Carolyn Heckman

Rutgers Cancer Institute of New Jersey · Cancer Prevention and Control

Skin cancer is the most common cancer in the United States, and early detection of melanoma may lead to diagnosis of thinner and more treatable cancers, resulting in improved survival rates. This study examined the effects of message interactivity (high vs. low) and imagery (cartoon, real human character, or customized imagery preference) on accura...

Background: Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in prevent...

Introduction: This study examined the effects of interactivity (high vs. low), imagery (cartoon or real person character), and personalization (imagery preference vs. not) on accuracy of identifying abnormal skin lesions (ASL) or skin self-examination (SSE) intention. Methods: The study employed a 3 (Cartoon character vs. Real person vs. Personali...

Background: Iron deficiency anemia (IDA) is common in colorectal cancer (CRC) patients. Timely diagnosis and management of IDA can improve response to cancer treatment and overall quality of life and reduce fatigue. Objective: To assess the proportion of CRC patients who are tested for IDA and factors that predict a formal diagnosis of IDA. Metho...

Background Timely diagnosis and management of iron deficiency anemia (IDA) in colorectal cancer (CRC) patients improves overall quality of life and survival. This study assessed the proportion of CRC patients who were formally diagnosed with IDA and factors that predict a formal diagnosis of IDA and receiving iron therapy. Methods We retrieved ele...

Individuals who work outside are at increased risk for skin cancer due to excessive exposure to ultraviolet (UV) radiation. Little is known about UV exposures and sun safety practices of outdoor day laborers, who are disproportionately Hispanic. This study identified the correlates of sunburn and sun protection behaviors in a sample of male, Hispan...

Background Identifying the characteristics of persons who benefit more from behavioral interventions can help health care providers decide which individuals should be offered particular interventions because this is the subgroup of persons who are more likely to derive greater benefit from the intervention and refine the underlying constructs of th...

Young melanoma survivors and their family are at increased risk for developing melanoma, but seldom engage in sun protection behaviors. Little is known about the role of family factors in sun protection. Our goals were: 1) examine correspondence between survivors and family sun protection, individual attitudes, and family attitudes and communicatio...

Background: Regular skin self-examination (SSE) reduces melanoma mortality but is not often conducted. Purpose: To promote SSE performance in individuals at increased risk for melanoma. Methods: One hundred sixteen individuals at heightened risk for development of melanoma (i.e., personal/family history of melanoma, high-risk mole phenotype) w...

Background Many patients with chronic itch and atopic dermatitis (AD) or psoriasis do not receive/use available medical and psychosocial treatments properly due to system, provider, and/or patient factors. Objective An educational website (ITCH-RELIEF) to improve itch-related quality of life (QoL) for adults with AD or psoriasis and chronic itch w...

Cancer survivors' emotional well-being is an integral part of their overall health and may influence their recovery and survival. The current study used the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 (N = 593) to evaluate the determinants of cancer survivors' emotional well-being. Internet cancer information seeking, social su...

Despite its increasing use, few studies have reported on demographic representativeness and costs of research recruitment via social media. It was hypothesized that cost, reach, enrollment, and demographic representativeness would differ by social media recruitment approach. Participants were 18–25 year-olds at moderate to high risk of skin cancer...

Background: The act of extinguishing, saving, and later relighting unfinished cigarettes is a common yet understudied behavior that may have implications for tobacco treatment and health. Methods: This paper presents four pilot studies investigating various aspects of this topic: (1) the prevalence of relighting among NJ and NY Quitline callers...

Introduction Although military veterans are at increased risk for skin cancer, little is known about the extent to which they have been screened for skin cancer. The study objective was to examine the prevalence and correlates of physician skin cancer screening among U.S. military veterans. Methods Data were drawn from the National Health Intervie...

Background The study objective was to assess potential correlates of sun protection behaviors among melanoma survivors. Methods Participants were 441 melanoma survivors recruited from three health centers and a state cancer registry in the United States. Sun protection behaviors (sunscreen, shade, protective shirts, and hats) were assessed through...

Background The incidence of skin cancer has been increasing in Puerto Rico in recent years. Sun protection behaviors are suboptimal among Puerto Ricans. However, there are limited data regarding major factors associated with Puerto Rican adults’ sun protection behaviors. To examine factors associated with Puerto Rican adults’ sun protection behavio...

