Perceptions and Practices of the Iranian Population regarding Skin Cancers: A Literature Review

Despite being preventable, more than 15% of all cancer cases in Iran occur in the skin, making them the most commonly diagnosed malignancy in the country. The purpose of this study is to gain an insight into the current skin cancer related knowledge, attitudes, beliefs, and practices among the Iranian population. A systematic computer based literature search was conducted using databases for articles published through April 2017. Research studies included those that measured skin cancer or sun protection related knowledge, attitudes, beliefs, and behaviors in different Iranian population groups. Exclusion criteria for the articles included (1) irrelevant topics to the review article’s aim, (2) articles that focused on the treatment of skin cancers instead of prevention practices, and (3) similar studies conducted on populations not indigenous to Iran. A total of 25 articles that met the eligibility criteria were included in the review. Predominant data were collected via questionnaires. Skin cancer related knowledge varied from low to high across the studies. Moreover, there was a pattern of low perceived skin cancer susceptibility and severity. Overall, there was low usage of sun protection methods among the Iranian population. The findings of this study show that efforts to prevent skin cancer are needed. Education concerning the dangers of sun exposure as well as strategies used to prevent or lower the risk of developing skin cancer should be stressed.

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Identification of Relevant Sociocognitive Determinants Explaining Multiple Parental Sun Protection Behaviors

Health Education & Behavior ◽

10.1177/10901981211010434 ◽

2021 ◽

pp. 109019812110104

Author(s):

Karlijn Thoonen ◽

Liesbeth van Osch ◽

Rik Crutzen ◽

Hein de Vries ◽

Francine Schneider

Keyword(s):

Skin Cancer ◽

Self Efficacy ◽

Sun Exposure ◽

Later Life ◽

Sun Protection ◽

Survey Study ◽

Skin Cancer Prevention ◽

Sun Safety ◽

And Behaviors ◽

Insight Into

Background Adequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their children, insight into the determinants associated with their sun protection behaviors is limited. Aims This study aims to identify the most relevant determinants in predicting multiple parental sun protection intentions and behaviors in different sun exposure situations. Method A longitudinal survey study with two measurements was conducted among Dutch parents ( N = 670) of children (4–12 years old). Twenty-seven sociocognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The Confidence Interval-Based Estimation of Relevance approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors. Results Behavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all sociocognitive determinants was highest for shade-seeking behavior ( R2 = .41 and .43) and lowest for supportive behavior ( R2 = .19 and .29) in both planned and incidental sun exposure situations, respectively. Discussion This study provides detailed insight into relevant sociocognitive determinants of parental sun protection behaviors in various sun exposure situations and directions for composing parental skin cancer prevention interventions. Conclusions Future composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.

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A Randomized Clinical Trial of Precision Prevention Materials Incorporating MC1R Genetic Risk to Improve Skin Cancer Prevention Activities Among Hispanics

Cancer Research Communications ◽

10.1158/2767-9764.crc-21-0114 ◽

2022 ◽

Vol 2 (1) ◽

pp. 28-38

Author(s):

John Charles A. Lacson ◽

Scarlet H. Doyle ◽

Jocelyn Del Rio ◽

Stephanie M. Forgas ◽

Rodrigo Carvajal ◽

...

Keyword(s):

