Casey L. Daniel

Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study.

Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation‐induced colorectal cancer (CRC). The Childrens Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at‐risk survivors.

An Evaluation Methodology for Longitudinal Studies of Short-Term Cancer Research Training Programs

The need to familiarize medical students and graduate health professional students with research training opportunities that cultivate the appeal of research careers is vital to the future of research. Comprehensive evaluation of a cancer research training program can be achieved through longitudinal tracking of program alumni to assess the program’s impact on each participant’s career path and professional achievements. With advances in technology and smarter means of communication, effective ways to track alumni have changed. In order to collect data on the career outcomes and achievements of nearly 500 short-term cancer research training program alumni from 1999–2013, we sought to contact each alumnus to request completion of a survey instrument online, or by means of a telephone interview. The effectiveness of each contact method that we used was quantified according to ease of use and time required. The most reliable source of contact information for tracking alumni from the early years of the program was previous tracking results, and for alumni from the later years, the most important source of contact information was university alumni records that provided email addresses and telephone numbers. Personal contacts with former preceptors were sometimes helpful, as were generic search engines and people search engines. Social networking was of little value for most searches. Using information from two or more sources in combination was most effective in tracking alumni. These results provide insights and tools for other research training programs that wish to track their alumni for long-term program evaluation.

Friendly tanning: young adults' engagement with friends around indoor tanning.

Abstract Indoor tanning (IT), particularly during early adulthood, increases risk for melanoma and is exceedingly common among youth. Social influence, including social norms, promotes IT but little is known about young adults’ engagement with friends around tanning. We examined IT behaviors and tanning-related communication with friends at three universities. Of 837 participants, 261 (31%) reported ever tanning (90% female, 85% White). Of those, 113 (43%) were former tanners and 148 (57%) current tanners. Current tanners reported more social tanning and discussions with friends about tanning, more frequent outdoor tanning, high propensity to tan, and greater lifetime IT exposure than former tanners. Risks-to-benefits discussion ratios were greater for former tanners. In adjusted analyses, current tanners were more likely to make plans to tan and to talk about tanning benefits with friends. Findings confirm IT is a social experience. Future work should examine social tanning’s role in the promotion and reduction of IT among youth.

The urgent need to ban youth indoor tanning: evidence from college undergraduates

Skin cancer is the most common malignancy in the USA, with over five million new diagnoses estimated in 2016 alone [1], and the incidence of melanoma, the deadliest form of skin cancer, doubled from 1982 to 2011 [2]. Of particular concern is the overwhelming increase in melanoma rates among adolescents and young adults [3]. A recent study analyzing Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 2011 found that melanoma incidence among individuals in these age groups (0–14 and 15– 39 years old) had increased by 253%, with young women at the greatest risk of developing melanoma [4]. Indoor tanning (IT) devices, common sources of ultraviolet (UV) radiation, appear to have played a significant role in the rising rates of melanoma and other skin cancers in recent decades, particularly among young women [5–7]. Previous research has conclusively determined that exposure to IT increases melanoma risk and the existence of a dose-response relationship between IT and increased risk [5]. Such risks have led to the classification of IT devices as, Bcarcinogenic to humans,^ by the World Health Organization’s International Agency for Research on Cancer [8, 9]. Additionally, in 2014, the U.S. Food and Drug Administration (FDA) reclassified IT devices as moderateto high-risk medical devices (class II) and required all IT devices to display a black box warning stating they should not be used by individuals under 18 years of age [10]. However, despite the demonstrated dangers of this behavior, IT remains common in the USA and several other countries, particularly among teenage girls and young women. Much recent attention has focused on ITon or around college campuses, where rates exceed 40% according to data from a recent systematic review and metaanalysis [11]. We examined time of IT initiation (history and current use) in college students. We conducted a study of undergraduate students from three colleges in the USA (in Massachusetts and Alabama). A crosssectional survey was administered in March–April 2014 using convenience sampling, a technique commonly employed in college tanning studies [12]. The institutional review boards of participating institutions granted the study exempt approval. Data obtained included demographics and tanning behaviors (including ever IT, currently IT, age of initiation, and frequency in past year) [15, 16]. Of 1014 surveys received, 971 met eligibility criteria (age 18 years or older and undergraduate enrollment at one of the participating institutions). Of these, 837 (86.1%) reported past IT practices (including none) and were included for analysis (80% female; 73% self-identified white; median age 20 years). Of the 837 respondents, 256 (30.6%) reported ever IT: 10.5% began before high school and 73.0% started during high school. Among these 256 who ever tanned, 135 (52.7%) reported IT in the past year; of these, 91% reported initiating IT in or before high school. Regarding frequency, individuals initiating IT before high school were 2.9 times (95% confidence interval [CI] [1.08–7.82]) more likely to have indoor tanned 10+ times in the past year compared with those starting in high school or college. Students at the two institutions in Alabama were significantly more likely to have engaged in IT than students at the university in Massachusetts (adjusted odds ratio [AOR] = 3.21, 95% CI [2.09–4.94] and AOR = 7.31, 95% CI [4.25–12.59], respectively). Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL 36604-1405, USA Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Department of Communication Studies, Northeastern University, Boston, MA, USA Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA Correspondence to: C Daniel cldaniel@health.southalabama.edu

