Kimberly A. Miller

e-Health Tools for Targeting and Improving Melanoma Screening: A Review.

The key to improved prognosis for melanoma is early detection and diagnosis, achieved by skin surveillance and secondary prevention (screening). However, adherence to screening guidelines is low, with population-based estimates of approximately 26% for physician-based skin cancer screening and 20–25% for skin self-examination. The recent proliferation of melanoma detection “e-Health” tools, digital resources that facilitate screening in patients often outside of the clinical setting, may offer new strategies to promote adherence and expand the proportion and range of individuals performing skin self-examination. The purpose of this paper is to catalog and categorize melanoma screening e-Health tools to aid in the determination of their efficacy and potential for adoption. The availability and accessibility of such tools, their costs, target audience, and, where possible, information on their efficacy, will be discussed with potential benefits and limitations considered. While e-Health tools targeting melanoma screening are widely available, little has been done to formally evaluate their efficacy and ability to aid in overcoming screening barriers. Future research needs to formally evaluate the potential role of e-Health tools in melanoma prevention.

Supporting long‐term follow‐up of young adult survivors of childhood cancer: Correlates of healthcare self‐efficacy

Healthcare self‐efficacy (HCSE), the perceived confidence to manage ones health care, has been identified as a critical component in the transition process from pediatric to adult‐oriented care for childhood cancer survivors (CCSs). HCSE is amenable to intervention and associated with long‐term follow‐up care among CCSs. However, factors associated with HCSE have not been fully explored among CCSs.

Current Data on Risk Factor Estimates Does Not Explain the Difference in Rates of Melanoma between Hispanics and Non-Hispanic Whites

United States Hispanics have seven times lower melanoma incidence rates than non-Hispanic whites (NHW). It is unclear whether this difference can be explained solely by phenotypic risk factors, like darker skin, or whether modifiable risk factors, like sun exposure, also play a role. The purpose of this paper is to summarize what is currently known about melanoma risk factors among Hispanics and NHWs, and whether or not those differences could explain the difference in melanoma incidence. Through literature review, relative risks and prevalence of melanoma risk factors in Hispanics and NHWs were identified and used to calculate the expected rate in Hispanics and rate ratio compared to NHWs. We found that melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, we found that melanoma incidence rates in the two groups should actually be similar. Sun exposure behavior among Hispanics may contribute to the explanation for the 7-fold difference in melanoma rates. Currently, limited data exist on sun exposure behavior among Hispanics, but possibilities for improving primary prevention by further studying these practices are substantial.

Living Profiles: an example of user-centered design in developing a teen-oriented personal health record

Abstract Living Profiles is a personal health record (PHR) designed for and by teens with chronic diseases transitioning from the world of pediatric care to the adult system of medical care. It incorporates typical teen behaviors and attitudes about health and wellness while promoting independence, empowerment, and self-care. Our multi-disciplinary team of designers, medical providers, and engineers employed a user-centered design approach to create a PHR prototype based on teen-specific needs, behaviors, and personal experiences. We advocate a human-centered design approach, especially in the collection of data that adolescents find important and insightful, such as peer interactions, short- and long-term aspirations, and goals. These data can be leveraged to be a part of a successful clinical encounter and promote better self-awareness and chronic disease management. Our collaboration that resulted in a semi-working prototype populated by data important both to teen and medical provider became a launch point for more meaningful patient-healthcare provider exchanges.

Prevalence and Predictors of Recent Skin Examination in a Population-Based Twin Cohort

Background: The incidence of melanoma is increasing worldwide. Guidelines for clinical skin exam for improving early diagnosis of melanoma remain inconsistent, and current data on factors associated with regular skin screening on a population basis are limited. Methods: We used self-reported data from 50,044 members of the California Twin Program, a population-based cohort of twins born in California between 1908 and 1982, to identify prevalence and determinants of recent clinical screening for skin cancer. Results: Prevalence of skin examination was higher than national estimates, with 32% of respondents of all ages reporting ever having skin examination. Sociodemographic and constitutional risk factors including white race, educational attainment, marital status, and number of large moles were strongly associated with recent screening, as were individual and family history of skin cancer. Lower socioeconomic status, racial/ethnic minority status, and paradoxically, frequent UV-related risk behaviors in adulthood were associated with a lower likelihood of recent screening. Conclusions: As the evidence concerning the efficacy of skin examination continues to evolve, attention should be paid to motivators and barriers of screening, particularly in high-risk subgroups where lack of screening may contribute to disparate rates of thicker melanomas and lower survival. Impact: Our results demonstrate the need for prevention strategies targeted to specific at-risk groups to increase earlier detection leading to improved outcomes. Cancer Epidemiol Biomarkers Prev; 24(8); 1190–8. ©2015 AACR.