Skin Cancer ◽

Cancer Prevention ◽

Cancer Susceptibility ◽

Sun Exposure ◽

Sun Protection ◽

Skin Cancer Prevention ◽

Public Health Approach ◽

Average Risk ◽

Cancer Worry ◽

Prevention Activities

Purpose: Skin cancer incidence is increasing among Hispanics, who experience worse outcomes than non-Hispanic Whites. Precision prevention incorporating genetic testing for (melanocortin-1 receptor) MC1R, a skin cancer susceptibility marker, may improve prevention behavior. Experimental Design: Hispanic participants (n = 920) from Tampa, FL and Ponce, PR, were block-randomized within MC1R higher- and average-risk groups to precision prevention or generic prevention arms. We collected baseline information on demographics, family history of cancer, phenotypic characteristics, health literacy, health numeracy, and psychosocial measures. Participants reported weekday and weekend sun exposure (in hours), number of sunburns, frequency of five sun protection behaviors, intentional outdoor and indoor tanning, and skin examinations at baseline, 3 months, and 9 months. Participants also reported these outcomes for their eldest child ≤10 years old. Results: Among MC1R higher-risk participants, precision prevention increased sunscreen use (OR = 1.74, P = 0.03) and receipt of a clinical skin exam (OR = 6.51, P = 0.0006); and it decreased weekday sun exposure hours (β = −0.94, P = 0.005) and improved sun protection behaviors (β = 0.93, P = 0.02) in their children. There were no significant intervention effects among MC1R average-risk participants. The intervention did not elevate participant cancer worry. We also identified moderators of the intervention effect among both average- and higher-risk participants. Conclusions: Receipt of MC1R precision prevention materials improved some skin cancer prevention behaviors among higher-risk participants and their children and did not result in reduced prevention activities among average-risk participants. Despite these encouraging findings, levels of sun protection behaviors remained suboptimal among participants, warranting more awareness and prevention campaigns targeted to Hispanics Significance: Our results support a precision public health approach to reducing skin cancers among Hispanics, an underserved population in precision medicine, and may additionally improve preventive behaviors among their children.

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A qualitative exploration of parental perceptions regarding children’s sun exposure, sun protection, and sunburn

10.31234/osf.io/f8brk ◽

2020 ◽

Author(s):

Karlijn Thoonen ◽

Liesbeth van Osch ◽

Rowan Drittij ◽

Hein de Vries ◽

Francine Schneider

Keyword(s):

Skin Cancer ◽

Sun Exposure ◽

Structured Interview ◽

Sun Protection ◽

Parental Perceptions ◽

Skin Cancer Prevention ◽

Protection Measure ◽

Sun Safety ◽

Protection Measures ◽

Lack Of Knowledge

Sun protection among children is of utmost importance since sunburn in early life is a major risk factor for skin cancer development. Because parents play a vital role in enhancing sun safety among children, this study explored parental perceptions concerning sun exposure, sun protection behaviors, and sunburn in children. Additionally, the context in which children experience sunburn in order to assist the development, optimization, and targeting of sun safety interventions for parents is revealed.A qualitative study design, using a semi-structured interview guide addressing several themes (e.g. sun exposure, sun protection, and sunburn experiences), was used. Data were collected in the Netherlands in the fall of 2019. Parents were recruited via purposive sampling at schools, youth services centers, and social media. In total, 26 interviews were performed. Execution, transcription, and coding of the interviews was done by two researchers, using the qualitative analyzing program Nvivo (interrater reliability of d =.84). Comprehensive findings concerning various themes were retrieved. It was found that sunburn was frequently prevalent among children, even though all parents reported using at least one sun protection measure. Parents were often unaware of their child’s sunburn and its severity. Regarding sun protection measures, parents demonstrated an overreliance on sunscreen, often failing to adequately protect their children’s skin. Water-related activities, a lack of shade, and lack of knowledge regarding UV-index were often related to sunburn. Moreover, unexpected sun exposure or longer exposure duration than initially planned were reported as challenging situations. The majority of parents had positive perceptions regarding tanned skin for both themselves as for children.This study provides directions for future skin cancer prevention efforts targeted at both parents and their children. Since a lack of knowledge regarding sufficient sun protection measures and sunburn occurrence in various situations was reported, educational efforts are warranted. Additionally, focusing on clothing, shade-seeking, and adequate sunscreen use is recommended to increase children’s sun safety. By intervening in the physical environment as well (e.g. providing shady areas), sun protection barriers can be reduced. Lastly, the general positive attitude toward tanned skin evident in this study is certainly worthy of attention in future interventions.

