Examination of cognitive variables relevant to sunbathing

Effects of multiple viewings of an ultraviolet photo on sun protection behaviors

OBJECTIVES

To determine whether multiple viewings of one's ultraviolet (UV) facial photo differentially affects subsequent sun protection behaviors relative to a single viewing.

STUDY DESIGN

Pretest-posttest control group.

METHODS

Southern California college students (N = 151) were randomly assigned to be shown their UV facial photo one time, multiple times over the course of 2 weeks, or not at all. Emotional reactions, perceived susceptibility to skin damage, and sun protection intentions were assessed immediately, and sun protection behaviors were assessed during a surprise telephonic follow-up 1 month later.

RESULTS

Immediately after viewing a UV photo of their face, participants reported significantly greater perceived susceptibility to skin damage, greater intentions to engage in future sun protection, and more negative emotions than those who had not seen a UV photo. Moreover, 1 month later, those who had viewed their UV photo were less likely to report having sunbathed and reported significantly greater sun protection than did controls. There were no differences in sun protection behaviors between those who had been shown their UV photo only once during the initial intervention session and those who had been sent their UV photo several times thereafter. However, among those who had been sent their UV photo several times, those who reported having viewed their photo on additional occasions reported significantly greater sun protection behaviors than those who had not.

CONCLUSIONS

Being randomly assigned to view a UV facial photo multiple times generally neither strengthened nor weakened effects on subsequent sun protection behaviors relative to being shown the photo just once. However, among those who were sent their photo and thus had the option of viewing it more often than they had been assigned to, those who chose to view their photo more frequently also engaged in more sun protection behaviors.

A Web-Based Intervention to Reduce Indoor Tanning Motivations in Adolescents: a Randomized Controlled Trial

Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.

Systematic and Iterative Development of a Smartphone App to Promote Sun-Protection Among Holidaymakers: Design of a Prototype and Results of Usability and Acceptability Testing

Background

Sunburn and intermittent exposure to ultraviolet rays are risk factors for melanoma. Sunburn is a common experience during holidays, making tourism settings of particular interest for skin cancer prevention. Holidaymakers are a volatile populations found at different locations, which may make them difficult to reach. Given the widespread use of smartphones, evidence suggests that this might be a novel, convenient, scalable, and feasible way of reaching the target population.

Objective

The main objective of this study was to describe and appraise the process of systematically developing a smartphone intervention (mISkin app) to promote sun-protection during holidays.

Methods

The iterative development process of the mISkin app was conducted over four sequential stages: (1) identify evidence on the most effective behavior change techniques (BCTs) used (active ingredients) as well as theoretical predictors and theories, (2) evidence-based intervention design, (3) co-design with users of the mISkin app prototype, and (4) refinement of the app. Each stage provided key findings that were subsequently used to inform the design of the mISkin app.

Results

The sequential approach to development integrates different strands of evidence to inform the design of an evidence-based intervention. A systematic review on previously tested interventions to promote sun-protection provided cues and constraints for the design of this intervention. The development and design of the mISkin app also incorporated other sources of information, such as other literature reviews and experts’ consultations. The developed prototype of the mISkin app was evaluated by engaging potential holidaymakers in the refinement and further development of the mISkin app through usability (ease-of-use) and acceptability testing of the intervention prototype. All 17 participants were satisfied with the mISkin prototype and expressed willingness to use it. Feedback on the app was integrated in the optimization process of the mISkin app.

Conclusions

The mISkin app was designed to promote sun-protection among holidaymakers and was based on current evidence, experts’ knowledge and experience, and user involvement. Based on user feedback, the app has been refined and a fully functional version is ready for formal testing in a feasibility pilot study.

All blogs are not created equal: the role of narrative formats and user-generated comments in health prevention

This study examined the extent to which narative versus nonnarrative blogs and compliant versus defiant user comments affect optimistic bias and behavioral intentions related to skin cancer prevention. Participants (N = 181) read one of four versions of a blog post about skin cancer that described a blogger's journey with skin cancer diagnosis and treatment, and included specific recommendations for skin cancer prevention. The post was written in either narrative or nonnarrative style, and was accompanied by reader comments that either agreed or disagreed with the prevention recommendations provided. Findings indicate that blog format reduces optimistic bias and increases behavioral intentions. Specifically, narrative blogs affect the two outcomes by way of eliciting transportation into the narrative world. Blog comments, on the other hand, were shown to have inconsistent effects on optimistic bias and behavioral intentions, via perceived social norms. While the social norms elicited by compliant blog comments had a direct positive effect on behavioral intentions, the indirect effect (via optimistic bias) was negative. Theoretical and practical implications, as well as suggestions for future research, are discussed.

