Association of Skin Cancer Risk and Protective Behaviors with Health Literacy Among Young Adults in the USA.

BACKGROUND: The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. METHOD: A US national sample of 958 adults, 18-25 years old, at moderate to high risk of developing skin cancer, completed a survey online. Behavioral outcomes were ultraviolet (UV) radiation exposure (e.g., indoor and outdoor tanning, sunburn) and protective (e.g., sunscreen use, sunless tanning) behaviors. Multivariable regression analyses were conducted to determine whether health literacy (a four-item self-report measure assessing health-related reading, understanding, and writing) was associated with behavioral outcomes while controlling for demographic factors. RESULTS: Higher health literacy was independently associated with less sunbathing, odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.98; less indoor tanning, OR = 0.38, CI = 0.31-0.48; and less use of tanning oils, OR = 0.54, CI = 0.43-0.69. However, health literacy was also associated with a lower likelihood of wearing long pants, OR = 0.76, CI = 0.58-0.99, or a hat, OR = 0.68, CI = 0.53-0.87, when outdoors. On the other hand, higher health literacy was associated with higher incidental UV exposure, OR = 1.69, CI = 1.34-2.14, and a greater likelihood of ever having engaged in sunless tanning, OR = 1.50, CI = 1.17-1.92. CONCLUSION: Interestingly, higher health literacy was associated with lower levels of intentional tanning yet also higher incidental UV exposure and lower skin protection among US young adults. These findings suggest that interventions may be needed for young adults at varying levels of health literacy as well as populations (e.g., outdoor workers, outdoor athletes/exercisers) who may be receiving large amounts of unprotected incidental UV.

Pregnancy-specific coping and changes in emotional distress from mid- to late pregnancy.

Objective: To examine whether pregnancy-specific coping predicts changes in emotional distress from mid- to late pregnancy. Background: There is a need to identify ways of coping that reduce or elevate emotional distress in pregnant women as such distress increases the risk of adverse birth outcomes. Methods: 132 women receiving prenatal care from a university hospital midwifery practice were recruited prior to 25 weeks gestation (M = 19.58, SD = 5.14). The state anxiety version of the State-Trait Personality Inventory (STPI) and the Revised Prenatal Distress Questionnaire (NuPDQ) were administered in mid- (M = 25.7 weeks, SD = 4.55) and late (M = 33.4 weeks, SD = 4.18) pregnancy and the Revised Prenatal Coping Inventory (NuPCI) at the latter timepoint. Results: Factor analysis of the NuPCI identified five distinct, conceptually interpretable types of coping: Prayer/Spirituality, Receiving Social Support, Planning/Preparation, Positive Appraisal, and Avoidant Coping. Avoidant Coping was used least frequently and Positive Appraisal was used most. The STPI and NuPDQ were aggregated to create a measure of emotional distress. After controlling for mid-pregnancy distress, Avoidant Coping predicted greater emotional distress in late pregnancy (ß = .18, R2 = .61, p < .01) and Positive Appraisal predicted lower late pregnancy distress (ß = -.15, R2 = .60, p < .01). Conclusion: This is one of the first studies to demonstrate that specific ways of coping with stress during pregnancy predict changes in pregnant women's emotional distress. The NuPCI is a psychometrically sound self-report instrument to examine coping and its association with emotional distress.

Prevalence and Correlates of Skin Cancer Screening Among Indoor Tanners and Nontanners.

