Prevention
Conditions
Keywords
skin cancer, physical activity
Brief summary
Recreational UV exposure is associated with every form of skin cancer and individuals who engage in more physical activity have a higher prevalence of sunburn, a proximal biomarker of melanoma risk, perhaps explaining why melanoma is the only cancer with which physical activity is positively correlated. Mobile technology for tracking physical activity has become increasingly prevalent and Strava, an activity tracking app and social networking site for athletes, is one of the most popular of these technologies. This research will test the feasibility of delivering location-based, ecologically-valid sun safety advice to Strava users at times when they are predicted to be engaged in outdoor physical activity, by utilizing Strava's public open-source Applications Programming Interface.
Detailed description
Skin cancer is the most common cancer in the United States. Over 5.4 million cases of keratinocyte cancers (basal and squamous cell) are diagnosed annually and incidence of melanoma has increased 3% each year for the past 30 years. In the 2014 Call to Action to Prevent Skin Cancer, the U. S. Surgeon General included strategies for coordinating messages on sun safety and physical activity, recognizing the need for sun safety among populations that engage in physical activity outdoors. Recreational UV exposure is associated with every form of skin cancer; individuals who engage in more physical activity have a higher prevalence of sunburn. Melanoma is the only cancer with which physical activity is positively correlated. Strava, a tracking app and social networking site for athletes, is one of the most popular of mobile technologies for logging physical activity and providing social feedback on activities by other Strava users. The goal of this R21 research is to test the feasibility of interfacing with the Strava website and its mobile app to develop an algorithm that a) predicts when individuals are likely to be engaged in physical activity outdoors in the sun when ultraviolet radiation is high and b) delivers sun safety advice tailored to the time, location, and personal risk (e.g., skin sun sensitivity) of the Strava users. Concept focus groups with Strava users and non-users will provide input on the feasibility, content, and functions in the Strava Sun (SS) intervention. The algorithm that predicts future outdoor exercise will be developed using machine learning modeling on activity data provided by Strava users. The SS intervention will be programmed to deliver ecologically-valid sun safety advice through Strava's open-source Applications Programming Interface (API) via email and comments in the Strava interface. The sun safety advice will be tailored to location, time, season and user's personal risk, employing advice algorithms we developed for a sun safety mobile app, sunZapp, and a social media message library in our Go Sun Smart intervention for outdoor recreation resorts. SS will be tested for usability prior to conducting a pilot field trial to establish feasibility of SS in practice. The project is significant and innovative. A sun protection interface for the Strava platform will provide individuals who engage in regular physical activity personalized, ecologically-valid advice to help them practice sun safety during outdoor activities. It will contain a novel machine learning algorithm that predicts future high-risk behavior, i.e., outdoor physical activity, to provide precision prevention advice.
Interventions
BEHAVIORALIntervention Group
Test the developed algorithm that delivers location-based, tailored sun safety advice to Strava users through Strava comments for acceptability, ways of interacting with it, and barriers/willingness to allowing access.
