Effects of a short messaging service-based skin cancer prevention campaign in adolescents.

BACKGROUND: Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages. PURPOSE: To evaluate a skin cancer prevention intervention using short messaging service (SMS, or text messages) to impact sun-related knowledge, beliefs, and behaviors among adolescents. METHODS: The intervention was conducted in middle school youth (N=113) recruited in April or October 2012. Participants were English speakers, 11-14 years old, routinely carried a mobile phone, and completed a 55-minute sun safety education program. Participants were sent three sun safety-themed SMS messages each week for 12 weeks. Skin and sun protective knowledge, beliefs, behaviors, and post-intervention program satisfaction were collected and analyzed at baseline and end of intervention (April/June 2012; October 2012/January 2013). Paired responses were tested for equality using Wilcoxon signed-rank tests. RESULTS: Ninety-six students (85%) completed the study. At 12 weeks, significant positive changes were reported for sun avoidance during peak ultraviolet radiation, sunscreen application, wearing hats and sunglasses, and knowledge about skin cancer risk. Participants expressed moderately high satisfaction with the program, and 15% shared messages with family or friends. CONCLUSIONS: A brief, SMS-based intervention affected youth skin cancer prevention behaviors and knowledge. Future research will determine whether program effects were sustained at 24 weeks and explore how sun safety parenting practices inform these effects.

Development of a photographic scale for consistency and guidance in dermatologic assessment of forearm sun damage.

OBJECTIVES: To develop a photographic sun damage assessment scale for forearm skin and test its feasibility and utility for consistent classification of sun damage. DESIGN: For a blinded comparison, 96 standardized 8 × 10 digital photographs of participants' forearms were taken. Photographs were graded by an expert dermatologist using an existing 9-category dermatologic assessment scoring scale until all categories contained photographs representative of each of 4 clinical signs. Triplicate photographs were provided in identical image sets to 5 community dermatologists for blinded rating using the dermatologic assessment scoring scale. SETTING: Academic skin cancer prevention clinic with high-level experience in assessment of sun-damaged skin. PARTICIPANTS: Volunteer sample including participants from screenings, chemoprevention, and/or biomarker studies. MAIN OUTCOME MEASURES: Reproducibility and agreement of grading among dermatologists by Spearman correlation coefficient to assess the correlation of scores given for the same photograph, κ statistics for ordinal data, and variability of scoring among dermatologists, using analysis of variance models with evaluating physician and photographs as main effects and interaction effect variables to account for the difference in scoring among dermatologists. RESULTS: Correlations (73% to >90%) between dermatologists were all statistically significant (P < .001). Scores showed good to substantial agreement but were significantly different (P < .001) for each of 4 clinical signs and the difference varied significantly (P < .001) among photographs. CONCLUSIONS: With good to substantial agreement, we found the development of a photographic forearm sun damage assessment scale highly feasible. In view of significantly different rating scores, a photographic reference for assessment of sun damage is also necessary.

Phase 1 study of topical perillyl alcohol cream for chemoprevention of skin cancer.

Perillyl alcohol (POH) is a natural product derived from plants such as cherry and lavendin. Previous studies have indicated that topical POH inhibits ultraviolet (UV) B-induced skin carcinogenesis in vivo, and it may be an effective chemopreventive agent for skin cancer. We performed a 1-mo, first-in-man, Phase 1 trial of topically administered POH cream in human subjects. Endpoints included safety and evaluation of any histopathological changes in skin after 1 mo use of POH cream. We randomized 25 subjects with normal, healthy skin with little or no sun damage and no history of skin cancer in a double-blind fashion to receive topical POH (0.76% wt/wt) on 1 forearm with placebo cream applied to the other forearm twice daily for 30 days. Subjects were monitored for toxicity, and a 4 mm punch biopsy in the treated area was performed at the end of study for histopathological evaluation. The topical cream was well tolerated. No serious cutaneous toxicities, systemic toxicities, or histopathological abnormalities were observed. A total of 8 subjects (32%) reported mild adverse events possibly or probably related to use of cream including reversible appearance of 1 to 2 small papules. However, there was no significant difference between lesions appearing on the POH treated forearm vs. the placebo-treated forearm.

Cross-validation of murine UV signal transduction pathways in human skin.

Acute UVB irradiation of mouse skin results in activation of phospatidyinositol-3 (PI-3) kinase and mitogen-activated protein kinase (MAPK) pathways leading to altered protein phosphorylation and downstream transcription of genes. We determined whether activation of these pathways also occurs in human skin exposed to 4x minimal erythemic dose of UVB in 23 volunteers. Biopsies were taken prior to, at 30 min, 1 and 24 h post-UVB. In agreement with mouse studies, the earliest UV-induced changes in epidermis were seen in phospho-CREB (two- and five-fold at 30 min and 1 h) and in phospho-MAPKAPK-2 (three-fold at both 30 min and 1 h). At 1 h, phospho-c-JUN and phospho-p38 were increased five- and two-fold, respectively. Moreover, phospho-c-JUN and phospho-p38 were further increased at 24 h (12- and six-fold, respectively). Phospho-GSK-3beta was similarly increased at all time points. Increases in phospho-p53 (12-fold), COX-2 (four-fold), c-FOS (14-fold) and apoptosis were not seen until 24 h. Our data suggest that UVB acts through MAPK p38 and PI-3 kinase with phosphorylation of MAPKAPK-2, CREB, c-JUN, p38, GSK-3beta and p53 leading to marked increases in c-FOS, COX-2 and apoptosis. Validation of murine models in human skin will aid in development of effective skin cancer chemoprevention and prevention strategies.

Evaluation of a new, wearable, precision phase-change thermometer in neonates.

The primary purpose of this research was to examine the quantitative relationship between a new, wearable, continuous-read, precision phase-change thermometer (WCPPT) and a glass-mercury thermometer used in the axilla (GMA) in neonates. The study design was prospective and quasi-experimental with each subject acting as his/her own control. Data were collected in a tertiary teaching facility in the Southwestern United States from a convenience sample of 29 neonates. Simultaneous test and reference temperature measurements were taken from each neonate. Measurements were compared to determine clinical bias (mean difference +/- 1 standard deviation [SD]) and clinical agreement portrayed graphically (mean difference and limits of agreement plotted against the mean of both test and reference measurements) (Bland & Altman, 1986). Key findings included a clinical bias between the GMA and the TraxIt WCPPT of 0.04 degrees C (+/- 0.22) (mean difference +/- 1 SD) during the first measurement session with the GMA slightly higher, and -0.11 degrees C (+/- 0.17) (mean difference +/- 1 SD) during the second measurement with the WCPPT slightly higher. Bland and Altman representations supported these findings. These outcomes support a conclusion that the TraxIt WCPPT is neither clinically nor statistically different from the GMA on initial placement and exceeds GMA readings during prolonged, continuous axillary contact. Continuous thermometer placement eliminates drawdown, the transitory, local cooling effect of intermittent thermometer placement.