Richard Bränström

Tanning habits and sunburn in a Swedish population age 13–50 years

As part of a skin cancer control programme, we studied the occurrence of self-reported outdoor tanning, sunbed use and ultraviolet (UV)-induced erythema in an urban area. A cross-sectional questionnaire study of 6000 adolescents aged 13-19 years, and 4000 adults aged 20-50 years was applied. Non-response was analysed for outdoor tanning and sunbed use. Results, in general, did not differ between responders and non-responders. Females aged 17-29 years tanned outdoors most frequently. Sunbed use and related erythema was twice as common in young females. In males, outdoor tanning was not age-related. In the past 12 months, 55% reported sunburn and/or burn from sunbed use, one-third were burned in Sweden, one-quarter on sunny resorts abroad. Sunburn occurs frequently. Compliance with recommendations for sunbed use is poor, especially among adolescents and young adults. To reduce the occurrence of erythema, the influence of risk settings upon behaviours is a critical issue for exploration.

The association between dispositional mindfulness, psychological well-being, and perceived health in a Swedish population-based sample

OBJECTIVES There is increasing recognition of the links between mindfulness, decreased stress, and healthier psychological functioning. However, the majority of this research has been conducted in US samples and the mechanisms through which mindfulness decreases stress and increases well-being are not well understood. The aim of this study was to examine the relations between mindfulness and psychological functioning in a general population sample in Sweden. DESIGN This cross-sectional study examined the association of mindfulness and five subscales of mindfulness with depression, anxiety, positive states of mind (PSOM), and perceived health. METHODS In the spring of 2007, a random population-based sample of N= 1,000 individuals aged 18-60 years in Sweden was contacted by mail with a request to participate in the study. RESULTS Mindfulness and some of its subscales, in particular Acting with awareness and Non-reactivity to inner experiences, were strongly related to PSOM and perceived health, and inversely related to depression and anxiety. Tests of the moderating role of mindfulness showed that the associations of perceived stress with depression and perceived health were diminished for those with higher levels of mindfulness. CONCLUSIONS Mindfulness is strongly related to well-being and perceived health. Results suggest that dispositional mindfulness might buffer against the negative influence of perceived stress on psychological well-being. These findings give additional support for the use of mindfulness training as a way of improving psychological functioning among people experiencing stress.

Beliefs, knowledge and attitudes as predictors of sunbathing habits and use of sun protection among Swedish adolescents.

In 1996, a random population sample of 2615 adolescents completed a questionnaire concerning habitual sun‐related behaviours, attitudes towards sunbathing, and knowledge about skin cancer. Females, older adolescents, those with less sun‐sensitive skin, those with higher knowledge and those with a positive attitude towards sunbathing were more likely to be frequent sunbathers. Younger adolescents, those who today sunbathe moderately, and those with sensitive skin were more likely to believe that they would sunbathe more often in the future. Males, adolescents with less sensitive skin, those with a positive attitude towards sunbathing and those sunbathing often, were less likely to use protection when sunbathing. Interventions to decrease sun exposure among adolescents should focus on changing attitudes toward sunbathing and having a tan, since knowledge of skin cancer and the damaging affect of sunbathing did not seem to effect current sunbathing habits, or use of sun protection.

Predictors of Sun Protection Behaviors and Severe Sunburn in an International Online Study

Background: The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behavior. The aim of this study was to examine the prevalence of self-reported sun protection behaviors and sunburn in users of the Internet, and to identify the demographic, clinical, and attitudinal/motivational correlates of sun protection behaviors. Methods: Self-report data were gathered on behalf of the GenoMEL consortium using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the United States, 2% from Israel, and 6% from other countries. Results: Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behavior were perceived barriers to protection (β = −0.44/β = −0.37), and respondents who reported a positive attitude toward suntans were less likely to protect (β = −0.16/β = −0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use. Conclusions: Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviors resulting in severe sunburn. Impact: Future strategies to decrease sunburn should target the practical, social, and psychological barriers associated with nonuptake of sun protection. Cancer Epidemiol Biomarkers Prev; 19(9); 2199–210. ©2010 AACR.

Stability of questionnaire items measuring behaviours, attitudes and stages of change related to sun exposure.

The use of questionnaires in epidemiological studies needs more methodological research. The time and effort spent on questionnaire design is often limited. Studies on the construction of questionnaires could lead to a higher quality of data, enhanced comparability and improved credibility of epidemiological findings. The aim of the present study was to examine the test–retest reliability of some common items measuring sun-related variables. A sample of 52 female Swedish nurses attending a postgraduate course in research methodology was chosen. They completed a questionnaire on two occasions spaced 3 weeks apart in the winter of 2000. When the results were analysed, items on sun-related behaviours and sunbed use were sufficiently reliable. The items on skin type and sunburn showed moderate stability. Stage of change related to sunlight exposure, items measuring beliefs about sunbathing along with items assessing self-efficacy and risk perception with regards to sunbathing showed lower stability. The results showed that many essential items concerning exposure to ultraviolet radiation and sunburns were sufficiently stable, but other items were less stable and could be improved upon; suggestions for improving these items are presented. The study illustrates the value of reliability testing in the process of item construction. Using methodological studies to improve the reliability and validity of data is an important step toward higher standards for questionnaire surveys.

