Skin Cancer Prevention Behaviors Research Articles

Future Application of Multitheory Model of Health Behavior Change for Skin Cancer Prevention Behaviors

ABSTRACT Skin cancer is a global health issue and constitutes the most common form of cancer worldwide. Exposure to ultraviolet radiation is a primary skin cancer risk. Engaging in sun protection behavior could mitigate this risk. Several sociobehavioral theories can be used to better explain and predict health behaviors. Unfortunately, application of theories has yielded mixed results with variable predictability. Most importantly, they do not impact long-term changes in behavior. Therefore, there is still a need to develop theoretical models that better explain and predict health behaviors, in particular, sun-safe behaviors. A recently proposed health behavior theory, called the multitheory model of health behavior change, may be the answer. The multitheory model has been shown to be effective in changing attitudes toward other health behaviors such as physical activity, portion size control, and sleep deprivation. It is unique from established health behavior theories because it emphasizes long-term change over short-term behavior modification, which is more likely associated with relapse. It does this by separating factors that lead to short-term change from those that promote long-term behavior adoption. This article presents the application of the principles of multitheory model to skin cancer preventative behaviors.

Skin Cancer Prevention Among Hispanics: a Review of the Literature

We review the existing scientific literature regarding skin cancer in Hispanics to aid in formulating a research agenda for prevention targeted to this at-risk population. Hispanics are a diverse population with a rising incidence of both melanoma and non-melanoma skin cancer. Compared with non-Hispanic whites, Hispanics have poorer disease outcomes and higher rates of acral lentiginous melanoma, an aggressive subtype. Hispanics practice suboptimal sun protection and skin surveillance behaviors and experience rates of sunburn comparable with non-Hispanic whites. Despite these risk behaviors, little skin cancer education and prevention has been targeted to this population. Further research is warranted to understand the interplay of biological, psychosocial, cultural, and health care factors influencing skin cancer prevention behaviors and outcomes in Hispanics. We recommend future investigation into the histological, sociocultural, and health care differences and disparities among Hispanics and within subpopulations to develop tailored, culturally informed prevention strategies.

Skin Cancer Preventive Behaviors and Its Determinants among High School Students in Sanandaj, Iran: An Application of PRECEDE Model

Background and Objectives: The prevalence of skin cancer has been rising in Iran in the recent years. This disease is the most common cancer in Kurdistan province, Iran. Regarding this, the present study aimed to investigate the determinants of skin cancer preventive behaviors (SCPBs) among the high school students of Sanandaj, Iran, using the PRECEDE model. Materials and Methods: This descriptive cross-sectional study was conducted on 225 second- and third-grade high school students (age range: 15-17 years) in Sanandaj during the academic year of 2013-2015. The study population was selected through multistage sampling method. The students filled out some questionnaires covering such data as knowledge, attitude, self-efficacy, social support (as reinforcing factors), enabling factors, and SCPBs. The data were analyzed using one-way ANOVA, independent t-test, Pearson correlation coefficient, and linear regression in SPSS software, version 21. Results: According to the results, SCPBs showed a direct correlation with attitude (r=0.175), self-efficacy (r=0.509), social support (r=0.332), and enabling factors (r=0.347). The mean SCPBs among the students was lower than moderate. The results of linear regression analysis revealed that the independent variables predicted 29.9% of SCPBs within which self-efficacy was the only significant variable (P<0.001, β=0.416). Conclusion: As the findings indicated, perceived self-efficacy was a vital factor for performing SCPBs. Therefore, perceived self -efficacy should be considered as the first priority while planning for skin cancer prevention programs for high school students.

The assessment of the protection motivation theory construct of skin cancer preventive behaviors in rural women

The assessment of the protection motivation theory construct of skin cancer preventive behaviors in rural women

Total body skin examination adherence among young adults with an increased risk for skin cancer

Although ultraviolent radiation exposure and skin cancer rates are rising in the US, there is not a consistent national message calling for routine total body skin examinations (TBSE) by a healthcare provider. This pilot study examined TBSE rates among adults at an increased risk for skin cancer (history of sunburn, indoor tanning use, excessive UV exposure, poor sunscreen use). Overall skin cancer prevention behaviors were insufficient among respondents (n=953) and only a quarter of respondents considered at an increased risk for skin cancer reported a TBSE. White, older students with light skin who regularly use sunscreen were significantly more likely to report a TBSE. These findings highlight the need for a national study examining TBSE across the lifespan among high-risk individuals.

Skin Cancer Risk and Other Health Risk Behaviors: A Scoping Review.

Purpose. To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Methods. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Results. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Conclusions. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.

Application of the Health Belief Model to U.S. Magazine Text and Image Coverage of Skin Cancer and Recreational Tanning (2000–2012)

The health belief model (HBM) has been widely used to inform health education, social marketing, and health communication campaigns. Although the HBM can explain and predict an individual’s willingness to engage in positive health behaviors, its application to, and penetration of the underlying constructs into, mass media content has not been well characterized. We examined 574 articles and 905 images about skin cancer and tanning risks, behaviors, and screening from 20 U.S. women’s and men’s magazines (2000–2012) for the presence of HBM constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Susceptibility (48.1%) and severity (60.3%) information was common in text. Perceived benefits (36.4%) and barriers (41.5%) to prevention of skin cancer were fairly equally mentioned in articles. Self-efficacy (48.4%) focused on sunscreen use. There was little emphasis on HBM constructs related to early detection. Few explicit cues to action about skin cancer appeared in text (12.0%) or images (0.1%). HBM constructs were present to a significantly greater extent in text versus images (e.g., severity, 60.3% vs. 11.3%, respectively, χ2 = 399.51, p < .0001; benefits prevention, 36.4% vs. 8.0%, respectively, χ2 = 184.80, p < .0001), suggesting that readers are not visually messaged in ways that would effectively promote skin cancer prevention and early detection behaviors.

Determinants of Skin Cancer Preventive Behaviors Among Rural Farmers in Iran: an Application of Protection Motivation Theory.

Skin cancer is one of the most prevalent cancers, worldwide, which happens more among those with more sunlight exposure like farmers. The aim of this study was to explore the determinants of skin cancer preventive behaviors (SCPBs) among rural farmers using Protection Motivation Theory (PMT). In this cross-sectional study, multistage random sampling was employed to enroll 238 farmers referring to rural health houses (HH) in Chaldoran County, Iran. A valid and reliable instrument based on PMT variables was used. Significant correlations were found between all PMT variables with SCPBs (p < 0.05). Hierarchical multiple linear regressions were performed with Protection Motivation and SCPBs as outcome variables. Predictors for these two outcome variables were classified in two different blocks according to their natures. Demographic characteristics (p > 0.05) and PMT constructs (p < 0.001) explained 3 and 63.6% of the observed variance in Protection Motivation, respectively. Also, no significant effect was found on SCPBs by demographic variables, in the first block (∆R 2 = 0.025); however, in the second block, Perceived Susceptibility (p = 0.000), Rewards (p = 0.022), Self-efficacy (p = 0.000), and Response Cost (p = 0.001) were significant predictors of SCPBs (∆R 2 = 0.432). Health care providers may consider PMT as a framework for developing educational interventions aiming at improving SCPBs among rural farmers.

Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults

Skin cancer is the most common cancer, and its incidence is increasing. Young adults expose themselves to large amounts of ultraviolet radiation (UV) and engage in minimal skin protection, which increases their risk. Internet interventions are effective in modifying health behaviors and are highly disseminable. The current study's purpose was to test an Internet intervention to decrease UV exposure and increase skin protection behavior among young adults. RCT conducted in 2014, with data analyzed in 2015. A national sample of adults aged 18-25 years at moderate to high risk of developing skin cancer by a self-report measure was recruited online. Participants were randomized to one of three intervention conditions: assessment only, the website of a skin cancer organization, or a tailored interactive multimedia Internet intervention program (UV4.me) based on the Integrative Model of Behavioral Prediction. Self-reported overall UV exposure and skin protection assessed at 3 and 12 weeks after baseline. Secondary outcomes were self-reported intentional and incidental UV exposure, sunburns, sunscreen use, and skin cancer screening. For the intervention arm, there were significant decreases in UV exposure and increases in skin protection at both follow-up time points compared with the assessment-only condition (p<0.001). The effect sizes (Cohen's d) comparing the experimental and assessment-only arm for exposure behaviors were 0.41 at 3-week follow-up and 0.43 at 12-week follow-up. The effect sizes for protection behaviors were 0.41 at 3-week follow-up and 0.53 at 12-week follow-up. The control condition was not significantly different from the assessment only condition. All three conditions exhibited decreased exposure and increased protection at both follow-ups (p<0.01), but the effect was much stronger in the intervention group. Secondary outcomes were generally also significantly improved in the intervention condition compared with the other conditions. This is the first published report describing the results of an RCT of an Internet intervention to modify skin cancer risk behaviors among young adults. The UV4.me intervention significantly improved self-reported skin cancer prevention behaviors. Future research will investigate mechanisms of change and approaches for dissemination. This study is registered at www.clinicaltrials.gov NCT02147080.

Mediation of improvements in sun protective and skin self-examination behaviours: results from the healthy text study.

Melanoma is on the rise, especially in Caucasian populations exposed to high ultraviolet radiation such as in Australia. This paper examined the psychological components facilitating change in skin cancer prevention or early detection behaviours following a text message intervention. The Queensland-based participants were 18 to 42 years old, from the Healthy Text study (N = 546). Overall, 512 (94%) participants completed the 12-month follow-up questionnaires. Following the social cognitive model, potential mediators of skin self-examination (SSE) and sun protection behaviour change were examined using stepwise logistic regression models. At 12-month follow-up, odds of performing an SSE in the past 12 months were mediated by baseline confidence in finding time to check skin (an outcome expectation), with a change in odds ratio of 11.9% in the SSE group versus the control group when including the mediator. Odds of greater than average sun protective habits index at 12-month follow-up were mediated by (a) an attempt to get a suntan at baseline (an outcome expectation) and (b) baseline sun protective habits index, with a change in odds ratio of 10.0% and 11.8%, respectively in the SSE group versus the control group. Few of the suspected mediation pathways were confirmed with the exception of outcome expectations and past behaviours. Future intervention programmes could use alternative theoretical models to elucidate how improvements in health behaviours can optimally be facilitated.

Common Genetic Risk for Melanoma Encourages Preventive Behavior Change

There is currently great interest in using genetic risk estimates for common disease in personalized healthcare. Here we assess melanoma risk-related preventive behavioral change in the context of the Coriell Personalized Medicine Collaborative (CPMC). As part of on-going reporting activities within the project, participants received a personalized risk assessment including information related to their own self-reported family history of melanoma and a genetic risk variant showing a moderate effect size (1.7, 3.0 respectively for heterozygous and homozygous individuals). Participants who opted to view their report were sent an optional outcome survey assessing risk perception and behavioral change in the months that followed. Participants that report family history risk, genetic risk, or both risk factors for melanoma were significantly more likely to increase skin cancer preventive behaviors when compared to participants with neither risk factor (ORs = 2.04, 2.79, 4.06 and p-values = 0.02, 2.86 × 10−5, 4.67 × 10−5, respectively), and we found the relationship between risk information and behavior to be partially mediated by anxiety. Genomic risk assessments appear to encourage positive behavioral change in a manner that is complementary to family history risk information and therefore may represent a useful addition to standard of care for melanoma prevention.

Skin cancer preventative behaviors in state park workers: a pilot study.

