BackgroundTesticular germ cell tumors (TGCTs) are the most common cancers among young men in the United States. Incidence rates among non-Hispanic White (NHW) men historically have been much higher than the rates among other men. To study whether this pattern had changed, the authors examined trends in TGCT incidence for the years 1992-2021.MethodsBy using the Surveillance, Epidemiology, and End Results 12 registries database, age-standardized incidence rates per 100,000 person-years and 95% confidence intervals (CIs) were calculated overall and by histologic type (seminoma and nonseminoma), age, stage at diagnosis, and race/ethnicity. Trends in 5-year survival also were examined.ResultsThe age-standardized incidence rate of TGCT per 100,000 person-years increased from 4.71 (95% CI, 4.39-5.05) in 1992 to 6.22 (95% CI, 5.88-6.58) in 2021. The rates increased for both seminoma (average annual percent change [AAPC], 0.57%; 95% CI, 0.40%-0.75%) and nonseminoma (AAPC, 1.41%; 95% CI, 1.17%-1.64%) and among all race/ethnic groups, although the rates stabilized among NHW men. Increases in incidence were greatest among Hispanic men (AAPC, 3.03%; 95% CI, 2.66%-3.40%), who had one of the youngest median ages at diagnosis and were more likely to be diagnosed at advanced stages compared with NHW men. Seminoma and nonseminoma rates among Hispanic men converged over the study period, whereas seminoma rates remained higher among most other groups.ConclusionsHispanic men now have the highest TGCT incidence rates in the United States, although the rates increased among all groups between 1992 and 2021. Racial/ethnic differences in rates require further investigation.

For melanoma patients (pts) with resectable regional or distant metastases, there is paucity of data related to inherited genetic variations and genetic ancestry in the North American patient population. We conducted genome-wide genotyping on samples from 744 consenting pts enrolled in E1609 adjuvant trial that tested ipilimumab vs interferon-α in high-risk melanoma including sites across the U. S. and Canada. We used Illumina Infinium Global Screening Array v.3.0. After imputation, pruning, and incorporating genotypes from 1KGP3 as reference, genetic ancestry was estimated using admixture v1.3.0 in the unsupervised mode. Population structure was visualized through a UMAP dimensionality reduction (R package umap_0.2.9.0). Genetic ancestry proportions were visualized using python package PONG v1.5. In UMAP reduction, most (728) cases clustered with the 1KGP3 European (EUR) reference, with small subsets (12 and 14, respectively) clustering with the admixed American (AMR) and East Asian (EAS) references. Considering potential ancestral origins for the study pts, we assumed between 4 to 8 ancestral populations in order to capture a wider range of ancestral contributions. Unsupervised admixture inference on the combined genetic data from our cohort and the 1000 Genomes reference identified ancestral axes clearly along continental geographical lines. K=5 was deemed most optimal in broadly capturing the potential complexity of genetic contributions in U.S. context. The ancestry populations identified were Africa (AFR), AMR, EAS, EUR, South Asia (SAS). For most (734) samples, the estimated EUR proportion was >50%, while 4 had >50% EAS ancestry, 4 >50% AMR ancestry, and 2 >40% EUR and AMR ancestry. Most (725) participants self-reported their race as White, 4 as Asian, and 1 as multi-race; 14 missing information on race. For the 725 White participants, 13 identified as Hispanic and 24 missing information on ethnicity; and for these participants, there was a high degree of EUR ancestry (>95% in 22), with only 2 having between 4-6% combined AMR and AFR contributions. The 4 Asian participants had a high degree of EAS ancestry, and the multi-race participant had a high degree of EUR ancestry with minor degrees of AMR and EAS ancestry. Participants with missing information on self-reported race had either a high degree of EUR ancestry or various combinations of significant AMR, EUR, and AFR contributions. The 17 participants reporting Hispanic ethnicity had a significant AMR ancestral contribution. The vast majority of participants not reporting (699) or missing (28) information on Hispanic ethnicity did not have AMR ancestry. Our analysis in the context of a U.S. Intergroup phase 3 trial revealed important insights into genetic ancestry of patients with high-risk melanoma. Ongoing analyses are investigating associations with survival outcomes and the risk of irAEs. Ahmad A. Tarhini, Zhihua Chen, Sandra J. Lee, F. Stephen Hodi, Islam Eljilany, Tingyi Li, Howard Streicher, Vernon K. Sondak, Xuefeng Wang, Peter A. Kanetsky, John M. Kirkwood. Insights into inherited genetic variations and genetic ancestry of patients with high-risk melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2107.

