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Comment & Response
July 2013

Concerns Regarding Results of a Randomized Controlled Trial to Promote Skin Self-Examination and Sun Protection Behaviors

Author Affiliations
  • 1The Cancer Institute of New Jersey, New Brunswick
  • 2Department of Medicine, UMDNJ–Robert Wood Johnson Medical School, New Brunswick, New Jersey
  • 3Department of Health Education and Behavioral Science, UMDNJ–School of Public Health, Piscataway, New Jersey
  • 4Department of Biostatistics, UMDNJ–School of Public Health, Piscataway, New Jersey
JAMA Dermatol. 2013;149(7):883-884. doi:10.1001/jamadermatol.2013.718

To the Editor We write regarding 2 articles by Aneja and colleagues1,2 describing results of a randomized trial to promote skin self-examination (SSE) and sun-protection behaviors among individuals attending dermatology clinics. A key concern is that imbalance in baseline levels of each behavioral outcome (ie, performance of SSE, use of sun-protective clothing, and sunscreen use) may explain or attenuate treatment arm differences at follow-up. For example, use of sun-protective clothing at the follow-up was significantly higher among intervention than control group participants.2 However, 40.2% of intervention group participants reported always or frequently using sun-protective clothing at baseline compared with 28.6% of control group participants.1 A prudent approach should include sensitivity regression analyses (akin to those summarized in Table 31 and the Table2) estimating intervention effects on behavioral outcomes at the 3-month follow-up after controlling for the baseline levels. If baseline adjustments yielded nonsignificant results, then intervention effects would need to be interpreted with more caution.

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