Diffusion of an effective skin cancer prevention program: design, theoretical foundations, and first-year implementation.

This article describes the design and theoretical foundations of the Pool Cool Diffusion Trial and reports 1st-year findings. Aims of the study are to evaluate the effects of 2 strategies for diffusion of the Pool Cool sun safety program on implementation, maintenance, and sustainability; improvements in environmental supports for sun safety in swimming pools; and sun protection habits and sunburn among participating children. There was a high rate of program participation (86.6%; n=375 swimming pools) in the 1st year and somewhat lower study participation (75.8%). Analysis of pool manager surveys revealed a time effect for overall sun safety programs and for sun safety policies, environmental strategies, and programs for pool users. There were few differences in implementation between treatment groups in year one.     

BEHAVIORAL COMMUNITY INTERVENTION TO REDUCE THE RISK OF SKIN CANCER

Peer leader modeling, posted feedback, posted goals, and a commitment raffle were used at two swimming pools to increase behaviors associated with skin cancer prevention. During the intervention condition, pool lifeguards modeled the protective behaviors by wearing sunglasses, t-shirts, and hats, using zinc oxide and sunscreen, and staying in the shade. Children and adolescents (1 to 16 years old) increased their use of two or more protective behaviors from a baseline mean of 6.5% to 26.9% during the intervention. Adults (older than 16 years) increased their protective behaviors from a baseline mean of 22% to 37.95% during the intervention. The lifeguards increased their use of all the protective behaviors from a baseline mean of 16.7% to 63.5% during intervention. Ways to improve and expand this intervention are discussed.     

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.     

Mediation of a middle school skin cancer prevention program.

This study tested potential mediators of a school-based skin cancer prevention intervention for middle school children (6th-8th grades; N = 1,788). Ten variables were tested on 4 criteria to establish mediation, including (a) intervention related to outcome, (b) intervention related to mediators, (c) mediators related to outcome, and (d) mediated effect statistically significant. Sun-safe behaviors (e.g., sunscreen use) and potential mediators were measured with a self-report questionnaire. All criteria were met for Barriers--Sunscreen, Perceived Self-Efficacy, and Knowledge when the mediators were tested separately. In multiple mediator analyses, barriers to sunscreen use and self-efficacy satisfied Criteria 1-3 but were not statistically significant (Criterion 4). Barriers to sunscreen use, perceived self-efficacy for sun-safe behavior, and knowledge may serve as mediators.     

Psychosocial factors in sunbathing and sunscreen use

Excessive exposure to the sun has been related to the development of various types of skin cancer, but use of sunscreen decreases the risk. The present project was designed to empirically examine psychosocial factors in sunbathing and sunscreen use. One hundred twenty sunbathing and nonsunbathing beachgoers were interviewed about their health practices, knowledge about skin cancer, moods, and social rewards obtained through sunbathing. They also completed several relevant personality questionnaires. Data were considered using a theoretical perspective combining aspects of health belief, social influence, social learning, and risk-taking models. Results indicate that sunbathing is clearly related to having a positive attitude toward risk taking, having little knowledge about skin cancer, reporting a relaxed mood, having friends who sunbathe, and engaging in activities related to maintaining a positive physical appearance. Sunscreen use is related to sex, having knowledge about skin cancer, knowing people who have had cancer, and reporting high levels of anxiety. The implications of these findings for the design of intervention strategies and for the future study of health-compromising behaviors are discussed.     

Message framing and sunscreen use: gain-framed messages motivate beach-goers.

Prospect theory suggests that people respond differentially to factually equivalent messages depending on how these messages are framed (A. Tversky & D. Kahneman, 1981). A. J. Rothman and P. Salovey (1997) relied on prospect theory to predict that messages highlighting potential "gains" should promote prevention behaviors such as sunscreen use best. This experiment compared the effectiveness of 4 differently framed messages (2 highlighting gains, 2 highlighting losses) to persuade 217 beach-goers to obtain and use sunscreen. Attitudes and intentions were measured before and immediately following the delivery of the framed information, and after completing the questionnaire participants were given a coupon redeemable for a small bottle of sunscreen later that same day. People who read either of the 2 gain-framed brochures, compared with those who read either of the 2 loss-framed brochures, were significantly more likely to (a) request sunscreen, (b) intend to repeatedly apply sunscreen while at the beach, and (c) intend to use sunscreen with a sun protection factor of 15 or higher.     

Changing knowledge and attitudes about skin cancer risk factors in adolescents.

We examined knowledge, attitudes, and behaviors related to skin cancer, sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about skin cancer was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to skin cancer, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The one-session, school-based intervention significantly increased knowledge and perceived susceptibility to skin cancer but not behavioral intentions.     

Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy.

Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436).

Main outcome measure: Parent's use of sunscreen on their children.

Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy.

Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects – although often used – had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

Engagement With Novel Virtual Environments: The Role of Perceived Novelty and Flow in the Development of the Deficient Self‐Regulation of Internet Use and Media Habits

This article extends theory on the deficient self‐regulation (DSR) of Internet use and media habits by integrating predictors relevant to technology use. It introduces novelty perceptions of a technology and flow as conditions that increase the likelihood of experiencing DSR and media habits. An experiment, with between‐ and within‐subjects components, was undertaken to test whether the relationships of DSR hypothesized at various stages of technology use are substantiated. Results demonstrated that the perceived novelty of a technology initiated flow, which in turn predicted growth of DSR during initial engagement with virtual environments. Growth of DSR in familiar stages of technology use corresponded to the formation of media habits over time.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy. Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436). Main outcome measure: Parent's use of sunscreen on their children. Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy. Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects - although often used - had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

An investigation of appearance motives for tanning: The development and evaluation of the Physical Appearance Reasons For Tanning Scale (PARTS) and its relation to sunbathing and indoor tanning intentions

Motives for UV exposure have been shown to be related to appearance concerns, yet little research has examined specific tan appearance attitudes. Given this lacuna, Study 1 involved the identification of six factors among college female tanners: general attractiveness, media influence, family/friends influence, physical fitness appearance, acne reasons, and skin aging concerns. In Study 2, a separate sample of college female tanners were used to validate a higher order factor model, which demonstrated acceptable fit. Additionally, the factors converged in the expected directions, with the general attractiveness and skin aging concerns being the best correlate of UV exposure and sun-protection intentions. The relevance of these findings to skin cancer prevention is discussed.     

Translating intentions into sunscreen use: an interaction of self-efficacy and appearance norms

The study examines whether self-efficacy mediates between intention and behavior, and whether appearance norms and self-efficacy are additive or synergistic predictors of sunscreen use. At two measurement points in time, 14 weeks apart, 154 individuals responded to an online questionnaire. Moderated mediation was tested by hierarchical regression analyses. Self-efficacy mediated the intention-behavior relationship, whereas appearance norms emerged as a moderator of the self-efficacy-sunscreen use relationship. The model accounted for 22% of the behavior variance at time 2. For individuals who believe that they would look more attractive with a tan, self-efficacy did not have a strong effect on behavior. Thus, for skin-protection motivation to become effective, self-efficacy is needed in conjunction with less positive appearance norms. Implications for public health promotion and mass media sunscreen use campaigns are discussed.     

Reducing Phobic Behavior Near Water and Increasing Water Approach Skills

Drowning is the leading cause of unintentional death worldwide, and the highest rates are among children. The purpose of this study was to utilize a multi‐component intervention to increase water skills for three typically developing children, who had a history of fear of swimming, and to evaluate changes in both phobic behaviors and positive affect. The intervention, comprised of goal setting, self‐monitoring, behavioral skills training and positive reinforcement, was used in community pools to teach basic water skills. Results suggest that the intervention was successful in increasing the participant's water skills and positive affect while intervals with phobic behaviors decreased. Copyright © 2016 John Wiley & Sons, Ltd.     

Mentoring Relationships and Programs for Youth

ABSTRACT— Mentoring is one of the most popular social interventions in American society, with an estimated three million youth in formal one-to-one relationships. Studies have revealed significant associations between youth involvement in mentoring relationships and positive developmental outcomes. These associations are modest, however, and depend on several intervening processes. Centrally important is the formation of close, enduring connections between mentors and youth that foster positive developmental change. Effects of mentoring programs likewise typically have been small in magnitude, but they increase systematically with the use of program practices likely to support relationship development. Gaps between research and practice are evident both in the indiscriminate use of the term mentoring in the prevention field and in a focus on the growth and efficiency of mentoring programs at the expense of quality. Continued expansion of effective mentoring will require a better alignment of research and practice.     

A randomized trial to evaluate the course of effects of a program to prevent adolescent depressive symptoms over 12 months

Although few prevention studies have been designed to investigate the course of prevention effects over time, it seems that the effects on depressive symptoms increase from post-intervention to 6-month follow-up but then decrease with longer lags to follow-up. Furthermore, previous prevention studies have found differential intervention effects for boys and girls without testing possible explanations for this effect. The present randomized control group study with 301 8th-grade students examined the effects of a depression prevention program from baseline until 12-month follow-up. As expected, while positive intervention effects were found on girls’ depressive symptoms, no such effects were found on boys’ depressive symptoms. Further, the positive intervention effects on girls’ depressive symptoms increased to the 6-month follow-up and remained stable through the 12-month follow-up, while depression symptoms in control-group girls increased from 6-month to 12-month follow-up. Further exploratory analyses revealed that neither baseline conduct problems nor cognitive or social knowledge of the prevention program at 12-month follow-up alone explained the sex effect. However, some limited evidence was found indicating that total knowledge (cognitive and social) might partially explain the effect but there was significant variability remaining to be explained.     