College tanning behaviors, attitudes, beliefs, and intentions: A systematic review of the literature

Despite well-established links between exposure to ultraviolet radiation (UVR) and skin cancer, UVR-based tanning behaviors persist among college students. Understanding tanning motivations, perceptions, barriers, and demographic characteristics of this population is critical to modifying these behaviors, but is limited by variability in study design, sample size, and outcomes measured in the current literature. To help clarify the tanning behaviors of this population and provide a concise reference for future studies, this review examines existing reports to determine the comparability of tanning behaviors across multiple U.S. college populations. A systematic review of the literature was performed in July 2016 to identify studies investigating tanning behaviors among U.S. college students. Twenty-three studies met inclusion criteria. High rates of indoor tanning (IT) and outdoor tanning (OT) were found among college students. Key motivators included appearance, emotion, health perceptions, and the influence of parents, peers, and the media. Misconceptions regarding skin protection, low rates of sun protective behaviors, and tanning dependence were barriers against safe UVR exposure. Understudied demographic factors may account for variance in observed tanning behaviors, emphasizing the need for standardization efforts to consistently identify trends associated with geographical region, age, year in college, and sex. The findings presented in this review reaffirm that college students are at high risk for tanning-associated skin cancer, emphasizing the critical need for effective, targeted interventions. Improved interventions will reduce the burden of skin cancer within this group, ultimately contributing to longer, healthier lives.

A truly safer alternative? Sunless tanning products and the unknown

Ultraviolet radiation (UVR) exposure is increasingly appreciated as a significant risk factor for the development skin cancers. Exposure to UVR through tanning behaviors, particularly the use of indoor tanning (IT) lamps or bed, has been attributed to the increasing incidence of skin cancer among adolescents and young adults (AYA), with individuals who initiate IT before the age of 35, significantly increasing their risk of developing skin cancer (Wehner et al., 2012). These findings have prompted age restriction legislation in a number of states and recommendations by the FDA for uniform, national legislation restricting sunlamp product use to individuals ≥18 years and requiring adult users to sign a risk acknowledgment statement before their first IT session and every six months following.(FDA, 2015) There is some evidence that rigorous IT policies and restrictions reduce the prevalence of IT among AYA females (Guy et al., 2014a; Guy et al., 2014b; Hester et al., 2005). However, compliance with tanning restrictions are highly varied from state to state, so the efficacy of these restrictions is hard to gauge (Williams et al., 2018). AYAs feel societal pressure to be tan due to the value of tanned appearance as a firmly established social norm (Dennis et al., 2009; Lazovich and Forster, 2005). Particularly in modern Western culture, tanned skin is frequently synonymous with attractiveness or healthiness, a concept consistently reinforced by media and peer influences (Dennis et al., 2009; Lazovich and Forster, 2005; Fogel and Krausz, 2013). AYAs are especially vulnerable to these influences, and while legislation may restrict their access to UV tanning options such as IT, it will likely have no bearing on their desire to achieve and maintain a tanned appearance (Hillhouse et al., 2009; Stapleton et al., 2008; Cafri et al., 2008; Banerjee et al., 2015). Consequently, many AYAs are likely to turn to other methods of tanning their skin, particularly those who are disinclined to tan naturally (Quinn et al., 2015). For these individuals, sunless tanning products (STPs) are an increasingly attractive and easily accessible alternative to IT and outdoor tanning (Quinn et al., 2015; Sheehan and Lesher, 2005; Mahoney et al., 2012; Sahn et al., 2012; Russo et al., 2012). STPs, which include spray tanning and the use of gels, foams, creams, and/or lotions, provide a tanned appearance without UV exposure. Most over-the-counter STPs contain dihydroxyacetone (DHA), the most popular and longest-used FDA-approved browning agent. DHA is a keto sugar that undergoes a Maillard-like reaction with the amines in the skins surface to produce a brown color within 3 h of application (Johnson and Fusaro, 1998). Darker skin is achieved by increasing the percentage of DHA in the STP (typically between 2 and 15%) and by increasing the frequency of application. There has been a prevailing attitude that DHA is “safe,” largely because it is a common by-product in carbohydrate metabolism and because its absorption has been thought to be limited to the keratinized outer layer of the epidermis, the stratum corneum. However, several reports have now shown that up to 20% of an applied 5% dose of DHA penetrates into and remains within the underlying viable layers of the epidermis and dermis (Yourick et al., 2004). This penetration into viable skin raises concerns about the safety of DHA. Surprisingly, there is a lack of literature examining exposures to DHA, particularly aerosolized exposures, such as would be experienced by spray tanning. DHA has been found to be cytotoxic to keratinocyte and melanoma cell models (Petersen et al., 2004; Smith et al., 2018), and co-exposure of DHA with UV has been shown to increase the formation of free radicals in ex vivo skin (Jung et al., 2008). While these results may not directly reflect potential biological effects of DHA in the complex skin microenvironment, they raise concerns about exposures to DHA, particularly through internal exposures from inhalation, absorption into mucous membranes, or through broken skin. Additionally, they raise fundamental questions about how these products are used. Despite their promotion in recent years by some as a safer alternative to UV tanning, there are limited data available on the use of STPs (Pagoto et al., 2010). Several surveys have measured sunless tanning

