Elliot J. Coups

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.

Ethnicity-Related Sources of Stress and Their Effects on Well-Being

Early research on ethnicity focused on the stereotyped thinking, prejudiced attitudes, and discriminatory actions of Euro-Americans. Minority-group members were viewed largely as passive targets of these negative reactions, with low self-esteem studied as the main psychological outcome. By contrast, recent research has increasingly made explicit use of stress theory in emphasizing the perspectives and experiences of minority-group members. Several ethnicity-related stressors have been identified, and it has been found that individuals cope with these threats in an active, purposeful manner. In this article, we focus on ethnicity-related stress stemming from discrimination, from stereotypes, and from conformity pressure arising from ones own ethnic group. We discuss theory and review research in which examination of ethnicity-related outcomes has extended beyond self-esteem to include psychological and physical well-being.

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.

Value for the future and preventive health behavior.

Many everyday decisions require trade-offs between immediate and delayed benefits. Although much research has assessed discounting of delayed outcomes by using hypothetical scenarios, little research has examined whether these discounting measures correspond to real-world behavior. Three studies examined the relationship between scenario measures of time preference and preventive health behaviors that require an upfront cost to achieve a long-term benefit. Responses to time preference scenarios showed weak or no relationship to influenza vaccination, adherence to a medication regimen to control high blood pressure, and adherence to cholesterol-lowering medication. The finding that scenario measures of time preference have surprisingly little relationship to actual behaviors exemplifying intertemporal trade-offs places limits on the applications of time preference research to the promotion of preventive health behavior.

Exposure to mass media health information, skin cancer beliefs, and sun protection behaviors in a United States probability sample

BACKGROUND The mass media is increasingly important in shaping a range of health beliefs and behaviors. OBJECTIVE We examined the association among mass media health information exposure (general health, cancer, sun protection information), skin cancer beliefs, and sun protection behaviors. METHODS We used a general population national probability sample comprised of 1633 individuals with no skin cancer history (Health Information National Trends Survey, 2005, National Cancer Institute) and examined univariate and multivariate associations among family history of skin cancer, mass media exposure, skin cancer beliefs, and sun protection (use of sunscreen, shade seeking, and use of sun-protective clothing). RESULTS Mass media exposure was higher in younger individuals, and among those who were white and more highly educated. More accurate skin cancer beliefs and more adherent sun protection practices were reported by older individuals, and among those who were white and more highly educated. Recent Internet searches for health or sun protection information were associated with sunscreen use. LIMITATIONS Study limitations include the self-report nature of sun protection behaviors and cross-sectional study design. CONCLUSION We identify demographic differences in mass media health exposure, skin cancer beliefs, and sun protection behaviors that will contribute to planning skin cancer awareness and prevention messaging across diverse population subgroups.

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.

Multiple Behavioral Risk Factors for Colorectal Cancer and Colorectal Cancer Screening Status

Background: Individuals who are not adherent to colorectal cancer screening have a greater prevalence of several other behavioral risk factors for colorectal cancer than adherent individuals. However, previous relevant studies have typically not considered the co-occurrence of such behavioral risk factors at the individual level. In the current study, we examined the prevalence, patterns, and predictors of multiple behavioral risk factors for colorectal cancer according to colorectal cancer screening status (adherent versus not adherent). Methods: The study sample consisted of 11,090 individuals ages 50 years and older who participated in the 2000 National Health Interview Survey. Based on responses to survey questions, individuals were categorized as being adherent or not adherent to colorectal cancer screening guidelines and were also denoted as having or not having each of seven behavioral risk factors for colorectal cancer (smoking, low physical activity, low fruit and vegetable intake, high caloric intake from fat, obesity, high alcohol intake, and low intake of multivitamins). Results: Individuals who were not adherent to screening reported having a greater number of risk factors than adherent individuals. For each screening group, there was a high prevalence of having low physical activity, low fruit and vegetable intake, and low intake of multivitamins. Demographic and health-related correlates of behavioral risk factor prevalence were identified in both screening groups. Conclusions: In combination with efforts to promote colorectal cancer screening uptake and adherence, there is a need to develop interventions to modify the colorectal cancer behavioral risk factors that are common among screening-adherent and nonadherent individuals. (Cancer Epidemiol Biomarkers Prev 2007;16(3):510–6)

