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2.
Afr J Reprod Health ; 24(1): 35-52, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358936

RESUMO

Risky sexual behavior exposes young adults to poor reproductive health outcomes. Parental social support is associated with reduced incidence of risky sexual behavior, but this association has not been adequately investigated in South Africa. We used data from Waves 1 and 3 of the Cape Area Panel Study (a longitudinal study of adolescents and young adults aged 14-22 years and living in the Cape Town metropolitan area) to investigate the associations between parental social support and young adult risky sexual behavior in South Africa. We conducted multivariable logistic regression analyses to assess whether lack of specific categories of parental social supports at wave 1 (baseline) are associated with higher risky sexual behaviors by young adults at wave 3 (follow-up). We found that young adults who never ate meals with their mothers and those who never discussed personal matters with their fathers had increased risks of multiple sexual partnerships. Also, young adults who never got pocket money or money for gifts from their mothers had increased risk to engage in unprotected sex during their first sexual encounter. Our findings suggest that eating family meals, discussing personal matters with youth, and providing them with pocket money, may protect young adults in South Africa from risky sexual behavior.

3.
J Adolesc Health ; 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387094

RESUMO

PURPOSE: The purpose of the study was to test whether those who initiate tanning during adolescence are more likely to continue tanning in young adulthood, potentially increasing their risk for melanoma. METHODS: The study included prospective data from the Growing Up Today Study, a cohort study started in 1996 (N = 5,882). RESULTS: Among men and women who ever indoor UV tanned, those who indoor UV tan by age 17 years consistently indoor tanned at least twice the prevalence as those who did not indoor UV tan by age 17 years. Indoor tanning prevalence at age 27 years was nearly 4 times as high (18.8% vs. 4.8%) among men who started indoor tanning by age 17 years than those who did not indoor tan by age 17 years. These differences persisted through age 27 years and are more pronounced in men (18.8% vs. 4.8%) than in women (30.5% vs. 13.0%). CONCLUSION: Adolescents who indoor UV tan by age 17 years are more likely to continue to indoor tan through young adulthood than those who begin indoor UV tanning at age 18 years or older. Our findings suggest that interventions to prevent indoor UV tanning among minors may substantially reduce years of exposure to this carcinogenic behavior in young adults.

5.
JAMA Dermatol ; 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374346
6.
Am J Public Health ; 110(6): 823-828, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32298165

RESUMO

Objectives. To examine indoor tanning trends among US adults, and the relation to indoor tanning youth access legislation.Methods. This study analyzed the Health Information National Trends Survey (HINTS), a mailed survey, from the years 2007, 2011, 2013, 2014, 2017, and 2018 (combined n = 20 2019).Results. Indoor tanning prevalence decreased significantly over time among all US adults from 2007 (10%) to 2018 (4%; P < .001), among young adults aged 18 to 34 years (14% to 4%; P < .001), and among both women (14% to 4%; P < .001) and men (5% to 4%; P < .05). Indoor tanning significantly decreased in states that enacted youth access legislation by 2018, but did not significantly decrease for other states. Frequent indoor tanning was common in 2018; about one quarter of respondents who reported any indoor tanning did so 25 times or more in the past year.Conclusions. This study identifies several challenges in continuing to reduce indoor tanning in the United States. Youth access legislation may be effective for reducing tanning among the broader population of tanners; however, there remains a need for focus on highly frequent tanners, as well as men.

7.
Am J Public Health ; 110(5): 731-733, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32191523

RESUMO

Objectives. To determine the effect of new therapies and trends toward reduced mortality rates of melanoma.Methods. We reviewed melanoma incidence and mortality among Whites (the group most affected by melanoma) in 9 US Surveillance, Epidemiology, and End Results registry areas that recorded data between 1986 and 2016.Results. From 1986 to 2013, overall mortality rates increased by 7.5%. Beginning in 2011, the US Food and Drug Administration approved 10 new treatments for metastatic melanoma. From 2013 to 2016, overall mortality decreased by 17.9% (annual percent change [APC] = -6.2%; 95% confidence interval [CI] = -8.7%, -3.7%) with sharp declines among men aged 50 years or older (APC = -8.3%; 95% CI = -12.2%, -4.1%) starting in 2014. This recent, multiyear decline is the largest and most sustained improvement in melanoma mortality ever observed and is unprecedented in cancer medicine.Conclusions. The introduction of new therapies for metastatic melanoma was associated with a significant reduction in population-level mortality. Future research should focus on developing even more effective treatments, identifying biomarkers to select patients most likely to benefit, and renewing emphasis on public health approaches to reduce the number of patients with advanced disease.

