Doctor of Philosophy

dissertationEvery year, over two million people are diagnosed with skin cancer. The primary method recommended for skin cancer prevention is reducing ultraviolet radiation (UVR) exposure. However, consistent daily sun protection is often inadequate, even among higher risk patients. This study tested both 1) the effectiveness of a daily, online intervention that provided color-coded feedback illustrating duration of UVR exposure on specific body sites, and 2) theoretically derived predictions regarding the process of reducing UVR exposure in response to feedback. Participants (n=47; 53.3% women, mean age=49.87) were recruited from dermatology clinics and had an elevated risk of skin cancer. The majority (63.8%) had a history of skin cancer, including 44.7% with melanoma. At baseline, then 1 and 2 months later, sun exposure was assessed by reflectance spectroscopy, an objective measure of skin color, and by the self-report Minutes of Unprotected Sun Exposure (MUSE) Inventory. Participants were randomly assigned to either a feedback, self-monitoring, or control condition. For feedback participants, the 14-day intervention included daily sun-protection reminders, the MUSE Inventory, color-coded feedback diagrams, and survey items on health-relevant cognitions and emotions. To control for the potential benefit of reporting one's behavior, self-monitoring participants completed these assessments but did not receive feedback. Control participants only received daily reminders. On the MUSE Inventory, feedback participants reported less sun exposure than self-monitoring participants during the intervention. In these conditions, higher perceptions of goal fulfillment for sun exposure occurred when reported sun exposure was lower and these perceptions predicted higher self-efficacy for sun protection. Only feedback participants reported decreased sun exposure at the 2-month follow-up; significant decreases in sun exposure were reported in the lower face, arms, and lower legs, which are common sites for melanoma. Reflectance spectroscopy measurements did not change over time or by condition, potentially because they were taken on a limited number of body sites (wrist, upper face) for which exposure did not decrease substantially. This study supports the feasibility and effectiveness of an online, daily feedback intervention for sun exposure among higher risk patients. Future directions include testing it among less compliant populations and investigating additional mechanisms (e.g., changes in goals) through which feedback operates

Assessing recall of personal sun exposure by integrating UV dosimeter and self-reported data with a network flow framework.

BackgroundMelanoma survivors often do not engage in adequate sun protection, leading to sunburn and increasing their risk of future melanomas. Melanoma survivors do not accurately recall the extent of sun exposure they have received, thus, they may be unaware of their personal UV exposure, and this lack of awareness may contribute towards failure to change behavior. As a means of determining behavioral accuracy of recall of sun exposure, this study compared subjective self-reports of time outdoors to an objective wearable sensor. Analysis of the meaningful discrepancies between the self-report and sensor measures of time outdoors was made possible by using a network flow algorithm to align sun exposure events recorded by both measures. Aligning the two measures provides the opportunity to more accurately evaluate false positive and false negative self-reports of behavior and understand participant tendencies to over- and under-report behavior.Methods39 melanoma survivors wore an ultraviolet light (UV) sensor on their chest while outdoors for 10 consecutive summer days and provided an end-of-day subjective self-report of their behavior while outdoors. A Network Flow Alignment framework was used to align self-report and objective UV sensor data to correct misalignment. The frequency and time of day of under- and over-reporting were identified.FindingsFor the 269 days assessed, the proposed framework showed a significant increase in the Jaccard coefficient (i.e. a measure of similarity between self-report and UV sensor data) by 63.64% (p ConclusionThese discrepancies may reflect lack of accurate recall of sun exposure during times of peak sun intensity (10am-2pm) that could ultimately increase the risk of developing melanoma. This research provides technical contributions to the field of wearable computing, activity recognition, and identifies actionable times to improve participants' perception of their sun exposure

Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change

This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. Findings indicate that no entity in the health care system self-identifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Individual Differences and Day-to-Day Fluctuations in Goal Planning and Type 1 Diabetes Management

ObjectiveTo examine whether individual differences and day-to-day fluctuations in diabetes goal planning are associated with Type 1 diabetes (T1D) management during late adolescence, and whether lapses in daily diabetes goal planning are more disruptive to diabetes management among those with poorer executive functioning (EF).MethodLate adolescents with T1D (N = 236, Mage = 17.77 years) completed survey measures assessing individual differences in levels of diabetes goal planning and adherence, as well as survey and performance-based measures of EF; glycemic control was assessed through glycated hemoglobin (HbA1c) assays. Participants then completed a 2-week daily diary, rating items measuring daily diabetes goal planning, goal effort, and adherence, and recording blood-glucose tests from their glucometer at the end of each day.ResultsAnalyses of survey measures indicated that higher individual differences in diabetes goal planning were associated with better adherence and glycemic control. Analyses of daily data using hierarchical linear modeling indicated that adolescents displayed higher daily adherence and lower blood-glucose levels on days when they had higher-than-their-average levels of daily goal planning and daily goal effort. EF moderated the association between daily goal planning and daily adherence, indicating that lapses in daily goal planning were more disruptive for adolescents with poorer EF.ConclusionBoth individual differences and day-to-day fluctuations in diabetes goal planning are associated with diabetes management, highlighting the challenges of managing T1D in daily life. Youth in late adolescence with poorer EF may especially benefit from planning to attain diabetes goals on a daily basis. (PsycINFO Database Recor

