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Tran T, Song S, Texeira AJ, Rechis R, Nelson KC. Educational interventions to promote sun-protection behaviors in adolescents in the United States: A systematic review. Pediatr Dermatol 2023. [PMID: 37160666 DOI: 10.1111/pde.15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/09/2023] [Indexed: 05/11/2023]
Abstract
The most prevalent modifiable risk factor for skin cancer is cumulative lifetime exposure to ultraviolet (UV) radiation, supporting the development of interventions promoting the early adoption of sun-protection behaviors. This systematic review summarizes behavioral interventions designed to promote sun-protection behaviors and reduce harmful UV exposure among U.S. adolescents. Ten studies describing 15 intervention arms were ultimately included in this review and comprised seven cross-sectional studies, a cohort study, a quasi-experimental study, and a randomized controlled trial. Most interventions included in this review were effective in increasing awareness of skin cancer and knowledge of the risk factors for skin cancer, but knowledge did not correlate with self-reported frequency of sun-protection behaviors in this population.
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Affiliation(s)
| | - Sarah Song
- The University of Texas Health Science Center at Houston John P. and Kathrine G. McGovern Medical School, Houston, Texas, USA
| | | | - Ruth Rechis
- Cancer Prevention and Control Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Prichard I, Kneebone A, Hutchinson AD, Wilson C. The relationship between skin tone dissatisfaction and sun tanning behaviour. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ivanka Prichard
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
| | - Anna Kneebone
- Cancer Council South Australia, Adelaide, South Australia, Australia,
| | - Amanda D. Hutchinson
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
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3
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Morris K, Swinbourne A. Identifying prototypes associated with sun‐related behaviours in North Queensland. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kayla Morris
- Department of Psychology, School of Arts and Social Sciences, James Cook University, Townsville, Queensland, Australia,
| | - Anne Swinbourne
- Department of Psychology, School of Arts and Social Sciences, James Cook University, Townsville, Queensland, Australia,
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Leske S, Young RM, White KM, Hawkes AL. A Qualitative Exploration of Sun Safety Beliefs Among Australian Adults. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stuart Leske
- School of Psychology and Counselling, Queensland University of Technology,
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
| | - Ross Mcd Young
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
- Faculty of Health, Queensland University of Technology,
| | - Katherine Marie White
- School of Psychology and Counselling, Queensland University of Technology,
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
| | - Anna L Hawkes
- Faculty of Health, Queensland University of Technology,
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland,
- School of Public Health and Social Work, Queensland University of Technology,
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5
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Haynes A, Nathan A, Dixon H, Wakefield M, Dobbinson S. Sun-protective clothing and shade use in public outdoor leisure settings from 1992 to 2019: Results from cross-sectional observational surveys in Melbourne, Australia. Prev Med 2020; 139:106230. [PMID: 32768510 DOI: 10.1016/j.ypmed.2020.106230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/11/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
Skin cancer presents a significant public health burden in Australia. The present study aimed to supplement population-based estimates of sun protection behaviour by examining setting-specific trends in directly observed sun protection in public outdoor leisure settings. Repeated cross-sectional observational surveys of adolescents and adults were conducted on summer weekends between 11 am and 3 pm from 1992 to 2002, 2006 to 2012, and 2018 to 2019 (N = 44,979) at pools/beaches and parks/gardens within 25 km of the centre of Melbourne, Victoria. The primary outcome was a binary index representing individuals having above or below the median level of body surface covered by hat, shirt, and leg garments in each setting type. The prevalence of above-median body coverage increased between 1992 and 2002 in both settings. At pools/beaches, a slight decline in above-median body coverage between 2006 and 2019 in males and females (adjusted odds ratio, AOR = 0.96 [0.94, 0.97]; 0.94 [0.93, 0.95]) appeared to be driven by a decline in leg coverage, while arm coverage, hat, sunglasses, and shade use remained stable. At parks/gardens, a decline in above-median body coverage between 2006 and 2019 (AOR = 0.90 [0.89, 0.91]; 0.94 [0.93, 0.95]) was accompanied by small declines across other protective behaviours that varied between males and females. Patterns in protective behaviours observed in outdoor leisure settings may reflect the changing composition of individuals choosing to remain outdoors during peak UV times and highlight the importance of continued promotion and monitoring of the use of multiple measures to protect against UV damage in Australia.