Importance: The US Food and Drug Administration recommends that indoor tanners (ITs) be screened regularly for skin cancer (SC). Objective: To investigate the association between indoor tanning and SC screening. Design, Setting, and Participants: The 2015 National Health Interview Survey was a multistage, clustered, cross-sectional design with 30 352 US adults participating. The response rate for the sample adult data used in this study was 55.20% after excluding 1099 individuals who reported a history of SC and 2221 individuals with unknown SC screening or indoor tanning history. To examine the independent correlates of screening, we conducted multiple logistic regressions separately for ITs and nontanners (NTs), simultaneously including all preselected variables of interest as potential predictors. Formal interaction analyses were also performed to determine if the covariate effects differed significantly between ITs and NTs. Exposures: Indoor tanning as well as sociodemographic, health care, and SC risk and sun protection factors. Main Outcomes and Measures: The primary outcome was self-reported full-body SC screening by a physician. Univariable and multivariable analyses were conducted to determine the secondary outcome, correlates of SC screening among ITs and NTs. Results: A total of 15 777 participants (51.98%) were female, and 23 823 (78.49%) were white; 4987 (16.43%) of the sample had indoor tanned, and 1077 (21.59%) of these had tanned last year. A total of 1505 ITs (30.18%) and 4951 NTs (19.52%) had been screened for SC. Correlates of screening for ITs and NTs were older age (ITs: odds ratio [OR], 4.29 [95% CI, 2.72-6.76]; NTs, OR, 5.14 [95% CI, 4.01-6.58], age ≥65 years vs 18-29 years), higher income (ITs: OR, 2.08 [95% CI, 1.50-2.88]; NTs: OR, 1.79 [95% CI, 1.51-2.12]; >$100 000 vs $0-34 999), seeking online health information (ITs, OR, 0.71 [95% CI. 0.56-0.91; NTs, OR, 0.65 [95% CI, 0.58-0.72], for not looking up health info online), family history of melanoma (ITs: OR, 1.92 [95% CI, 1.26-2.93]; NTs: OR, 1.58 [95% CI, 1.21-2.05]) or SC (ITs: OR, 1.59 [95% CI, 1.17-2.17; NTs: OR, 1.61 [95% CI, 1.33-1.94]), very high SPF sunscreen use (ITs: OR, 0.57 [95% CI, 0.42-0.78]; NTs: OR, 0.71 [95% CI, 0.61-0.82], use of SPF of 1-14 vs SPF of >50), and receipt of a professional spray-on tan (ITs: OR, 0.60 [ 95% CI, 0.41-0.88]; NTs: OR, 0.51 [95% CI, 0.32-0.81], for not receiving a salon spray-on tan). Correlates for NTs only were white race (blacks: OR, 0.45 [95% CI, 0.37-0.54], others: OR, 0.40 [95% CI, 0.33-0.48]), non-Hispanic ethnicity (Hispanics: OR, 0.42 [95% CI, 0.36-0.50]), email use (no email: OR, 0.67 [95% CI, 0.56-0.80]), having a usual clinic/or physician's office (no usual place: OR, 0.56 [95% CI, 0.40-0.78]), emergency department visits (OR, 1.20 [95% CI, 1.06-1.35]), having had a previous cancer diagnosis (no cancer diagnosis: OR, 0.67 [95% CI, 0.57-0.79]), not being worried about medical bills (OR, 1.37 [95% CI, 1.15-1.63] vs very worried), sun protection (rarely/never: OR, 0.43 [95% CI, 0.34-0.56]), and sunless self-tanning (not using: OR, 0.62 [95% CI, 0.47-0.83]). Conclusions and Relevance: Few ITs have been screened for SC, although SC rates are higher than among NTs. It is not surprising that SC screening is associated with SC risk factors (eg, family history of SC and age) among ITs. However, some unscreened ITs may be putting themselves at even greater risk of SC by also being more likely to use low SPF sunscreen than ITs who have been screened for SC.

Patient-provider communication, maternal anxiety, and self-care in pregnancy.