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Identification of socio-cognitive determinants of parental sun protection behaviors to optimize intervention development

10.31234/osf.io/yuqzd ◽

2020 ◽

Author(s):

Karlijn Thoonen ◽

Liesbeth van Osch ◽

Rik Crutzen ◽

Hein de Vries ◽

Francine Schneider

Keyword(s):

Skin Cancer ◽

Self Efficacy ◽

Sun Exposure ◽

Action Planning ◽

Later Life ◽

Sun Protection ◽

Survey Study ◽

Skin Cancer Prevention ◽

Sun Safety ◽

Cognitive Determinants

Background: Adequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their children, interventions are often not directed at parents. This study identifies the most relevant determinants in predicting parental sun protection intentions and behaviors to provide guidance for future intervention development.Methods: A longitudinal survey study with two measurements was conducted among Dutch parents (N=670) of children (4-12 years old). Twenty-seven socio-cognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The CIBER approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors.Results: Behavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all socio-cognitive determinants was highest for shade-seeking behavior (R2= .41 and .43) and lowest for supportive behavior (R2=.19 and .29) in both planned and incidental sun exposure situations respectively.Discussion: This study provides detailed insight into relevant socio-cognitive determinants of parental sun protection behaviors in various sun exposure situations. This insight provides guidance for composing parental skin cancer prevention interventions. Future composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.

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Testing Wearable UV Sensors to Improve Sun Protection in Young Adults at an Outdoor Festival: Field Study

JMIR mhealth and uhealth ◽

10.2196/21243 ◽

2020 ◽

Vol 8 (9) ◽

pp. e21243

Author(s):

Caitlin Horsham ◽

Jodie Antrobus ◽

Catherine M Olsen ◽

Helen Ford ◽

David Abernethy ◽

...

Keyword(s):

Skin Cancer ◽

Field Study ◽

Sun Exposure ◽

Sun Protection ◽

Incidence Rates ◽

The Body ◽

Childhood And Adolescence ◽

Uv Sensor ◽

Sunscreen Use ◽

Uv Sensors

Background Australia and New Zealand have the highest skin cancer incidence rates worldwide, and sun exposure is the main risk factor for developing skin cancer. Sun exposure during childhood and adolescence is a critical factor in developing skin cancer later in life. Objective This study aims to test the effectiveness of wearable UV sensors to increase sun protection habits (SPH) and prevent sunburn in adolescents. Methods During the weeklong school leavers outdoor festival (November 2019) at the Gold Coast, Australia, registered attendees aged 15-19 years were recruited into the field study. Participants were provided with a wearable UV sensor and free sunscreen. The primary outcome was sun exposure practices using the SPH index. Secondary outcomes were self-reported sunburns, sunscreen use, and satisfaction with the wearable UV sensor. Results A total of 663 participants were enrolled in the study, and complete data were available for 188 participants (188/663, 28.4% response rate). Participants provided with a wearable UV sensor significantly improved their use of sunglasses (P=.004) and sunscreen use both on the face (P<.001) and on other parts of the body (P=.005). However, the use of long-sleeve shirts (P<.001) and the use of a hat (P<.001) decreased. During the study period, 31.4% (59/188) of the participants reported receiving one or more sunburns. Satisfaction with the wearable UV sensor was high, with 73.4% (138/188) of participants reporting the UV sensor was helpful to remind them to use sun protection. Conclusions Devices that target health behaviors when outdoors, such as wearable UV sensors, may improve use of sunscreen and sunglasses in adolescents.

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Skin Cancer Prevalence in Outdoor Workers of Ski Resorts

Journal of Skin Cancer ◽

10.1155/2020/8128717 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Yolanda Gilaberte ◽

Josep Manel Casanova ◽

Ana Julia García-Malinis ◽

Salvador Arias-Santiago ◽

Maria Reyes García de la Fuente ◽

...

