Carolyn J. Heckman

Measures of Sun Exposure and Sun Protection Practices for Behavioral and Epidemiologic Research

OBJECTIVE To develop, in a collaborative project, core measures of sun exposure and sun protection habits, since the lack of standard outcome measures hampers comparison of population surveys and interventions used in skin cancer prevention research. DESIGN A work group of investigators evaluated available questionnaire measures of sun exposure and protection. Their deliberations led to a proposed set of core questionnaire items for adults, adolescents aged 11 to 17 years, and children 10 years or younger. These core items were used in cognitive testing by the investigators. Cross-site summaries of methods, response samples, and descriptive data were prepared. SETTING Nine locations across the United States. PARTICIPANTS The study population comprised 81 individuals. RESULTS No unusual response patterns were detected in any of the respondent groups or for any specific question. Some revisions to the survey items resulted from the need for clarification or emphasis of frames of reference such as adding or underlining key phrases in a question. CONCLUSIONS The combination of expert review followed by cognitive interviewing yielded standardized core survey items with good clarity and applicability for measuring sun exposure and sun protection behaviors across a broad range of populations. They are appropriate for studies tracking morbidity and/or mortality and evaluating prevention program effects.

Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis

Objective A systematic review and meta-analysis to investigate the efficacy of interventions incorporating motivational interviewing for smoking cessation and identify correlates of treatment effects Data sources Medline/PubMed, PsycInfo and other sources including grey literature Study selection Title/abstract search terms were motivational interview* OR motivational enhancement AND smok*, cigarette*, tobacco, OR nicotine. Randomised trials reporting number of smokers abstinent at follow up were eligible. Data extraction Data were independently coded by the first and third authors. We coded for a variety of study, participant, and intervention related variables. Data synthesis A random effects logistic regression with both a random intercept and a random slope for the treatment effect. Results 31 smoking cessation research trials were selected for the study: eight comprised adolescent samples, eight comprised adults with chronic physical or mental illness, five comprised pregnant/postpartum women and 10 comprised other adult samples. Analysis of the trials (9485 individual participants) showed an overall OR comparing likelihood of abstinence in the motivational interviewing (MI) versus control condition of OR 1.45 (95% CI 1.14 to 1.83). Additional potential correlates of treatment effects such as study, sample, and intervention characteristics were examined. Conclusions This is the most comprehensive review of MI for smoking cessation conducted to date. These findings suggest that current MI smoking cessation approaches can be effective for adolescents and adults. However, comparative efficacy trials could be useful.

Multiple Skin Cancer Risk Behaviors in the U.S. Population

BACKGROUND The incidence of all types of skin cancer has increased over the past 3 decades in the United States. Increased skin cancer risk is associated with exposure to ultraviolet radiation. This study examined the age-stratified prevalence and correlates of multiple skin cancer risk behaviors (infrequent use of sun-protective clothing, staying in the sun when outside on a sunny day, infrequent use of sunscreen, indoor tanning, and receiving a sunburn) among U.S. adults. METHODS 28,235 adults participating in the 2005 National Health Interview Survey (NHIS) answered questions regarding sun-protection behaviors, indoor tanning in the past year, and sunburns in the past year. Examined correlates included geographic location, demographics, healthcare access, BMI, physical activity, smoking, alcohol use, melanoma family history, perceived cancer risk, skin sensitivity to the sun, and receipt of a total skin exam. RESULTS The most commonly reported skin cancer risk behaviors were infrequent use of sun-protective clothing and infrequent use of sunscreen. The majority of individuals reported multiple skin cancer risk behaviors. Although significant correlates varied according to age, individuals reporting more risk behaviors were more likely younger, residing in the Midwest, male, non-Hispanic white, less-educated, smokers, risky drinkers, and had skin that was less sun-sensitive. CONCLUSIONS The majority of the U.S. population engage in multiple skin cancer risk behaviors. A comprehensive approach to skin cancer prevention requires attention to multiple skin cancer risk behaviors that are common in the U.S. population.

Prevalence and correlates of indoor tanning among US adults

BACKGROUND Little is known about the prevalence of indoor tanning among the US general adult population. OBJECTIVES This study sought to: (1) describe the prevalence of indoor tanning throughout adulthood; (2) identify demographic and psychosocial correlates of indoor tanning; and (3) determine whether these correlates vary by age group. METHODS This study used data from the 2005 National Health Interview Survey, an annual health survey of the US adult population. RESULTS Indoor tanning rates were higher among individuals who were young, white, and female. Rates of indoor tanning in the last year varied from 20.4% for those aged 18 to 29 years to 7.8% for those aged 65 years and older. A variety of demographic, health, and behavioral health risk factors correlated with indoor tanning. LIMITATIONS The study design was cross-sectional and all data were self-reported. CONCLUSIONS Health care providers should address indoor tanning as a health risk factor across the lifespan.

A Pilot Randomized Clinical Trial of Two Medication Adherence and Drug Use Interventions For HIV+ Crack Cocaine Users

BACKGROUND Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skill model to improve HAART adherence and reduce crack cocaine problems. METHODS Participants were 54 adults with crack cocaine use and HIV with <90% HAART adherence. Most participants were African-American (82%) heterosexual (59%), and crack cocaine dependent (92%). Average adherence was 58% in the past 2 weeks. Average viral loads (VL) were detectable (logVL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (MI+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14-day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measure ANOVA assessed main effects of the interventions and interactions by condition. RESULTS Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition. CONCLUSIONS A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use.

A preliminary investigation of the predictors of tanning dependence.