Transcriptome-wide association studies (TWASs) have the potential to identify susceptibility genes associated with testicular germ cell tumors (TGCTs). We conducted a comprehensive TGCT TWAS by integrating genome-wide association study (GWAS) summary data with predicted expression models from normal testis, TGCT tissues, and a cross-tissue panel that encompasses shared regulatory features across 22 normal tissues, including the testis. Gene associations were evaluated while accounting for variant-level effects from GWASs, followed by fine-mapping analyses in regions exhibiting multiple TWAS signals, and finally supplemented by colocalization analysis. Expression and protein patterns of identified TWAS genes were further examined in relevant tissues. Our analysis tested 19,805 gene- disease links, revealing 165 TGCT-associated genes with a false discovery rate of less than 0.01. We prioritized 46 candidate genes by considering GWAS-inflated signals, correlations between neighboring genes, and evidence of colocalization. Among these, 23 genes overlap with 22 GWAS loci, with 7 being associations not previously implicated in TGCT risk. Additionally, 23 genes located within 21 loci are at least 1 Mb away from published GWAS index variants. The 46 prioritized genes display expression levels consistent with expected expression levels in human gonadal cell types and precursor tumor cells and significant enrichment in TGCTs. Additionally, immunohistochemistry revealed protein-level accumulation of two candidate genes, ARID3B and GINM1, in both precursor and tumor cells. These findings enhance our understanding of the genetic predisposition to TGCTs and underscore the importance of further functional investigations into these candidate genes.

Background: Testicular germ cell tumor (TGCT) is the most common cancer among young White men. TGCT is highly heritable, although there are no known highpenetrance predisposition genes. CHEK2 is associated with moderate TGCT risk. Objective: To identify coding genomic variants associated with predisposition to TGCT. Design, setting, and participants: The study involved 293 men with familial or bilateral (high risk; HR)-TGCT representing 228 unique families and 3157 cancer-free controls. Outcome measurements and statistical analysis: We carried out exome sequencing and gene burden analysis to identify associations with TGCT risk. Results and limitations: Gene burden association identified several genes, including lossof-function variants of NIN and QRSL1. We identified no statistically significant association with the sex- and germ-cell development pathways (hypergeometric overlap test: p = 0.65 for truncating variants, p = 0.47 for all variants) or evidence of associations with the regions previously identified via genome-wide association studies (GWAS). When considering all significant coding variants together with genes associated with TGCT on GWAS, there were associations with three major pathways: mitosis/cell cycle (Gene Ontology identity GO:1903047: observed/expected variant ratio [O/E] 6.17, false discovery rate [FDR] 1.53 x 10 -11 ), co -translational protein targeting (GO:0006613: O/ E 18.62, FDR 1.35 x 10 -10 ), and sex differentiation (GO:0007548: O/E 5.25, FDR 1.90 x 10 -4 ). Conclusions: To the best of our knowledge, this study is the largest to date on men with HR-TGCT. As in previous studies, we identified associations with variants for several genes, suggesting multigenic heritability. We identified associations with cotranslational protein targeting, and chromosomal segregation and sex determination, identified via GWAS. Our results suggest potentially druggable targets for TGCT prevention or treatment. Patient summary: We searched for gene variations that increase the risk of testicular cancer and found numerous new specific variants that contribute to this risk. Our results support the idea that many gene variants inherited together contribute to the risk of testicular cancer.

Background. Little is known about the impact of low- to moderate-penetrance genetic testing for skin cancer, which is a promising approach to skin cancer prevention. Methods. To address this deficit, we conducted an analysis comparing changes in skin cancer-related behaviors, distress, and beliefs measured at a baseline and twice after the receipt of skin cancer precision prevention materials containing MC1R risk feedback (higher or average risk) among 568 non-Hispanic White (NHW) and 463 Hispanic participants. Results. Regression analyses identified decreased average weekend hours in the sun (β = −0.25; 95% CI, −0.46–[−0.04]) and increased average skin cancer worry (β = 0.09; 95% CI, 0.01–0.18) among higher-risk NHW participants at the first but not second follow-up. On average, higher-risk NHW and Hispanic participants reported a persistent increased risk of developing skin cancer compared with similar others (β = 0.49; 95% CI, 0.33, 0.65; β = 0.42; 95% CI, 0.17, 0.67, respectively). Conclusions.MC1R genetic testing resulted in durable elevated skin cancer risk perceptions and shorter-term behavior changes among higher-risk individuals. Although higher-risk participants reported slight heightened worry at the first follow-up, the overall levels of skin cancer-related distress were low. The lack of sustained behavioral changes highlights the need for intervention reinforcement in precision prevention approaches to reduce cancer risk.