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Affiliation(s)
- Ashleigh Haynes
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia.
| | - Andrea Nathan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria 3004, Australia
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6
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Holman DM, Ding H, Guy GP, Watson M, Hartman AM, Perna FM. Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults. JAMA Dermatol 2019. [PMID: 29541756 DOI: 10.1001/jamadermatol.2018.0028] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts. Objective To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population. Design, Setting, and Participants In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey-Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017. Main Outcomes and Measures The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling. Results A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non-aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non-binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non-overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups. Conclusions and Relevance Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.
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Affiliation(s)
- Dawn M Holman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Ding
- DB Consulting Group Inc, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne M Hartman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Frank M Perna
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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McWhirter JE, Byl S, Green A, Sears W, Papadopoulos A. Availability of tanning salons in Ontario relative to indoor tanning policy (2001-2017). Prev Med Rep 2018; 12:40-45. [PMID: 30167354 PMCID: PMC6115533 DOI: 10.1016/j.pmedr.2018.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
Ultraviolet (UV) radiation from indoor tanning equipment is a known cause of skin cancer; however, little is known about how the availability of indoor tanning salons has been impacted by indoor tanning legislation, including Ontario's Skin Cancer Prevention Act: Tanning Beds (SCPA). Tanning salon listings were obtained from the 2001 to 2017 editions of InfoCanada's Ontario Business to Business Sales and Marketing directories. Using descriptive statistics and regression analysis, we assessed the number of tanning salons before and after: 1) the 2006 International Agency for Research on Cancer (IARC) report on indoor tanning and skin cancer; 2) the 2009 World Health Organization (WHO) reclassification of artificial UV radiation as carcinogenic; and 3) the passing and enactment of Ontario's SCPA in 2013 and 2014, respectively. There were fewer tanning salon listings in the years after vs. before the IARC report, the WHO reclassification, and the passing and enactment of the SCPA. The number of tanning salons in Ontario, Canada has been declining since 2006, which may reflect a decline in indoor tanning bed use. Key public health policy instruments, including legislation and public education, appear to be associated with this trend, suggesting they may contribute to deterring indoor tanning. Number of tanning salons in Ontario, Canada decreased from 2006 to 2017. Number of tanning salons declined after passing and enactment of indoor tanning legislation. Number of tanning salons declined after international report and decision on carcinogenic nature of tanning devices. Legislation, expert exhortation, and public education may contribute to declines in tanning salon availability.
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Affiliation(s)
- Jennifer E McWhirter
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Spencer Byl
- Department of Biomedical Sciences, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Alyssa Green
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - William Sears
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
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8
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Sex Differences in the Relationship Between Socio-Cultural Norms and Sunbathing. Int J Behav Med 2016; 24:428-437. [DOI: 10.1007/s12529-016-9606-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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9
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McWhirter JE, Hoffman-Goetz L. Coverage of Skin Cancer Risk Factors and UV Behaviors in Popular U.S. Magazines from 2000 to 2012. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:382-388. [PMID: 25761763 DOI: 10.1007/s13187-015-0808-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mass media is an influential source of skin cancer and tanning information for the public, but we know little about its content or emphasis. The objective of this research was to describe the volume and nature of skin cancer and tanning messages in 20 popular U.S. men's and women's magazines (2000-2012). We used a directed content analysis to determine frequency information about risk factors and ultraviolet (UV) behaviors in 608 articles and 930 images. Chi-square and Fisher's exact tests determined coverage differences based on content type (text vs. image) and target audience (women vs. men). UV exposure was the most common risk factor mentioned (37.7 %) and sunscreen use the most common behavior encouraged (60.0 %); information about other risk factors and protective behaviors was uncommon. Both articles (25.2 %) and images (36.9 %) promoted the tanned look as attractive. In most cases, images infrequently contained helpful information on skin cancer risk factors and prevention, except for high-SPF sunscreens. Women's magazines published more articles on skin cancer and tanning than men's magazines (456 vs. 159, χ(2) = 143.43, P < .01), and the nature of the messages differed between them. Magazine skin cancer and tanning content may contribute to inaccurate public understanding of risks and prevention. These findings are relevant to cancer educators, who may wish to counter potentially harmful messages and enhance positive ones through cancer education efforts.
