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Using Machine Learning Techniques to Predict Sunburn Risk in Outdoor Exercisers

Using Machine Learning Techniques to Predict Sunburn Risk in Outdoor Exercisers

In response to recreational UV exposure being associated with skin cancer (1), Julia Berteletti, MSW, and David Buller, PhD, of Klein Buendel have launched a new research project to harness technology to increase individual’s sun safety during outdoor physical activity. The title of the new project is “Using Retrospective and Real-Time Physical Activity Tracking to Predict Risk of Sunburn in Outdoor Exercisers on Strava.”

The Strava Sun Project is based on evidence that individuals who engage in more physical activity have a higher prevalence of sunburn (2, 3-6), a proximal biomarker of melanoma risk, and melanoma is positively associated with physical activity (7). For some athletes, forgetting to apply sunscreen (8,9) or not liking its feel while engaged in physical activity can be barriers to sun protection (8,10). An expert meeting hosted by the National Cancer Institute identified sun safety during physical activity as a priority research area (11) and the U.S. Surgeon General prioritized strategies for coordinating messages on sun safety and physical activity in the Call to Action to Prevent Skin Cancer (12).

Online and mobile technologies for tracking physical activity have exploded over the past decade. Many Americans wear activity trackers or GPS-enabled devices, such as  Fitbit and Garmin, and upload their physical activity data to websites/mobile apps. Strava, an activity tracking app and social networking site for athletes of all abilities, is one of the most popular. Millions share their own activities and follow and comment on physical activity by other users in their network. The goal of this project is to increase skin cancer prevention among a high-risk population, adults who engage in outdoor physical activity by establishing feasibility of interfacing sun protection advice with the Strava website/mobile app.

Specifically, the research will create an algorithm that predicts when individuals are likely to be engaged in physical activity outdoors, and delivers sun safety advice tailored to time, location, and personal risk (for example, skin sun sensitivity). The Strava Sun program will obtain user data and deliver ecologically-valid sun safety advice by utilizing Strava’s open-source Applications Programming Interface (API) and location-based advice algorithms developed by Klein Buendel for the sun safety mobile app, sunZapp (13). Machine learning techniques will be employed to develop an algorithm using Strava activities to predict high-risk behavior, such as outdoor physical activity when UV levels are high and sun safety is advised.

Overall, a sun protection interface for the Strava platform will allow for the identification of a large population of Americans at high risk for skin cancer who routinely engage in physical activity, often outdoors with high-risk sun exposure, and reach them with sun safety advice they may not seek on their own to motivate them to practice sun safety during outdoor activities.

This project is funded by a grant from the National Cancer Institute at the National Institutes of Health (CA241637; Dr. David Buller and Ms. Julia Berteletti, Multiple Principal Investigators). Co-Investigators include Dr. Kim Henry and Dr. Chuck Anderson from Colorado State University. Other collaborators include Dr. Sherry Pagoto from the University of Connecticut and Mr. Scott Camichael, a recent software engineer at Strava. Developers at Klein Buendel will produce the API database and program.

References

  1. Moehrle M. Outdoor sports and skin cancer. Clin Dermatol. 2008;26(1):12-15.
  2. Holman DM, Ding H, Guy GP, Jr., Watson M, Hartman AM, Perna FM. Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults. JAMA Dermatol. 2018;154(5):561-568.
  3. Holman DM, Berkowitz Z, Guy GP, Jr., Hartman AM, Perna FM. The association between demographic and behavioral characteristics and sunburn among U.S. adults – National Health Interview Survey, 2010. Prev Med. 2014;63:6-12.
  4. Hall HI, Saraiya M, Thompson T, Hartman A, Glanz K, Rimer B. Correlates of sunburn experiences among U.S. adults: results of the 2000 National Health Interview Survey. Public Health Rep. 2003;118(6):540-549.
  5. Coups EJ, Manne SL, Heckman CJ. Multiple skin cancer risk behaviors in the U.S. population. Am J Prev Med. 2008;34(2):87-93. doi: 10.1016/j.amepre.2007.09.032
  6. Lawler S, Sugiyama T, Owen N. Sun exposure concern, sun protection behaviors and physical activity among Australian adults. Cancer Causes Control. 2007;18(9):1009-1014.
  7. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016;176(6):816-825.
  8. Petty KN, Knee CR, Joseph AK. Sunscreen use among recreational cyclists: how intentions predict reported behavior. J Health Psychol. 2012;18(3):439-447.
  9. Wysong A, Gladstone H, Kim D, Lingala B, Copeland J, Tang JY. Sunscreen use in NCAA collegiate athletes: Identifying targets for intervention and barriers to use. Prev Med. 2012;55(5):493-496.
  10. Berndt NC, O’Riordan DL, Winkler E, McDermott L, Spathonis K, Owen N. Social cognitive correlates of young adult sport competitors’ sunscreen use. Health Educ Behav. 2011;38(1):6-14.
  11. Geller AC, Jablonski NG, Pagoto SL, et al. Interdisciplinary perspectives on sun safety. JAMA Dermatol. 2018;154(1):88-92. PMC5839662.
  12. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General;2014.
  13. Heron KE, Smyth JM. Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010;15(Pt 1):1-39.

