of respondents associated skin cancer with 'moderate' tanning. Overall, 86% of respondents claimed that they always took precautions against ultraviolet exposure when in the sun, but only 26% applied sunscreen most or all of the time when they were exposed to the sun for more than 1 h. In most of the countries, outside workers reported lower sunscreen use than other respondents. Nonmelanoma skin cancer awareness and prevention behaviors varied significantly among the countries studied. Improved population-specific documentation of skin cancer knowledge and prevention behaviors will facilitate the development and assessment of public health campaigns.

The role of health education versus safety regulations in generating skin cancer preventive behavior among outdoor workers in Israel: an exploratory photosurvey

SUMMARY The present photosurvey corroborated with our 1995‐1997 evaluation study of a multifaceted skin cancer control program among outdoor workers of Mekorot—Israel National Water Company (Shani et al., 1998, Final Research Report presented to the Committee for Research and Prevention in Occupational Safety and Health). While the survey’s primary purpose was to investigate the impact of health education versus sun-protection regulations (issued when the project ended) on workers’ skin cancer preventive behavior (SCPB), it also experimented with ‘objective’ tools of data collection. Visiting working sites and mother-base, 118 workers were approached. Of these, 51 former program-involved workers (‘education’ group) and 50 former non-participants (technical barriers), and newly recruited ones (‘regulation’ group) who filled out a one-page questionnaire, had their photographs taken and were measured (spectrophotometer) for melanin presence, were included in the present study. Findings indicated that participants in the ‘regulation’ group had a significantly lower mean years of seniority and a higher number of workers in semi-skilled occupations. Both groups were identical in age, ethnic origin and reported skin type. Consistent and significant between-group differences were observed in the SCPB and melanin presence mean scores, suggesting better SCPB habits among the ‘education’ group employees in comparison to their counterparts. The multiple regression analysis indicated that former programinvolved participants and older workers were significantly more likely than others to comply with desired SCPB practices. Combined, our previous and present findings suggest that the educational approach was indispensable for generating and sustaining long-term skin cancer control practices and was preferable to the use of regulations, per se. Though no final conclusions could be drawn regarding the validity of the spectrophotometer- and camera-related procedures, and both are limited with regard to uncovering the motivational factors of behavioral outcomes, it should be recognized that the camera is a low-cost and easily available tool for capturing ‘reality’ while overcoming management’s claims on workers’ time. Results are also discussed in terms of practical implications.

Communicating to Farmers About Skin Cancer The Behavior Adaptation Model

Although health campaigns promote avoidance of behaviors that put an individual's health at risk, often these behaviors cannot be avoided, and campaign messages designed to encourage behavior adaptation afford greater likelihood of success. With that in mind, a model of health risk behavior adaptation was proposed and tested using four different behaviors in a communication campaign aimed at reducing farmers' risk for skin cancer, farmers and farm wives answered a series of questions about their skin cancer prevention and detection behaviors and attitudes. Interpersonal expectancies, social resources, and actual procedural knowledge predicted perceived procedural knowledge and public commitment, which, in turn, predicted behavior adaptation.

Communicating Safe Sun Practices to Farm Youth

SUMMARY The Georgia Harvesting Healthy Habits Campaign evaluated farm youths' skin cancer prevention outcome expectancies using Social Cognitive Theory as a framework. The evaluation was de-signed to enable farm youth to experience sun protection and skin cancer prevention behaviors and to form outcome expectancies about performance. It also provided the opportunity for participants to ob-serve peers performing these promoted practices–a method of facili-tating the formation of outcome expectancies. It was hypothesized that positive outcome expectancies would positively correlate with behavioral intentions to wear and negatively correlate with intentions to not wear particular sunscreens and hats while in the sun. Implica-tions for the design of health education curricula to increase farm youths' positive outcome expectancies for sun protective practices are discussed.

Skin Cancer Prevention Behaviors Among Parents of Young Children

We examined the relation between several relevant variables and parents' (n = 88) skin cancer prevention behaviors on behalf of their young children (ages 3 to 8 years). Results show that stable demographic factors (e.g., child age, socioeconomic status) are most predictive of parents' skin cancer knowledge and that healthier attitudes and perceptions about sun exposure are most predictive of effective sun protection behaviors by parents. These findings highlight the need for awareness and dissemi- nation of sun exposure and skin cancer information as well as for effective prevention behaviors.

Educating the public about skin cancer prevention: a role for pharmacists.

The incidence of skin cancer is increasing at an alarming rate. This study aimed to assess pharmacists' willingness to counsel patients about skin cancer and factors which are predictive of this. A 30 item survey assessing skin cancer prevention counselling attitudes and behaviours, personal skin cancer prevention behaviours, and willingness to counsel on skin cancer prevention, was mailed to 300 randomly selected San Diego County pharmacists. Data obtained from 128 pharmacists (43% response rate) indicated that the incidence of skin cancer prevention counselling was very low, with over one-third stating that they never counsel patients on this topic. Of those that did counsel, the percentage of patients counselled on skin cancer prevention was below 5%. Bivariate analyses indicated that pharmacists who counselled on this topic differed from those that did not on knowledge of skin cancer, attitudes and beliefs about counselling patients, pharmacy setting, services offered by their pharmacies, and their personal sun protective behaviours. Multivariate analysis indicated that two variables independently predicted skin cancer prevention counselling; whether the pharmacy where the respondent was employed offered this service, and attitude about counselling. Over 90% of respondents reported they were willing to counsel patients on skin cancer prevention and other health-related topics. Future studies should focus on skin cancer prevention counselling barriers and environmental prompts encouraging this type of interaction between pharmacists and patients.

Georgia's harvesting healthy habits: a formative evaluation.

Occupational safety and health researchers seek to conduct effective cancer awareness campaigns to increase agricultural workers' skin cancer prevention and detection behaviors. Georgia undertook such a project using a social cognitive theory (Bandura, 1986) conceptual model, with its objectives focusing on personal determinants of and environmental influences on farmers' behavior. One underused strategy to increase the success of health campaigns, formative evaluation, was undertaken during year one of the demonstration project, with four goals. These included an assessment of: (1) the availability of societal resources to support farmers' practices, (2) the affordability for farmers to follow through with behaviors being promoted, (3) the social support for behaving in ways that reduce farmers' skin cancer risk, and (4) farmers' current knowledge, outcome expectations, and self-efficacy in this regard. Formative evaluation revealed an absence of information, products, services, and social support for farmers' skin cancer prevention and detection. As a result, the Georgia project's plan was refined to include specific activities aimed at increasing the environmental support for health promotion activities relating to farmers' skin cancer prevention and detection. These include a seminar for rural primary care physicians and public health nurses to increase knowledge and skills relating to conducting clinical skin exams; programs for agricultural extension agents, cotton scouts, and 4-H groups to provide opportunities to learn more about and practice sun safety; and a feed and seed store campaign.