An examination of direct and indirect effects of exposure and attention to health media on intentions to avoid unprotected sun exposure

Skin cancer is the most commonly diagnosed cancer in the United States, accounting for more than 2 million diagnoses and more than 9,000 deaths annually. A regional online survey of students enrolled at institutions of higher education (N = 1,251) examined (a) associations between health media use and intentions to avoid unprotected sun exposure and (b) theoretically derived health behavior constructs that may mediate the relationship between media use and individuals' decisions to avoid unprotected sun exposure. Individuals with greater exposure and attention to health information in television, magazines, and newspapers had higher intentions to avoid unprotected sun exposure. Multiple mediation models indicated that health behavior constructs collectively mediated the relationship between television use and sun-protective behavioral intentions. Both cumulative and specific indirect mediating effects were observed for the relationship between magazine use and sun-protective behavioral intentions. However, the direction of effects was opposite to the hypothesized direction, due primarily to the association of magazine use with less favorable attitudes about sun protection and reduced behavioral control to avoid unprotected sun exposure. This study provides preliminary evidence for the interrelationships among media use, internal psychological states and cognitions, and health behavior decision making. Future studies should further explicate the mediating processes that account for the relationships between media and health behavior.

Being healthy or looking good? The effectiveness of health versus appearance-focused arguments in two-sided messages

Two experimental studies test the effectiveness of health versus appearance-related arguments in two-sided messages. The first study shows that two-sided messages to discourage suntanning are more effective when using appearance-focused instead of health-focused arguments. Study 2 elaborates on the underlying mechanism and extends the generalization of the results of the first study, by investigating two-sided messages to promote physical exercise. The results show that for health-motivated consumers, a health-focused message is more effective, whereas for appearance-motivated consumers, an appearance-focused message is more effective. This matching effect is mediated by argument relevance.

Psychiatric and addictive symptoms of young adult female indoor tanners

PURPOSE

Indoor tanning (IT) increases risk for melanoma and is particularly common among young adult women. IT has also been linked with some psychiatric symptoms, and frequent tanning may indicate tanning dependence (addiction) associated with endorphin release during ultraviolet radiation exposure. The objective of the current study was to investigate associations between IT, tanning dependence, and psychiatric and substance use symptoms in young adult women.

DESIGN

Cross-sectional survey and psychiatric interview.

SETTING

Online, except for the Mini International Neuropsychiatric Interview (MINI), which was completed over the telephone.

SUBJECTS

Participants were 306 female university students aged 18 to 25 years.

MEASURES

MINI, Seasonal Scale Index, tanning dependence scales, reporting ever having used a tanning bed or booth with tanning lamps (single item), reporting smoking a cigarette in the last 30 days (single item).

ANALYSIS

Descriptive statistics, χ(2) analysis, multivariate logistic regression.

RESULTS

Forty-six percent of the sample reported a history of IT, and 25% were classified as tanning dependent. Multivariate logistic regression analyses showed that IT was significantly associated with symptoms of alcohol use disorders, generalized anxiety, and not having social anxiety. Tanning dependence was associated with symptoms of alcohol use disorders.

CONCLUSION

Tanning is of concern not only for its association with skin cancer but for its association with psychiatric and substance use symptoms. Young women with certain psychological problems may seek relief from their symptoms by IT. These findings suggest that indoor tanners may benefit from health behavior and other psychosocial interventions.

Impact of a facial-ageing intervention versus a health literature intervention on women's sun protection attitudes and behavioural intentions

This study was designed to investigate the impact of a facial-ageing intervention on women's sun protection attitudes and behavioural intentions, compared to a health literature intervention where participants viewed literature on the effect of ultraviolet (UV) exposure on health. Seventy women (35 in each condition) completed questionnaires at baseline and immediately post-intervention. The average age of the participants was 23.70 (SD = 5.03) years. Participants in the facial-ageing intervention condition scored significantly higher on intentions, negative attitudes and perceived sun damage susceptibility after taking part in the intervention, compared to those in the health literature intervention condition. The results are discussed in relation to suggestions for sun protection interventions aimed at women aged from 18 to 34. It is concluded that appearance-based interventions have a role to play in healthcare and educational settings with regard to UV exposure and sun protection intentions.