Keyword(s):

Skin Cancer ◽

Sierra Nevada ◽

Sun Exposure ◽

Solar Ultraviolet Radiation ◽

Cross Sectional ◽

Ski Resort ◽

Outdoor Workers ◽

Ski Resorts ◽

Validated Questionnaire ◽

Skin Cancers

Background. Snow reflectivity and altitude increase the exposure of ski resort workers to solar ultraviolet radiation. The aim was to assess the presence of skin cancer in ski resorts workers and compare it with other groups of outdoor workers reviewing published studies. Methods. An observational cross-sectional prospective study was conducted in the three largest ski resorts in Spain: Baqueira Beret, Lleida; Formigal, Huesca and Sierra Nevada, Granada. All outdoor workers including ski instructors were invited to participate in the study. The participants completed a validated questionnaire about sun exposure and underwent a skin examination. Results. 219 workers were included in the study (80% male; mean age 43.8 (SD 11.31) years). Actinic keratosis (AK) but no other skin cancers were detected in 32 participants (14.62%). Those with AK worked in the Southernmost ski resort, were more likely to have light colour hair, and were older and with higher photoaging grade than those without them. Conclusion. Compared to other studies, outdoor workers on ski resorts show a higher prevalence of AK than general population but a lower prevalence than other groups of outdoor workers.

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Skin Cancers Among Chronic Lymphocytic Leukemia (CLL) Patients - the Effect of UV Radiation and CLL Clinical Characteristics

Blood ◽

10.1182/blood.v128.22.4772.4772 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4772-4772 ◽

Cited By ~ 4

Author(s):

Geffen Kleinstern ◽

Abdul Rishi ◽

Sara J Achenbach ◽

Kari Rabe Chaffee ◽

Neil E. Kay ◽

...

Keyword(s):

Skin Cancer ◽

Uv Radiation ◽

Mayo Clinic ◽

Research Funding ◽

Sun Exposure ◽

Prior History ◽

Skin Cancers ◽

History Of ◽

Very High

Abstract Background: It is well established that the incidence of skin cancers in patients with CLL are significantly elevated compared to age- and sex- matched controls. However, little is known about the characteristics of CLL patients who develop skin cancer. Herein, we evaluate the associations of CLL clinical and prognostic characteristics, along with UV radiation exposure, with risk of first skin cancer following CLL diagnosis. Methods: Newly diagnosed CLL patients from Minnesota, Iowa, and Wisconsin were enrolled in the Mayo Clinic case-control study from 2002-2015 and systematically followed in the Iowa/Mayo Lymphoma SPORE. Clinical and prognostic CLL data were obtained from the Mayo Clinic CLL database, and skin cancer clinical data were abstracted from medical records using a standard protocol. The CLL international prognostic index (CLL-IPI) was computed using a weighted average of five independent CLL prognostic factors (IGHV mutational status, serum b2-microglobulin, Rai stage, age, and FISH 17p deletion/TP53 status). Self-reported history of midday sun exposure at various ages (birth to age 12; 13 to 21 years; 22 to 40 years, and 41+ years) was obtained from a risk factor questionnaire. For each age, we asked the extent of mid-day sun as: practically no exposure (under 3 hours per week), little exposure (4-7 hours per week), moderate exposure (8 to 14 hours per week) and extensive exposure (15+ hours per week). Midday sun exposure was modeled as an ordinal covariate. To evaluate associations with risk of skin cancer following CLL diagnosis, we calculated time from date of CLL diagnosis to date of first skin cancer, death, or last known follow-up. We used Cox regression analysis to estimate hazard ratios (HRs) and 95% CIs. CLL treatment was considered a time-dependent covariate. Results: Among 846 CLL patients enrolled, the median age at diagnosis was 63 years (range 28-91), 68% were male, 7% had Rai stage III-IV at diagnosis. Based on the CLL-IPI, 42% were categorized as low risk, 33% as intermediate risk, and 25% as high or very-high risk. 109 CLL cases (13%) had one or more reported skin cancers at or prior to CLL diagnosis. Melanoma was observed in 19 (2%) cases and non-melanoma was in 90 (11%) cases. At a median follow-up of 7 years from CLL diagnosis, 165 patients (20%) had one or more skin cancers after CLL diagnosis. Among these patients, 49 had skin cancer before CLL diagnosis. The most frequent skin cancer was squamous cell carcinoma (59%), followed by basal cell (31%), melanoma (5%), and Merkel cell (1%). 552 (65%) of the 846 patients returned a questionnaire. Significant associations of clinical and prognostic characteristics with risk of first skin cancer were observed for age (HR=1.35 per 10 year increase, 95% CI=1.17-1.56, P<0.001), male sex (HR=1.38, 95% CI 0.98-1.96, p=0.07), prior history of skin cancer (HR=4.19, 95% CI=2.98-5.88, P<0.001), and CLL-IPI (HR=1.26, 95% CI= 1.03-1.54, P=0.026, after adjusting for age, sex, and prior skin cancer). Of note, the risk of first skin cancer in those CLL patients categorized as very high via CLL-IPI had 2.28 fold risk (95% CI 1.02-5.11). Midday sun exposures for each of the ages considered showed no evidence of association with risk of first skin cancer (all P>0.05). 50 CLL patients were treated prior to first skin cancer following CLL diagnosis; we observed no evidence of association between treatment and risk of first skin cancer (HR=1.44, 95% CI= 0.93-1.92, P=0.12). Conclusion: CLL patients who are at an increased risk of skin cancer following CLL diagnosis are those who either have had a prior history of skin cancer or a more aggressive CLL disease at diagnosis, according to CLL IPI. Routine skin cancer screening is currently recommended for CLL patients. Our data suggest that more frequent screening would be particularly important among patients with aggressive CLL and who have a prior history of skin cancer. Unexpectedly, we found no evidence of association of skin cancer risk with UV radiation following CLL diagnosis or with CLL treatment. Further investigation is needed to determine whether other factors increase the risk of skin cancer following CLL diagnosis. Disclosures Shanafelt: Genentech: Research Funding; GlaxoSmithkKine: Research Funding; Janssen: Research Funding; Celgene: Research Funding; Cephalon: Research Funding; Pharmacyclics: Research Funding; Hospira: Research Funding.

