Patterns of sun safety behaviors in parents: Associations with physical activity, sedentary behavior, and access to neighborhood physical activity resources.

Exposure to ultraviolet rays is associated with increased risk of sunburn - a biomarker of skin cancer risk - and physical activity can increase exposure. Sun safety behaviors can mitigate the increased risk of skin cancer. The objective of this cross-sectional study was to determine associations between physical activity behaviors, access to neighborhood physical activity resources, and sunburn across different patterning of sun safety behaviors. Data collected in 2014 from parents in the United States were analyzed (N = 1680; 75% female, primarily between the ages of 35-44 and 45-59, and 67% White). Latent class analysis was conducted to identify classes of sun safety behaviors based on engagement in sun protective behaviors (wearing a hat, shirt with sleeves, and seeking shade) and sun exposure (tanning outdoors). The latent classes were then examined as moderators of the association between physical activity related variables and sunburn. Three classes were identified corresponding to Low, Moderate, and High Risk for sunburn. There was no evidence of moderation, so equality constraints were imposed across the classes. Moderate-to-vigorous physical activity (MVPA) (odds ratio [OR] = 1.09) and neighborhood environments favoring physical activity (OR = 1.39) were associated with an increased likelihood of sunburn. Greater engagement in physical activity and access to built environments that favour activity are associated with a higher likelihood of sunburn, regardless of sun safety behaviors. Physically active parents are a vulnerable population for melanoma, and cancer prevention efforts focused on physical activity should also address sun safety.

Shutting the door on death: Low openness individuals become less open (to death) following mortality reminders.

OBJECTIVE: We examine if individuals low in openness cope with death reminders (i.e., mortality salience) by becoming less open and more avoidant of death. METHOD: In Study 1, openness was measured before and after a mortality salience manipulation (N = 128; Mage  = 35.82; 54.7% male; 85.2% Caucasian). In Study 2, we measured openness, manipulated mortality salience, and measured implicit avoidance of death-related words using a lexical decision task (N = 162; Mage  = 20.58; 72.8% female; 43.8% Caucasian). We predicted that for low, but not high, openness individuals, mortality salience would further decrease openness and increase the speed of responses aimed at avoiding death. RESULTS: For low openness individuals, mortality salience decreased openness scores (Study 1) and caused faster avoidance responses toward death-related words. High openness individuals demonstrated slower avoidance responses (Study 2). CONCLUSIONS: A spiraling effect may occur where mortality salience causes low openness people to become even less open, and avoid death, positioning them to respond defensively.

Health Behaviors of Cancer Survivors and Population Controls From the National Health Interview Survey (2005-2015).

BACKGROUND: Population-based data from the National Health Interview Survey were examined to provide estimates of a wide range of health behaviors in cancer survivors (ie, physical activity, sun protection, alcohol use, cigarette and e-cigarette use, sleep, and diet) and trends over time. METHODS: Data were collected from 92 257 participants across 3 waves of the National Health Interview Survey. A total of 8050 participants reported having had cancer (2428 in 2005, 2333 in 2010, 3289 in 2015). Weighted and adjusted odds ratios (OR) between cancer survivors and controls were calculated using logistic and multivariable regressions in SPSS, and trend analyses from 2005 to 2015 were conducted. All statistical tests are 2-sided. RESULTS: After adjusting for demographics (2005-2015), cancer survivors, compared with controls, were more likely to wear sunscreen (OR = 1.41, 95% confidence interval [CI] = 1.32 to 1.51) and protect their skin (P < .001) and were less likely to tan indoors (OR = 0.81, 95% CI = 0.69 to 0.95), but reported less sleep (OR = 0.91, 95% CI = 0.85 to 0.98). In adjusted models, no differences were found for physical activity, sunburns, alcohol use, smoking, e-cigarette use, and diet. Smoking rates for cancer survivors decreased from 2005 to 2015 (P < .001) and physical activity increased (P = .02), but physical activity was not statistically significant after adjusting for multiple comparisons. All other health behavior rates for cancer survivors were unchanged from 2005 to 2015 (P > .14). CONCLUSION: After adjusting for covariates, cancer survivors exhibited healthier sun protection, but not sleep behaviors, compared with controls. Cancer survivors (and controls) exhibited decreased smoking rates over time. These results may inform interventions focused on improving cancer control and prevention of other chronic conditions among cancer survivors.