An examination of psychological variables relevant to artificial tanning tendencies

Cognitions relevant to tanning salon decision making were studied using Jaccard's Theory of Alternative Behavior (J. Jaccard. Journal of Experimental Social Psychology1981; 17: 286-307). Questionnaires were administered assessing tanning salon use, attitudes toward tanning salon use, attitudes toward reasonable behavioral alternatives, and cognitive variables underlying these variables. Tanning salon use reports were very high in this sample. The results support the notion that young people make decisions regarding using tanning salons based on the behavioral alternatives available to them. Specifically, subjects with stronger preferences for using clothing to enhance appearance were less likely to use tanning salons. Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention is discussed.

Reducing skin cancer risk: an intervention based on protection motivation theory

Caucasian college students who intentionally tanned participated in a brief skin cancer intervention based on protection motivation theory (PMT). This intervention targeted skin appearance and consisted of brief lectures, a comprehensive essay, video clips about a young man who died of melanoma, and short discussions. Compared to a waitlist control group, the intervention group showed increases on PMT variables and intentions at post-test. The waitlist group later received the intervention and showed similar increases. Additionally, all but one PMT variable maintained post-test levels at a one-month follow-up. Photographs taken at post-test and at the one-month follow-up were judged by raters blind to the hypothesis. Seventy-two percent of participants were judged to have lighter skin whereas only 16 percent had darker skin. These results provide additional support for theory-based methods for changing maladaptive attitudes and behaviors associated with skin cancer risk.

Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: a systematic review and meta-analyses

OBJECTIVES

A systematic review and meta-analyses were conducted to identify and review research examining the impact of appearance-based interventions on sun protection intentions and/or ultraviolet (UV) exposure behaviour.

METHODS

A search of 16 databases including PsycARTICLES, Cochrane Library and Web of Knowledge was conducted to identify studies examining the impact of appearance-based interventions on reducing UV exposure and/or increasing sun protection intentions and behaviours. A total of 21 articles met the inclusion criteria, and these studies were subjected to a systematic review and meta-analyses to determine the effectiveness of the interventions.

RESULTS

Interventions used a variety of techniques including UV technology and photoaging information. Study design and outcome measures varied. The research indicated that appearance-based interventions have a positive effect on UV exposure and sun protection intentions and behaviour.

CONCLUSIONS

Findings suggest that interventions based on the appearance-damaging effects of UV exposure, and the positive effects of sun protection, may have a role in health promotion. It is concluded that there is a need for further research incorporating a wider range of participants, and using qualitative and mixed methods designs.

STATEMENT OF CONTRIBUTION

What is already known on the subject? Recreational exposure to ultraviolet (UV) radiation, are the primary causes of all melanomas, leading to skin cancer. A previous systematic review (Dodd & Forshaw, ) looking at the efficacy of appearance-focussed interventions in skin cancer prevention, suggested that there were significant effects for UV protection behaviour after such interventions. What does this study add? An up-to-date systematic review of studies that has carried out appearance-based interventions to reduce UV exposure and/or increase sun protection intentions and behaviours. A meta-analysis of data providing statistical evidence indicating that appearance-based interventions have a positive effect on UV exposure and sun protection intentions and behaviour.

Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: a randomized, controlled experiment

This experiment examined the impact of adding upward and/or downward social comparison information on the efficacy of an appearance-based sun protection intervention (UV photos and photoaging information). Southern California college students (N = 126) were randomly assigned to one of four conditions: control, intervention, intervention plus upward social comparison, intervention plus downward social comparison. The results demonstrated that all those who received the basic UV photo/photoaging intervention reported greater perceived susceptibility to photoaging (d = .74), less favorable tanning cognitions (d = .44), and greater intentions to sun protect (d = 1.32) relative to controls. Of more interest, while the basic intervention increased sun protective behavior during the subsequent 5 weeks relative to controls (d = .44), the addition of downward comparison information completely negated this benefit. Upward comparison information produced sun protection levels that were only slightly (and nonsignificantly) greater than in the basic intervention condition and, as such, does not appear to be a cost-effective addition. Possible mechanisms that may have reduced the benefits of upward comparison information and contributed to the undermining effects of downward comparison information are discussed.