OBJECTIVES To investigate possible predictors of tanning dependence including demographic variables, exposure and protective behaviors, and other health-related behaviors. METHODS This study consisted of an online survey of 400 students and other volunteers from a university community. RESULTS Twenty-seven percent of the sample was classified as tanning dependent. Tanning dependence was predicted by ethnicity and skin type, indoor and outdoor tanning and burning, and lower skin protective behaviors, as well as smoking and body mass index. CONCLUSIONS Young adults are at risk for tanning dependence, which can be predicted by specific demographic and behavioral variables.

Prevalence and Correlates of Skin Cancer Screening among Middle-aged and Older White Adults in the United States

BACKGROUND Total skin examinations performed by a physician have the potential to identify skin cancers at an early stage, when they are most amenable to successful treatment. This study examined the prevalence rates of, and factors associated with, receipt of a total skin examination by a dermatologist or other doctor during the past year. METHODS The participants were 10,486 white men and women aged 50 years and older drawn from a random sample of 31,428 adults aged 18 years and older who took part in the 2005 National Health Interview Survey. The data were collected via in-person interviews, and participants answered questions about their receipt of total skin examinations, their demographic characteristics, health and health care access, receipt of other cancer screenings, and personal and family history of skin cancer. RESULTS Sixteen percent of men and 13% of women reported having a skin examination in the past year. The factors associated with lowest skin examination rates in multivariable analyses included younger age (50-64 years), lower education level, lack of screening for colorectal, breast (women only), and prostate cancers (men only), and lack of a personal history of skin cancer. CONCLUSIONS Rates of having a skin examination in the past year were low among men and women and among all sub-groups. Systematic efforts are needed to increase screening rates among higher risk individuals. Physicians should be particularly aware of the need to consider skin cancer screening examinations for their male, elderly patients, as well as individuals with less education.

Measuring Nonsolar Tanning Behavior : Indoor and Sunless Tanning

OBJECTIVE To develop items to measure indoor tanning and sunless tanning that can be used to monitor trends in population surveys or to assess changes in behavior in intervention studies. DESIGN A group of experts on indoor tanning convened in December 2005, as part of a national workshop to review the state of the evidence, define measurement issues, and develop items for ever tanned indoors, lifetime frequency, and past-year frequency for both indoor tanning and sunless tanning. Each item was subsequently assessed via in-person interviews for clarity, specificity, recall, and appropriateness of wording. SETTING Universities in Tennessee and Virginia, a medical center in Massachusetts, and a high school in New Hampshire. PARTICIPANTS The study population comprised 24 adults and 7 adolescents. RESULTS Participants understood indoor tanning to represent tanning from beds, booths, and lamps that emit artificial UV radiation, rather than sunless tanning, even though both can be obtained from a booth. Two items were required to distinguish manually applied from booth-applied sunless tanning products. Frequency of use was easier for participants to recall in the past year than for a lifetime. CONCLUSIONS While indoor tanning items may be recommended with confidence for clarity, sunless tanning items require additional testing. Memory aids may be necessary to facilitate recall of lifetime use of nonsolar tanning. In addition, studies that assess reliability and validity of these measures are needed. Since study participants were primarily young and female, testing in other populations should also be considered.

Social-cognitive processes associated with fear of recurrence among women newly diagnosed with gynecological cancers

OBJECTIVE This cross sectional study aimed to characterize fears of recurrence among women newly diagnosed with gynecologic cancer. The study also evaluated models predicting the impact of recurrence fears on psychological distress through social and cognitive variables. METHODS Women (N=150) who participated in a randomized clinical trial comparing a coping and communication intervention to a supportive counseling intervention to usual care completed baseline surveys that were utilized for the study. The survey included the Concerns about Recurrence Scale (CARS), Beck Depression Inventory (BDI), Impact of Event Scale (IES), and measures of social (holding back from sharing concerns and negative responses from family and friends) and cognitive (positive reappraisal, efficacy appraisal, and self-esteem appraisal) variables. Medical data was obtained via medical chart review. RESULTS Moderate-to-high levels of recurrence fears were reported by 47% of the women. Younger age (p<.01) and functional impairment (p<.01) correlated with greater recurrence fears. A social-cognitive model of fear of recurrence and psychological distress was supported. Mediation analyses indicated, that as a set, the social and cognitive variables mediated the association between fear of recurrence and both depression and cancer-specific distress. Holding back and self-esteem showed the strongest mediating effects. CONCLUSION Fears of recurrence are prevalent among women newly diagnosed with gynecologic cancer. Social and cognitive factors play a role in womens adaptation to fears and impact overall psychological adjustment. These factors may be appropriate targets for intervention.

Comparing Alternative Methods of Measuring Skin Color and Damage

ObjectiveThe current study investigated the reliability and validity of several skin color and damage measurement strategies and explored their applicability among participants of different races, skin types, and sexes.MethodsOne hundred college-aged participants completed an online survey about their perceived skin damage and skin protection. They also attended an in-person session in which an observer rated their skin color; additionally, UV photos and spectrophotometry readings were taken.ResultsTrained research assistants rated the damage depicted in the UV photos reliably. Moderate to high correlations emerged between skin color self-report and spectrophotometry readings. Observer rating correlated with spectrophotometry rating of current but not natural skin color. Lighter-skinned individuals reported more cumulative skin damage, which was supported by UV photography. Although women’s current skin color was lighter and their UV photos showed similar damage to men’s, women reported significantly more damaged skin than men did.ConclusionsThese findings suggest that self-report continues to be a valuable measurement strategy when skin reflectance measurement is not feasible or appropriate and that UV photos and observer ratings may be useful but need to be tested further. The results also suggest that young women and men may benefit from different types of skin cancer prevention interventions.