Physical Activity Maintenance in African American Men

Physical Activity Maintenance in African American Men

In a recent publication in mHealth, Dr. Robert Newton, Dr. Valerie Myers, and their coauthors describe the development of a smartphone app to help African American men maintain physical activity. The formative research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Minority Health and Health Disparities.

African American men experience higher rates of morbidity and mortality from several chronic diseases that have low physical activity as a modifiable risk factor. For example, increased levels of physical activity have been shown to reduce the risk of developing obesity, cardiovascular disease, and diabetes. Yet, African American men’s levels of regular physical activity remain low.

The study set out to develop and test the feasibility of a prototype smartphone app to promote physical activity maintenance in African American men. The publication describes formative research (focus groups), user-centered design, and evaluation (usability testing and one-month beta testing) of the MobileMen app through an iterative process with participants from the target population.

MobileMen and its learning activities were designed with a Social Cognitive Theory framework. The programmed app included a dashboard, learning activities, a prompting system, an activity tracker, and rewards.

Users reported above average satisfaction with the app. They also rated the app as user-friendly, helpful, enjoyable, and culturally relevant. The participants reported willingness to use the app to improve their physical activity. Rates of app use and other data are reported in the paper. A full description of the methods, results, conclusions, strengths, and limitations of the feasibility study, as well as a discussion on the inclusion of nutrition information, can be found in the mHealth publication.

The STTR Phase I project was funded by grant number MD010304 (Dr. Robert Newton, Pennington Biomedical Research Center, Principal Investigator). Coauthors include Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Leah Carter and Jessica Romain from the Pennington Biomedical Research Center, and Dr. Derek Griffith from Vanderbilt University.

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

Dr. Valerie Myers, Klein Buendel (KB) Senior Scientist, is the Principal Investigator leading a new research project aimed at helping Latinas combat barriers to physical activity using smartphone technology and social networks.

Hispanic women are a growing and influential segment of the population, yet health disparities for Latinas remain high. Latinas are more likely than their non-Hispanic White counterparts to be overweight, diagnosed with diabetes, and physically inactive. Regular physical activity promotes physical and emotional well-being, such as lower risk of heart disease and diabetes, weight management, and improved quality of life, yet physical activity interventions for Latinas remain limited.

Community-focused walking interventions produce improvements in physical activity and are well-received by Latinas when they are socioculturally sensitive. New technology has the ability to provide Latinas with innovative ways to connect socially and increase PA. Location-based services (LBS) are a popular technology that uses geographical positioning to allow individuals to use their smartphones to connect to their surrounding environment.

¡Caminemos Juntas! is a physical activity walking app that uses location-based services to connect Latinas within nearby neighborhoods as a way to provide social support for increased walking behavior. A prototype of the ¡Caminemos Juntas! app was programmed for both iOS and Android smartphones in a previous Phase I project. Multi-method formative research was conducted to guide app design and content prior to conducting field usability testing. To guide prototype development, a national sample of Latinas (n=98; mean age 32.7 +/- 7.8 years; 45% primary Spanish speaking; 28.6% with annual income < $15,000) were surveyed to better understand their preferences, usage, needs, and obstacles of current apps in relation to health and physical activity. Latinas’ current physical activity behaviors and smartphone use, opinions on health-related apps using LBS, how often they access social networking sites on their mobile phone, and their likelihood of using a social networking app to connect to others with intentions to be physically active were also examined.

Phase I results revealed that 22.5% never or rarely exercised, 73.5% accessed social networking sites daily with an average of 8 times a day, and 43.9% used LBS every day. Ease of use (82%), informationally accurate (79.2%), and reliability (84.7%) were app features rated as highly important. Over 63% reported high likelihood of using a social networking app to connect to others with the intentions of being physically active, and 67.4% reported that this type of app would be very helpful. Focus groups showed that the app was appealing, also.

In the new Phase II project, the ¡Caminemos Juntas! app will be fully developed and evaluated in a randomized control trial with Latinas aged 18-45 in San Jose, CA and Denver, CO. Changes in physical activity, social support for exercise, and quality of life will be evaluated. New features to be explored include Fitbit® device integration, mapping of walks, and social media integration. The LBS features of the app will allow Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity.

The research is funded by the National Institute on Minority Health and Health Disparities (MD009652) at the National Institutes of Health through the Small Business Innovation Research Program. Dr. Myers’ collaborators include Dr. Abby King from Stanford University, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.