A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis

The reduction of intentional exposure to ultraviolet (UV) radiation is an important area of skin cancer prevention. Hillhouse et al. (Cancer 113:3257-3266, 2008) have developed an appearance-focused intervention with evidence of efficacy in lowering indoor tanning UV exposure in young women. In the current study, a subgroup approach was used to determine moderators of intervention efficacy. Undergraduate females in two regions of the United States (n = 362) were randomized into an intervention or control condition. Latent profile analysis was used to identify subgroups of indoor tanners based on patterns of indoor tanning motives. Intervention efficacy was examined within each subgroup. We found evidence for 4 subgroups of tanners: knowledgeable-appearance tanners, low-knowledge tanners, low-knowledge, relaxation tanners, and knowledgeable, low-appearance and low-relaxation tanners. The intervention significantly reduced indoor tanning for the low-knowledge subgroup (34% of the sample). The utility of the subgroup approach in developing targeted behavioral skin cancer interventions is discussed.

Adolescent attitudes towards tanning: does age matter?

Adolescents seem to be obsessed with tanning. One third of both adolescents and adults report sunbathing. On average, about 20% of adolescents report ever-using of artificial UV tanning devices with 15% currently using them. Tanning attitudes appear similar for adolescents and adults. The top three reasons for tanning included beliefs that a tan makes them more comfortable socializing with friends, looks better and is attractive. The top reason for using artificial UV tanning devices is also aesthetics, followed by relaxation. Other reasons for using artificial UV tanning devices include vacation preparation and to gain a protective base. Attitudes related to appearance that result in more frequent tanning may be difficult to change.

The influence of appearance, health, and future orientations on tanning behavior

OBJECTIVE

To compare the influence of appearance, health, and future orientations on tanning attitudes and behaviors.

METHODS

The study was an online survey of 406 volunteers from a university community.

RESULTS

Appearance and future orientations were more closely related to ultraviolet radiation exposure and protection than was health orientation.

CONCLUSIONS

Future research and interventions may benefit from closer attention to associations between specific motivational orientations and behaviors.

A preliminary investigation of the predictors of tanning dependence

OBJECTIVES

To investigate possible predictors of tanning dependence including demographic variables, exposure and protective behaviors, and other health-related behaviors.

METHODS

This study consisted of an online survey of 400 students and other volunteers from a university community.

RESULTS

Twenty-seven percent of the sample was classified as tanning dependent. Tanning dependence was predicted by ethnicity and skin type, indoor and outdoor tanning and burning, and lower skin protective behaviors, as well as smoking and body mass index.

CONCLUSIONS

Young adults are at risk for tanning dependence, which can be predicted by specific demographic and behavioral variables.

Social norms information enhances the efficacy of an appearance-based sun protection intervention

This experiment examined whether the efficacy of an appearance-based sun protection intervention could be enhanced by the addition of social norms information. Southern California college students (N=125, predominantly female) were randomly assigned to either an appearance-based sun protection intervention that consisted of a photograph depicting underlying sun damage to their skin (UV photo) and information about photoaging or to a control condition. Those assigned to the intervention were further randomized to receive information about what one should do to prevent photoaging (injunctive norms information), information about the number of their peers who currently use regular sun protection (descriptive norms information), both injunctive and descriptive norms information, or neither type of norms information. The results demonstrated that those who received the UV photo/photoaging information intervention expressed greater sun protection intentions and subsequently reported greater sun protection behaviors than did controls. Further, the addition of both injunctive and descriptive norms information increased self-reported sun protection behaviors during the subsequent month.

Comparing college students' value-, outcome-, and impression-relevant involvement in health-related issues

The purpose of this study was to examine the role of receiver involvement in the context of health communication. Students (N = 277) completed Cho and Boster's (2005) measures of value-, outcome-, and impression-relevant involvement across 6 health behaviors, including cigarette smoking, organ and tissue donation, sunscreen use, alcohol use, sexually transmitted disease testing, and nutrition. Confirmatory factor analyses across all 6 health topics provided evidence of the 3-factor structure conceptualized by Johnson and Eagly (1989) and measured by Cho and Boster (2005). When health behaviors were regressed onto value-, outcome-, and impression-relevant involvement, outcome- and value-involvement, generally speaking, emerged as significant predictors. Results and implications of considering health campaign audience members' levels of involvement are discussed in the domain of preventive medicine.

Mediating Variables in a Parent Based Intervention to Reduce Skin Cancer Risk in Children

The present study examined theoretical mediators of a parent-based intervention on sunbathing tendencies and sunburn frequencies based on the work of Turrisi et al. [Turrisi, R., Hillhouse, J., Heavin, S., Robinson, J., Adams, M., & Berry, J. (2004). Journal of Behavioral Medicine, 27, 393-412.]. Three hundred and forty parents in two regions of the United States were educated about the dangers of risky sun behavior and how to convey information about skin cancer prevention to their children. Attitudes toward sunbathing, health beliefs, appearance beliefs, and social normative beliefs were examined and found to be significant mediators of program effects on sunbathing tendencies and sunburn frequencies. The findings are discussed with respect to maximizing the effectiveness of future skin cancer interventions with children.