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Fighting Skin Cancer With a Musical Sound

Social Marketing Quarterly ◽

10.1177/1524500413506583 ◽

2013 ◽

Vol 19 (4) ◽

pp. 279-289 ◽

Cited By ~ 3

Author(s):

Sofia Potente ◽

Vanessa Rock ◽

Jacqueline McIver ◽

Melinda Williams ◽

Christopher Magee ◽

...

Keyword(s):

Skin Cancer ◽

Sun Exposure ◽

Sun Protection ◽

Skin Cancer Prevention ◽

The Sun ◽

Media Campaigns ◽

Social Marketing Campaign ◽

South Wales ◽

The Media ◽

Key Barrier

Australian youth have good knowledge about skin cancer prevention as a result of over three decades of traditional mass media campaigns. However, youth sun protection behavior remains poor. This case study describes the results of a unique social marketing campaign (the Sun Sound) aimed at translating youths’ knowledge into improved sun protection behavior. Formative research identified that a key barrier to sun protection was youth regularly forgot to protect their skin. As such, the campaign centered on a musical jingle that was broadcast at outdoor recreational settings as a “cue to action” reminder to use sun protection at the time and point of sun exposure. The Sun Sound was trialed at two coastal communities in New South Wales, Australia, during summer 2009–2010. The media launch generated 17.6 million Australian audience impressions (advertising value A$257,785). Intercept surveys conducted with 467 youth aged 12–18 years found there was high unprompted recall (41%) and understanding (79%) of the Sun Sound message. The Sun Sound was found to be an effective cue to action in prompting sun protection behaviors when heard, with over a third (38%) of respondents reporting use of additional sun protection upon hearing the jingle. Since the pilot, the Sun Sound has expanded to over 60 pools, beaches, and selected venues across Australia. The campaign demonstrates it is possible to influence behavior by targeting audiences at the actual point that behavior occurs, using research-informed insights and a relevant marketing mix.

