Sun exposure and protection behaviors in urban and rural long-term melanoma survivors

Abstract

Given the increased risk for another occurrence of melanoma among melanoma survivors, safe sun behaviors are important. Little data exist about differences in sun behaviors among melanoma survivors residing in urban versus rural communities. We wanted to describe differences in sun exposure and protection behaviors by urban/rural status among melanoma survivors. We conducted a secondary data analysis of 724 melanoma survivors who participated in a cross-sectional survey. Unadjusted and adjusted logistic regression models assessed urban versus rural differences in sun exposure and protection behaviors. Unadjusted analyses showed evidence that urban melanoma survivors spent less time in the sun on weekdays and were more likely to use sunscreen, however, these differences disappeared when adjusting for confounding factors. Our study provides little evidence that rurality is an independent risk factor for worse sun protection behaviors in melanoma survivors after accounting for sociodemographic differences, but rurality as a broader term may be partially defined by urban versus rural sociodemographic differences. Skin health messaging to rural melanoma survivors should emphasize on ways to protect oneself from UV radiation even when spending time outside.

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References

  1. 1.

    American Cancer Society (2016) Cancer treatment and survivorship facts & figures 2016–2017. American Cancer Society, Atlanta

    Google Scholar 

  2. 2.

    Cormier JN, Cromwell KD, Ross MI (2012) Health-related quality of life in patients with melanoma: overview of instruments and outcomes. Dermatol Clin 30(2):245–254, viii. https://doi.org/10.1016/j.det.2011.11.011. (Epub 2012/01/31; PubMed PMID: 22284139)

  3. 3.

    Singh SD, Ajani UA, Johnson CJ, Roland KB, Eide M, Jemal A, Negoita S, Bayakly RA, Ekwueme DU (2011) Association of cutaneous melanoma incidence with area-based socioeconomic indicators–United States, 2004–2006. J Am Acad Dermatol 65(5):S58.e1–S.e12

  4. 4.

    Gilchrest BA, Eller MS, Geller AC, Yaar M (1999) The pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med 340(17):1341–1348

    CAS  Article  Google Scholar 

  5. 5.

    Narayanan DL, Saladi RN, Fox JL (2010) Ultraviolet radiation and skin cancer. Int J Dermatol 49(9):978–986

    Article  Google Scholar 

  6. 6.

    Zahnd WE, James AS, Jenkins WD, Izadi SR, Fogleman AJ, Steward DE, Colditz GA, Brard L (2018) Rural–urban differences in cancer incidence and trends in the United States. Cancer Epidemiol Biomarkers Prev 27(11):1265–1274

    Article  Google Scholar 

  7. 7.

    Pérez-Gómez B, Aragonés N, Gustavsson P, Lope V, López-Abente G, Pollán M (2008) Socio-economic class, rurality and risk of cutaneous melanoma by site and gender in Sweden. BMC Public Health. 8(1):33

    Article  Google Scholar 

  8. 8.

    Moy E, Garcia MC, Bastian B, Rossen LM, Ingram DD, Faul M, Massetti GM, Thomas CC, Hong Y, Yoon PW (2017) Leading causes of death in nonmetropolitan and metropolitan areas-United States, 1999–2014. Morb Mortal Wkly Rep Surveill Summ 66(1):1–8

  9. 9.

    Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC (2017) Invasive cancer incidence, 2004–2013, and deaths, 2006–2015, in nonmetropolitan and metropolitan counties—United States. MMWR Surveill Summ 66(14):1

    Article  Google Scholar 

  10. 10.

    Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P (2015) Challenges of rural cancer care in the United States. Oncology 29(9):633–640

    PubMed  Google Scholar 

  11. 11.

    Kaufman BG, Thomas SR, Randolph RK, Perry JR, Thompson KW, Holmes GM, Pink GH (2016) The rising rate of rural hospital closures. J Rural Health 32(1):35–43

    Article  Google Scholar 

  12. 12.

    Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D (2008) Geographic access to cancer care in the US. Cancer 112(4):909–918

    Article  Google Scholar 

  13. 13.

    American Society of Clinical Oncology (2019) ASCO announces new task force to address rural cancer care gap. https://www.asco.org/about-asco/press-center/news-releases/asco-announces-new-task-force-address-rural-cancer-care-gap

  14. 14.

    Vogel RI, Strayer LG, Engelman L, Nelson HH, Blaes AH, Anderson KE, Lazovich D (2017) Sun exposure and protection behaviors among long-term melanoma survivors and population controls. Cancer Epidemiol Prev Biomark 26(4):607–613

    Article  Google Scholar 

  15. 15.

    von Schuckmann LA, Wilson LF, Hughes MCB, Beesley VL, Janda M, van der Pols JC, Smithers BM, Khosrotehrani K, Green AC (2019) Sun protection behavior after diagnosis of high-risk primary melanoma and risk of a subsequent primary. J Am Acad Dermatol 80(1):139–48.e4. https://doi.org/10.1016/j.jaad.2018.06.068

    Article  Google Scholar 

  16. 16.