Brief report: Examining children's disruptive behavior in the wake of trauma - A two-piece growth curve model before and after a school shooting.

School shootings may have serious negative impacts on children years after the event. Previous research suggests that children exposed to traumatic events experience heightened fear, anxiety, and feelings of vulnerability, but little research has examined potential aggressive and disruptive behavioral reactions. Utilizing a longitudinal dataset in which a local school shooting occurred during the course of data collection, this study sought to investigate whether the trajectory of disruptive behaviors was affected by the shooting. A two-piece growth curve model was used to examine the trajectory of disruptive behaviors during the pre-shooting years (i.e., piece one) and post-shooting years (i.e., piece two). Results indicated that the two-piece growth curve model fit the data better than the one-piece model and that the school shooting precipitated a faster decline in aggressive behaviors. This study demonstrated a novel approach to examining effects of an unexpected traumatic event on behavioral trajectories using an existing longitudinal data set.

Correlates of sun protection behaviors among Hispanic children residing in a high UV environment

Rates of melanoma are rising in Hispanics in the United States. Excessive sun exposure in childhood increases the risk of melanoma in adulthood, and little is known about the factors motivating sun protection behaviors among Hispanic youth.

Skin Cancer Prevention Among Hispanics: a Review of the Literature

Purpose of ReviewWe review the existing scientific literature regarding skin cancer in Hispanics to aid in formulating a research agenda for prevention targeted to this at-risk population.Recent FindingsHispanics are a diverse population with a rising incidence of both melanoma and non-melanoma skin cancer. Compared with non-Hispanic whites, Hispanics have poorer disease outcomes and higher rates of acral lentiginous melanoma, an aggressive subtype. Hispanics practice suboptimal sun protection and skin surveillance behaviors and experience rates of sunburn comparable with non-Hispanic whites. Despite these risk behaviors, little skin cancer education and prevention has been targeted to this population.SummaryFurther research is warranted to understand the interplay of biological, psychosocial, cultural, and health care factors influencing skin cancer prevention behaviors and outcomes in Hispanics. We recommend future investigation into the histological, sociocultural, and health care differences and disparities among Hispanics and within subpopulations to develop tailored, culturally informed prevention strategies.

Prevalence of sun protection behaviors in Hispanic youth residing in a high ultraviolet light environment

Although rates of late‐stage melanoma are rising in Hispanics, particularly those living in high ultraviolet light environments, little is known about the prevalence of sun protective behaviors in Hispanic children. We analyzed baseline data including frequency of sunburn, sun protective behaviors, level of U.S. acculturation, and skin phototype from a cross‐sectional survey of 2003 Hispanic elementary school children in Los Angeles, California, who participated in a skin cancer prevention intervention. Although the Hispanic children reported frequently engaging in some sun protective behaviors, they also had a high rate of sunburn (59%) that exceeded previous national estimates for non‐Hispanic white children (43%). Fewer U.S.‐acculturated children reported more frequent shade‐seeking at home (P = .02), along with less shade‐seeking at school (P = .001) and more sunscreen use at school (P = .02). The surprisingly high rate of sunburn in Hispanic children suggests that the way in which they are practicing sun protection is not preventing sunburns. Sun safety interventions should be targeted toward Hispanic youth to provide them with practical methods of effective sun protection, in addition to education on the risks of high sun exposure.

Acculturation, Mental Health, and Quality of Life among Hispanic Childhood Cancer Survivors: A Latent Class Analysis

Objective Acculturation appears to be an important aspect of the association between ethnicity and disease, but it has not been explored in depth among childhood cancer survivors (CCS). The purpose of our study was to identify distinct acculturative profiles among Hispanic CCS and to assess differences in quality of life and depressive symptoms. Design Latent class analysis was used to identify distinct acculturative profiles using 9 indicator items reflecting Hispanic and Anglo cultural orientation. Multinomial logistic regression was performed to explore differences in depressive symptoms and quality of life between acculturation classes. Setting and Participants Participants were diagnosed in Los Angeles County, California, USA between 2000-2007 and were recruited for the study in 2009. Main Outcome Measures Center for Epidemiologic Studies depression scale and the PedsQL 4.0 quality of life scale. Results Three distinct acculturation classes emerged. All classes displayed a high probability of endorsing all Anglo orientation items. One class additionally demonstrated a high probability of endorsing all Hispanic orientation items and was labeled bicultural 40%); another demonstrated low probability of endorsing the Hispanic items so was labeled assimilated (32%); and the last demonstrated a high probability of endorsing only the Hispanic items related to language use and was labeled linguistically Hispanic/culturally Anglo (LH) (28%). Conclusions The assimilated group had significantly more depressive symptoms and lower quality of life than the other two groups. This may indicate that loss of the Hispanic culture may be associated with poorer psychosocial health among CCS.