Alana D. Steffen

A randomized trial of tailored skin cancer prevention messages for adults: Project SCAPE.

OBJECTIVESnWe 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.nnnMETHODSnAdults 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.nnnRESULTSnA 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.nnnCONCLUSIONSnTailored 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.

Diffusion of an effective skin cancer prevention program: design, theoretical foundations, and first-year implementation.

This article describes the design and theoretical foundations of the Pool Cool Diffusion Trial and reports 1st-year findings. Aims of the study are to evaluate the effects of 2 strategies for diffusion of the Pool Cool sun safety program on implementation, maintenance, and sustainability; improvements in environmental supports for sun safety in swimming pools; and sun protection habits and sunburn among participating children. There was a high rate of program participation (86.6%; n=375 swimming pools) in the 1st year and somewhat lower study participation (75.8%). Analysis of pool manager surveys revealed a time effect for overall sun safety programs and for sun safety policies, environmental strategies, and programs for pool users. There were few differences in implementation between treatment groups in year one.

A day at the beach while on tropical vacation: sun protection practices in a high-risk setting for UV radiation exposure.

OBJECTIVEnTo conduct an assessment of levels of UV radiation (UVR) exposure and the range of sun protection behaviors of beachgoers at a popular vacation destination.nnnDESIGNnParticipants completed the sun habits survey prior to entry to the beach and completed an exit survey on leaving regarding their sun protection practices while at the beach. Ambient UVR was monitored using polysulfone dosimeters.nnnSETTINGnA popular beach for vacationers in Honolulu, Hawaii.nnnMAIN OUTCOME MEASURESnSun protection practices and UVR.nnnRESULTSnParticipants spent an average of 3 hours at the beach and received an estimated UVR dose of 10.4 standard erythemal doses. Latent class analysis identified 3 homogeneous classes with distinct characteristics and sun protection behaviors. Those in class 1 (unconcerned and at low risk) were at least risk of skin cancer, intended to tan, and used the least amount of sun protection. Those in class 2 (tan seekers) had the second highest risk of skin cancer, had the highest proportion of women, became sunburned easily, intended to tan, had used tanning beds in past 30 days, and had the highest proportion of sunscreen coverage and the least clothing coverage. Those in class 3 (concerned and protected) had the highest skin cancer risk, the highest proportion of clothing coverage and shade use, and were more likely to be residents of Hawaii.nnnCONCLUSIONSnBeachgoers were exposed to 5 times the UVR dose required to result in erythema among unprotected fair-skinned populations. Latent class analysis was effective in identifying subgroups of beachgoers who would benefit from targeted, population-based interventions aimed at reducing skin cancer risks while enjoying outdoor leisure-time activities.

Baseline results from Hawaii's Nā Mikimiki Project: a physical activity intervention tailored to multiethnic postpartum women.

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Nā Mikimiki (“the active ones”) Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2–12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008–2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian–American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infants age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic samples demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Nā Mikimiki Projects innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women.

The prevalence of obesity in ethnic admixture adults.

Objective: To determine whether the prevalence of obesity in ethnic admixture adults varies systematically from the average of the prevalence estimates for the ethnic groups with whom they share a common ethnicity.

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 childrens 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 childrens 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.

Sun protection practices of beachgoers using a reliable observational measure.

Background: Skin cancer is the most prevalent form of cancer in the United States and is rising rapidly; however, most skin cancers are preventable. Compared to self-report, direct observational methodologies could be a more valid and reliable tool for assessing sun protective behaviors within a specific environment.Purpose: The aim of the study is to assess the sun protection practices of beachgoers using a reliable observational measure.Methods: A systematic observation system for assessing sun protective behaviors among beachgoers was developed. Data were collected by 2 raters over 3 days using momentary ecological sampling methods. Individuals in a representative zone were assessed for head wear, upper body wear, sunglasses use, shade use, and gender.Results: Over the 3 days, Observers A and B made 1,678 and 1,725 observations, respectively. Interrater reliability ranged from 0.77 to 0.99. Hats, sunglasses, shirts, and shade were all used by less than 30% of the population. Sun protection behaviors varied by time of day and cloud cover.Conclusions: A reliable, observational measure designed to assess population behavior at the setting level showed low use of sun protection practices among beachgoers. Test-retest reliability, the inclusion of low body protection, coding for age, and skin tone are recommended for future versions of this system.

