Jerod L. Stapleton

A randomized controlled trial of an appearance‐focused intervention to prevent skin cancer

Skin cancer represents a significant health threat with over 1.3 million diagnoses, 8000 melanoma deaths, and more than

Evaluating a Measure of Tanning Abuse and Dependence

1 billion spent annually for skin cancer healthcare in the US. Despite findings from laboratory, case‐control, and prospective studies that indicate a link between youthful indoor tanning (IT) and skin cancer, IT is increasing among US youth. Appearance‐focused interventions represent a promising method to counteract these trends.

Peer Crowd Identification and Indoor Artificial UV Tanning Behavioral Tendencies

OBJECTIVE To evaluate the Structured Interview for Tanning Abuse and Dependence (SITAD). DESIGN Longitudinal survey. SETTING College campus. PARTICIPANTS A total of 296 adults. MAIN OUTCOME MEASURES The SITAD modified items from the Structured Clinical Interview for DSM-IV Axis I Disorders that focus on opiate abuse and dependence. Indoor tanning (IT) behavioral patterns and opiate-like reactions to tanning were measured, and IT behavior was measured 6 months later. RESULTS Of 296 participants, 32 (10.8%) met the SITAD criteria for tanning abuse (maladaptive pattern of tanning as manifested by failure to fulfill role obligations, physically hazardous tanning, legal problems, or persistent social or interpersonal problems) and 16 (5.4%) for tanning dependence as defined by 3 or more of the following: loss of control, cut down, time, social problems, physical or psychological problems, tolerance, and withdrawal. The IT frequency in dependent tanners was more than 10 times the rate in participants who do not meet the SITAD criteria for tanning abuse or dependence. Tanning-dependent participants were more likely to report being regular tanners (75%; odds ratio, 7.0). Dependent tanners scored higher on the opiate-like reactions to tanning scale than did abuse tanners, who scored higher than those with no diagnosis. CONCLUSIONS The SITAD demonstrated some evidence of validity, with tanning-dependent participants reporting regular IT, higher IT frequency, and higher scores on an opiate-like reactions to tanning scale. A valid tanning dependence screening tool is essential for researchers and physicians as a tanning-dependent diagnosis may facilitate a better understanding of tanning motivations and aid in the development of efficacious intervention programs.

Relationship and partner moderator variables increase self-efficacy of performing skin self-examination.

In this study, the relation between peer crowd identification and indoor tanning behavioral tendencies was examined. Participants were 174 undergraduate students at a large university in the USA. Results indicated peer crowd identification was significantly associated with indoor artificial UV tanning behavioral tendencies (attitudes, normative beliefs, past year use and intentions) independent of gender and skin type. Participants who identified with the popular peer crowd were at the greatest risk for indoor tanning UV exposure while identification with the brain crowd was protective against such behavior. The findings are discussed in terms of implications for future skin cancer intervention efforts.

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

OBJECTIVE We sought to identify relationship and partner-related moderating variables that influence the effectiveness of both a couples and a solo learning intervention designed to increase skin self-examination behavior in a sample of patients at risk for developing melanoma. METHODS Patients received a brief intervention designed to teach skin self-examination skills and were randomly assigned into either a solo learning condition where the intervention was administered to the patient alone (n = 65) or a couple learning condition where the intervention was administered to the patient and patients spouse or cohabiting partner (n = 65). The main outcome measure was skin self-examination self-efficacy, which is the strongest mediator of skin self-examination. The relationship moderator variables measured were quality of relationship, partner motivation, and ability to assist in implementation of the intervention. RESULTS When quality of the marital/partner relationship was high, the beneficial effects provided by the partner being included in the skin self-examination skills training were the highest and patients exhibited higher self-efficacy. Similar effects were observed for those with partners who were motivated to implement the intervention, and for those with partners high in ability to provide support. LIMITATIONS Study limitations include the need to evaluate whether the effects can be sustained long term and the exclusion of patients with melanoma without partners. CONCLUSIONS The amount of beneficial effects gained by the patient from the skin self-examination intervention was influenced by marital/partner relationships. Clinicians may need to consider these relationship and partner characteristics when communicating to patients about skin cancer screening.