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Affiliation(s)
- Jennifer E McWhirter
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Laurie Hoffman-Goetz
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
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10
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Dobbinson SJ, Volkov A, Wakefield MA. Continued Impact of SunSmart Advertising on Youth and Adults' Behaviors. Am J Prev Med 2015; 49:20-8. [PMID: 25794474 DOI: 10.1016/j.amepre.2015.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 12/22/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Televised advertising campaigns play a central role in public education for skin cancer prevention in Australia. Continued impact on behavior is crucial to optimize these investments. This study examines whether exposure to increased intensity of summer campaigns in the past decade has continued to influence sun protection behaviors and to examine behavioral impact across age groups. METHODS Cross-sectional weekly telephone surveys of Melbourne residents were conducted over summers from 1987-1988 to 2010-2011, and analyzed in 2012-2014. Respondents' sun-related attitudes and their sun protection and sunburn on the weekend prior to interview were assessed. Population exposure to campaign TV advertising was measured as cumulated weekly target audience rating points (TARPs) for 4 weeks prior to interviews. Multiple logistic and linear regression models examined the relationship of campaign advertising with tanning preference and behavioral outcomes (N=11,881). RESULTS Respondents' attitudes and behaviors in 1987-2011 were associated with TARPs. Increasing TARPs were related to increased preference for no tan (OR=1.12, 95% CI=1.07, 1.17); sunscreen use (OR=1.09, 95% CI=1.02, 1.17); and overall reduced mean percentage of skin exposed to the sun (B=-0.01, 95% CI=-0.01, 0.00). These effects had limited interaction with time period, age group, gender, or skin type. There was evidence of diminishing returns at the highest TARP quartile for tan preference but not for behavioral outcomes. CONCLUSIONS Sustained youth-focused advertising campaigns (for adolescents and young adults), when broadcast with sufficient TARPs during the summer months, continue to provide consistent beneficial impact on sun protection behaviors population-wide.
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Affiliation(s)
| | - Angela Volkov
- Cancer Council Victoria, Melbourne, Victoria, Australia
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11
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Basch CH, Hillyer GC, Ethan D, Berdnik A, Basch CE. Tanning Shade Gradations of Models in Mainstream Fitness and Muscle Enthusiast Magazines. Am J Mens Health 2014; 9:301-6. [DOI: 10.1177/1557988314543511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tanned skin has been associated with perceptions of fitness and social desirability. Portrayal of models in magazines may reflect and perpetuate these perceptions. Limited research has investigated tanning shade gradations of models in men’s versus women’s fitness and muscle enthusiast magazines. Such findings are relevant in light of increased incidence and prevalence of melanoma in the United States. This study evaluated and compared tanning shade gradations of adult Caucasian male and female model images in mainstream fitness and muscle enthusiast magazines. Sixty-nine U.S. magazine issues (spring and summer, 2013) were utilized. Two independent reviewers rated tanning shade gradations of adult Caucasian male and female model images on magazines’ covers, advertisements, and feature articles. Shade gradations were assessed using stock photographs of Caucasian models with varying levels of tanned skin on an 8-shade scale. A total of 4,683 images were evaluated. Darkest tanning shades were found among males in muscle enthusiast magazines and lightest among females in women’s mainstream fitness magazines. By gender, male model images were 54% more likely to portray a darker tanning shade. In this study, images in men’s (vs. women’s) fitness and muscle enthusiast magazines portrayed Caucasian models with darker skin shades. Despite these magazines’ fitness-related messages, protanning images may promote attitudes and behaviors associated with higher skin cancer risk. To date, this is the first study to explore tanning shades in men’s magazines of these genres. Further research is necessary to identify effects of exposure to these images among male readers.