Objective: Examine retention and evaluation of incorporating melanocortin-1 receptor genetic risk information materials in a skin cancer prevention intervention conducted in Hispanics living near Tampa, Florida and Ponce, Puerto Rico.Methods: Two researchers applied thematic content analysis to identify major themes of open-ended responses (n = 1689) from 489 participants.Results: Five major thematic categories emerged: 1) intervention comments; 2) tips and tricks; 3) cancer prevention; 4) general information; and 5) risk factors and genetics. Responses captured under intervention comments (e.g., information was clear, easy to understand) and tips and tricks for sun protection (e.g., using sunscreen, wearing protective clothing) were most frequent. Participants noted the importance of conducting skin exams professionally or at home. English-preferring Tampa residents stated their individual risk factors, especially race and/or ethnicity, more frequently than Ponce residents and Spanish-preferring Tampa residents. Ponce residents were more likely to comment on wanting to share intervention materials with family and friends.Conclusion: Findings suggest Hispanic participants implemented sun safety activities.

Background: The shared inherited genetic contribution to risk of different cancers is not fully known. In this study, we leverage results from 12 cancer genome-wide association studies (GWAS) to quantify pairwise genome-wide genetic correlations across cancers and identify novel cancer susceptibility loci.Methods: We collected GWAS summary statistics for 12 solid cancers based on 376 759 participants with cancer and 532 864 participants without cancer of European ancestry. The included cancer types were breast, colorectal, endometrial, esophageal, glioma, head and neck, lung, melanoma, ovarian, pancreatic, prostate, and renal cancers. We conducted cross-cancer GWAS and transcriptome-wide association studies to discover novel cancer susceptibility loci. Finally, we assessed the extent of variant-specific pleiotropy among cancers at known and newly identified cancer susceptibility loci.Results: We observed widespread but modest genome-wide genetic correlations across cancers. In cross-cancer GWAS and transcriptome-wide association studies, we identified 15 novel cancer susceptibility loci. Additionally, we identified multiple variants at 77 distinct loci with strong evidence of being associated with at least 2 cancer types by testing for pleiotropy at known cancer susceptibility loci.Conclusions: Overall, these results suggest that some genetic risk variants are shared among cancers, though much of cancer heritability is cancer-specific and thus tissue-specific. The increase in statistical power associated with larger sample sizes in cross-disease analysis allows for the identification of novel susceptibility regions. Future studies incorporating data on multiple cancer types are likely to identify additional regions associated with the risk of multiple cancer types.

BACKGROUND:Prostate cancer affects African American men disproportionately compared with men of other racial/ethnic groups. To identify biological bases for this health disparity, we sought to create a state-wide biobank of African American prostate cancer survivors in Florida. METHODS:African American men diagnosed with prostate cancer between 2013 and 2017 and living in Florida at diagnosis were identified through the State of Florida's cancer registry. Individuals were approached via mail and telephone, assessed for eligibility, and asked for informed consent. χ2 and t tests were conducted to identify differences between eligible and reachable individuals (i.e., had valid contact information) versus consented participants. RESULTS:Of the 5,960 eligible and reachable individuals, 3,904 were eligible and contacted at least once, and 578 consented [overall consent rate = 10% (578/5,960); adjusted consent rate = 15% (578/3,904)]. Statistically significant (Ps < 0.05) but small differences in demographic and clinical variables were observed. Consented participants were less likely to be older than 64 (35% vs. 41%) and less likely to have received radiotherapy (36% vs. 41%) and hormone therapy (16% vs. 21%), but more likely to have regional prostate cancer (13% vs. 11%) and have undergone surgery (44% vs. 39%). Consented participants did not differ from reachable individuals on other demographic and clinical factors (Ps > 0.05). CONCLUSIONS:Recruiting African American prostate cancer survivors to biobanking research through a cancer registry is feasible. However, the consent rate was low, and existing challenges limit consent and participation. IMPACT:Strategies for overcoming barriers to informed consent and increasing participation in biospecimen research are needed to address cancer disparities.