An estimated 419 245 cases of skin cancer in the US each year are attributable to indoor tanning.¹ Efforts to increase regulations on indoor tanning continue, given its well-established association with melanoma and keratinocyte cancers as well as its popularity among adolescents and young adults. This Viewpoint provides an overview of legislative...

Adherence to regular, thorough skin self-examination (SSE) and consistent sun protection behaviors among melanoma survivors is relatively low. This study reports on the impact of an online intervention, called mySmartSkin (MSS), on engagement in SSE and sun protection behaviors among melanoma survivors, as well as the mediators of the intervention...

Objective: How couples communicate about cancer is an important predictor of psychological outcomes for men diagnosed with localised prostate cancer and their spouses. We examined the predictive role of disclosure, responsiveness, mutual avoidance, and holding back on depressive symptoms, psychological adjustment, cancer-specific distress, and can...

BACKGROUND Exposure to ultraviolet radiation from the sun or indoor tanning is the cause of the majority of skin cancers. Though indoor tanning has decreased in recent years, it remains most common among adolescents and young adults, whose skin is particularly vulnerable to long-term damage. States have adopted several types of legislation to attem...

Background Exposure to ultraviolet radiation from the sun or indoor tanning is the cause of most skin cancers. Although indoor tanning has decreased in recent years, it remains most common among adolescents and young adults, whose skin is particularly vulnerable to long-term damage. US states have adopted several types of legislation to attempt to...

Background: The study objective was to assess potential correlates of sun protection behaviors among melanoma survivors. Methods: Participants were 441 melanoma survivors recruited from three health centers and a state cancer registry in the United States. Sun protection behaviors (sunscreen, shade, protective shirts, and hats) were assessed throug...

Introduction Despite continuing efforts to reduce tobacco use in the USA, decline in smoking rates have stalled and smoking remains a major contributor to preventable death. Implementation science could potentially improve uptake and impact of evidence-based tobacco control interventions; however, no previous studies have systematically examined ho...

Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing...

Background: Breastfeeding is the biologically normative mode of feeding human infants, and reduces the risk of breast cancer for mothers. This systematic review assesses engagement in breastfeeding and the factors associated with breastfeeding among breast cancer survivors. Methods: An online literature search was performed using the PubMed, Emb...

Importance: Several state governments have enacted bans on the use of indoor tanning beds at tanning salons among minors, but studies of the association of such restrictions with tanning behavior have produced mixed results. Little is known about the prevalence of tanning in nonsalon locations that are typically not covered by restrictions. Eviden...

Objectives: Given the effectiveness of human papillomavirus (HPV) vaccination in preventing cervical cancer and other diseases, as well as the low rates of HPV vaccination in the United States, it is important to examine the determinants of perceived HPV vaccine effectiveness. In this study, we examined the associations between potential factors as...

Melanoma patients are at elevated risk for recurrence of the primary cancer as well as second primary melanomas. Regular skin self-examination (SSE) is recommended as part of follow-up surveillance. In this study, we examined SSE performance and comprehensiveness as well as knowledge and attitudinal correlates of SSE performance and comprehensivene...

Objective Self-efficacy is an important psychological resource to assist people in managing chronic illness and has been associated with psychological outcomes among patients coping with cancer. Little is known about the course of self-efficacy among gynecological cancer patients coping with cancer and the sociodemographic, medical, and psychologic...

Self-report measures are needed to better understand the relationships among sleep, itching, scratching, and chronic itch conditions and their associations with disease severity, quality of life, health, and functioning. Two scales related to sleep and/or scratch were recently developed and assessed in 137 patients with chronic itch and atopic derm...

Background The aim of this study was to validate the English version of the Itch Cognition Questionnaire in a sample of patients with chronic itch due to psoriasis or atopic dermatitis. An English-language version of an instrument assessing itch-related cognitions is needed since cognitions can contribute to a worsening of itch, and chronic itch is...

BACKGROUND Harnessing supportive influences in close relationships is an innovative and potentially effective strategy to improve sun protection behaviors. This pilot randomized controlled clinical trial evaluated the feasibility and preliminary impact of Sun Safe Partners Online, an online, couple-focused intervention to improve sun protection beh...

Background: Harnessing supportive influences in close relationships is an innovative and potentially effective strategy to improve sun protection behaviors. Objective: This pilot randomized controlled clinical trial evaluated the feasibility and preliminary impact of Sun Safe Partners Online, an online, couple-focused intervention to improve sun...