Significant Engagement in Tanning Behaviors by Men at a U.S. University

Adolescent and young adult men are a potentially overlooked population with respect to risky tanning behaviors. This study sought to determine the prevalence of various modes of tanning and associated variables among young men in a university setting in the southeastern United States. Undergraduate students at a public institution in Mobile, Alabama were surveyed electronically in March 2016. Of the 818 undergraduate men surveyed, over 90% reported tanning behaviors, with 37% reporting engaging in indoor tanning. Additionally, over 25% reported engaging in two or more types of tanning concurrently. These findings indicate that early intervention efforts targeting young men are needed to reduce risky tanning behaviors and associated negative health outcomes.

Dihydroxyacetone induces G2/M arrest and apoptotic cell death in A375P melanoma cells

The active ingredient in sunless tanning products (STPs) is a simple sugar, dihydroxyacetone (DHA). Several studies have demonstrated that DHA is absorbed within the viable layers of skin and not fully contained within the stratum corneum. Additionally, spray tanning and other aerosolized application methods have increased the risk of internal exposure through mucous membranes and inhalation. Beyond its presence in STPs, DHA also occurs as an endogenous by‐product of fructose metabolism, and an excess of DHA in cells can induce advanced glycation end (AGE) products and oxidative stress. Therefore, exogenous and endogenous exposures to DHA may be harmful to cells, and it has already been demonstrated that exogenous exposure to DHA is cytotoxic in immortalized keratinocytes. Still, little is known about the exogenous DHA exposure effects on other skin components. In this study, we explore the effects of exogenous DHA exposure in a human melanoma cell line, A375P. Melanoma cells were sensitive to DHA and displayed a transient burst of reactive oxygen species within an hour of exposure. Cell cycle arrest at G2/M was observed within 24 h of exposure, and apoptosis, monitored by the cleavage of PARP‐1 and Caspase‐3, was detected within 72 h of exposure to DHA. Together, these demonstrate that exogenous exposure to DHA has cytotoxic effects in our selected cell model and indicates the need to further investigate the exogenous exposure effects of DHA in other relevant exposure models.

Intentional tanning behaviors among undergraduates on the United States’ Gulf Coast

BackgroundRates of melanoma have dramatically increased among adolescents and young adults in recent years, particularly among young women. Exposure to ultraviolet radiation from intentional tanning practices is likely a major contributor to this epidemic. Southern and coastal regions have higher melanoma mortality rates among non-Hispanic whites in other parts of the U.S., yet little is known about tanning practices of adolescents and young adults in these regions. This study determines the prevalence and methods of intentional tanning utilized by an undergraduate population located on the United States’ Gulf Coast.MethodsUndergraduate students enrolled at a university on the Gulf Coast completed an online survey from March–April 2016, self-reporting their engagement, knowledge, and attitudes regarding outdoor tanning (OT), indoor tanning (IT) and spray tanning (ST). Univariate and multivariate analyses were performed to identify factors associated with tanning behaviors.Results2668 undergraduates completed the survey. Of these, 64.9% reported OT tanning, 50.7% reported ever IT, and 21.2% reported ever ST.ConclusionsIn the largest study to date of intentional tanning behaviors of adolescents and young adults from coastal regions, we found high rates of intentional tanning behaviors. There was also significant engagement in spray tanning by this population, not previously reported for adolescents and young adults in a sample of this size. We also identified a high association between different tanning methods, indicating this population engages in multiple tanning behaviors, a phenomenon whose health consequences are not yet known.

Predictors of Colorectal Cancer Surveillance among Radiation-treated Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study

Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation‐induced colorectal cancer (CRC). The Childrens Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at‐risk survivors.