Background: Social distancing and stay-at-home policies during the COVID-19 pandemic impacted health behaviors [1]. However, the impact on skin cancer primary prevention activities is unknown. We hypothesized increased time at home would lead to more time outside, and thus increased sun exposure. We conducted a cross-sectional study to quantify the impact of the pandemic on sun habits of patients with melanoma. An electronic survey was administered between June 2020 and May 2022 to patients with melanoma enrolled in registries established by Moffitt Cancer Center (MCC; Tampa, Florida; n=207) and Oregon Health & Science University (OHSU; Portland, Oregon; n=123). The median age of melanoma diagnosis was 66.0 years, and most (92.1%) participants were diagnosed within the previous 2-5 years. Compared to pre-pandemic, participants reported fewer hours spent outside per day between 10 am and 4 pm on weekdays (45.5%) and weekends (48.2%) during the pandemic.

PURPOSE:Inherited variation in MC1R imparts low to moderate risk of melanoma. Research on genetic risk recall, factors predicting recall, and whether recall influences adoption of preventive behaviors is limited. METHODS:Participants (n = 447) enrolled in a melanoma precision prevention trial were provided with MC1R risk information (average or higher) and after 6 and 12 months, were asked to recall their genetic risk. Predictors of recall were identified using backward stepwise selection. Intervention effects were reassessed after stratifying by recall. RESULTS:Participants at higher risk were 2 to 3 times more likely to misremember or not recall than participants with average risk. Misremembering was almost exclusively observed among participants at higher risk. Among the participants with average risk, lower health numeracy and not completing the telephone follow-up were associated with not recalling or misremembering. Among the participants at higher risk, lower education was associated with not recalling and lower perceived comparative chance of developing melanoma was associated with misremembering. In general, participants at higher risk who correctly recalled had modestly stronger intervention effects on sun protection behaviors than those who misremembered or did not recall. CONCLUSION:Future studies should examine different strategies to increase genetic risk recall, which may result in improved behavioral outcomes, especially among participants with lower education and health numeracy.

Objective: To identify predictors of genetic risk recall and examine whether recall influences adoption of skin cancer preventive behaviors among Hispanic individuals.Methods: Hispanic participants randomized to intervention arms (n = 463) of a precision prevention trial were provided MC1R risk information (average, higher) and asked to recall their risk after 3 and 9 months. Predictors of recall (correct versus did not recall/misremembered) were determined by backwards stepwise logistic regression. Intervention effects on preventive behaviors were estimated within strata of 3-month recall.Results: Age inversely predicted correct recall in both risk groups (average: OR3-months(3)= 0.97, 95% CI:0.94-1.01, OR9-months(9)= 0.96, 95%CI:0.93-0.99; higher: OR3 = 0.98, 95%CI:0.95-1.01, OR9 = 0.98, 95% CI:0.95-1.00). Education positively predicted recall among participants at average risk (OR3 =1.64, 95% CI:1.06-2.63, OR9 =1.73, 95%CI:1.12-2.81). Darker untanned skin color inversely predicted recall among participants at higher risk (OR3 =0.68, 95%CI:0.45-0.99, OR9 =0.74, 95%CI:0.50-1.09). Intervention effects for routine sunscreen use and undergoing a clinical skin exam were stronger among participants at higher risk who correctly recalled at 3 months than those who did not recall/misremembered.Conclusions: Younger age, higher education, and lighter untanned skin color predicted correct recall. Better recall may improve skin cancer prevention outcomes. Practice Implications: Additional strategies are needed to boost recall among Hispanic individuals who are older, less educated, and darker-skinned.

Objective:To explore factors associated with communication and information-seeking after receipt of skin cancer prevention information among Hispanic individuals.Methods:Multivariable logistic regression was used to analyze existing data on demographics, personal experience, salience, and beliefs variables collected from Hispanic individuals to determine independent associations with sharing and seeking information about skin cancer prevention.Results:Of 578 participants, 53% reported any communication about skin cancer prevention behaviors or skin cancer genetic risk; and 31% and 21% sought additional information about preventive behaviors or genetic risk, respectively. Female sex, greater perceived severity, higher comparative chance of getting skin cancer, and lower health literacy were associated with greater communication, while having no idea of one's own skin cancer risk was related to less communication. Greater health numeracy and higher cancer worry were associated with information-seeking about prevention behaviors and genetic risk.Conclusion:Up to half of participants reported communication or information-seeking, although factors associated with specific activities differed. Future studies should evaluate how to promote communication behaviors in the Hispanic community and how sharing and seeking information influence an individual's network prevention practices.Innovation:Several factors related to communication behaviors among Hispanic people after obtaining skin cancer prevention information were identified.Trial registration: This trial was registered on clinicaltrials.gov (NCT03509467).