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12
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Sinclair C, Makin JK. Implications of lessons learned from tobacco control for tanning bed reform. Prev Chronic Dis 2013; 10:E28. [PMID: 23449282 PMCID: PMC3592784 DOI: 10.5888/pcd10.120186] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tanning beds used according to the manufacturer’s instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations.
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Robinson NG, White KM, Hamilton K. Examining Young Recreational Sportswomen's Intentions to Engage in Sun-Protective Behavior: The Role of Group and Image Norms. Women Health 2013; 53:244-61. [DOI: 10.1080/03630242.2013.782939] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Assessing population-wide behaviour change: concordance of 10-year trends in self-reported and observed sun protection. Int J Public Health 2013; 59:157-66. [PMID: 23519893 DOI: 10.1007/s00038-013-0454-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 02/27/2013] [Accepted: 03/01/2013] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Increases in socially desirable responses in self-reports might occur in the context of ongoing public education. We examine concordance of trends in two long-term studies monitoring population impact for SunSmart. METHODS One study employed telephone interviews of Melbourne residents; the other entailed observations at public recreation venues across Melbourne. The studies assessed people's sun protection on identical weekend dates (Nw = 33 dates). Data from five summers between 1992 and 2001 (n ~ 23,000 individuals) were analysed. A body cover index score was calculated for participants on each date. Outcomes were aggregated separately for Saturdays and Sundays by date and year. Regression analyses tested whether these trends differed by survey method. RESULTS The pattern of change in body cover over time was similar for both surveys. Self-reported body cover was consistently higher than observed body cover, suggesting that social desirability bias may be present. Regression analyses showed no divergence between self-reported and observed trends in mean body cover, suggesting no evidence of significant increased social desirability bias in self-reporting over time. CONCLUSION Findings suggest that self-report offers a valid means of assessing change in a population's sun protection compliance over time, at least when self-reports are precisely focussed for time and activity context.
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Dixon H, Warne C, Scully M, Dobbinson S, Wakefield M. Agenda-setting effects of sun-related news coverage on public attitudes and beliefs about tanning and skin cancer. HEALTH COMMUNICATION 2013; 29:173-181. [PMID: 23485415 DOI: 10.1080/10410236.2012.732027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The topics and framing of news stories relevant to skin cancer prevention have shifted over time. This study examined agenda-setting effects of such news stories on public attitudes and beliefs about tanning and skin cancer. Content analysis data on 516 articles published in two major daily newspapers in Melbourne, Australia, from 1994 to 2007 were combined with circulation data to generate indices of potential news exposure. Associations between these indices and cross-sectional telephone survey data from the same period on 6,244 adults' tanning attitudes and perceived susceptibility to skin cancer were examined using logistic regression models, accounting for the temporal precedence of news content. Pro-sun protection stories on attitudes and behavior were associated with older adults not thinking a tan looks healthy. Pro-sun protection stories on solaria were associated with less preference for a deep tan among young adults who like to suntan. Stories on vitamin D that were unsupportive of or ambiguous about sun protection were associated with a number of pro-tan attitudes among younger adults. Results indicate news coverage during 1994-2007 served an important agenda-setting role in explaining the public's attitudes and beliefs about tanning and skin cancer. Vitamin D stories appeared most influential, particularly among young adults.
