ABSTRACT
Indoor tanning using ultraviolet (UV) radiation increases skin cancer risk. However, there is little objective information on when or where indoor tanning is used. We aimed to evaluate tanning salon geography and patterns of use using objective data rather than self-report. We used data from SafeGraph, a company that combines smartphone location data and proprietary geographic data. Our dataset included aggregate, anonymous data from January 1, 2018-December 31, 2020. We developed and validated an algorithm (positive predictive value 92.6%) to identify businesses offering UV indoor tanning. We evaluated tanning salon locations, number of tanning salons per state population, and foot traffic patterns by visits per month, per day of the week, and per hour of the day. Our algorithm identified 7412 businesses as tanning salons. Of those, 2795 (37.7%) had foot traffic data available. The highest concentrations of tanning salons were in Midwestern states. We found peaks in the spring (April) of 2018 and 2019, a slightly later peak (June) in 2020, and a short-term decrease in tanning salon visits during the early phases of the COVID-19 pandemic (March-May 2020). Visits were most frequent during weekdays (Monday-Friday). Peak times of day were 12pm-3pm. Our study has limitations: it includes only a small portion of the US population (approximately 10% of mobile devices) and we could not account for indoor tanning outside of tanning salons. Indoor tanning is a known carcinogen, but the majority of information on use is based on cross-sectional surveys. Our study represents new information for public health strategies to decrease exposure to this carcinogen.
ABSTRACT
The COVID-19 pandemic has accelerated the adoption of telemedicine. However, current tools pose substantial barriers for older adults and those with low digital literacy. By implementing user-centered design, we developed a digital tool, Dermatology for Older Adults (DORA), for home-based monitoring of skin disease, specifically designed for older adults. DORA is a virtual assistant based on REDCap and Twilio APIs that automates image and symptom collection and allows communication between patients and the research team. We evaluated the feasibility, usability, patient compliance, retention, and clinical utility of DORA. Eligibility criteria included patients >70 years with any skin disease, access to a smartphone, and no cognitive impairment. We recruited 62 patients aged 70-94 (mean age 77), 39% female, 81% white from Stanford’s Dermatology Clinic from August-December 2021. We asked patients to send weekly photos and answer a questionnaire of a single skin lesion for 4 weeks, then monthly for 4 months. We measured response time, photo quality, and participant satisfaction using mHealth app usability questionnaire (MAUQ). The median response time was 1.4 days (IQR 0.6-3.4). Four participants dropped out. 83% completed photo submission requests (48% at initial request, 19% after 1st reminder and 16% after 2nd reminder). 80% of all questionnaires requested (131 of 163) were completed. Four dermatology clinicians evaluated the quality of the first 88 images and reported good confidence in triaging skin diseases. MAUQ scores were high for ease of use (5.6 SD1.3), interface satisfaction (5.5 SD1.3), and usefulness (5.2 SD1.3). Patients were consistently able to use DORA to submit photos and symptoms and reported high usability and satisfaction. Patient retention was high, and clinicians felt confident making triage recommendations based on DORA images. This approach can be used in other settings where digital literacy barriers and unequal access to dermatologists contribute to healthcare disparities.
Subject(s)
Dermatology , Skin Diseases , Telemedicine , Aged , Dermatologists , Humans , Quality Improvement , Skin Diseases/therapyABSTRACT
Problem The COVID-19 pandemic highlighted existing healthcare disparities in the US, with people of color dying from COVID-19 at twice the rate of white people. A striking disparity in vaccination rates for racial minorities followed, with vaccination rates among white people over 2.5 times that for Latinx and nearly twice that for Black people (March 2021). It is vital we ensure tailored public health messaging regarding the COVID-19 vaccine is delivered to all communities. Facebook provides an opportunity for large-scale, targeted health promotion. Description of practice Our goal is to increase COVID-19 vaccination uptake across the US, with a specific focus on reaching underrepresented communities most affected by the pandemic. We created a public health campaign centered on a representative group of physicians conveying their own short (<1 minute) video messages that the COVID-19 vaccine is safe and effective. We placed these videos as advertisements on Facebook and directed them using geotargeting to reach zip codes in the US with the highest COVID-19 death rates cross-referenced with zip codes in which >50% of the population is Black or Latinx. We launched the campaign in California on April 9, and nationwide on April 12 2021. The primary outcome measures of the campaign were reach (number of individuals exposed, frequency and duration of views) and engagement (number of likes and shares). Results During our campaign (April 9-April 30), the videos appeared on Facebook newsfeeds 54.4 million times, reaching 9.9 million individuals an average of 5.5 times each. Overall, the videos received 10,053 reactions and 1,161 shares. 1.8 million video plays ran for at least 25% of the video. Lessons We demonstrate the feasibility of rapid, social media-based dissemination of tailored public health messages regarding the COVID-19 vaccine to communities in need. We are now focusing efforts on strategies to assess the impact of such messaging on vaccination uptake. Key messages Geotargeting on social media enabled rapid dissemination of COVID-19 vaccine uptake messages to underrepresented communities. Further work is required to evaluate behavioral change impact.