Supplementary file (clean version) including Supplementary text on Materials and Methods, and the following tables: Supplementary Table 1. Genomic variants included in the genomic risk estimates and their published associations with melanoma. Supplementary Table 2. Sun Protection Index: Individual items. Supplementary Table 3. Preliminary effect of the intervention on resource use and costs at 3-months.

Abstract Background It is unclear whether genetic variants affecting vitamin D metabolism are associated with melanoma prognosis. Two functional missense variants in the vitamin D–binding protein gene (GC), rs7041 and rs4588, determine 3 common haplotypes, Gc1s, Gc1f, and Gc2, of which Gc1f may be associated with decreased all-cause death among melanoma patients based on results of a prior study, but the association of Gc1f with melanoma-specific death is unclear. Methods We investigated the association of the Gc1s, Gc1f, and Gc2 haplotypes with melanoma-specific and all-cause death among 4490 individuals with incident, invasive primary melanoma in 2 population-based studies using multivariable Cox-proportional hazards regression. Results In the pooled analysis of both datasets, the patients with the Gc1f haplotype had a 37% lower risk of melanoma-specific death than the patients without Gc1f (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.47 to 0.83, P = .001), with adjustments for age, sex, study center, first- or higher-order primary melanoma, tumor site, pigmentary phenotypes, and Breslow thickness. Associations were similar in both studies. In pooled analyses stratified by Breslow thickness, the corresponding melanoma-specific death HRs for those patients with the Gc1f haplotype compared with those without Gc1f were 0.89 (95% CI = 0.63 to 1.27) among participants with tumor Breslow thickness equal to or less than 2.0 mm and 0.40 (95% CI = 0.25 to 0.63) among participants with tumor Breslow thickness greater than 2.0 mm (Pinteraction = .003). Conclusions Our findings suggest that individuals with the GC haplotype Gc1f may have a lower risk of dying from melanoma—specifically from thicker, higher-risk melanoma—than individuals without this Gc1f haplotype.

among children around the globe.From an individual perspective:i. vaccinated children are less likely to be infected with Covid-19; ii. if infected, vaccinated children are less likely to be admitted to a hospital or to die from Covid-19; and iii.vaccination offers protection from Covid-19-related complications in children and can reduce the disproportionate health impacts already placed on children due to prolonged control measures (e.g.school and community closures), differential risk factors and social contexts. 4 Given that there are still several unanswered questions surrounding the aetiology, transmission and social determinants of Covid-19 4 : from a public health standpoint, the more children vaccinated, the less the virus will circulate and therefore the closer the world will be to controlling the disease.The International Epidemiological Association therefore urges individuals, families, health professionals, governments and all institutions to encourage the vaccination of children against Covid-19.We must remind the world that vaccines eradicated smallpox and eliminated and mitigated many other diseases in the history of public health, and consequently saved millions of lives.We now have plenty of vaccines, and what matters is increasing the public health workforce so that public health targets can be reached and vaccines can be received by those in need, either for individual protection or for the community at large to achieve population protection.

A copy of a booklet communicating personalised risk of melanoma.

Skin cancer incidence is increasing among US Hispanics, who experience higher morbidity and mortality and are underserved in precision medicine. A large proportion of Hispanics carry risk variants at MC1R, a robust genetic locus for skin cancer susceptibility. Recall is a fundamental psychological mechanism underlying how people receive health recommendations: better recall has been associated with greater adherence and improved outcomes. However, research on recall of genetic testing information for low to moderate penetrance genes, what predicts recall, and the influence of recall on preventive behavior is limited, especially among Hispanics. We report results of secondary analyses from our previously published randomized controlled trial among self-identified Hispanic participants from Tampa, Florida and Ponce, Puerto Rico. Participants randomized to the precision prevention arm (n=282) were provided MC1R risk information (average or higher) and were asked to recall their genetic risk after 3 and 9 months. Predictors of recall (correct recall, did not recall, or misremembered) at each timepoint were determined by backwards stepwise selection that optimizes AIC, which maximizes overall model fit notwithstanding individual variable p-values. Using all trial participants (n=920), intervention effects on 11 primary and secondary preventive behaviors collected at baseline and post-intervention were estimated within strata of 3-month recall. At 9 months post-intervention, there was a borderline difference in risk recall comparing average- and higher-risk participants (p=0.051), with higher-risk participants 3 times less likely to correctly recall their MC1R risk category (vs. misremember, OR=0.31, 95%CI:0.10-0.95) than average-risk participants. Among average-risk participants, common predictors of correct recall across the 3- and 9-month final models were younger age (OR3=0.97, 95%CI:0.94-1.01, OR9=0.96, 95%CI:0.93-0.99) and higher education (OR3=1.64, 95%CI:1.06-2.63, OR9=1.73, 95%CI:1.12-2.81). Among higher-risk participants, higher education was associated with correct recall at both timepoints (OR3=1.30, 95%CI:0.93-1.85, OR9=1.66, 95%CI:1.21-2.32). Reassessment of intervention effects showed no pattern of improved or worsened preventive behavior by 3-month recall among average-risk participants. However, higher-risk participants who correctly recalled at 3 months had greater odds of wearing sunscreen often or always (OR=1.97, p=0.04) and odds of undergoing a professional skin exam (OR=8.89; p=0.001) than those who did not recall or misremembered (OR=1.32, p=0.45, OR=6.36, p=0.007, respectively). Our results suggest the need for additional strategies, such as reinforcement, for Hispanics with lower education to boost recall, which may consequently improve adoption of preventive behaviors. Citation Format: John C. Lacson, Youngchul Kim, Steven K. Sutton, Richard G. Roetzheim, Susan T. Vadaparampil, Brenda Soto-Torres, Peter A. Kanetsky. Predictors of correct recall of MC1R genetic risk among Hispanic individuals participating in a skin cancer precision prevention trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1974.

Few studies have examined cognitive responses to mailed precision prevention materials. MC1R is a robust, well-described melanoma susceptibility marker. The purpose was to assess cognitive responses to generic or precision prevention materials incorporating MC1R genetic risk. Non-Hispanic White participants (n = 1134) enrolled in a randomized controlled trial received either precision prevention materials incorporating MC1R genetic risk (higher/average) or generic prevention (standard) materials. Six months after baseline, 808 (71.3%) participants reported on the amount of prevention materials read (5-point scale); believability and clarity of materials; intention to change preventive behaviors (7-point Likert scale); and recall of their MC1R genetic risk. Comparisons were conducted using Kruskal-Wallis and chi-squared tests. Overall, participants read most to all (Mdn = 4, IQR = 2) of the prevention materials, reported high believability (Mdn = 7, IQR = 1) and clarity (Mdn = 7, IQR = 1), and moderate intention to change preventive behaviors (Mdn = 5, IQR = 2). Higher-risk participants reported slightly less clarity (Mdn = 6, IQR = 2) than either average-risk (Mdn = 6, IQR = 1, p = 2.50 × 10-3) or standard participants (Mdn = 7, IQR = 1, p = 2.30 × 10-5); and slightly less believability (Mdn = 6, IQR = 1) than standard participants (Mdn = 7, IQR = 1, p = .005). Higher-risk participants were 2.21 times as likely (95% CI = 1.43-3.43) to misremember or forget their risk compared to average-risk participants; misremembering was observed only among higher-risk participants (14%). Mailed precision prevention information were mostly read, highly believable and clear, and resulted in moderate levels of intention to change sun protection behaviors, bolstering the feasibility of population-level precision prevention. Defensive reactions may explain lower clarity, believability, and higher incorrect risk recall among higher-risk participants.

The negative consequences of the COVID-19 pandemic on mental health have been widely reported, but less is known about how the impact of COVID-19 on others in one's social circle shapes these high distress levels. This study examines associations between social COVID-19 exposure-knowing someone who had a COVID-19 infection-and psychological functioning, as well as whether socio-demographic factors moderate these relationships. In June 2020, respondents (N = 343) from clinics in Tampa, Florida, U.S.A. reported whether they had social COVID-19 exposure, anxiety, depression, and stress, and other COVID-19-related concerns. Social COVID-19 exposure was associated with increased anxiety, stress, and concerns about a family member getting sick, and concerns about drinking and substance use. Several associations between exposure and psychological functioning were stronger in women, younger people, and people with lower income, implying these groups face elevated psychological risks due to the pandemic, and should be prioritized in mental health recovery efforts.