Joel J. Hillhouse - US grants

[unreadable] DESCRIPTION (provided by applicant): Knowledge of skin cancer risk factors and the subsequent success of prevention interventions clearly depends upon the accuracy of the assessment of UV-risk behaviors, such as intentional radiation exposure and protection. The vast majority of studies in the skin cancer literature rely on un-validated, single-item global retrospective measurements of their UV-risk outcome factors. There is an extensive literature documenting the potentially serious errors and systematic biases to which retrospective measures are subject to. There is preliminary data that indicates that electronic online diary assessments of UV-risk behaviors avoid many of the biases and errors associated with retrospective measures. However, electronic diary assessments are more expensive and less acceptable to respondents than global measures, making them problematic for many research projects. This proposal aims to examine the reliability and validity of commonly used single-item retrospective assessments of UV exposure behavior using electronic diary measures as criterion variables. It also proposes to compare the accuracy of a composite retrospective index to the single-item measures, and evaluate the relationship of objective skin color measures to daily UV exposure reports. Two-hundred participants will be recruited for this study. Objective skin color measures will be taken during the wintertime, and then at the beginning and end of one summer. Participants will also record their UV-risk behaviors during this same summer using daily electronic online diaries. At the end of summer, participants will complete a questionnaire which assesses UV-risk behaviors using a variety of global retrospective measures. Diary data will be used to validate the global measures, and compare their relative accuracy. Diary data will also be used to explore the dynamics of skin color change. If successful, this proposal will significantly improve the assessment of UV-risk behavior in the skin cancer prevention literature. Public Health Relevance: This research will improve the ability to accurately measure behaviors that lead to skin cancer development. This improvement in the measurement of skin cancer related behaviors should improve prevention efforts and lead to the prevention of future skin cancer. [unreadable] [unreadable] [unreadable]

The objective of this research study is to translate the results of an earlier Small Grant for Exploratory Research (SGER) award (BCS-0522301, HSD SGER: Factors Affecting Behavioral Response to Natural Warning Signs of Tsunami: the Case Study of the December 26, 2004 Earthquake) to a robust longitudinal study to provide greater insight into people?s social-cognitive processing of information related to environmental cues and warnings and corresponding protective action behavior. Very few social science studies had investigated human response to tsunamis? environmental cues and informal and official warnings before the 2004 Indian Ocean earthquake and tsunami, but the largest and most comprehensive study was conducted in Thailand in the months afterward by NSF SGER award BCS-0522301. The SGER showed that the high death toll from the 2004 tsunami was not due to a lack of warning, but to people?s inability to accurately interpret and act on information that was available to them before the tsunami impacted the shore. The information included diverse environmental cues and informal warnings at differing time scales. For example, the SGER showed that environmental cues and informal warnings provided enough forewarning for most people to survive in 2004, as some 74 percent of tsunami survivors in Thailand noticed the shoreline recession or unusual waves and currents up to 15minutes before the first wave crest hit the shore. However, these cues did NOT trigger appropriate behavior, as 65 percent saw many people in the danger zone, watching the sea, when the first crest arrived! Similar behavior was recorded in nearly every tsunami-affected country. This project will study the current situation in Thailand and aspects of the 2004 and 2005 events there. First, the SGER respondents (N=663) will be re-interviewed to test whether the Protective Action Decision Model (PADM; Lindell and Perry, 2004) can predict response to environmental cues and warnings in 2010. A separate but parallel study focuses on understanding aspects of disaster memory in this population. The goal is to improve fundamental understanding of the links between environmental cues and warnings and response and to develop improved predictive models and educational materials.