Closing the gap on institutional delivery in northern India: a case study of how integrated machine learning approaches can enable precision public health.

INTRODUCTION: Meeting ambitious global health goals with limited resources requires a precision public health (PxPH) approach. Here we describe how integrating data collection optimisation, traditional analytics and causal artificial intelligence/machine learning (ML) can be used in a use case for increasing hospital deliveries of newborns in Uttar Pradesh, India. METHODS: Using a systematic behavioural framework we designed a large-scale survey on perceptual, interpersonal and structural drivers of women's behaviour around childbirth (n=5613). Multivariate logistic regression identified factors associated with institutional delivery (ID). Causal ML determined the cause-and-effect ordering of these factors. Variance decomposition was used to parse sources of variation in delivery location, and a supervised learning algorithm was used to distinguish population subgroups. RESULTS: Among the factors found associated with ID, the causal model showed that having a delivery plan (OR=6.1, 95% CI 6.0 to 6.3), believing the hospital is safer than home (OR=5.4, 95% CI 5.1 to 5.6) and awareness of financial incentives were direct causes of ID (OR=3.4, 95% CI 3.3 to 3.5). Distance to the hospital, borrowing delivery money and the primary decision-maker were not causal. Individual-level factors contributed 69% of variance in delivery location. The segmentation analysis showed four distinct subgroups differentiated by ID risk perception, parity and planning. CONCLUSION: These findings generate a holistic picture of the drivers and barriers to ID in Uttar Pradesh and suggest distinct intervention points for different women. This demonstrates data optimised to identify key behavioural drivers, coupled with traditional and ML analytics, can help design a PxPH approach that maximise the impact of limited resources.

Decision Tree Model vs Traditional Measures to Identify Patterns of Sun-Protective Behaviors and Sun Sensitivity Associated With Sunburn.

Importance: Understanding patterns of sun-protective behaviors and their association with sunburn can provide important insight into measurement approaches and intervention targets. Objective: To assess whether decision-based modeling can be used to identify patterns of sun-protective behaviors associated with the likelihood of sunburn and to compare the predictive value of this method with traditional (ie, composite score) measurement approaches. Design, Setting, and Participants: This cross-sectional study used a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey, consisting of household interviews conducted in person and completed by telephone when necessary. Participants included civilian noninstitutionalized US adults. Data were collected from January 1 through December 31, 2015. Main Outcomes and Measures: The associations among sun sensitivity, multiple sun-protective behaviors (ie, using sunscreen, seeking shade, wearing a hat, and wearing protective clothing), and sunburn were examined using a χ2 automatic interaction detection method for decision tree analysis. Results were compared with a composite score approach. Results: In our study population of 28 558 respondents with complete data (54.1% women; mean [SD] age, 49.0 [18.0] years), 20 patterns of sun protection were identified. Among 15 992 sun-sensitive individuals, those who used only sunscreen had the highest likelihood of sunburn (62.4%). The group with the lowest likelihood of sunburn did not report using sunscreen but engaged in the other 3 protective behaviors (24.3% likelihood of sunburn). Among 12 566 non-sun-sensitive individuals, those who engaged in all 4 protective behaviors had the lowest likelihood of sunburn (6.6%). The highest likelihood of sunburn was among those who only reported sunscreen use (26.2%). The decision tree model and the composite score approach correctly classified a similar number of cases; however, the decision tree model was superior in classifying cases with sunburn (44.3% correctly classified in the decision tree vs 25.9% with the composite score). Conclusions and Relevance: This innovative application of a decision tree analytic approach demonstrates the interactive and sometimes counterintuitive effects of multiple sun-protective behaviors on likelihood of sunburn. These data show where traditional measurement approaches of behavior may fall short and highlight the importance of linking behavior to a clinically relevant outcome. Given the scope of those affected and enormous associated health care costs, improving efforts in skin cancer prevention has the potential for a significant effect on public health.

Women as Animals, Women as Objects: Evidence for Two Forms of Objectification.