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Affiliation(s)
- Helen Dixon
- a Centre for Behavioural Research in Cancer Cancer Council Victoria
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16
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Makin J, Warne C, Dobbinson S, Wakefield M, Hill D. Population and age-group trends in weekend sun protection and sunburn over two decades of the SunSmart programme in Melbourne, Australia. Br J Dermatol 2012; 168:154-61. [DOI: 10.1111/bjd.12082] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Hamilton K, White KM, McD Young R, Hawkes AL, Starfelt LC, Leske S. Identifying critical sun-protective beliefs among Australian adults. HEALTH EDUCATION RESEARCH 2012; 27:834-843. [PMID: 22949500 DOI: 10.1093/her/cys093] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We investigated critical beliefs to target in interventions aimed at improving sun-protective behaviours of Australian adults, a population at risk for skin cancer. Participants (N = 816) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of sun-protective behaviour. A range of behavioural, normative and control beliefs correlated with sun-protective behaviour, with no and only minimal differences observed in correlations between beliefs and behaviour by gender and age, respectively. A range of key beliefs made independent contributions to behaviour; however, the behavioural belief about being less likely to tan (β = 0.09); normative belief about friends (β = 0.20); and control beliefs about forgetfulness (β = -0.14), inconvenience (β = -0.17), knowing I will be in the sun for a long time (β = 0.16) and more fashionable sun-protective clothing (β = 0.13) were significant critical beliefs guiding people's sun-protective behaviour. Our study fills a gap in the literature by investigating an at-risk population for skin cancer and using an established theoretical framework to identify critical beliefs that guide Australian adults' decisions to sun protect. Attention to these critical beliefs will assist health campaigns and interventions aimed at combating the increasing rates of skin cancer for adults.
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Affiliation(s)
- Kyra Hamilton
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane 4059, Australia
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18
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Williams AL, Grogan S, Clark-Carter D, Buckley E. Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: a systematic review and meta-analyses. Br J Health Psychol 2012; 18:182-217. [PMID: 22989352 DOI: 10.1111/j.2044-8287.2012.02089.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 06/27/2012] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Alison L Williams
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK.
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McWhirter JE, Hoffman-Goetz L. Visual images for skin cancer prevention: a systematic review of qualitative studies. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:202-216. [PMID: 22481615 DOI: 10.1007/s13187-012-0355-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Visual images play an important role in educating the public about skin cancer prevention. The objectives of this systematic review were to: 1) determine how visual images are evaluated in skin cancer and tanning qualitative research studies (including theoretical and methodological approaches) and 2) summarize and discuss the image-related findings of the studies with respect to cancer education and public health. Seven databases were searched (PubMed-MEDLINE, EMBASE, PsycINFO, Sociological Abstracts, Social Sciences Full Text, ERIC, and ABI/INFORM) using multiple search terms, including MeSH terms, resulting in 5330 citations. Studies were included if they were in English, peer-reviewed, qualitative in design or methodology, dealt with skin cancer or UV exposure, used visual images, and had a focus on the public or patients (i.e., not medical professionals). Eight studies met the inclusion criteria: seven content analyses and one focus group study. Content analysis studies in this review suggest the mass media portray Caucasian men and women as unprotected from the sun and with tanned skin, and thus, may inform behaviors related to skin cancer risk. The focus group study suggests visible minorities may benefit from the incorporation of images of melanoma on ethnic skin in cancer education materials. None of the studies used visual communication theory to explicitly guide the research, nor were standardized tools used for image assessment. The lack of guiding theory and standardized assessment instruments can introduce bias in how images are selected and used in research on skin cancer education.
