Barbara J. Walkosz

Background: The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the web-based spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer. Objective: This study aimed to develop and pilot test a theory-based intervention via the web to reduce 6 cancer risk factors among rural emerging adults (EAs) through community-engaged research. Methods: This mixed methods evaluation describes the development of a web-based cancer prevention intervention aimed at rural EAs aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and cocreated with EA and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. We report on 3 formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development. Descriptive statistics were applied to the surveys and pilot intervention baseline results to produce means and SDs using R. Results: We developed posts (n=400) for a Facebook feed aimed at reducing 6 cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the EA and stakeholder advisory boards. Formative surveys with rural EAs (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material. Conclusions: This web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural EAs. We offer key insights into the design and implementation of web-based cancer prevention interventions for EAs by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging EA and community stakeholder partners are presented, and we discuss how their involvement resulted in modifications that strengthened the intervention. Finally, we highlight the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability. Trial Registration: ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 International Registered Report Identifier (IRRID): RR2-10.2196/50392

Extreme heat is the leading cause of weather-related deaths. Prevention includes personal practices and emergency procedures. Behavioral interventions to i

BACKGROUND The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the web-based spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer. OBJECTIVE This study aimed to develop and pilot test a theory-based intervention via the web to reduce 6 cancer risk factors among rural emerging adults (EAs) through community-engaged research. METHODS This mixed methods evaluation describes the development of a web-based cancer prevention intervention aimed at rural EAs aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and cocreated with EA and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. We report on 3 formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development. Descriptive statistics were applied to the surveys and pilot intervention baseline results to produce means and SDs using R. RESULTS We developed posts (n=400) for a Facebook feed aimed at reducing 6 cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the EA and stakeholder advisory boards. Formative surveys with rural EAs (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material. CONCLUSIONS This web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural EAs. We offer key insights into the design and implementation of web-based cancer prevention interventions for EAs by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging EA and community stakeholder partners are presented, and we discuss how their involvement resulted in modifications that strengthened the intervention. Finally, we highlight the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability. CLINICALTRIAL ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 INTERNATIONAL REGISTERED REPORT RR2-10.2196/50392

Training men and women who live in prison to assist corrections staff with the care of growing numbers of older, sicker, cognitively impaired, and dying people in prison is an innovative and viable option to help meet pressing care demands. The purpose of this paper is to report findings from the usability testing of the fully developed Just Care electronic learning program for training carefully vetted people living in prison to assist staff with geriatric and end-of-life care. Research ethics approvals and informed consent were obtained. There were two rounds of usability testing conducted via videoconference. Interdisciplinary staff (i.e., corrections specialists, supervisors, nurses, and chaplains) and people living in prison were recruited from one men’s and one women’s prison. Fifteen participants completed the testing in each round. Results include participant demographics, concerns and areas for improvement by severity level of programming, and mean scores for both participant groups on the System Usability Scale. Overall, both the incarcerated and staff participants found the program easy to navigate and the interactive content was useful, engaging, and relevant to caring for aging and dying people who are incarcerated. Findings will be used to refine Just Care before usability testing with a larger sample.

Background: Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance. Objective: In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media. Methods: A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother–daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Results: Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=–0.10, 95% CI –0.12 to –0.08, P<.001) and daughters (b=–0.10, 95% CI –0.18 to –0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=–0.04, 95% CI –0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers’ intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=–0.50, 95% CI –0.99 to –0.01, P=.05). Conclusions: Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general. Trial Registration: ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807

Although tattoo artists provide tattoo aftercare instructions to their clients, recommendations are often not cost-effective or supported by evidence. A 22-year-old man developed a pruritic red rash over his healing tattoo one week after receiving the tattoo. Although multiple queries were negative, the patient did note use of a scented lotion before the eruption. We determined that allergic contact dermatitis from the scented lotion caused scarring and premature fading of the new tattoo. Tattoo artists should recommend avoidance of scented lotions and instruct clients to care for their new tattoo like a wound in their aftercare instructions.

Background: Outdoor workers experience chronic exposure to harmful ultraviolet radiation (UV) elevating their risk for skin cancer.Methods: A controlled randomized trial promoted the adoption of workplace sun safety policy and employee education at 98 public organizations in Colorado. A 2‐year follow‐up study with 68 organizations assessed the association of senior manager awareness of sun safety policies and implementation of sun safety actions.Results: Senior managers’ awareness of existing sun safety policies, but not their personal sun protection behaviors, predicted implementation of sun safety actions including the number of sun protection messages and sun protection items in the workplace and increased communication about sun safety to employees.Conclusions: Organizational adoption of sun safety policy must include efforts to broadly inform a workplace's senior management to ensure the policies are actually implemented and provide support for sun protection behaviors by outdoor workers to reduce UV exposure and skin cancer risk.

Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention. Two-year follow-up assessment in a randomized pretest–posttest controlled design. Local government organizations with workers in public safety, public works, and parks and recreation. Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers. Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education. Observations of SSW messages and sun safety items and surveys on organizations’ communication and actions on sun safety. Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed). At intervention worksites, more SSW messages (P < .001) and sun safety items (P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen (P = .005) and communicated about sun safety (P < .001); and more workers recalled receiving sun safety messages (P < .001) and sun safety training (P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats (P = .009), long work pants (P = .017), and shade structures (P = .036). Older workers received the most written messages (P = .015). Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

Background: Exposure to solar ultra violet radiation (UVR) is a primary risk factor for skin cancer. Vacationers often fail to protect themselves from harmful UVR. Purpose: The study assessed the sun protection practices of resort guests in various outdoor leisure and recreation venues during warm-weather seasons. Method: Forty-one North American resorts were enrolled in a quasi-experimental randomized controlled trial. Adult guests were observed (n = 4 091) and surveyed (n = 3 694) in a cross-sectional sample. Data collection was conducted in recreation and leisure venues with outdoors commons/reception areas acting as the comparison condition. Results: The mean percentage of vacationers at pools and beaches were more likely (P < .001) to wear sunscreen than in commons areas but less likely (P < .001) to wear coverup clothing or use shade. In both samples, the combined sun protection scores were higher in commons areas compared to all venues except for outdoor dining (P < .001). Discussion: Sun safety was suboptimal in all venues and was potentially mitigated by venue type. Translation to Health Education Practice: Approaches are needed to encourage vacationers to practice comprehensive sun protection and to work with resorts to construct built environments that facilitate rather than act as barriers to sun safety.