Objective: In a previously published trial, we compared the effect of an intimacy-enhancing therapy (IET) and a General Health and Wellness intervention (GHW) on psychological and relationship outcomes among men diagnosed with localized prostate cancer and their partners. Results suggested partial effects of IET on psychological adjustment and rel...

Youth should be allowed and encouraged to engage in sun-safe behaviors in educational, childcare, and recreational settings, including use of sunscreen, wide-brimmed hats, other sun-protective clothing, and shade.

>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in...

Background The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. Method A US national sample of 958 adults, 18–25 years old, at moderate to high risk of developing skin cancer, completed a survey...

A systemic review was conducted to better understand the relationship between indoor tanning and body mass index (BMI), physical activity, or dietary practices. Articles included in this review were obtained via a systematic search of PubMed following PRISMA guidelines. Available articles were published between September, 2003 and May, 2017 and con...

BACKGROUND Skin cancer is the most common cancer in the United States, disproportionately affecting young women. As many young adults use Twitter, it may be an effective channel to communicate skin cancer prevention information. OBJECTIVE The current study was conducted to assess the reach of the National Council on Skin Cancer Prevention’s 2018 D...

Background Skin cancer is the most common cancer in the United States, disproportionately affecting young women. Since many young adults use Twitter, it may be an effective channel to communicate skin cancer prevention information. Objective The study aimed to assess the reach of the National Council on Skin Cancer Prevention (NCSCP)’s 2018 Don’t...

The ultraviolet radiation index (UVI) was adopted internationally to raise awareness about and encourage the public to protect their skin from skin cancer. The current paper is a systematic review of over 20 years of research investigating awareness, comprehension, use, and impact of the UVI. Thirty-one studies were included from the USA, Canada, E...

Objectives Few couple‐focused interventions have improved psychological and relationship functioning among men diagnosed with localized prostate cancer and their spouses. This study compared the impact of intimacy‐enhancing therapy (IET), a general health and wellness intervention (GHW), and usual care (UC) on the psychological and relationship fun...

Purpose Although studies have demonstrated a protective role for benefit finding in psychological distress, little is known about how benefit finding leads to lower psychological distress. This study’s goal was to use a multiple mediator model to evaluate whether the effect of benefit-finding on depression was mediated by acceptance of cancer, acce...

Introduction Online surveys are a valuable tool for social science research, but the perceived anonymity provided by online administration may lead to problematic behaviors from study participants. Particularly, if a study offers incentives, some participants may attempt to enroll multiple times. We propose a method to identify clusters of non-inde...

Table of screening questions from the BRAT scale. (DOCX)

Quality measures in detail. (XLSX)

Data dictionary (for S1 and S2 Datasets). (DOCX)

Euclidean distance matrix based on screener responses. Red indicates small pairwise distances, blue indicates large distances. (TIFF)

R code to implement analysis in section 2 (cluster identification). (R)

R code to implement sensitivity and specificity analysis in section 2.3.1. (R)

Data used in clustering analysis. (CSV)

Data used in quality and outcome evaluation. (CSV)

Supporting RData file for S2 Code. (ZIP)

R code to implement analysis in sections 3–4 (response quality, effect on outcomes). (R)

Perceived unsupportive responses from close others play an important role in psychological adaptation of patients with cancer. Little is known about whether these negative responses change after someone experiences a serious life event, and even less is known about the individual characteristics and related factors that might contribute to both the...

We aimed to further the understanding of the low rates of sun protection in young women at risk for skin cancer. Six-hundred-sixty-one daily diary entries were received via text message over 14 days from 56 young women at moderate to high risk of developing skin cancer. Women reported whether or not they used sun protection and also listed what the...

Background: Because Operating Engineers (heavy equipment operators) are outdoor workers at risk for skin cancer, interventions are needed to promote sun safety. The objectives were to determine changes in sunscreen use and sunburning among Operating Engineers randomized to four conditions in the Sun Solutions study: (i) education only; (ii) educati...

The National Council on Skin Cancer Prevention¹ created a public awareness campaign, “Don’t Fry Day,” to encourage sun safety awareness and proper sun protection behaviors. Don’t Fry Day occurs on the Friday before Memorial Day, and council members promote sun safety through all media channels and mediums.² Owing to the regular use of social media...