Comparing the Efficacy of an In-Person Intervention With a Skin Self-examination Workbook

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.

Skin Self-Examination Education for Early Detection of Melanoma: A Randomized Controlled Trial of Internet, Workbook, and In-Person Interventions

From 1992 to 2004, melanoma incidence for all categories of tumor thickness increased 3.1% annually, and there was a 3.8% annual increase in the thickest cancers (Breslow depth, >4 mm), which have the least favorable prognosis.1–3 Since most melanomas are discovered by the patient or a partner, skin self-examination (SSE) with the assistance of a partner has the potential to improve long-term survival.4–6 Given the challenge of examining difficult-to-see body areas (eg, the back), partner assistance is important.7 By creating a workbook from our experience with 130 in-person interventions that increased SSE and partner-assisted skin examination (PASE),7–9 we extend our groups previous research. The workbook codifies the dialog of the in-person intervention with exercises that amplify skills and provide a framework for the patient and partner to understand the significance of melanoma by “story telling” about other people with melanoma in a way that is a call to action. Herein, we compare the efficacy of the workbook with that of in-person training.

A Comparison of 2 Brief Intervention Approaches to Reduce Indoor Tanning Behavior in Young Women Who Indoor Tan Very Frequently

Background Early detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined. Objective The electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention. Methods The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention. Results The demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist’s examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes). Conclusions This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention’s role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations. Trial Registration ClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK).

Skin cancer surveillance behaviors among US Hispanic adults

Case-control studies have found evidence linking UV radiation exposure through indoor artificial UV tanning to all forms of skin cancer, and these risks increase exponentially for those who indoor tan more than 10 times a year.1,2 Compounding the problem are the high rates of indoor UV tanning among young women, who engage in significantly more indoor tanning than men.3,4 Despite these risks, few prevention efforts have been developed specifically targeting indoor tanners who tan very frequently. The present pilot study tested the efficacy of 2 brief intervention approaches, shown to be successful in modifying other difficult-to-change health behaviors, in reducing very frequent indoor tanning behavior in young women: (1) the peer-delivered Motivational Interview5 (PMI) and (2) personalized graphic feedback (PGF).6 The PMI uses a one-on-one, 30-minute counseling session to provide cognitive-behavioral skills information and help participants evaluate the effects of current indoor tanning behaviors with the aim of enhancing their desire to reduce harmful behaviors. The benefit of the PMI is that the health and appearance information can be tailored to the salient aspects of the participants’ concerns. The PMI uses a personalized graphic feedback sheet that incorporates information on the participants’ indoor tanning behaviors, normative beliefs about tanning, beliefs about tanning effects, tanning-related problems, tanning financial costs, family history of skin cancers, and skin-protective behaviors (Figure). Figure One-on-one peer-counseling intervention personalized graphic feedback sheet. The PGF uses the same feedback sheet used in the PMI (Figure) but is delivered via mail with no person-to-person contact. To ensure that our subjects read the PGF material, we had them log on to a secured Web site and answer questions regarding its content. A benefit of the PGF is its low cost and ease of implementation, making it potentially more sustainable than the PMI. We hypothesized that individuals completing either of the 2 interventions (PMI or PGF) would engage in fewer indoor tanning sessions than subjects in a nonintervention control group during the 3-month postintervention follow-up period.

Patterns of drinking-related protective and risk behaviors in college student drinkers

BACKGROUND Little skin cancer prevention research has focused on the US Hispanic population. OBJECTIVE This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. METHODS A population-based sample of 788 Hispanic adults residing in 5 southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. RESULTS The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. LIMITATIONS The cross-sectional design limits conclusions regarding the causal nature of observed associations. CONCLUSIONS Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors.