Background: Estimates of an individualââ?¬â?¢s cumulative ultraviolet (UV) radiation exposure can be useful since\nultraviolet radiation exposure increases skin cancer risk, but a comprehensive tool that is practical for use in the\nclinic does not currently exist.\nThe objective of this study is to develop a geographically-adjusted tool to systematically estimate an individualââ?¬â?¢s\nself-reported cumulative UV radiation exposure, investigate the association of these estimates with skin cancer\ndiagnosis, and assess test reliability.\nMethods: A 12-item online questionnaire from validated survey items for UV exposure and skin cancer was\nadministered to online volunteers across the United States and results cross-referenced with UV radiation indices.\nCumulative UV exposure scores (CUES) were calculated and correlated with personal history of skin cancer in a\ncaseââ?¬â??control design. Reliability was assessed in a separate convenience sample.\nResults: 1,118 responses were included in the overall sample; the mean age of respondents was 46 (standard\ndeviation 15, range 18 ââ?¬â?? 81) and 150 (13 %) reported a history of skin cancer. In bivariate analysis of 1:2 agematched\ncases (n = 149) and controls (n = 298), skin cancer cases were associated with (1) greater CUES prior to first\nskin cancer diagnosis than controls without skin cancer history (242,074 vs. 205,379, p = 0.003) and (2) less\nengagement in UV protective behaviors (p < 0.01). In a multivariate analysis of age-matched data, individuals with\nCUES in the lowest quartile were less likely to develop skin cancer compared to those in the highest quartile. In\nreliability testing among 19 volunteers, the 2-week intra-class correlation coefficient for CUES was 0.94. We have\nprovided the programming code for this tool as well as the tool itself via open access.\nConclusions: CUES is a useable and comprehensive tool to better estimate lifetime ultraviolet exposure, so that\nindividuals with higher levels of exposure may be identified for counseling on photo-protective measures.
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