Physicians' perspectives on medication adherence and health promotion among cancer survivors

Survey responses from primary care physicians ( n= 30), oncologists ( n= 30), and other specialists who treat cancer patients ( n= 31), along with interviews of 12 oncologists, indicate that physicians do not often engage in healthy lifestyle promotion with cancer survivors and fear that providing health promotion advice would distress or overwhelm patients, compromising their medical regimen adherence. Additional health promotion barriers were perceived patient disinterest, cancer as oncologists’ focal concern, time pressure, insufficient behavior change training, and care coordination challenges

Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory: Measure description and comparisons to UVR sensor and sun protection survey data

One in five US adults will be diagnosed with skin cancer. As most skin cancers are attributable to sun exposure, this risk factor is an important target for research and intervention. Most sun exposure measures assess frequency of specific sun-protection behaviors, which does not account for the use of multiple, potentially overlapping sun-protection methods. In contrast, the Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory assesses sun-protection behavior during self-reported activities, providing several useful metrics, including duration of unprotected sun exposure on 17 body sites, combined to yield an overall MUSE score weighted by percent of body exposed. The present study was conducted July–September 2017, in Chicago, IL USA. For 10 days, participants (39 melanoma survivors; Mage = 58.59, 64.5% female) wore an ultraviolet radiation (UVR) sensor and completed the Daily MUSE Inventory each evening. The Sun Habits Survey was completed at the end of the study. Outdoor time reported in the MUSE Inventory significantly predicted outdoor time recorded by UVR sensors, B = 0.53, p < .001. For all sun-protection behaviors except shade, reports from the Daily MUSE Inventory (i.e., percentage of outdoor time a particular strategy was used) correlated with frequency ratings of the same strategy from the Sun Habits Survey (rs = 0.66–0.75, p < .05). In sum, the Daily MUSE Inventory corresponds with sensor and survey data, and provides a novel metric of unprotected sun exposure that will be useful for evaluating overall extent of sun exposure, including exposure on several smaller body sites that are at high risk for skin cancer. Keywords: Measurement, Sun protection, Concurrent validity, Self-report assessment, UVR, Skin cance

Longitudinal Trajectories of Illness Perceptions Among Adolescents With Type 1 Diabetes

ObjectivesTo examine development in illness perceptions of type 1 diabetes across adolescence and relationships with intelligence, diabetes responsibility, and diabetes outcomes.MethodsIllness perceptions were measured via the Illness Perceptions Questionnaire at 3 times, every 6 months in 213 adolescents (M age = 13.00; SD = 1.54) with type 1 diabetes. Intelligence and adolescents' perceived responsibility for diabetes were examined, and adolescents' report of adherence and quality of life (QOL), and glycosylated hemoglobin (HbA1c) from medical records addressed diabetes-related outcomes.ResultsLinear growth models showed significant increases in perceptions of diabetes coherence, chronicity, consequences, personal and treatment control, and decreases in diabetes cyclicality and parental control across time. More favorable illness perceptions were generally associated with adolescent intelligence at baseline, more adolescent responsibility for management, better adherence and QOL, and lower HbA1c at each time point.ConclusionsResults suggest that adolescents develop complex illness perceptions, which are associated with better diabetes management

Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma

https://kent-islandora.s3.us-east-2.amazonaws.com/node/17927/87871-thumbnail.jpgBackground Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. Purpose To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one\u27s risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sunprotection behavior 1 year later. Methods A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. Results Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. Conclusions Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.</p

Rationale and design of the SenseWhy project: A passive sensing and ecological momentary assessment study on characteristics of overeating episodes

Objectives Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors (e.g., stress eating), as well as new phenotypes based on social and psychological features. Method Up to 60 adults with obesity in the Chicagoland area will be recruited for a 14-day free-living observational study. Participants will complete ecological momentary assessments and wear 3 sensors designed to capture features of overeating episodes (e.g., chews) that can be visually confirmed. Participants will also complete daily dietitian-administered 24-hour recalls of all food and beverages consumed. Analysis Overeating is defined as caloric consumption exceeding 1 standard deviation of an individual's mean consumption per eating episode. To identify features that predict overeating, we will apply 2 complementary machine learning methods: correlation-based feature selection and wrapper-based feature selection. We will then generate clusters of overeating types and assess how they align with clinically meaningful overeating phenotypes. Conclusions This study will be the first to assess characteristics of eating episodes in situ over a multiweek period with visual confirmation of eating behaviors. An additional strength of this study is the assessment of predictors of problematic eating during periods when individuals are not on a structured diet and/or engaged in a weight loss intervention. Our assessment of overeating episodes in real-world settings is likely to yield new insights regarding determinants of overeating that may translate into novel interventions