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Affiliation(s)
- Jennifer E McWhirter
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Makin JK, Hearne K, Dobbinson SJ. Compliance with age and skin type restrictions following the introduction of indoor tanning legislation in Melbourne, Australia. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2012; 27:286-93. [PMID: 22092731 DOI: 10.1111/j.1600-0781.2011.00613.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE The study aimed to establish compliance of indoor tanning businesses with 2009 legislation, particularly with requirements to provide information on skin cancer and exclude people under 18 or with fair skin. METHODS Compliance was tested through surveys and in-person visits to 30 businesses in Melbourne, Australia. Research assistants presented as potential customers with different profiles: young adults eligible to use a sunbed, young adults with fair skin, under age customers who prompted with their age and under age customers who concealed their age and claimed to be 18 if asked. RESULTS Communicating the risks of skin cancer during the visit improved from 70% in 2003, prior to the introduction of legislation, to 97% in 2009. While there were improvements in restricting access to sunbeds among high-risk groups, compliance of indoor tanning businesses with age and skin type restrictions remained less than optimal. Almost half (47%) allowed access to fair-skinned research assistants, compared with 90% in 2003. Only one of the 30 operators allowed access to a teenager who prompted with her age; in 2003, 52% of under age teenagers were granted access without parental consent. However, when teenagers concealed their age or claimed to be 18, 80% of operators granted them access. CONCLUSIONS The findings suggest that regulation of the indoor tanning industry is a better approach to this health issue than voluntary standards and/or education. Nonetheless, inadequate compliance with requirements to exclude high-risk groups lends weight to calls for stricter monitoring and enforcement, or an absolute ban.
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Affiliation(s)
- Jennifer K Makin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Carlton, Vic., Australia.
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Paul CL, Paras L, Harper A, Coppa K. Harm minimization in tan seekers: an exploration of tanning behaviour and the potential for substitutional use of sunless tanning products. J Health Psychol 2011; 16:929-37. [PMID: 21441364 DOI: 10.1177/1359105310396393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Exposure to ultraviolet (UV) light from the sun or solaria is a major contributor to high rates of skin cancer. The study aimed to explore the intentions of active tan seekers in relation to the substitutional use of sunless tanning products. Participants were reluctant to reduce UV exposure in favour of using sunless tanning products, which were considered to be another tanning method rather than an avenue for reducing skin cancer risk. The 'sunless tan' approach is unlikely to reduce UV exposure in the majority of tan seekers, but may be valuable in targeting women with fairer skin.
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Affiliation(s)
- Christine L Paul
- Centre for Health Research & Psycho-oncology, Cancer Council New South Wales & University of Newcastle, Australia.
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Dixon HG, Warne CD, Scully ML, Wakefield MA, Dobbinson SJ. Does the Portrayal of Tanning in Australian Women’s Magazines Relate to Real Women’s Tanning Beliefs and Behavior? HEALTH EDUCATION & BEHAVIOR 2011; 38:132-42. [DOI: 10.1177/1090198110369057] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Content analysis data on the tans of 4,422 female Caucasian models sampled from spring and summer magazine issues were combined with readership data to generate indices of potential exposure to social modeling of tanning via popular women’s magazines over a 15-year period (1987 to 2002). Associations between these indices and cross-sectional telephone survey data from the same period on 5,675 female teenagers’ and adults’ tanning attitudes, beliefs, and behavior were examined using logistic regression models. Among young women, greater exposure to tanning in young women’s magazines was associated with increased likelihood of endorsing pro-tan attitudes and beliefs. Among women of all ages, greater exposure to tanned models via the most popular women’s magazines was associated with increased likelihood of attempting to get a tan but lower likelihood of endorsing pro-tan attitudes. Popular women’s magazines may promote and reflect real women’s tanning beliefs and behavior.
