Mediation analysis of decisional balance,sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

Objective: Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant.

Design: Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention.

Main outcome measures: Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use.

Results: With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126–.614), and the pros predicted the outcomes (r = .181–.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes.

Conclusion: In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.     

Psychometric assessment of the processes of change scale for sun protection

The fourteen-factor Processes of Change Scale for Sun Protection assesses behavioral and experiential strategies that underlie the process of sun protection acquisition and maintenance. Variations of this measure have been used effectively in several randomized sun protection trials, both for evaluation and as a basis for intervention. However, there are no published studies, to date, that evaluate the psychometric properties of the scale. The present study evaluated factorial invariance and scale reliability in a national sample (N = 1360) of adults involved in a Transtheoretical model tailored intervention for exercise and sun protection, at baseline. Invariance testing ranged from least to most restrictive: Configural Invariance (constraints only factor structure and zero loadings); Pattern Identity Invariance (equal factor loadings across target groups); and Strong Factorial Invariance (equal factor loadings and measurement errors). Multi-sample structural equation modeling tested the invariance of the measurement model across seven subgroups: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Strong factorial invariance was found across all subgroups. Internal consistency coefficient Alpha and factor rho reliability, respectively, were .83 and .80 for behavioral processes, .91 and .89 for experiential processes, and .93 and .91 for the global scale. These results provide strong empirical evidence that the scale is consistent, has internal validity and can be used in research interventions with population-based adult samples.     

Relationships between stage of change for stress management behavior and perceived stress and coping

The main aim of this study was to examine the relationships between stage of change, which was guided by the transtheoretical model, for stress management behavior and perceived stress and coping. First, we developed the Korean version of the Rhode Island Stress and Coping Inventory (RISCI). Second, we related stage of change for stress management behavior to perceived stress and coping. Based on two surveys that we conducted (n = 530 for survey 1 and n = 299 for survey 2), we developed the Korean version of the RISCI with acceptable internal consistency and criterion‐related validity against the depressive level measured using the Korean Beck Depression Inventory II. The stress score of the Korean version of the RISCI was significantly lower in maintenance than in the other stages, while the coping score was significantly higher in action and maintenance than in the first three stages (n = 804), irrespective of sex. These results provided further empirical evidence to validate stage classification in the field of stress management behavior.     

A psychosocial model of sun protection and sunbathing in young women: the impact of health beliefs, attitudes, norms, and self-efficacy for sun protection.

A psychosocial model of sun protection and sunbathing as distinct behaviors was developed on 202 young Caucasian women and replicated in an independent sample (n = 207). Proximal outcomes were intention to sun protect and intention to sunbathe; distal outcomes included sun protection and sunbathing behavior measured 5 months later. Objective risk for skin cancer plus 4 classes of psychosocial variables (sun-protective health beliefs, self-efficacy for sun protection, attitudes toward sunbathing, and norms for sunbathing and sun protection) served as predictors. Sun-protective norms and self-efficacy for sun protection predicted only intention to sun protect; sunbathing norms predicted only intention to sunbathe. Susceptibility and advantages of tanning predicted both intention constructs, which, in turn, predicted behavior. These findings distinguish sun protection from sunbathing and provide a basis for intervention design.     

Development and validation of an appearance motivation attitudes scale for sun protection

A reliable two-factor instrument measuring appearance motivation attitudes for sun protection was developed using a longitudinal sample of beachgoers. At baseline, data on sun protection and appearance motivation attitudes were collected on 2324 individuals. Principal components analyses (PCA) indicated a two-factor solution measuring attitudes toward tan attractiveness and skin protection with only 2 items loading on the skin protection factor. At 12-months, the instrument was revised and shortened but including 3 new skin protection items. Split-half analyses were conducted to further refine and develop the instrument. PCA on half of the sample revealed a two-factor solution, which was confirmed using structural equation modeling on the remaining half. This resulted in a two correlated-factor, 10-item measure. Each factor was summed to create two scales. Both scales were internally consistent and demonstrated good external validity, correlating with sun protection specific Transtheoretical model variables. The tan attractiveness attitudes scale significantly improved prediction of sun protection outcomes over 24 months, over and above TTM variables.     

Long-term effects of appearance-based interventions on sun protection behaviors.

OBJECTIVES: To examine the longer term efficacies of exposure to UV photographs and photoaging information (e.g., wrinkles and age spots) for increasing sun protection intentions and behaviors of young adults. DESIGN: Randomized controlled trial with 4- to 5-month and 12-month follow-ups. MAIN OUTCOME MEASURES: Participants' self-reported sun protection intentions assessed immediately after the interventions, and both self-reported sun protection behaviors and an objective assessment (via spectrophotometry) of skin color change measured at the end of summer (4-5 months following interventions) and 1 year following interventions. RESULTS: Both interventions resulted in immediate positive effects on future sun protection intentions. Both interventions showed objective evidence of less skin darkening at the postsummer follow-up, with those in the photoaging information condition also reporting more sun protective behavior and continuing to show less skin darkening 1 year after intervention. There was also evidence that effects of photoaging information on subsequent skin color change were mediated by the earlier positive effect photoaging information had on participants' intentions to sun protect and their subsequent sun protection behaviors. CONCLUSIONS: UV photo and photoaging-information interventions each show promise as a brief and relatively inexpensive approach for motivating sun protection practices that may reduce skin cancer risk.     