Experiences of a mindfulness-based stress-reduction intervention among patients with cancer.

Background: There is increasing recognition of mindfulness and mindfulness training as a way to decrease stress and increase psychological functioning. Objective: The aim of this study was to examine the perceived effects and experiences of mindfulness stress-reduction training as described by patients with cancer participating in a mindfulness-based stress-reduction training program. Interventions/Methods: The study is based on analysis of data collected in semistructured interviews of the participants (n = 18) after the completion of a mindfulness-meditation training program. The intervention consisted of an 8-week mindfulness-training course. Results: Most participants expressed a number of perceived positive effects of participating in the mindfulness program including increased calm, enhanced sleep quality, more energy, less physical pain, and increased well-being. However, a few participants experienced no effect. Both negative and positive views of the specific meditation and yoga exercises included in the program were expressed. Components that were described as of particular importance, regarding the experience of participating in the program, were the nonjudgmental and accepting approach guiding the program and the instructors, the influence of the group process and sharing experiences with patients with similar experiences, and the emphasis on increased awareness of the present moment. Conclusion: This study gives support for the use of mindfulness programs in reducing stress-related complaints among some patients with a cancer diagnosis. Implications for Practice: The positive experiences of mindfulness training reported by patients with cancer call for further studies examining the possibilities and requirements for implementation of mindfulness programs in clinical practice.

A randomized study of the effects of mindfulness training on psychological well-being and symptoms of stress in patients treated for cancer at 6-month follow-up.

BackgroundThere is increasing evidence showing beneficial effects of mindfulness and mindfulness training on various indicators of mental and physical health.PurposeThis paper reports the 6-month follow-up effects of a mindfulness stress reduction training program among patients treated for cancer on perceived stress, depression, anxiety, post-traumatic stress symptoms, positive states of mind, coping self-efficacy, and mindfulness.MethodsPatients with a previous cancer diagnosis were recruited and randomized into an intervention group or a waiting list control group. The intervention consisted of an 8-week mindfulness training course.ResultsCompared to participants in the control group, the intervention group showed a larger increase in mindfulness at 6-month follow-up. However, there were no differences on any of the other outcomes between the intervention and control groups. Continued meditation practice was associated with a significant reduction in post-traumatic stress symptoms of avoidance.ConclusionsThe study draws attention to the need to better understand the mechanisms behind the effect of mindfulness training and to potential modification of mindfulness interventions to promote sustained benefits over time.

Disclosure and Nondisclosure Among People Newly Diagnosed with HIV: An Analysis from a Stress and Coping Perspective

Disclosing HIV status to friends, family, and sex partners is often stressful. However, HIV disclosure has been associated with improved physical health, psychological well-being, and improved health behaviors. The aim of this study was to address some of the gaps in the literature regarding the disclosure process by conducting a mixed-methods study of disclosure in people newly diagnosed with HIV and the relationship of disclosure to stigma and social support. The CHAI (Coping, HIV, and Affect Interview) Study was a longitudinal cohort study that followed individuals who were newly diagnosed with HIV. The study took place from October 2004 to June 2008 in the San Francisco Bay Area. This sample includes data from 50 participants who were interviewed 1, 3, and 9 months following diagnosis with HIV. We identified four main approaches to HIV disclosure that revealed distinct differences in how participants appraised disclosure, whether disclosure was experienced as stressful, and whether disclosure or nondisclosure functioned as a way of coping with an HIV diagnosis. Implications of these findings for disclosure counseling are discussed.

A randomised population-based intervention to examine the effects of the ultraviolet index on tanning behaviour

The aim of the following study was to examine the effects of the Ultraviolet (UV) Index and a personal ultraviolet radiation (UVR) intensity indicator on tanning behaviour compared with general, written information about sun protection. A population-based random sample in Sweden was randomly assigned to four groups receiving different information packages (n=3200). Questionnaires were sent before and after the summer of 2001. Positive attitudes towards sunbathing as well as tanning and sunburn frequencies decreased. Knowledge about UV radiation and the use of sun protection increased for all groups. There were no between-group differences. Sun-related behaviours and beliefs changed, but information about the UV Index or a personal UVR intensity indicator did not decrease sunbathing and sunburn more than general, written information.

Coping with Breast Cancer: A Meta-Analysis

Objective The primary aim of this study was to examine the associations between different types of coping and psychological well-being and physical health among women with breast cancer. A second aim was to explore the potential moderating influences of situational and measurement factors on the associations between coping and psychological well-being and physical health. Methods On 14 February 2011, a literature search was made for articles published in the PubMed and PsycINFO databases before January 2010. On 5 September 2013, a repeated literature search was made for articles published before May 2013. In the final analyses, 78 studies with 11 948 participants were included. Results Efforts to facilitate adaptation to stress, such as Acceptance and Positive Reappraisal, were related to higher well-being and health. Disengagement and avoidance types of coping were associated with lower well-being and health. The analyses indicated that, in several circumstances, coping effectiveness was dependent on cancer stage, treatment, disease duration, and type of coping measure. Conclusions Use of coping targeting adjustment and avoiding use of disengagement forms of coping were related to better psychological well-being and physical health. Adaptive strategies and avoiding disengagement forms of coping seemed particularly beneficial for women undergoing treatment.