The Social Psychology of Tanning and Sunscreen Use: Self-Presentational Motives as a Predictor of Health Risk1

To the extent that many people seek and maintain a suntan because they believe it makes them more attractive, people who are particularly motivated to make good impressions on others or to be seen as physically attractive are at increased risk for skin cancer. This study examined cognitive, motivational, and attitudinal predictors of two factors that are associated with increased risk for skin cancer: engaging in behaviors that increase one's exposure to UV radiation and inadequate use of sunscreen. Self-presentational motives involving a concern for one's personal appearance and the belief that being tan enhances one's attractiveness were the strongest predictors of the degree to which respondents exposed themselves to natural and artificial sources of UV radiation. Sunscreen use was best predicted by knowing someone with skin cancer. Implications for attempts to promote safe-sun practices are discussed.     

Community Screening for Preschool Child Inhibition to Offer the ‘Cool Little Kids’ Anxiety Prevention Programme

Temperamental inhibition has been identified as a key risk factor for childhood anxiety and internalizing problems. An efficacious early prevention programme for shy/inhibited children has been developed; however, accurate, efficient and acceptable screening is needed to support wider implementation. We explore community screening options in the context of a trial implementing the Cool Little Kids prevention programme for anxiety disorders. In comparison to the Australian Temperament Project's inhibition scale, we examine the Strengths and Difficulties Questionnaire's (SDQ) ability to screen for inhibited preschool children. Parents of 6307 children aged 3 to 6 years enrolled in preschool programmes from eight socio‐economically diverse districts in Melbourne, Australia, first completed the measures of inhibition and SDQ. Parents with inhibited children then enrolled in the Cool Little Kids randomized trial (n = 545). Of these, 88% provided feedback about inhibition screening. Parents allocated to the intervention also provided feedback on the Cool Little Kids parenting programme. Results demonstrated that parents of preschool children (i) find inhibition screening acceptable, (ii) take up this parenting programme and (iii) report favourable feedback. The SDQ emotional symptoms subscale demonstrated acceptable sensitivity but insufficient specificity to identify inhibited preschool children. Presenting parents with a brief, validated inhibition scale could be a low‐cost option for identifying inhibited preschool children in the community to offer early anxiety prevention. Copyright © 2014 John Wiley & Sons, Ltd.     

A family-focused randomized controlled trial to prevent adolescent alcohol and tobacco use: The moderating roles of positive parenting and adolescent gender

Four years of longitudinal data from 2,153 families with a 5th- or 6th-grade preadolescent participating in a family-focused pediatric primary-care-based prevention program were used to examine whether prevention effects were moderated by positive parenting and/or adolescent gender. Alcohol and tobacco use, internalizing problems, and externalizing problems were examined. Although findings revealed no main effect of the prevention program, positive parenting and adolescent gender were moderators of internalizing problems and adolescent gender was a moderator of externalizing problems. Clinical implications and future directions for research are discussed.     

Efficacy of a Self-Administered Home-Based Parent Intervention on Parenting Behaviors for Preventing Adolescent Substance Use

A growing body of literature suggests that parenting practices characterized by careful monitoring, firm and consistent limit setting, and nurturing communication patterns with children are protective against adolescent substance use and other problem behaviors. Family-based prevention programs that promote these behaviors can be an effective way to prevent adolescent substance use. However, low participation rates remain problematic for many such programs, particularly programs that require parents to attend scheduled meetings outside the home. The purpose of this study was to determine the efficacy of a newly developed substance use prevention program when self-administered at home by parents of middle school students. As part of a randomized trial, 338 parents of middle school students either received the parent prevention program or served as control group participants. Parents completed self-report surveys at home that assessed parenting behaviors at pre-test, post-test, and one-year follow-up time points. A series of mixed model ANCOVAs were conducted, examining the post-test and one-year follow-up means for the parent outcomes, controlling for pre-test levels on these outcomes. Analyses showed that at the post-test assessment, intervention parents reported significant increases relative to controls in appropriate role modeling, disciplinary practices, family communication, and parental monitoring skills. At the one-year follow-up assessment, intervention effects on family communication skills remained significant and effects on parental role modeling were marginally significant. This study shows that a theoretically rich prevention program can be effectively self-administered by parents at home and improve key parenting skills that have been shown to prevent adolescent substance use.