Sponsors
National Cancer Institute (NCI)
Colorado State University
Klein Buendel, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* 18 or older; reside in the United States; read/write in English; upload outdoor activity to Strava ≥3 times per week
Exclusion criteria
* Younger than 18; reside outside of the United States; read/write in a language other than English; uploads Strava activity less than 3 times per week OR does not use Strava; having a cognitive or visual impairment that would interfere with participating; having another family member participating in the research; having participated in the focus group and usability testing
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of Sun Protection Practices | baseline and four-weeks post intervention | What proportion of 8 sun protection practices did participants do on reported days of exercise. Participants responded to 8 potential sun protection practices and provided the number of days they did each practice within the timeframe provided (3 months at baseline; 4 weeks at posttest). Participants also provided number of days of outdoor exercises within timeframe. Proportion was calculated by dividing the frequency of each sun protection practice by the number of days of outdoor exercise within the timeframe. Mean score of all sun protection practices per day of outdoor exercise is reported. Range = 0-1, where a higher number indicates more sun safety practices performed. A proportion was used to account for different timeframes at baseline and posttest. |
| Prevalence of Sunburn | Baseline | Participants were asked if their skin was sunburned (described as being red and/or painful from exposure to the sun) in the past three months, and if so, how many times. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Physical Activity (Godin Leisure-Time Exercise Questionnaire) | Baseline | Duration in minutes of exercise multiplied by number of times per week, in the past 7 days. Total minutes per week calculated; mean per treatment group reported. |
| Recall of Sun Protection Messages | four weeks post intervention | Participants in intervention only were asked about how many messages they read. Scale ranges from 0 - 3. 0 = none of the messages; 1 = some of the messages; 2 = most of the messages; 3 = all of the messages. Higher score indicates higher message recall. |
| Self-Efficacy for Sun Protection When Exercising | baseline and four-weeks post intervention | Participants were asked: how confident are you that you can practice sun safety next time that you exercise. 1 = not confident; 2 = a little confident; 3 = somewhat confident; 4 = very confident. Higher scores indicates more self-efficacy for sun safety. |
| Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire) | baseline | Duration in minutes of exercise multiplied by number of times per week, in the past 7 days. Total minutes per week calculated; mean per treatment group reported. |
Countries
United States
Participant flow
Pre-assignment details
n=123 participants were recruited and screened for participation in formative research prior to the pilot study detailed, including focus groups, usability testing, and collection of activity data. None of those participants were randomized. n=41 participants participated in the randomized pilot as described in this entry.
Participants by arm
| Arm | Count |
|---|---|
| Intervention Group Participants will be enrolled on a rolling basis and participate in SS for 4 months in the intervention condition. After pretesting, participants will receive sun protection messages from SS through emails/comments based on algorithm results from their profile and activity data. All participants will complete posttest survey 4 months from randomization.
Intervention Group: Test the developed algorithm that delivers location-based, tailored sun safety advice to Strava users through Strava comments for acceptability, ways of interacting with it, and barriers/willingness to allowing access. | 31 |
| Control Group A small control group will be included to see if a no-treatment control condition is acceptable to users and estimate follow-up rates for planning a randomized trial. Participants will be enrolled on a rolling basis and will complete a pretest at randomization. All participants will complete a posttest survey 4 months from randomization. | 10 |
| Total | 41 |
Baseline characteristics
| Characteristic | Intervention Group | Control Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 3 Participants | 3 Participants | 6 Participants |
| Age, Categorical Between 18 and 65 years | 28 Participants | 7 Participants | 35 Participants |
| Age, Continuous | 42.2 years STANDARD_DEVIATION 14.8 | 48.9 years STANDARD_DEVIATION 17.9 | 43.9 years STANDARD_DEVIATION 15.7 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 31 Participants | 9 Participants | 40 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 26 Participants | 10 Participants | 36 Participants |
| Sex: Female, Male Female | 22 Participants | 7 Participants | 29 Participants |
| Sex: Female, Male Male | 9 Participants | 3 Participants | 12 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 31 | 0 / 10 |
| other Total, other adverse events | 0 / 31 | 0 / 10 |
| serious Total, serious adverse events | 0 / 31 | 0 / 10 |
Outcome results
Primary
Prevalence of Sunburn
Participants were asked if their skin was sunburned (described as being red and/or painful from exposure to the sun) in the past three months, and if so, how many times.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Prevalence of Sunburn | 1.0 sunburn | Standard Deviation 2.7 |
| Control Group | Prevalence of Sunburn | 0.2 sunburn | Standard Deviation 0.6 |
Primary
Prevalence of Sunburn
Participants were asked if their skin was sunburned (described as being red and/or painful from exposure to the sun) in the past four weeks, and if so, how many times.