8.
Int J Cancer ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32064604

RESUMO

Information on cutaneous melanoma (melanoma) burden attributable to ultraviolet (UV) radiation by state could inform state and local public health policies to mitigate the burden. We estimated numbers, proportions and age-standardized incidence rates of malignant melanomas attributable to UV radiation in each US state by calculating the difference between observed melanomas during 2011-2015 and expected cases based on historically low incidence rates among whites in Connecticut from 1942 to 1954. The low melanoma burden in Connecticut during this period likely reflected UV exposure accumulated in the 1930s or earlier, when exposure was likely minimized by clothing style and limited recreational exposure. The estimated number of melanoma cases attributable to UV exposure during 2011-2015 in the United States was 338,701, or 91.0% of the total cases (372,335); 94.3% (319,412) of UV-attributable cases occurred in non-Hispanic whites. By state, the attributable proportion among non-Hispanic whites ranged from 87.6% in the District of Columbia to 97.3% in Hawaii. The attributable age-standardized rate (per 100,000) among non-Hispanic whites ranged from 15.1 (95% CI, 13.4-16.7) in Alaska to 65.1 (95% CI, 61.4-68.9) in Hawaii and was ≥23.3 in half of states. Considerable proportions and incidence rates of melanoma attributable to UV radiation in all states underscores the need for broad implementation or enforcement of preventive measures across states, with priority for states with higher burden.

9.
Patient Educ Couns ; 103(5): 1013-1026, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31917011

RESUMO

OBJECTIVE: To investigate how skin self-examination was operationalized and the psychometric properties of the scales used to assess this behavior in randomized controlled trials (RCTs) testing interventions that promote SSE among individuals at increased risk for melanoma. METHOD: Eight scientific databases (e.g., Medline, EMBASE, CINAHL, PsycINFO) and four trial registries (e.g., Clinicaltrials.gov, UK Clinical Trails Gateway) were searched from inception through April 2, 2019. Three reviewers carried out the selection of relevant trials and conducted data extraction. RESULTS: The review identified 13 unique RCT's. The definition of skin self-exams, extrapolated from instructions provided to participants during the trials and reported in only 6/13 trials, included periodically checking the skin of the entire body, individually or with partners/mirrors, with or without tracking or monitoring tools, and using the ABCDE criteria to identify early signs of melanoma. There was variability in how skin self-examination behavior was measured with respect to item content, number of items, response format, and type of outcome variable used: continuous or binary). No validity evidence and minimal reliability evidence for the measures were identified. CONCLUSIONS AND PRACTICE IMPLICATIONS: Future studies are needed to establish the psychometric properties of measures assessing skin self-examination.

10.
Am J Public Health ; 110(3): 309-316, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31944837

RESUMO

"Anchor Institutions"-universities, hospitals, and other large, place-based organizations-invest in their communities as a way of doing business. Anchor "meds" (anchor institutions dedicated to health) that address social needs and social determinants of health have generated considerable community-based activity over the past several decades.Yet to date, virtually no research has analyzed their current status or effect on community health. To assess the current state and potential best practices of anchor meds, we conducted a search of the literature, a review of Web sites and related public documents of all declared anchor meds in the country, and interviews with 14 key informants.We identified potential best practices in adopting, operationalizing, and implementing an anchor mission and using specific social determinants of health strategies, noting early outcomes and lessons learned. Future dedicated research can bring heightened attention to this emerging force for community health.