Objective Emotional awareness is the ability to recognize, describe, and attend to emotions. A known correlate is emotional processing, the ability to orient to and use inner experiences for information. The goal was to examine emotional awareness during therapy among gynecologic cancer patients, identify baseline predictors, and explore the relati...

The present study focused on intimacy processes in the relationships of men diagnosed with localized prostate cancer and their partners. Using the actor–partner interdependence model (APIM), we examined the interpersonal process model of intimacy, which proposes associations between self- and perceived partner disclosure about cancer and perceived...

Importance: The US Food and Drug Administration recommends that indoor tanners (ITs) be screened regularly for skin cancer (SC). Objective: To investigate the association between indoor tanning and SC screening. Design, setting, and participants: The 2015 National Health Interview Survey was a multistage, clustered, cross-sectional design with...

Background Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical edu...

Skin cancers, ie, melanoma and keratinocyte skin cancer, are the most common cancers.¹ The number of melanomas is expected to nearly double by 2030, tripling annual treatment costs in the United States.² Because skin cancer is strongly associated with UV radiation (UVR) exposure,¹ the Centers for Disease Control and Prevention recommend reducing un...

The study’s purpose was to select/refine measures assessing psychosocial constructs associated with skin cancer risk/protective behaviors. Cognitive interviewing was conducted with twenty participants locally, and a survey was conducted with 965 adults aged 18–25 years at moderate to high risk of developing skin cancer, recruited nationally online....

Background: The elevated rates of ultraviolet radiation (UVR) exposure and low rates of sun protection in young adult women indicate a need for age- and gender-appropriate interventions that address these behaviors. Aims: To examine the effects of daily behavior tracking and individually tailored text messages on sun protection and UVR exposure...

Purpose: The course of quality of life after diagnosis of gynecologic cancer is not well understood. We aimed to identify subgroups of gynecologic cancer patients with distinct trajectories of quality of life outcomes in the 18-month period after diagnosis. We also aimed to determine whether these subgroups could be distinguished by predictors deri...

Objective Our aim was to compare changes in emotional processing by women newly diagnosed with gynecological cancer enrolled in either a coping and communication skills intervention (CCI) or a supportive counseling (SC) intervention. We examined the association between in-session emotional processing and patient-rated therapeutic progress. Method...

Objective: Although a number of effective psychotherapies have been identified for cancer patients, little is known about therapy processes as they unfold the course of treatment and the role of therapy processes in treatment outcome. We used growth curve modeling to evaluate the associations between therapy processes and outcomes among gynecologi...

The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterati...

Objective: The study's purpose was to investigate moderator, implementation, and mediator variables related to the efficacy of UV4.me, an Internet intervention that decreased ultraviolet radiation (UV) exposure and increased skin protection behaviors among young adults. Method: A total of 965 18-25 year olds at risk for skin cancer were recruite...

Objective: This study compared the efficacy of two psychological interventions, a coping and communication-enhancing intervention (CCI) and supportive counseling (SC), in reducing depressive symptoms, cancer-specific distress, fear of recurrence, and emotional well-being of women diagnosed with gynecological cancer. Demographic, medical, and psych...

Objective: There has been little attention paid to the role of therapeutic processes in group therapy outcomes for cancer patients participating in group. The goal was to evaluate the contribution of three group processes - group climate (conflict, engagement, avoidance) working alliance, and therapeutic realizations - to the outcomes of two coupl...

Background Night shift work and sleep duration have been associated with breast and other cancers. Results from the few prior studies of night shift work and skin cancer risk have been mixed and not fully accounted for other potentially important health-related variables (eg, sleep characteristics). This study evaluated the relationship between rot...

Objective: Fear of cancer recurrence is an important clinical phenomenon and is associated with decrements in life domains. The study goals were to characterize patterns of global fear of recurrence (FOR) and four domains of fear (health, role, womanhood, and death worry) over time in women who were diagnosed with gynecological cancer and to ident...

Indoor tanning (IT) has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction). The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirt...

Objective: The aims of this study were to evaluate the efficacy of the 2 types of couple-focused group interventions on couples' psychological and relationship functioning, and to examine possible moderators for each intervention. Method: Three hundred and two women with early stage breast cancer who were recruited within 1 year of diagnosis and...