Frequent tanning bed use, weight concerns, and other health risk behaviors in adolescent females (United States)

OBJECTIVE

To examine the association between tanning bed use and weight concerns, health risk behaviors, and peer influence.

METHODS

The Growing Up Today Study (GUTS) is an ongoing prospective cohort study of adolescents established in 1996. In 1999, a total of 6,373 adolescent females ages 12-18 (offspring of participants in the Nurses Health Study 2) completed the survey.

RESULTS

Almost nine percent (8.6%) of the adolescent girls had used a tanning bed 1-9 times and an additional 5.4% had used tanning beds at least 10 times in the past year (frequent users). Logistic regression models revealed that frequent tanning bed use was associated with being highly concerned about weight (OR = 1.5, 95%CI = 1.1, 2.0), frequently dieting to lose weight (OR = 1.5, 95%CI = 1.1, 2.0), using laxatives or vomiting to control weight (OR = 3.6; 95%CI = 2.2-5.8), having friends who placed a lot of importance on being thin (OR = 2.6; 95%CI = 1.3-5.1), smoking cigarettes (OR=1.7, 95%CI = 1.1, 2.6), binge drinking (OR = 2.1, 95%CI = 1.3, 3.1), using recreational drugs (OR = 3.0; 95%CI = 2.4, 3.8), and trying to look like females in the media (sometimes/pretty much: OR = 1.3, 95%CI = 1.0, 1.8).

CONCLUSION

Frequent tanning bed use among adolescent females is associated with a range of health risk behaviors. This effect may be mediated by peer influence and a desire to look like other females in the media. Multi-pronged approaches, particularly those that target attitudes of young females, are needed to combat increased use of tanning beds.

Motives of Belgian Adolescents for Using Sunscreen: The Role of Action Plans

The first objective of this study was to analyze the differences between adolescents who use sunscreen frequently and those who do not. The second objective was to explore the importance of specific action plans when planning sunscreen use. Data was gathered among 602 Belgian secondary school students. Frequent and infrequent users of sunscreen were compared on several determinants related with sunscreen use, and a regression analysis on sunscreen use was done. Frequent users of sunscreen measures had significantly higher scores on attitudes, social influence, self-efficacy, some awareness factors, intention, and action plans. The integrated model for exploring motivational and behavioral change (I-Change model) explained 57% of the total variance of using sunscreen every 2 hours. Frequent sunscreen use was most strongly predicted by action plans, followed by positive intentions to use sunscreen, wearing protective clothing, seeking shade, attitude toward sunscreen use, education, social influence, and exposure to the sun. Our results suggest that skin cancer prevention programs aimed at promoting sunscreen use need to emphasize the advantages of sunscreen to infrequent users and to increase feelings of self-efficacy. Moreover, support by friends and parents should be stimulated. Finally, developing specific action plans for the use of sunscreen should be promoted to more effectively translate general intentions into actual sunscreen use.

Evaluation of a multicomponent appearance-based sun-protective intervention for young women: Uncovering the mechanisms of program efficacy

An appearance-based sun-protection intervention program was developed, implemented, and evaluated in a sample of 211 Caucasian women (ages 18-25) randomly assigned to the sun-protection program or to a stress management (control) program. The sun-protection program incorporated a novel construct of image norms of aspirational peers (i.e., female media figures, fashion models) approving paleness. The authors targeted these image norms as well as the advantages of tanning, health beliefs about photoaging and skin cancer, and self-efficacy for sun protection. The intervention produced significant differences across conditions favoring sun protection on all constructs but severity of skin cancer and barriers to sun protection. At follow-up, treatment participants exceeded controls both in intention to sun protect and sun-protective behavior and reported lower intention to sunbathe and fewer hours of sunbathing. A mediational model of intervention outcomes revealed distinct mediators for sun protection versus sunbathing.

