Dataset Information

Decision Tree Model vs Traditional Measures to Identify Patterns of Sun-Protective Behaviors and Sun Sensitivity Associated With Sunburn.

ABSTRACT:

Importance

Understanding patterns of sun-protective behaviors and their association with sunburn can provide important insight into measurement approaches and intervention targets.

Objective

To assess whether decision-based modeling can be used to identify patterns of sun-protective behaviors associated with the likelihood of sunburn and to compare the predictive value of this method with traditional (ie, composite score) measurement approaches.

Design, setting, and participants

This cross-sectional study used a nationally representative sample of 31?162 US adults from the 2015 National Health Interview Survey, consisting of household interviews conducted in person and completed by telephone when necessary. Participants included civilian noninstitutionalized US adults. Data were collected from January 1 through December 31, 2015.

Main outcomes and measures

The associations among sun sensitivity, multiple sun-protective behaviors (ie, using sunscreen, seeking shade, wearing a hat, and wearing protective clothing), and sunburn were examined using a ?2 automatic interaction detection method for decision tree analysis. Results were compared with a composite score approach.

Results

In our study population of 28?558 respondents with complete data (54.1% women; mean [SD] age, 49.0 [18.0] years), 20 patterns of sun protection were identified. Among 15?992 sun-sensitive individuals, those who used only sunscreen had the highest likelihood of sunburn (62.4%). The group with the lowest likelihood of sunburn did not report using sunscreen but engaged in the other 3 protective behaviors (24.3% likelihood of sunburn). Among 12?566 non-sun-sensitive individuals, those who engaged in all 4 protective behaviors had the lowest likelihood of sunburn (6.6%). The highest likelihood of sunburn was among those who only reported sunscreen use (26.2%). The decision tree model and the composite score approach correctly classified a similar number of cases; however, the decision tree model was superior in classifying cases with sunburn (44.3% correctly classified in the decision tree vs 25.9% with the composite score).

Conclusions and relevance

This innovative application of a decision tree analytic approach demonstrates the interactive and sometimes counterintuitive effects of multiple sun-protective behaviors on likelihood of sunburn. These data show where traditional measurement approaches of behavior may fall short and highlight the importance of linking behavior to a clinically relevant outcome. Given the scope of those affected and enormous associated health care costs, improving efforts in skin cancer prevention has the potential for a significant effect on public health.

SUBMITTER: Morris KL

PROVIDER: S-EPMC6143023 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Decision Tree Model vs Traditional Measures to Identify Patterns of Sun-Protective Behaviors and Sun Sensitivity Associated With Sunburn.

Morris Kasey L KL Perna Frank M FM

JAMA dermatology 20180801 8

<h4>Importance</h4>Understanding patterns of sun-protective behaviors and their association with sunburn can provide important insight into measurement approaches and intervention targets.<h4>Objective</h4>To assess whether decision-based modeling can be used to identify patterns of sun-protective behaviors associated with the likelihood of sunburn and to compare the predictive value of this method with traditional (ie, composite score) measurement approaches.<h4>Design, setting, and participant ...[more]

PMID: 29955755

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Project description:Sun protection among children is of utmost importance since sunburn in early life is a major risk factor for skin cancer development. Because parents play a vital role in enhancing sun safety among children, this study explored parental perceptions concerning sun exposure, sun protection behaviors, and sunburn in children. Additionally, the context in which children experience sunburn in order to assist the development, optimization, and targeting of sun safety interventions for parents is revealed. A qualitative study design, using a semi-structured interview guide addressing several themes (e.g., sun exposure, sun protection, and sunburn experiences), was used. Data were collected in the Netherlands in the fall of 2019. Parents were recruited via purposive sampling at schools, youth services centers, and social media. Execution, transcription, and coding of the interviews was done by two researchers, using the qualitative analyzing program Nvivo (interrater reliability of d = 0.84). In total, 26 interviews were performed (n = 17 mothers, n = 17 daughters, aged between 4 and 11 years). Parental perceptions and recall of their child's lifetime sunburn were frequent, even though all parents reported using at least one sun protection measure during sun exposure situations and parents seemed often unaware of their child's sunburn. Moreover, parents reported an overreliance on sunscreen, often failing to adequately protect their children's skin. Water-related activities, a lack of shade, and misconceptions regarding UV-index were often related to sunburn. In addition, unexpected sun exposure or longer exposure duration than initially planned were reported as challenging situations. The majority of parents had positive perceptions regarding tanned skin for both themselves as for children. This study provides directions for skin cancer prevention efforts targeted at both parents and their children. Since a lack of knowledge regarding sufficient sun protection measures and sunburn occurrence in various situations was reported, educational efforts are warranted. Additionally, focusing on clothing, shade-seeking, and adequate sunscreen use is recommended to increase children's sun safety. By intervening in the physical environment as well (e.g., providing shady areas), sun protection barriers can be reduced. Lastly, the general positive attitude toward tanned skin evident in this study is certainly worthy of attention in future interventions.

Project description:Background: Sun exposure has short- and long-term adverse effects on eyes, skin, and the immune system. The most serious effect, melanoma, is largely attributable to natural ultraviolet radiation. Its prevalence is steadily increasing in fair-skinned populations in most European countries. Despite annual prevention campaigns, the French population continues to be overexposed to the sun and under-protected. Social and psychosocial characteristics may play an important role in sun protection determinants. Overexposure is partially motivated by a desire to tan oneself for aesthetic reasons. During summer, intense exposure constitutes a major risk factor for melanoma, making tourists a particularly high-risk population. Literature reviews concluded that appearance-based interventions highlighting the aesthetic effects of sun exposure on skin photoaging showed promise in terms of improving sun-exposure and sun-protection behaviors, especially among younger people, but that more rigorous studies were needed. In this context, we implemented the PRISME study to: - identify the determinants, in particular social and psychosocial, of sun-protection of French summer tourists visiting the Mediterranean coastline; - design two prevention interventions grounded in psychosocial theories; - compare the impact of both interventions on tourists' sun-protection behaviors, and identify the determinants influencing this impact. This paper presents the methodology of the PRISME study. Methods: During summer 2019, we conducted a cluster randomized crossover trial to compare two prevention interventions, one based on health-related messages (health effects information, phototype calculation), the other on appearance-related messages (photoaging information, ultraviolet photography), among French tourists aged 12-55 years old in coastline campsites in the French region of Occitanie. Both interventions were anchored in the theory of planned behavior and in the transtheoretical model. The interventions' impact was measured using face-to-face questionnaires and skin color measurements both immediately before and 4 days after the interventions. A second follow-up, using an online questionnaire, will be conducted in September 2020 to measure the longer-term effects of both interventions. Discussion: Despite certain study limitations, PRISME take into consideration several known methodological gaps. The study's results will enable to evaluate the efficacy of the promising appearance-based approach in France, and to identify vulnerable sub-populations and mechanisms to improve sun-protection behaviors of French tourists.

Dataset Information

Decision Tree Model vs Traditional Measures to Identify Patterns of Sun-Protective Behaviors and Sun Sensitivity Associated With Sunburn.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

Decision Tree Model vs Traditional Measures to Identify Patterns of Sun-Protective Behaviors and Sun Sensitivity Associated With Sunburn.

Similar Datasets

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