Interventions to Prevent Skin Cancer by Reducing Exposure to - PowerPoint PPT Presentation

Interventions to Prevent Skin Cancer by Reducing Exposure to Ultraviolet Radiation An Updated Review Mona Saraiya MD, MPH August 30, 2012 UICC Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion

US Preventive Services Task Force Recommendation: Behavioral Counseling on Skin Cancer Annals of Internal Medicine May 2011 Date of download: 8/29/2012

General Steps in a Community Guide Review ! Recruit a multidisciplinary team ! Develop an intervention definition ! Determine research questions ! Develop an Analytic Framework ! Search for evidence ! Abstract and evaluate the identified studies ! Synthesize evidence ! Present findings to the Task Force ! Task Force adopts consensus conclusions Recommended for/against Insufficient Evidence 3

Task Force Recommendation Options " Recommend – Strong Evidence – Sufficient Evidence " Recommend against – Strong Evidence – Sufficient Evidence " Insufficient evidence to recommend for or against 4

Coordination Team CDC Task Force ! Paramjit Sandhu ! Karen Glanz … .Univ of Penn ! Randy Elder ! Dawn Holman External Partners ! Mona Saraiya ! Frank Perna … ... ………… NIH ! Robert Smith …………… . ACS ! David Buller …… .. Klein Buendel ! Craig Sinclair.. Cancer Council Victoria, Australia ! Tony Reeder … Cancer Research Unit Dunedin, New Zealand ! Jen Makin … Cancer Council Victoria, Australia 5

Previous Review (2004) vs. Current Review (2012) Interventions Implemented in Specific Settings Primary school settings Recommended 2004 Recommended 2012 Outdoor recreation settings Recommended Pending 2012 Child care centers Insufficient evidence Pending 2012 Secondary schools and colleges Insufficient evidence Pending 2012 Outdoor occupation settings Insufficient evidence Pending 2012 Health care settings and Insufficient evidence providers Pending 2012 http://www.thecommunityguide.org/cancer/skin/education-policy/index.html 6

Previous Review Interventions Implemented in Cross-Cutting Settings Mass media campaigns Insufficient evidence (2004) Insufficient evidence (2012) Community-wide multicomponent Insufficient evidence interventions Recommended (2012) Interventions targeting children’s Insufficient evidence parents and caregivers Pending (2012) http://www.thecommunityguide.org/cancer/skin/parents-caregivers/index.html 7

Why were some categories considered insufficicent evidence ! The 2004 reviews found insufficient evidence " Limitations in design and execution of available studies " Small number of qualifying studies " Variability in interventions and outcomes evaluated 8

Original Reviews and Subsequent Work ! Overview of original reviews " Search period January 1966-June 2000 " Paper published in AJPM 2004 ! Interim databases used to help update reviews " Emory " New Zealand ! Updated review from January 2000-May 2011 ! Full update-Mass Media and Multicomponent community –based intervention ! Interval update-hence forth 9

Considerations on this Update ! Update strategy: Full update vs. Interval Update ! Clarify definition of “mass media” as it relates to new approaches (e.g., Internet, social media) ! Clarify definitions of “primary school” ! “Sunscreen use” and “tanning bed use” as Recommendation outcomes 10

Mass Media

Intervention Description— Mass Media Interventions (Revised 2011) ! Mass media interventions to prevent skin cancer by reducing exposure to ultraviolet (UV) radiation use mass media channels such as print media (e.g., newspapers, magazines), broadcast media (e.g., radio, television), billboards, and the Internet to disseminate information, behavioral guidance, or both to a wide audience. They may be aimed at specific target audiences, but typically use broad distribution channels. Some of these interventions simply provide the audience with current information on the risk of UV exposure (i.e., a UV index), with the goal of raising awareness of the dangers of UV exposure and providing a basis for informed decision-making regarding outdoor activities. Others use persuasive techniques to attempt to change knowledge, attitudes, beliefs, intentions, and behaviors related to sun- protection and skin cancer. ! Although this review assesses the effectiveness of mass media interventions themselves, eligible interventions could also use small media (e.g., brochures, flyers, newsletters) or promotional products to increase awareness of campaign messages. 12