Time frame: four-weeks post intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Prevalence of Sunburn | 0.3 sunburn | Standard Deviation 0.6 |
| Control Group | Prevalence of Sunburn | 0.3 sunburn | Standard Deviation 0.7 |
Primary
Prevalence of Sun Protection Practices
What proportion of 8 sun protection practices did participants do on reported days of exercise. Participants responded to 8 potential sun protection practices and provided the number of days they did each practice within the timeframe provided (3 months at baseline; 4 weeks at posttest). Participants also provided number of days of outdoor exercises within timeframe. Proportion was calculated by dividing the frequency of each sun protection practice by the number of days of outdoor exercise within the timeframe. Mean score of all sun protection practices per day of outdoor exercise is reported. Range = 0-1, where a higher number indicates more sun safety practices performed. A proportion was used to account for different timeframes at baseline and posttest.
Time frame: baseline and four-weeks post intervention
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Prevalence of Sun Protection Practices | baseline | 0.30 proportion of practices/day | Standard Deviation 0.35 |
| Intervention Group | Prevalence of Sun Protection Practices | four week posttest | 0.35 proportion of practices/day | Standard Deviation 0.37 |
| Control Group | Prevalence of Sun Protection Practices | baseline | 0.43 proportion of practices/day | Standard Deviation 0.43 |
| Control Group | Prevalence of Sun Protection Practices | four week posttest | 0.41 proportion of practices/day | Standard Deviation 0.45 |
Secondary
Physical Activity (Godin Leisure-Time Exercise Questionnaire)
Duration in minutes of exercise multiplied by number of times per week, in the past 7 days. Total minutes per week calculated; mean per treatment group reported.
Time frame: four-weeks post intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 474.6 minutes | Standard Deviation 238.4 |
| Control Group | Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 657.5 minutes | Standard Deviation 578 |
Secondary
Physical Activity (Godin Leisure-Time Exercise Questionnaire)
Duration in minutes of exercise multiplied by number of times per week, in the past 7 days. Total minutes per week calculated; mean per treatment group reported.
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 578.1 minutes | Standard Deviation 603.3 |
| Control Group | Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 465.8 minutes | Standard Deviation 250.4 |
Secondary
Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire)
Duration in minutes of exercise multiplied by number of times per week, in the past 7 days. Total minutes per week calculated; mean per treatment group reported.
Time frame: baseline
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Intervention Group | Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 578.1 minutes |
| Control Group | Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 465.8 minutes |
Secondary
Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire)
Duration in minutes of exercise multiplied by number of times per week, in the past 7 days. Total minutes per week calculated; mean per treatment group reported.
Time frame: four weeks post-intervention
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Intervention Group | Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 474.6 minutes |
| Control Group | Range of Physical Activity (Godin Leisure-Time Exercise Questionnaire) | 657.5 minutes |
Secondary
Recall of Sun Protection Messages
Participants in intervention only were asked about how many messages they read. Scale ranges from 0 - 3. 0 = none of the messages; 1 = some of the messages; 2 = most of the messages; 3 = all of the messages. Higher score indicates higher message recall.
Time frame: four weeks post intervention
Population: Control group participants were not given this item.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Group | Recall of Sun Protection Messages | 1.9 units on a scale | Standard Deviation 1 |
Secondary
Self-Efficacy for Sun Protection When Exercising
Participants were asked: how confident are you that you can practice sun safety next time that you exercise. 1 = not confident; 2 = a little confident; 3 = somewhat confident; 4 = very confident. Higher scores indicates more self-efficacy for sun safety.
Time frame: baseline and four-weeks post intervention
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention Group | Self-Efficacy for Sun Protection When Exercising | baseline | 3.1 units on a scale | Standard Deviation 0.9 |
| Intervention Group | Self-Efficacy for Sun Protection When Exercising | four-week follow-up | 3.4 units on a scale | Standard Deviation 0.8 |
| Control Group | Self-Efficacy for Sun Protection When Exercising | baseline | 3.4 units on a scale | Standard Deviation 0.8 |
| Control Group | Self-Efficacy for Sun Protection When Exercising | four-week follow-up | 3.3 units on a scale | Standard Deviation 0.5 |