Assuntos
Disparidades nos Níveis de Saúde , Administração Hospitalar , Determinantes Sociais da Saúde , Relações Comunidade-Instituição , Economia Hospitalar , Política de Saúde , Hospitais , Humanos , Saúde Pública , Isenção Fiscal
11.
Cancer ; 126(4): 775-781, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31714593

RESUMO

BACKGROUND: Health insurance plays a critical role in the accessibility to and quality of health care for patients with melanoma in the United States. Current knowledge regarding the association between insurance status and stage of melanoma is limited because few studies to date have simultaneously controlled for factors known to influence the risk of diagnosis of late-stage melanoma. The current study was conducted to examine the association between health insurance status and stage of melanoma at the time of diagnosis in nonelderly adults, accounting for known risk factors for late-stage diagnosis. METHODS: In this cross-sectional study, the authors analyzed the National Cancer Data Base for cases of invasive melanoma diagnosed between 2004 and 2015 among individuals aged 26 to 64 years. Using the American Joint Committee on Cancer melanoma staging system, early-stage melanoma was defined as stage I or stage II whereas late-stage melanoma was defined as stage III or stage IV. Late-stage diagnosis was the primary outcome compared across 4 insurance types (private, Medicaid, none, and unknown). Adjusted covariates were age, sex, race/ethnicity, educational level, income, year of diagnosis, number of comorbidities, and facility location. Logistic regression was used for univariable and multivariable analyses. RESULTS: Among 177,247 cases, individuals with Medicaid or no health insurance were found to have 3.12 (95% CI, 2.97-3.28) and 2.21 (95% CI, 2.10-2.33) times greater odds, respectively, of being diagnosed with late-stage melanoma compared with individuals with private insurance after adjusting for risk factors in late-stage diagnosis. CONCLUSIONS: Future investigation into insurance disparities in the diagnosis of late-stage melanoma may help to prioritize melanoma screening in populations with nonprivate insurance.

13.
J Invest Dermatol ; 139(9): 1898-1905.e2, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30959042

RESUMO

Because rates of skin cancer are greater among adult survivors of childhood cancer who received radiation therapy than among the general population, the National Cancer Institute recommends skin self-examinations and annual physician examination. There has been no comprehensive assessment of survivors' adherence to the skin cancer screening guidelines associated with skin self-examination (SSE) and physician whole-body skin examination (PSE). We conducted a cross-sectional survey of radiation-treated, adult 5-year survivors of childhood cancer, diagnosed between 1970 and 1986, in the Childhood Cancer Survivor Study cohort. Multivariate multinomial logit regression investigated the association between demographic, cancer diagnosis, patient activation, cancer treatment characteristics, and skin cancer screening practice. Among 728 survivors, 13.1% reported performing SSE in the prior 2 months plus receiving PSE in the prior 12 months, and 16.4% and 11.0% reported performing only an SSE or a PSE, respectively; 59.5% of survivors reported having had neither. Participants at the highest patient activation score were most likely to report SSE plus PSE compared with neither (adjusted relative risk ratio = 4.16, 95% confidence interval = 1.34-12.85). Most adult survivors of childhood cancer who had radiation therapy do not practice strategies that promote early detection of skin cancer. Interventions designed to activate survivors to increase their participation in screening are needed.

14.
J Natl Cancer Inst ; 111(12): 1314-1322, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30863861

RESUMO

BACKGROUND: Nodular melanoma (NM) is more likely to be fatal compared with other melanoma subtypes, an effect attributed to its greater Breslow thickness. METHODS: Clinicopathological features of NM and superficial spreading melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), the United States, and Australia between 2006 and 2015, were analyzed by multivariable logistic regression analysis, with emphasis on thin (T1 ≤ 1.0 mm) melanomas. Cox analysis assessed melanoma-specific survival. All statistical tests were two sided. RESULTS: In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included. Compared with T1 SSM, T1 NM was less likely to have regression (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI = 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm2, P < .001). Cox multivariable analysis showed a higher risk for melanoma-specific death for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting for center heterogeneity, the difference was statistically significant only for T1 (HR = 2.20, 95% CI = 1.28 to 3.78). The NM subtype did not confer increased risk within each stratum (among localized tumors or cases with regional metastasis). CONCLUSIONS: T1 NM (compared with T1 SSM) was associated with a constellation of aggressive characteristics that may confer a worse prognosis. Our results indicate NM is a high-risk melanoma subtype that should be considered for inclusion in future prognostic classifications of melanoma.