Analytic Framework: Mass Media Interventions Potential Harms: • Vitamin D deficiency • Less physical activity Increase knowledge of: Decrease incidence • UV effects Change in protective Change in of sunburn (photodamage, wrinkling) behavior attitudes re: • Skin cancer (different • Increased UV • UV exposure types, prevention related) protection (use of (exposure during appropriate clothing, peak hours, limit Mass Media • UV protection shade, and sunscreen) exposure) (knowledge of how to Interventions protect oneself) • Limit UV exposure • Indoor tanning (avoiding sun Decrease • Recognition of terms exposure during peak incidence (related to intervention) hours, avoid using of skin tanning bed) cancer Additional benefits: Early detection of skin cancer through: • Self exam • Increased doctor visits 13

Methods: Interval Search (Overall) ! Databases: Medline, CINAHL , PsycINFO ! Search Period: June 2000-May 2011 ! General Inclusion Criteria: " Primary intervention study with one or more outcomes of interest to these update reviews " Written in English " Conducted in a high-income country 14

Methods: Study Inclusion/Exclusion Criteria ! Inclusion criteria " Interventions provided information through mass media channels • Print media (e.g., newspapers, magazines, and billboards) • Broadcast media (e.g., television, radio, and billboards) " Interventions delivered via Internet or social media are eligible if the messages are intended for distribution to a large audience ! Exclusion criteria " Mass media was part of a multicomponent intervention* (e.g., mass media plus environmental/policy interventions) * Interventions were not considered multicomponent if mass media interventions were accompanied by: • Delivery of complementary messages through small media • Distribution of promotional materials to increase awareness of campaign messages 15

Interval Search Yield: 2000–2011 Broad Skin Cancer Topic Search Note: As per our update methods, we did not redo the original Potentially relevant articles from electronic databases and review of 1966-2000 search for evidence. reference lists (2000–2011) (11,106) Articles potentially relevant to skin cancer interventions (143) Articles assessing interventions other than mass media ( 124) Number of mass media papers identified (19) Articles excluded after full review (14) Studies that met inclusion criteria (5) Studies with limited quality of execution ���� � Studies identified from original New studies included in analysis + 5 � review period 3 � 16

Body of Evidence (Search Period 1966-2011) Suitability of Design Quality of Execution Greatest Moderate Least Good 1 (0–1 limitations) Dobbinson, 2008 (1) Fair 3 (3) (Kiekbusch, (2–4 limitations) Koster, 2011; 2000) Broadwater, 2004; Smith, 2002; (Lynch, 2003); (Geller, 1997); (Theobald, 1991) Limited 0 (>5 limitations) Qualifying studies: 4; (Additional evidence studies: 4) 17

Study Design Characteristics Suitability of Study Design Greatest Moderate Least Study Before and After Time Series: 1 Before-and-After: 3(1) Designs with concurrent Koster, 2011; Dobbinson, 2008 Described control: (1) Broadwater, 2004; in the (Kiekbusch, Smith, 2002; Included 2000) (Theobald, 1991) Studies Post only with treated comparison: (1) (Geller, 1997) Post only (comparison within exposed group): (1) (Lynch, 2003); 18

Locations of Included Studies and Study Samples Utah Broadwater United States (24 cities) , 2004 Geller, 1997 Sweden Kiekbusch, 2000 Denmark Denmark Koster, Koster, 2011 2011 Australia Dobbinson, 2008; Lynch, 2003; Smith, 2002; Theobald, 1991 19

Analytic Framework: Mass Media Interventions Potential Harms: • Vitamin D deficiency • Less physical activity 0 4 Increase knowledge of: Decrease incidence • UV effects Change in protective Change in of sunburn (photodamage, wrinkling) behavior attitudes • Skin cancer (different • Increased UV • UV exposure types, prevention related) protection (use of (exposure during appropriate clothing, peak hours, limit Mass Media • UV protection shade, and sunscreen) exposure) 0 (knowledge of how to Interventions protect oneself) • Limit UV exposure • Suntanning (avoiding sun Decrease • Recognition of terms exposure during peak incidence (related to intervention) hours, avoid using of skin tanning bed) cancer Additional benefits: Early detection of skin cancer through: • Self exam • Increased doctor’s visits 20