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Comment and Response |

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

Elliot J. Coups, PhD1,2,3; Jerod L. Stapleton, PhD1,2,3; Pamela A. Ohman-Strickland, PhD1,4
[+] 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.
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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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