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Makin JK, Dobbinson SJ. Changes in solarium numbers in Australia following negative media and legislation. Aust N Z J Public Health 2010; 33:491-4. [PMID: 19811490 DOI: 10.1111/j.1753-6405.2009.00436.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To monitor changes in the number of indoor tanning facilities in Australia's capital cities following widespread negative publicity and the introduction of legislation in some states. METHODS An audit of listings under Solarium/Tanning Centres in the most recent hard copy Yellow Pages for Australia's capital cities was conducted, and results were compared with those from a previous audit from 2006. RESULTS There was a 32% drop in solarium listings for Australia's capital cities between 2006 and 2008/09. In most cases, larger decreases were observed in states where legislation was introduced. CONCLUSIONS Despite underestimating solarium numbers, regular audits of business listings can be a useful way of monitoring trends, particularly when more accurate figures are not available. Solarium numbers can decrease following a combination of negative publicity and legislation. IMPLICATIONS To achieve and maintain predicted reductions in skin cancer incidence, mortality and costs to the health system, solarium legislation should be a priority for those states where it has not yet been introduced, accompanied by compliance monitoring and enforcement to ensure it is effective.
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Affiliation(s)
- Jennifer K Makin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Carlton, Victoria
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Kemp GA, Eagle L, Verne J. Mass media barriers to social marketing interventions: the example of sun protection in the UK. Health Promot Int 2010; 26:37-45. [PMID: 20713412 DOI: 10.1093/heapro/daq048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The role of the mass media in communicating health-related information to the wider population is the focus of this paper. Using the example of sun protection within the UK, we highlight some of the major challenges to raising awareness of steadily increasing melanoma rates and of effective sun protection strategies. The implications of potential barriers to official sun protection messages via conflicting messages in the media are discussed in terms of editorial on sun protection and in the way in which television programme content portrays the issues. Implications for public policy and future research conclude the paper.
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Affiliation(s)
- Gillian Ann Kemp
- University of the West of England, Coldharbour Road, Frenchay, Bristol, Bristol BS16 1QY, UK.
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Bandi P, Cokkinides VE, Weinstock MA, Ward E. Sunburns, sun protection and indoor tanning behaviors, and attitudes regarding sun protection benefits and tan appeal among parents of U.S. adolescents-1998 compared to 2004. Pediatr Dermatol 2010; 27:9-18. [PMID: 20199403 DOI: 10.1111/j.1525-1470.2009.01074.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study presents nationally representative trends (1998-2004) and patterns in skin cancer risk behaviors, including sunburns, sun protection, and indoor tanning behaviors, and attitudes regarding ultraviolet radiation exposure among parents of U.S. adolescents. Data were from the American Cancer Society Sun Surveys I and II, telephone-based random digit dialed cross-sectional surveys of U.S. adolescents and their parents conducted in the summers of 1998 and 2004. Between 1998 and 2004, use of sunscreen, wide-brimmed hats and composite use of three to five behaviors increased significantly; concurrently, indoor tanning use increased significantly and sunburn prevalence changed a little. In 2004, 47% reported summer sunburns and more than half of those received painful sunburns. Parents continued to report low compliance with recommended behaviors; sunscreen use was most frequently reported, but many followed inappropriate application practices. About 13% practiced indoor tanning in the past year. Parents reported high levels of positive attitudes toward sun protection benefit, but at the same time, significant proportions reported positive tan appeal and outdoor sun exposure attitudes. The low rates and mixed progress in safe ultraviolet radiation exposure behaviors demand more attention for primary skin cancer prevention among parents of adolescents that focuses on changing beliefs about tanning appeal and promotes comprehensive ultraviolet radiation exposure protection.
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Affiliation(s)
- Priti Bandi
- Department of Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia 30303-1002, USA.
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Dobbinson S, Wakefield M, Hill D, Girgis A, Aitken JF, Beckmann K, Reeder AI, Herd N, Fairthorne A, Bowles KA. Prevalence and determinants of Australian adolescents' and adults' weekend sun protection and sunburn, summer 2003-2004. J Am Acad Dermatol 2008; 59:602-14. [DOI: 10.1016/j.jaad.2008.06.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 05/15/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
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