Differences by race/ethnicity in older adults' beliefs about the relative importance of dietary supplements vs prescription medications: results from the SURE Study.

Dietary supplement use is widespread among adults across races/ethnicities, yet reasons for use can vary across these groups. The Supplement Reporting (SURE) study quantified dietary supplement use and reasons for taking supplements in a multiethnic sample of adults who took at least one supplement. This study explored sociodemographic differences, including by race/ethnicity, associated with specific reasons/motivations for taking dietary supplements, including perceived importance of taking supplements relative to prescription medications. The study time period was March 2005 to August 2006. Participants (n=397) were older adults (ages 52 to 88 years) recruited from the Multiethnic Cohort Study in Hawaii and Los Angeles, CA, with equal representation of males and females from six ethnic groups (ie, white, Japanese American, Native Hawaiian, African American, US-born Latino, and foreign-born Latino). Subgroups of participants were compared by χ(2) tests and logistic regression. The most common reasons for taking supplements were to maintain a healthy life, because they were recommended by a health professional, and to prevent a disease/medical problem. A majority (76%) of participants reported that their dietary supplements were as important as prescription medications, with foreign-born Latinos and Japanese Americans being most likely to state this belief. The relative importance of supplements was not associated with excessive use, but 27% of participants exceeded the upper limit for a nutrient. It is crucial for health professionals to better understand why individuals take supplements and the importance that they attach to their use. This information could lead to better monitoring and education efforts to prevent overuse of supplements and possible interactions with medications.

Social support mediates an increase in moderate-to-vigorous physical activity over 12 months

s were reviewed, yielding 37 papers with sufficient data for metaanalysis. Studies comprised a sample of 4,199 participants (66% female, 72% Caucasian). The weighted averaged effect size across studies for pain severity (k=38)was (g)=0.34 (95%CI=0.23 0.46) and for pain interference (k=4) was (g)=0.40 (CI=0.21 0.60). Moderators examined included study design (e.g., monitoring of intervention fidelity, pain as a primary versus secondary outcome) and sample composition (e.g., gender, percentage of minority participants). Studies monitoring fidelity of interventions to the protocol showed larger effect sizes than those that did not (g=.52 vs. .29, p=.04). No other moderators were statistically significant (ps>.26). The current presentation will focus on some of the challenges encountered by the meta-analysis group and how they were resolved. These include logistical challenges, such as coordination of data extraction among multiple rater pairs, as well as design issues such as the selection of study inclusion criteria and moderator variables. The ways in which these lessons can be applied to future meta-analyses will also be discussed. CORRESPONDING AUTHOR: Heather Jim, PhD, Moffitt Cancer Center, Tampa, FL, 33612; heather.jim@moffitt.org Symposia Sessions 2012 Annual Meeting Supplement s53

Abstract 3736: Correlates of vitamin D: A measurement pilot study

Vitamin D has protective effects for colorectal cancer and possible benefits for breast and ovarian cancers yet the determinants of vitamin D status are not fully understood. This study measured sun exposure, sun protection, diet, body mass index, and skin color and correlated them with serum 25(OH)D to understand better the impact of these factors on vitamin D status. Women (n=28) ages 18-30 residing in Hawaii attended small group sessions where they completed questionnaires about diet, supplement use, and skin type and had skin color measured by reflectance spectrophotometry. Participants wore polysulphone dosimeters mounted on wristbands, photographed clothing outfits and kept daily diaries for the 7 days before their blood draw. Results: Participants were, on average, 24.6 (3.3) years old, had BMI of 23.6 (range 17.7 – 34.7), consumed 308 IU vitamin D daily (range 10 – 1202), used sunscreen on 12% of their body (range 0 to 44%), were 44% covered by clothing (range 22 – 79%), received 2.3 standard erythemal doses (range .1 to 5.9) of UVB and had 34.7 ng/mL of 25(OH)D3 (range 17.7 – 90.5). Personal UVB dose accounted for 22% of the variance in 25(OH)D, and the addition of clothing and sunscreen coverage increased the R2 value to 0.33. Skin color and diet were not associated with 25(OH)D. While BMI was showed an association 25(OH)D, it did not improve the model and was inversely related to UVB exposure. While the measured sun-related variables were useful for predicting 25(OH)D, the majority of variance in vitamin D status is unexplained. More research is needed to understand how this hormone is regulated in the body. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3736. doi:10.1158/1538-7445.AM2011-3736