Co-creating change within a child protection system: integrating art therapy with family therapy practice

This paper considers family art therapy intervention using a partnership developed between an art therapist and a family therapist within a child protection system. The aim of this co-working relationship is to bring together skills that can amplify the child's voice within the family, using art as a means of extending the family story. The use of metaphor adds to the repertoire of skills available when working with families, and offers a particular form of communication in which children can more easily engage. By co-working, we also bring together our personal and professional stories, creating multiple ideas and ways of seeing and taking account of differences in the life experiences of individual families.     

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.     

早期道教的日月崇拜与存思日月法

对太阳和月亮的崇拜,在世界各国的古代宗教中是非常普遍的现象。道教在原始的日月崇拜的基础上,进一步明确了日月之神的姓氏、服饰和威权职掌。在道教中,日为大明之神,称为日宫太丹炎光郁明太阳帝君,或称日宫太阳帝君孝道仙王,作男像,以金色太阳为饰;月为夜明之神,称为月宫黄华素耀元精圣后太阴元君,或称月宫太阴皇君孝道明王,作女像,以白色月光为饰。①道教又称,日中有五帝,月中有五帝夫人。《上清太上帝君九真中经》说:日中青帝讳圆常无,字照龙韬。日中赤帝讳丹灵峙,字绿红映。日中白帝讳浩郁将,字回金霞。日中黑帝讳澄增停,字玄录炎。日…     

Engineering technology and behavior analysis for interdisciplinary environmental protection

Engineering strategies for saving environmental resources have been widespread. However, many of those engineering advances have not been widely accepted nor generally applied by large segments of the general population. This paper considers the need to examine behavioral/environmental variables in the application of engineering technology, with particular reference to specific behavioral strategies for encouraging the use of engineering technology from an interdisciplinary perspective. A model for the study of factors contributing to the solution of ecological/environmental problems is presented and examples of interdisciplinary research are described. The model implies a need for the examination of the effects of antecedent and consequent manipulation of a variety of variables including: behavioral, physiological, environmental, technical and legal conditions. It is concluded that while interdisciplinary research efforts between engineering technologists and behavioral analysts are necessary, they have not received sufficient attention in the literature nor have they focused on the comprehensive study of antecedents and consequences as they relate to ecological/environmental problems. Thus, an extended "family" of research efforts is important for the success of these efforts.     

Use of social networking sites and associations with skin tone dissatisfaction,sun exposure,and sun protection in a sample of Australian adolescents

Objective: Previous research has indicated that greater exposure to traditional media (i.e. television, film, and print) predicted skin cancer risk factors in adolescents; however, the relationship between social media usage and these outcomes remains unexplored. We examined whether social networking site (SNS) usage, and the particular manner of this use, was associated with skin tone dissatisfaction, sun exposure and sun protection among Australian adolescents. We also explored sex differences in SNS usage related to tanning.

Method: A total of 1856 South Australian secondary school students completed the Australian School Students Alcohol and Drug 2014 survey. SNS usage related to tanning comprised posting pictures, posting text, viewing pictures, viewing text and liking or sharing posts.

Results: Adolescents spent 214.56 minutes, on average, per day using SNSs. Behaviours related to tanning that involved pictures (i.e. viewing pictures, posting pictures, and liking or sharing content) were significantly associated with more skin tone dissatisfaction, more sun exposure and less sun protection. Females performed all SNS-linked behaviours more frequently than did males, with the exception of posting text.

Conclusion: Australian adolescents spend a considerable amount of time using SNSs, and their behaviours related to tanning on these SNSs are significantly associated with skin cancer risk factors.     

A precise and valid measure of behavior and behavior change in the classroom

A method for the direct and continuous observation of behavior as it occurs in the natural environment (classroom) is suggested as an alternative to individual testing and other observational techniques, especially those which use predetermined time segments and chart behavior in percentages. The method-behavior rates-using a base of movements per minute is seen as increasing the information obtained per unit of assessment time and providing daily, accurate feedback concerning the efficacy of a behavioral strategy.     

Effects of a multicomponent intervention on motivation and sun protection behaviors among midwestern beachgoers.

Skin cancer is the most prevalent of all cancers in the United States. Although avoiding sun exposure and using sun protection reduces skin cancer risk, rates of such behaviors are moderate at best. The present study examined the impact of a multicomponent intervention that aimed to increase the saliency of skin cancer risk while promoting the use of sun protection. Midwestern beachgoers (n = 100) participated in an intervention or questionnaire-only control group. Sun protection, stage of change, and sun exposure were measured at baseline and 2-month follow-up. The intervention group significantly improved in sun protection use and stage of change, but not sun exposure, compared with the control group. Personalizing the risks of unprotected sun exposure combined with providing education about sun protection facilitated healthy changes in behavior and motivation.