18.
Am J Health Promot ; 33(1): 107-117, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29772910

RESUMO

PURPOSE: As public housing agencies and other low-income housing providers adopt smoke-free policies, data are needed to inform implementation approaches that support compliance. DESIGN: Focused ethnography used including qualitative interviews with staff, focus groups with residents, and property observations. SETTING: Four low-income housing properties in Massachusetts, 12 months postpolicy adoption. PARTICIPANTS: Individual interviews (n = 17) with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups with resident smokers (n = 28) and nonsmokers (n = 47). MEASURES: Informed by the social-ecological model: intrapersonal, interpersonal, organizational, and community factors relating to compliance were assessed. ANALYSIS: Utilized MAXQDA in a theory-driven immersion/crystallization analytic process with cycles of raw data examination and pattern identification until no new themes emerged. RESULTS: Self-reported secondhand smoke exposure (SHSe) was reduced but not eliminated. Challenges included relying on ambivalent maintenance staff and residents to report violations, staff serving as both enforcers and smoking cessation counsellors, and inability to enforce on nights and weekends. Erroneous knowledge of the policy, perception that SHSe is not harmful to neighbors, as well as believing that smokers were losing their autonomy and being unfairly singled out when other resident violations were being unaddressed, hindered policy acceptance among resident smokers. The greatest challenge to compliance was the lack of allowable outdoor smoking areas that may have reduced the burden of the policy on smokers. CONCLUSION: Smoke-free policy implementation to support compliance could be enhanced with information about SHSe for smokers and nonsmokers, cessation support from external community partners, discussion forums for maintenance staff, resident inclusion in decision-making, and framing the policy as part of a broader wellness initiative.


Assuntos
Habitação Popular , Política Antifumo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pobreza/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Adulto Jovem
19.
J Cancer Educ ; 34(4): 647-653, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29569143

RESUMO

Culturally relevant health promotion is an opportunity to reduce health inequities in diseases with modifiable risks, such as cancer. Alaska Native people bear a disproportionate cancer burden, and Alaska's rural tribal health workers consequently requested cancer education accessible online. In response, the Alaska Native Tribal Health Consortium cancer education team sought to create a framework for culturally relevant online learning to inform the creation of distance-delivered cancer education. Guided by the principles of community-based participatory action research and grounded in empowerment theory, the project team conducted a focus group with 10 Alaska Native education experts, 12 culturally diverse key informant interviews, a key stakeholder survey of 62 Alaska Native tribal health workers and their instructors/supervisors, and a literature review on distance-delivered education with Alaska Native or American Indian people. Qualitative findings were analyzed in Atlas.ti, with common themes presented in this article as a framework for culturally relevant online education. This proposed framework includes four principles: collaborative development, interactive content delivery, contextualizing learning, and creating connection. As an Alaskan tribal health worker shared "we're all in this together. All about conversations, relationships. Always learn from you/with you, together what we know and understand from the center of our experience, our ways of knowing, being, caring." The proposed framework has been applied to support cancer education and promote cancer control with Alaska Native people and has motivated health behavior change to reduce cancer risk. This framework may be adaptable to other populations to guide effective and culturally relevant online interventions.

20.
J Am Acad Dermatol ; 2018 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-30543833

RESUMO

BACKGROUND: There have been no studies of the American Academy of Dermatology's SPOTme skin cancer screening program that have collectively analyzed the factors associated with suspected diagnoses of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), dysplastic nevus (DN), and cutaneous melanoma (CM). OBJECTIVE: Describe the demographics, risk factors, and access to care profile associated with suspected diagnoses of BCC, SCC, DN, and CM among first-time SPOTme screenees from 2009 to 2010. METHODS: We conducted a cross-sectional analysis of data from SPOTme skin cancer screenings conducted in 2009 and 2010. We performed multivariable logistic regression analysis for each diagnosis, incorporating traditional demographic, access to care, and risk factor variables in the models. RESULTS: Men, those without a regular dermatologist, persons reporting recently changing moles, and those with a personal history of melanoma were at increased risk for each of the suspected diagnoses analyzed. The uninsured were at increased risk for the suspected malignancies (BCC, SCC, and CM). LIMITATIONS: Lack of histological confirmation for diagnoses; cross-sectional design. CONCLUSION: Among first-time SPOTme participants, suspected diagnoses of BCC, SCC, DN, and CM shared several associated factors which may be considered when planning outreach and screening for populations at risk for skin cancer.

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