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Design and implementation of a health promotion program to prevent the harmful effects of ultraviolet radiation at primary school students of rural areas of Greece

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20172505 ◽

2017 ◽

Vol 3 (3) ◽

pp. 306 ◽

Cited By ~ 3

Author(s):

Maria Sakoufaki ◽

Aravella Stergiopoulou ◽

Alexander Stratigos

Keyword(s):

Skin Cancer ◽

Educational Intervention ◽

School Children ◽

Primary Schools ◽

Intervention Program ◽

Sun Exposure ◽

Sun Protection ◽

School Intervention ◽

Health Promotion Program ◽

Harmful Effects

Background: Skin cancer is the most common type of cancer presenting with a dramatic increase in its incidence among Caucasian populations worldwide. Primary prevention in childhood and early detection is important in reducing the risk of skin cancer later in life.The objectives of the study were to investigate the effect of a focused educational intervention in school children aiming to increase their knowledge about the harmful effects of sun exposure and promote prevention behaviors regarding skin cancerMethods: The study consisted of a before/after 6-month assessment of a school intervention program applied in two hundred children from four primary Schools (Grades 3-6) at a rural area in Western Greece. The program included the presentation and distribution of educational material (activity guide, manual for pupils, posters). A detailed questionnaire with close-ended questions was distributed before and after the intervention. Both between and in groups analysis was conducted.Results: Of the participating pupils, 48% were boys, whereas 78.5% reported a fair skin complexion and 79% reported freckles and 1-20 nevi. After the intervention, an increased number of pupils were taught to enjoy sun exposure while avoiding its harmful effects. A significantly greater number of children stated proper use of sunscreen (74% vs. 31%, p=0.001) and sun protection (that avoided going outside especially at the intense hours of daily UV exposure (65% vs. 25.5% prior to the intervention). Melanoma awareness was also significantly raised. Conclusions: Students’ knowledge about the effects of sun exposure as well as the need for sun protection increased following a targeted and well-designed educational intervention. The development of preventive educational programs on skin cancer for school children is important to increase awareness in this sensitive age group.

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Testing Wearable UV Sensors to Improve Sun Protection in Young Adults at an Outdoor Festival: Field Study (Preprint)

10.2196/preprints.21243 ◽

2020 ◽

Author(s):

Caitlin Horsham ◽

Jodie Antrobus ◽

Catherine M Olsen ◽

Helen Ford ◽

David Abernethy ◽

...

Keyword(s):

Skin Cancer ◽

Field Study ◽

Sun Exposure ◽

Sun Protection ◽

Incidence Rates ◽

The Body ◽

Childhood And Adolescence ◽

Uv Sensor ◽

Sunscreen Use ◽

Uv Sensors

BACKGROUND Australia and New Zealand have the highest skin cancer incidence rates worldwide, and sun exposure is the main risk factor for developing skin cancer. Sun exposure during childhood and adolescence is a critical factor in developing skin cancer later in life. OBJECTIVE This study aims to test the effectiveness of wearable UV sensors to increase sun protection habits (SPH) and prevent sunburn in adolescents. METHODS During the weeklong school leavers outdoor festival (November 2019) at the Gold Coast, Australia, registered attendees aged 15-19 years were recruited into the field study. Participants were provided with a wearable UV sensor and free sunscreen. The primary outcome was sun exposure practices using the SPH index. Secondary outcomes were self-reported sunburns, sunscreen use, and satisfaction with the wearable UV sensor. RESULTS A total of 663 participants were enrolled in the study, and complete data were available for 188 participants (188/663, 28.4% response rate). Participants provided with a wearable UV sensor significantly improved their use of sunglasses (P=.004) and sunscreen use both on the face (P<.001) and on other parts of the body (P=.005). However, the use of long-sleeve shirts (P<.001) and the use of a hat (P<.001) decreased. During the study period, 31.4% (59/188) of the participants reported receiving one or more sunburns. Satisfaction with the wearable UV sensor was high, with 73.4% (138/188) of participants reporting the UV sensor was helpful to remind them to use sun protection. CONCLUSIONS Devices that target health behaviors when outdoors, such as wearable UV sensors, may improve use of sunscreen and sunglasses in adolescents.

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