A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: One out of every three cancer diagnoses is a skin cancer, and the incidence of both melanoma and non‐melanoma type skin cancers is increasing. Skin cancers, including melanoma, are typically treatable if detected early. However, there is insufficient evidence to support recommendations to establish population based skin cancer screening programs. The specific aims of this study are 1) to evaluate characteristics of participants who attend a community skin cancer screening event and who are referred for follow up due to suspicious lesions, 2) to determine the proportion of participants with suspicious lesions identified at a community skin cancer screening event who complied with a request to visit a dermatologist or primary care physician, and 3) to evaluate attitudes toward sun protection practices, and perceived risk of developing skin cancer among participants who attend a community skin cancer screening and have a suspicious skin lesion. Methods: The Skin Cancer Institute sponsored a series of community skin cancer screening events in Tucson, Arizona from 2006 to 2013. Participants completed an American Academy of Dermatology screening form prior to a skin examination by a dermatologist. Participants with suspicious lesions identified at the examination who agreed to be contacted again received questionnaires 4 months after the initial screening to assess compliance with follow‐up recommendations, and their sun protection practices and risk perceptions. Results: 1979 community members attended the skin cancer screenings. The majority of the participants were Caucasian, females, had blue eyes and brown hair, were college educated, had no prior personal or family history of skin cancer, had health insurance but did not have a regular dermatologist, reported that they had never been to a skin cancer screening before, and stated that without this screening that they would not have their skin examined. 748 (37.8%) of community members were referred and instructed to see a dermatologist for further evaluation of a skin lesion. Of the 441 participants with a suspicious lesion who consented to participate in the follow‐up study, 120 returned a questionnaire; 90 (75%) reported that they followed up with a dermatologist or physician, and 30 (25%) did not. Of the 90 participants who followed up, 53% received a skin biopsy. The self reported diagnoses from the biopsies of the suspicious skin lesions were the following: 1% atypical or dysplastic nevus, 21% actinic keratosis, 16% basal cell carcinoma, 8% squamous cell carcinoma, 2% melanoma, and 38% did not have skin cancer. Conclusions/Impact: This study demonstrated that 38% of community skin cancer screening participants were referred for follow up due to a suspicious skin lesion being identified during a skin cancer screening event. It also appeared that 75% of those who responded to the follow‐up questionnaire complied with the request within four months, although the response rate for the follow‐up questionnaire was low. Therefore, implementing a formal reminder system following the skin cancer screenings may increase the percentage of participants who follow up with a primary care physician or dermatologist after the screening for further evaluation of their suspicious skin lesion.

Current ACS guidelines recommend routine screening for cancer (ACS, 2002). Motivation to adhere to guidelines may be different for individuals with and without a family history of melanoma (Jonna, et al., 1998). Prior research examining the relationship between family history and skin cancer detection behaviors (Berwick et al., 1996; Friedman et al., 1993; Oliveria et al., 1999) have failed to utilize a theoretical framework to derive hypotheses. The purpose of the present study was to examine the utility of Protection Motivation Theory (PMT) in explaining intentions to engage in skin cancer screening (SCS) and skin self-examination (SSE). In addition, the present study explored whether PMT variables explained the relationship between having a family history of melanoma and SCS/SSE intentions. The research design was cross-sectional with 101 participants in the positive family history group and 80 participants in the negative family history group. Using a standardized, self-report measure, participants were assessed on demographic characteristics, melanoma risk factors, PMT variables, family history, and SCS/SSE behaviors and intentions. Statistical analyses included descriptive statistics, chi square for categorical variables, t-tests for continuous variables, correlational analyses, and multiple regression analyses. The majority of participants (N = 181) were Caucasian (97%) and female (59%). As expected, findings indicated that greater perceived vulnerability, self-efficacy, and response efficacy were associated with greater SCS intentions (p greater or less than .0001). Additionally, greater self-efficacy and response efficacy were associated with greater SSE intention (p greater or less than .01). Additionally, positive family history individuals reported greater perceived vulnerability, greater self-efficacy, and less perceived severity than negative family history individuals (p greater or less than .01). Individuals with a family history of melanoma also had greater SCS intentions and were more likely to have a healthcare provider who recommended SCS. Finally, perceived vulnerability and self-efficacy partially mediated the relationship between group status and SCS intentions. The present study confirms and extends prior research on psychological factors associated with SCS/SSE intentions and on individuals with a family history of melanoma. Clinical implications and future directions are discussed.

Title from PDF of title page. / Document formatted into pages; contains 117 pages. / Thesis (Ph.D.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT Current ACS guidelines recommend routine screening for cancer (ACS, 2002). Motivation to adhere to guidelines may be different for individuals with and without a family history of melanoma (Jonna, et al., 1998). Prior research examining the relationship between family history and skin cancer detection behaviors (Berwick et al., 1996; Friedman et al., 1993; Oliveria et al., 1999) have failed to utilize a theoretical framework to derive hypotheses. The purpose of the present study was to examine the utility of Protection Motivation Theory (PMT) in explaining intentions to engage in skin cancer screening (SCS) and skin self-examination (SSE). In addition, the present study explored whether PMT variables explained the relationship between having a family history of melanoma and SCS/SSE intentions. / ABSTRACT: The research design was cross-sectional with 101 participants in the positive family history group and 80 participants in the negative family history group. Using a standardized, self-report measure, participants were assessed on demographic characteristics, melanoma risk factors, PMT variables, family history, and SCS/SSE behaviors and intentions. Statistical analyses included descriptive statistics, chi square for categorical variables, t-tests for continuous variables, correlational analyses, and multiple regression analyses. The majority of participants (N = 181) were Caucasian (97%) and female (59%). As expected, findings indicated that greater perceived vulnerability, self-efficacy, and response efficacy were associated with greater SCS intentions (p greater or less than .0001). Additionally, greater self-efficacy and response efficacy were associated with greater SSE intention (p greater or less than .01). / ABSTRACT: Additionally, positive family history individuals reported greater perceived vulnerability, greater self-efficacy, and less perceived severity than negative family history individuals (p greater or less than .01). Individuals with a family history of melanoma also had greater SCS intentions and were more likely to have a healthcare provider who recommended SCS. Finally, perceived vulnerability and self-efficacy partially mediated the relationship between group status and SCS intentions. The present study confirms and extends prior research on psychological factors associated with SCS/SSE intentions and on individuals with a family history of melanoma. Clinical implications and future directions are discussed. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.