Considering the potential for occupational sun exposure among state park workers, the purpose of this pilot study was to identify skin cancer knowledge, health beliefs, self-efficacy, and sun protection behaviors (SPBs) among state park employees. The current study used a cross-sectional survey research design with state park workers in a Southern state. Of the 94 possible employees who could have participated in the study, 87 completed the survey. Assessment of the participants' skin cancer knowledge demonstrated an average correct response rate of 68.8 %. While the vast majority (87.4 %) believed that skin cancer is a serious disease, a minority (42.5 %) believed they would develop skin cancer sometime during their lifetime, and even fewer (35.6 %) believed their risk was higher than average. Collectively, workers reported low levels of SPBs. The most commonly reported barriers to sun protection were "inconvenient," "too hot to wear," and "forget to protect." Half of the participants (50.6 %) were highly confident in their ability to wear long pants while in the sun. About the same proportion of participants was highly confident they could wear a wide-brimmed hat (21.8 %) and sunscreen (20.7 %). Based on available evidence, a need exists to develop individual and worksite programs and interventions to increase skin cancer prevention behaviors among this occupational group. This data could serve as a baseline to monitor and evaluate the efficacy of these interventions.

Effects of a short messaging service-based skin cancer prevention campaign in adolescents.

Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages. To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents. The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11-14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety-themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests. Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends. A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects.

Uptake of Skin Self-examination and Clinical Examination Behavior by Outdoor Workers

ABSTRACT This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

Skin Cancer Prevention among School Children: a Brief Review

In many countries the incidence of melanoma has been doubling in every 10 years. Since 1930, the rate of melanoma has increased over 1,800% and researchers are expecting this trend to continue and increase for the next 10 to 20 years. Primary prevention and early detection of skin cancer in childhood is important to reduce the risk of developing skin cancer later in life. Primary prevention programmes are more beneficial and effective in children, not only due to the particular importance of sunlight exposure during this period, but because this is when individuals are more open to changes and adopt new attitudes and behaviour. The purpose of this manuscript is to review the results of intervention studies designed to modify sun exposure behaviour among children in the United States of America, Australia and Europe. An additional purpose is to summarize the recommendations obtained from the reviewed studies. The strongest recommendation to emerge from this review is that the skin cancer primary prevention programme should be carried out over several school years, not just one time, to produce changes in the sun safety behaviour. Moreover, it recommends that parents should be targeted to educate their children about sun protective skills and promote skin cancer prevention behaviour.

Skin Cancer Preventive Behavior and Sun Protection Recommendations

To summarize, in tabular form, the current literature and information available for skin cancer preventive behaviors and sun protection recommendations. Peer-reviewed literature, web sites of professional and federal organizations. The link between skin cancer and ultra-violet radiation (UVR) exposure is well documented. Primary skin cancer prevention must focus on proven ways to reduce the amount of UVR that reaches the skin, including avoiding UVR, covering up, wearing a wide-brimmed hat and sunglasses and use of sunscreen. Nurses play a key role in patient education and should use evidence-based resources to provide skin cancer prevention recommendations.

Randomized Trial of Tailored Skin Cancer Prevention for Children: The Project SCAPE Family Study

This study evaluated a tailored intervention to promote sun protection in parents and their children, hypothesizing that the tailored intervention would lead to improved skin cancer prevention behaviors compared to generic materials. Families were recruited through schools and community centers and were included if there was 1 child in Grades 1–3 at moderate to high risk for skin cancer. Participants were randomized into one of two intervention groups: a tailored intervention, in which they received personalized skin cancer education through the mail; or a control group who received generic skin cancer information materials. Before and after intervention, parents completed questionnaires about their and their children's skin cancer risk and prevention knowledge and behaviors. Parents also completed 4-day sun exposure and protection diaries for their child and themselves. Tailored group participants demonstrated significantly greater positive changes in prevention behavior after the intervention, including children's use of sunscreen, shirts, and hats, and parents' use of shade, and skin examinations. Effect sizes were small and perceived benefits and social norms mediated intervention effects. Findings from this study support the efficacy of focusing tailored communications to families in order to change skin cancer prevention practices in young children.