No behavioral model has been tested for tsunamis but the SGER data provide the best starting point. The PADM has proven successful in predicting response to other hazards in the US, but is untested elsewhere. Demonstrating the utility of the PADM, developed for a Western society, in an Eastern (Asian) society would add greatly to its utility. Likewise, understanding the occurrence, order and timing of environmental cues, warnings and response in diverse settings during 2004 and how memory of the event has changed will help identify root causes of many deaths across space and time as the 2004 disaster unfolded. This is important because tsunamis will continue to threaten both residents and visitors in swelling coastal populations worldwide. Through improved understanding of how society interfaced with the 2004 disaster and recalls memory of it now (five years later), real change can be created in how and what information should be communicated. Moreover, these methods can be replicated for other hazards. This research is critical to help build coastal community resilience to tsunamis in the US and elsewhere and it addresses the fact that an effective tsunami warning system must reflect the social dynamics associated with environmental cues and informal warnings in addition to official warnings. Findings will be widely disseminated through print publications, the Web and used to frame effective education programs preparing communities for future tsunamis.

DESCRIPTION (provided by applicant): The International Agency for Research in Cancer (IARC) has recently assigned indoor tanning to its highest cancer risk category, "carcinogenic to humans", joining asbestos, tobacco, arsenic and mustard gas. A comprehensive meta-analysis concluded that the risk of melanoma increased by 75% when indoor tanning is initiated before 30 years old. Melanoma incidence is rising faster than any other cancer with an estimated 60,000 diagnoses annually in the US. Despite this, indoor tanning is gaining tremendous popularity, especially among youth. Recent reviews report approximately 10% of US adolescents under the age of 15 have used indoor tanning in the past year, with prevalence among older adolescent females estimated at 25-40%. There is evidence that female indoor tanning use increases dramatically from freshman to senior years of high school (HS) making high school a critical time period for anti-tanning interventions to be implemented. This proposal assesses the efficacy of a skin cancer prevention program that will be delivered via the Internet to a nationally representative sample of high school teens in a randomized controlled trial. The anti-tanning intervention has proven success in reducing UV risk behaviors across multiple trials and multiple sites over the past 8 years with adult samples when delivered via a booklet. Our research will identify HS females at risk for future UV risk behavior (i.e., current users plus women indicating strong intentions to initiate indoor tanning in the next 6 months), and provide them with persuasive information on the appearance damaging effects of UV exposure, delivered via an attractive, user friendly website. The intervention is based on proven theories of health behavior change (i.e., behavioral alternatives model, social cognitive theory, theory of reasoned action and protection motivation theory), and formative research in high school samples. A national, award-winning web development team will produce the website which will be beta tested with groups of teen tanners to ensure congruence with current teen culture, values and beliefs. The research team has successfully worked with the web-development team and with teen testers to produce and modify a prototype of the intervention which has proven to be relevant and of interest to teen tanners in pilot studies. The proposal uses practices that ensure intervention fidelity and assessments of intervention dosage. We will follow these women from HS through post-HS to examine whether the intervention is able to reduce the overall frequency of long-term UV exposure. The intervention is cost-effective, can be easily disseminated and is likely to be engaging for the targeted teen audience. If successful, wide dissemination of this intervention is likely to substantially reduce indoor tanning initiation and use in high school teens and thus the future occurrence of and mortality from melanoma and non- melanoma skin cancers in this population. The investigative team has the experience and skills needed to successfully complete all aspects of the research, and the approach has been used successfully in previously funded projects. The study is innovative. It will be the first anti-tanning intervention directed at high school students, the first appearance-focused intervention targeting HS tanners, the first Internet-delivered intervention focusing on skin cancer risk behavior in teens, and the first using a nationally representative sample. There is a strong rationale for the use of an appearance-based, Internet delivered intervention with long-term follow-up targeting high school students. High school represents a critical developmental stage for both melanoma risk (i.e., risk appears to increase with indoor tanning in youth) and for the development of regular, frequent intentional UV exposure through tanning. Empirical results testing our conceptual model of teen tanning provides evidence that changing the key cognitive variables in the intervention will reduce tanning motivations and behaviors in teens. An Internet-delivered intervention can be easily and cheaply disseminated, and will be well received by the targeted teen population. PUBLIC HEALTH RELEVANCE: This research will improve our understanding of, and ability to affect UV risk behavior in teenage populations. If successful, its dissemination has the potential to substantially reduce future melanoma and non-melanoma skin cancer morbidity and mortality in adolescents.