    Ferrucci LM, Cartmel B, Clare RA, Choy CC, Kershaw T, Leffell DJ, Mayne ST (2018) Cross-sectional assessment of ultraviolet radiation–related behaviors among young people after a diagnosis of melanoma or basal cell carcinoma. J Am Acad Dermatol 79(1):149–152. https://doi.org/10.1016/j.jaad.2017.12.056

    Article  PubMed  Google Scholar 

  17. 17.

    Bradford PT, Freedman DM, Goldstein AM, Tucker MA (2010) Increased risk of second primary cancers after a diagnosis of melanoma risk of secondary cancers after melanoma diagnosis. Arch Dermatol 146(3):265–272. https://doi.org/10.1001/archdermatol.2010.2

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Brown DL, Schafft KA (2011) Rural people and communities in the 21st century: resilience and transformation. Polity Press, Malden, MA

    Google Scholar 

  19. 19.

    Werner M (2018) It’s an addiction crisis. MN Center For Rural Policy and Development, Mankato. https://www.ruralmn.org/its-an-addiction-crisis/

  20. 20.

    Weaver KE, Geiger AM, Lu L, Case LD (2013) Rural-urban disparities in health status among US cancer survivors. Cancer 119(5):1050–1057

    Article  Google Scholar 

  21. 21.

    Borders TF, Booth BM (2007) Rural, suburban, and urban variations in alcohol consumption in the United States: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. J Rural Health 23(4):314–321

    Article  Google Scholar 

  22. 22.

    Bennett KJ, Olatosi B, Probst JC (2008) Health disparities: a rural-urban chartbook. Health disparities: a rural-urban chartbook. South Carolina Rural Health Research Center, Columbia

  23. 23.

    Quinn M, Alamian A, Hillhouse J, Scott C, Turrisi R, Baker K (2015) Prevalence and correlates of indoor tanning and sunless tanning product use among female teens in the United States. Prev Med Rep 2:40–43

    Article  Google Scholar 

  24. 24.

    Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC (2003) Use of indoor tanning facilities by white adolescents in the United States. Arch Pediatr Adolesc Med 157(9):854–860

    Article  Google Scholar 

  25. 25.

    Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM (2010) Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Biomark Prev. 19(6):1557–1568. https://doi.org/10.1158/1055-9965.EPI-09-1249(Epub 2010/05/29; PubMed PMID: 20507845; PMCID: 2883000)

    Article  Google Scholar 

  26. 26.

    Glanz K, Yaroch AL, Dancel M, Saraiya M, Crane LA, Buller DB, Manne S, O’Riordan DL, Heckman CJ, Hay J (2008) Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol 144(2):217–222

    Article  Google Scholar 

  27. 27.

    Rural Urban Commuting Areas (2019) ZIP RUCA version 3.10. Center United States Department of Agriculture. https://ruralhealth.und.edu/ruca

  28. 28.

    Thomas NE, Kanetsky PA, Edmiston SN, Alexander A, Begg CB, Groben PA, Hao H, Busam K, Ollila DW, Berwick M, Conway K (2010) Relationship between germline MC1R variants and BRAF-mutant melanoma in a North Carolina population-based study. J Invest Dermatol 130(5):1463–1465. https://doi.org/10.1038/jid.2009.410(PubMed PMID: 20043015; PMCID: 2950750)

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Zahnd WE, Goldfarb J, Scaife SL, Francis ML (2010) Rural-urban differences in behaviors to prevent skin cancer: an analysis of the Health Information National Trends Survey. J Am Acad Dermatol 62(6):950–956

    Article  Google Scholar 

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Acknowledgements

This study was funded by a grant from the Masonic Cancer Center of the University of Minnesota's Internal Grants Program to D. Lazovich, National Cancer Institute NIH grant P30 CA77598 (Principal InvestigatOR D. Yee) utilizing the Biostatistics Core shared resource of the Masonic Cancer Center, and University of Minnesota and Award Number UL1TR000114 (Principal InvestigatOR B. Blazar) from the National Center for Advancing Translational Sciences (NCATS) of the NIH. R.I. Vogel is supported by a Young Investigator Award from the Melanoma Research Alliance. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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PJ: Data analysis and interpretation; manuscript draft and review; approval of final manuscript. DL: Conception/design; data acquisition and interpretation; manuscript draft and review; approval of final manuscript. HW: Literature review; data analysis and interpretation; manuscript review; approval of final manuscript. CB: Data interpretation; manuscript draft and review; approval of final manuscript. RV: Conception/design; data acquisition, analysis and interpretation; manuscript draft and review; approval of final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Rachel I. Vogel.

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The authors have no conflict of interest to declare.

Human and animal rights statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Minnesota Institutional Review Board and the Minnesota Cancer Surveillance System (1312S46684) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Jewett, P.I., Lazovich, D., Wehelie, H. et al. Sun exposure and protection behaviors in urban and rural long-term melanoma survivors. Arch Dermatol Res 312, 413–420 (2020). https://doi.org/10.1007/s00403-019-02023-7

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Keywords

  • Melanoma
  • Rural–urban differences
  • Cancer survivorship
  • Sun behaviors
  • Sun exposure