A Preliminary Study of a Video Intervention to Inform Solid Organ Transplant Recipients About Skin Cancer

PurposeTo obtain preliminary evidence on the effect of a skin cancer prevention video for adult solid organ transplant recipients (SOTR) and informational brochures on outcomes of skin cancer knowledge, beliefs, prevention and detection behaviors, and personal agency (self-confidence/personal control) for behaviors. BackgroundSOTR have a high risk of skin cancer potentiated by life-long immunosuppressive therapy posttransplantation. Skin cancer in SOTR is aggressive and difficult to treat. Prevention and early detection are important for reducing risk and improving skin cancer outcomes, but methods to inform SOTR about their risk are understudied. MethodsA brief, evidence-based skin cancer informational video tailored to SOTR was evaluated using a quasi-experimental design that compared the outcome variables in two groups of SOTR seen in 4 transplantation clinics within 4–6 weeks posttransplantation. The video/brochure group (VBG) viewed the video once and received skin cancer information brochures. The brochure group (BG) received brochures only. Participants completed a survey on sun protection behavior (6 items; alpha = 0.75), personal agency (6 items; alpha = 0.64), beliefs (6 items; alpha = 0.60), skin cancer knowledge (6 items), and skin self-examination (SSE; 1 item) at baseline and 3 months postintervention. Data were analyzed using descriptive statistics and 2 × 2 analysis of variance. ResultsOf 113 participants, 90 completed both surveys (VBG, n = 46; BG, n = 44). Both groups had a significant increase in sun protective behavior (P < .001), skin cancer knowledge (P < .001), beliefs (P = .003), and personal agency (P = .003). There was no effect of either intervention on SSE. ConclusionBoth interventions effectively informed SOTR about skin cancer and sun protection, promoted favorable beliefs, and improved personal agency, but were not differentially effective, suggesting that the addition of the video may not be necessary or that the video may need to be viewed more than once. More in-depth SSE teaching strategies may be necessary.

Systematic review of population-based studies on the impact of images on UV attitudes and behaviours

Visual images have been shown to influence health behaviours. The effectiveness of population interventions, which use visual images to influence skin cancer prevention behaviours, has not been systematically evaluated. We, therefore, undertook a systematic review of peer-reviewed, health education and health promotion research on skin cancer and tanning to examine the outcomes of studies, which used visual images as part of their methodology. Our objective was to describe the impact of visual images on UV protection and exposure attitudes and behaviours across the studies. Twenty-three studies met the inclusion criteria. Images positively impact knowledge, attitudes and behaviours related to UV exposure and UV protection. Images also influence the perceived attractiveness of untanned or tanned skin, which in turn, influences UV exposure attitudes and behaviours. Implications for future health promotion research and practice are discussed.

The HealthyTexts study: A randomized controlled trial to improve skin cancer prevention behaviors among young people

Several randomized trials have found behavior change programs delivered via text messaging to be efficacious to improve preventive health behaviors such as physical activity and stopping smoking; however few have assessed its value in skin cancer prevention or early detection. The HealthyTexts study enrolled 678 participants 18–42years, and assigned them to receive 21 text messages about skin cancer prevention, skin self-examination or physical activity (attention control) over the course of one year. Baseline data have been collected and outcomes will be assessed at three months and twelve months post-intervention. The trial aims to increase the mean overall sun protection habits index score from 2.3 to 2.7 with a standard deviation of 0.5 (effect size of 0.5) and the proportion of people who conduct a whole-body skin self-examination by an absolute 10%. This paper describes the study design and participants' baseline characteristics. In addition, participants' goals for their health, and strategies they apply to achieve those goals are summarized.