Skin cancer prevention: behaviour and motives of Dutch adolescents

Skin cancer incidence is rising in the Netherlands and prevention programmes are needed. We analysed sun protection behaviours and beliefs in 500 adolescents aged 15-20 years using the Integrated Model for Change. The results show that adolescents with the fairest skin type exposed themselves significantly less to the sun, but had more burns than groups with a darker skin type. Sunscreen was the most commonly used method by adolescents to protect themselves and 77% of adolescents frequently used this strategy. Sunscreen use was also higher in females than in males. Wearing protective clothing (34%) and seeking shade between 1200 and 1500 h (26%) were less popular and used by adolescents in our study. Frequent use of sunscreen was most strongly predicted by positive intentions to use sunscreen, parental support, a positive attitude towards using sunscreen, support of friends and perceiving skin cancer risks. Wearing protective clothing was predicted most strongly by parental support, having a positive attitude towards wearing protective clothing, seeking shade, support of friends, high self-efficacy levels, low exposure to the sun and being male. Seeking shade was most strongly predicted by a positive attitude towards seeking shade, support of friends, using protective clothing, high self-efficacy, parental support, a negative attitude towards tanning, and perceiving skin cancer risks. Implications for Dutch skin cancer prevention programmes are that the efficacy and advantages of all protective methods need to be outlined more clearly in health education programmes on skin cancer prevention.

Effects of appearance-based interventions on sun protection intentions and self-reported behaviors

Two appearance-based interventions designed to increase sun protection intentions and behaviors were evaluated. Sixty-eight college students in Experiment 1 and 76 beachgoers in Experiment 2 were randomly assigned to receive or not receive a photoaging (premature wrinkling and age spots) information intervention and, separately, to receive or not receive a novel ultraviolet (UV) photo intervention that makes the negative-appearance consequences of UV exposure more salient. Both experiments indicated that the UV photo intervention significantly increased intentions to use sunscreen in the future. A follow-up conducted with the beach sample indicated that UV photo information also produced greater protective behaviors for incidental sun exposure and that the combination of UV photo and photoaging information resulted in substantially lower reported sunbathing.

Sunbed use at home: risk behaviour and psychosocial determinants

The objective of this study was to analyse the behaviour of people with regard to sunbed use at home, and to analyse the psychosocial determinants of intention and behaviour with regard to limiting the health risk of using sunbeds at home. Data were collected by means of a telephone survey among 349 adults from the Dutch general public who use sunbeds at home (response=95%). Determinants that were assessed were: attitude with respect to safer use and the use of sunbeds in general, the social influences people encounter to use sunbeds in a safer way, and the self-efficacy expectations people have of their ability to use sunbeds more safely. The results showed that there were great differences between people's perceptions of their safe sunbed behaviour, and their actual safety behaviour. Almost all respondents (94%) thought that their sunbed behaviour was safe, while in reality only 37% of the respondents used the sunbed in accordance with the safety guidelines. The safer users of sunbeds differed on many determinants from the unsafe users. Intention to minimize the health risk when using sunbeds could be predicted by a person's perceived self-efficacy, the overall attitude and anticipated regret beliefs (R2=0.52). Sunbed users should be made aware of their risk behaviour with regard to sunbeds as well as providing information on changing determinants, in order to positively change people's intentions and behaviour with regard to the safer use of sunbeds.

Examination of the efficacy of an appearance-focused intervention to reduce UV exposure

This study designed and implemented an appearance-based skin cancer prevention intervention in college-aged females. One hundred and forty-seven respondents were randomly assigned to treatment or control groups. Treatment respondents received a short workbook describing the appearance damaging effects of indoor tanning. At short-term follow-up (2 weeks later) treatment respondents had significantly more negative attitudes toward indoor tanning, and reported fewer intentions to indoor tan. At 2-month follow-up, treatment respondents reported indoor tanning one-half as much as control respondents in the previous 2 months. This appearance-based intervention was able to produce clinically significant changes in indoor tanning use tendencies that could have a beneficial effect on the future development of skin cancer.

Examination of cognitive variables relevant to sunscreen use

The present study is an examination of the underlying psychological variables relevant to a sun-damage preventive behavior, sunscreen use. The focus of the research was to examine cognitive predictors of sunscreen use, utilizing a decision theoretic framework. Two hundred thirty subjects were recruited from psychology classes and administered questionnaires assessing sunscreen behavioral tendencies, attitudes toward sunscreen use, and internal- and external-based cognitions relevant toward sunscreen use. In contrast to previous work that had examined only one or two of these predictor variables in isolation, the present study evaluated the relative impact of these variables on sunscreen use tendencies. The findings revealed evidence of a multivariate model (using structural equation modeling; LISREL VIII) relating perceived need for, perceived efficacy of, perceived consequences of, and social normative influences on sunscreen use. The findings are discussed with respect to improving the effectiveness of short-term education efforts to increase sunscreen use.