Fatigue and Functional Impairment in Early-Stage Non-Small Cell Lung Cancer Survivors

CONTEXT Fatigue is the most common sequela among non-small cell lung cancer (NSCLC) survivors one to six years post-treatment and is associated with functional limitations. OBJECTIVES This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors. METHODS Three-hundred fifty individuals diagnosed and surgically treated for Stage IA or IB NSCLC completed a survey that included the Brief Fatigue Inventory (BFI) to assess the prevalence and severity of fatigue. The Karnofsky Self-Reported Performance Rating scale (SR-KPS) was used as a measure of functional status and was compared with the severity of fatigue through Chi-squared analyses. Demographic, psychological, and medical correlates of fatigue were examined using logistic regression. RESULTS The prevalence of fatigue was 57%. Forty-one percent (n=142) of participants had mild fatigue and 16.8% (n=59) had moderate or severe fatigue (BFI≥4). Among the individuals reporting moderate or severe fatigue, 23.7% (n=14) had significant functional impairment (SR-KPS≤70%) compared with 2.8% (n=8) with mild or no fatigue (χ(2)=58.1, P<0.001). In the multivariate analysis, NSCLC survivors with pulmonary disease (odds ratio [OR]=2.28), depressive symptoms (OR=6.99), and anxiety symptoms (OR=2.31) were more likely to report experiencing clinically significant fatigue, whereas those who met physical activity guidelines (OR=0.29) reported less fatigue. CONCLUSION Fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue includes the screening and management of anxious and depressive symptoms, and pulmonary disorders such as chronic obstructive pulmonary disease.

Correlates of physical activity among lung cancer survivors

Objective: Lung cancer survivors commonly experience impairments in quality of life, which may be improved through regular physical activity. However, little is known regarding correlates of physical activity in this survivor population. The current study addressed this research gap.

Linguistic Acculturation and Skin Cancer–Related Behaviors Among Hispanics in the Southern and Western United States

OBJECTIVE To examine the association between linguistic acculturation (assessed using the Language Use and Linguistic Preference subscales from the Bidimensional Acculturation Scale for Hispanics) and skin cancer-related behaviors among US Hispanic adults to determine whether, compared with Hispanics denoted as Spanish-acculturated, English-acculturated Hispanics would report less frequent shade seeking and use of sun protective clothing and higher rates of sunscreen use, sunbathing, and indoor tanning. DESIGN Online survey study conducted in September 2011. SETTING Five southern and western US states. PARTICIPANTS A population-based sample of 788 Hispanic adults drawn from a nationally representative web panel. MAIN OUTCOME MEASURES Self-reported sunscreen use, shade seeking, use of sun protective clothing, sunbathing, and indoor tanning. RESULTS Multivariate regression analyses were conducted to examine predictors of the skin cancer-related behaviors. As hypothesized, English-acculturated Hispanics had lower rates of shade seeking and use of sun protective clothing and reported higher rates of sunbathing and indoor tanning than Spanish-acculturated Hispanics. English-acculturated Hispanics and bicultural Hispanics (ie, those with high Spanish and high English acculturation) reported comparably high rates of sunbathing and indoor tanning. Results suggested that bicultural Hispanics seek shade and wear sun protective clothing less often than Spanish-acculturated Hispanics but more often than English-acculturated Hispanics. Acculturation was not associated with sunscreen use. CONCLUSIONS Hispanic adults do not routinely engage in behaviors that reduce their risk of skin cancer. Bicultural and English-acculturated Hispanics are particularly in need of skin cancer prevention interventions.