RATIONALE: Favorable relationships with health care providers predict greater patient satisfaction and adherence to provider recommendations. However, the specific components of patient-provider relationships that account for these benefits have not been identified. The potential benefits of strong patient-provider relationships in pregnancy may be especially important, as care providers have frequent, intimate interactions with pregnant women that can affect their emotions and behaviors. In turn, prenatal emotions and health behaviors have potent effects on birth outcomes. OBJECTIVE: This study investigated whether pregnant women's relationships with their midwives predicted better self-care. Specific components of the patient-provider relationship (communication, integration, collaboration, and empowerment) were examined. We also investigated a mechanism through which these relationship components may be associated with salutary health behaviors: by alleviating women's anxiety. METHODS: In total, 139 low-risk patients of a university-affiliated midwifery practice in the northeastern United States completed well-validated measures assessing their relationship with midwives, state anxiety, and prenatal health behaviors in late pregnancy; state anxiety was also assessed in mid-pregnancy. RESULTS: Women's perceptions of better communication, collaboration, and empowerment from their midwives were associated with more frequent salutary health behavior practices in late pregnancy. Controlling for mid-pregnancy anxiety, lower anxiety in late pregnancy mediated associations of communication and collaboration with health behavior practices, indicating that these associations were attributable to reductions in anxiety from mid- to late pregnancy. CONCLUSION: Results substantiate that benefits of patient-provider relationships in pregnancy may extend beyond providing medical expertise. Some aspects of patient-provider relationships may offer direct benefits to pregnant women in promoting better health practices; other aspects of these relationships may indirectly contribute to better health practices by alleviating negative emotions. The benefits of strong midwife relationships may derive from the reassurance, comfort, and warmth these relationships offer, as well as the information and education that midwives provide to their patients.

Psychometric properties of the Prenatal Health Behavior Scale in mid- and late pregnancy.

INTRODUCTION: Psychometrically sound self-report measures are important tools to advance research on health behaviors in pregnancy. The Prenatal Health Behavior Scale (PHBS) has been used in prior studies to quantify health behaviors and examine their associations with relevant variables, but its psychometric properties have not been carefully investigated. METHODS: In a sample of low-risk women, we examined the factor structure, reliability, and validity of the PHBS at mid- (N = 138) and late (N = 102) pregnancy. RESULTS: In confirmatory factor analysis, items on the PHBS loaded onto a single reliable factor, but separating health-promoting and health-impairing behavior into two factors had better model fit. The scales defined by these two factors had good internal consistency in mid- and late pregnancy, were only moderately correlated, and were predicted by somewhat different sets of sociodemographic and psychological variables. Pregnancy-specific stress was a robust predictor of health-promoting and health-impairing behavior across time. DISCUSSION: Results bolster confidence in the reliability and validity of the PHBS and its appropriateness as a self-report tool for investigation of health behaviors among pregnant women. This study is one of the first investigations to examine patterns and predictors of health behavior practices at two time periods of pregnancy.

Psychosocial correlates of health-promoting and health-impairing behaviors in pregnancy.

Behaviors during pregnancy including eating, exercise, cigarette smoking, and other substance use affect the health of a pregnant woman and her fetus. However, little is known about what influences pregnant women to engage in these health behaviors. Based upon relevant theory, we hypothesized that because health-promoting behaviors require continuous efforts that may depend upon a reliable, stable set of resources, intrapersonal traits, namely self-esteem and optimism, would be associated with the practice of health-promoting behaviors during pregnancy. In addition, we hypothesized that variables reactive to the more immediate context, pregnancy-specific stress and perceived control over pregnancy, would be associated with the practice of health-impairing behaviors. We distinguished health-promoting and health-impairing behaviors in a diverse sample of 165 pregnant women and investigated whether such behaviors are associated with distinct psychosocial factors. Results supported study hypotheses and provide evidence that even after controlling for maternal age, income, body mass index, and gestation, a stable, self-relevant disposition, self-esteem, is associated with the practice of health-promoting behaviors in pregnancy whereas pregnancy-specific stress, a situationally-evoked factor, is associated with the practice of health-impairing prenatal behaviors. Perceived control over pregnancy, which may reflect stable disposition and situational perceptions, was associated with health-promoting and health-impairing behaviors.