Women are objectified through overt sexualization and through a focus on physical appearance, but empirical research has not yet made this distinction. In three studies, we found evidence consistent with the hypothesis that although both forms of objectification strip women of their humanness, there are unique dehumanizing signatures associated with each. When women were objectified by a focus on their sexual features or functions ( sexual objectification), they were perceived as lacking uniquely human attributes (i.e., animalistic dehumanization). Conversely, when women were objectified by an emphasis on their beauty or physical appearance ( appearance-focused objectification), they were perceived as lacking human nature (i.e., mechanistic dehumanization). In Study 3, we also examined an outcome associated with women's risk of harm and found that mechanistic dehumanization, in response to appearance-focused objectification, uniquely promoted the perception that a woman was less capable of feeling pain. Implications for objectification research are discussed.

Interdisciplinary Perspectives on Sun Safety.

Overexposure to the sun is associated with an increased risk of melanoma and nonmelanoma skin cancer, but indications of improvements in sun protection behavior are poor. Attempts to identify emerging themes in skin cancer control have largely been driven by groups of experts from a single field. In December 2016, 19 experts from various disciplines convened for Interdisciplinary Perspectives on Skin Cancer, a 2-day meeting hosted by the National Academy of Sciences. The group discussed knowledge gaps, perspectives on sun exposure, implications for skin cancer risk and other health outcomes, and new directions. Five themes emerged from the discussion: (1) The definition of risk must be expanded, and categories for skin physiology must be refined to incorporate population diversities. (2) Risky sun exposure often co-occurs with other health-related behaviors. (3) Messages must be nuanced to target at-risk populations. (4) Persons at risk for tanning disorder must be recognized and treated. (5) Sun safety interventions must be scalable. Efficient use of technologies will be required to sharpen messages to specific populations and to integrate them within multilevel interventions. Further interdisciplinary research should address these emerging themes to build effective and sustainable approaches to large-scale behavior change.

Trio of terror (pregnancy, menstruation, and breastfeeding): an existential function of literal self-objectification among women.

Research and theorizing suggest that objectification entails perceiving a person not as a human being but, quite literally, as an object. However, the motive to regard the self as an object is not well understood. The current research tested the hypothesis that literal self-objectification can serve a terror management function. From this perspective, the female body poses a unique existential threat on account of its role in reproduction, and regarding the self as an object is posited to shield women from this threat because objects, in contrast to humans, are not mortal. Across 5 studies, 3 operationalizations of literal self-objectification were employed (a denial of essentially human traits to the self, overlap in the explicit assignment of traits to the self and objects, and implicit associations between self and objects using an implicit association test) in response to 3 aspects of women's bodies involved in reproduction (pregnancy, menstruation, and breastfeeding). In each study, priming mortality led women (but not men, included in Studies 1, 3, 4, and 5) to literally self-objectify in conditions where women's reproductive features were salient. In addition, literal self-objectification was found to mediate subsequent responsiveness to death-related stimuli (Study 4). Together, these findings are the first to demonstrate a direct link between mortality salience, women's role in reproduction, and their self-objectification, supporting an existential function of self-objectification in women.

Improving the efficacy of appearance-based sun exposure interventions with the terror management health model.

The terror management health model (TMHM) suggests that when thoughts of death are accessible people become increasingly motivated to bolster their self-esteem relative to their health, because doing so offers psychological protection against mortality concerns. Two studies examined sun protection intentions as a function of mortality reminders and an appearance-based intervention. In Study 1, participants given a sun protection message that primed mortality and shown a UV-filtered photo of their face reported greater intentions to use sun protection on their face, and took more sunscreen samples than participants shown a regular photo of their face. In Study 2, reminders of mortality increased participants' intentions to use facial sun protection when the UV photo was specifically framed as revealing appearance consequences of tanning, compared to when the photo was framed as revealing health consequences or when no photo was shown. These findings extend the TMHM, and provide preliminary evidence that appearance-based tanning interventions have a greater influence on sun protection intentions under conditions that prime thoughts of death. We discuss implications of the findings, and highlight the need for additional research examining the applicability to long-term tanning behaviour.