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.     

Interventions to Promote Sun Protection Behaviors: What Do We Know About the Efficacy of Health‐ and Appearance‐based Messages and the Role of Cognitions and Emotions?

Human behavior has been implicated as a critical component in the development of a number of diseases, including skin cancer. More than 85% of all skin cancers are attributed to over‐exposure to the sun, and two primary types of interventions have been utilized to motivate sun protection practices – those that focus on the health consequences (i.e., skin cancer) and those that highlight the negative appearance consequences (i.e., wrinkles and age spots) of sun exposure. Both health‐based and appearance‐based interventions have been demonstrated to increase awareness of sun exposure dangers and of recommended risk reduction behaviors. Much of the literature examining the efficacy of appearance‐based interventions also contains evidence of behavior change in response to such interventions. The role of consciously accessible attitudes and perceptions as mechanisms of behavior change has been extensively examined, and there is evidence that sun protection interventions may promote behavior change in part by altering various health‐related cognitions (e.g., perceived susceptibility to skin damage). However, the role of nonconscious mechanisms in the efficacy of sun protection interventions has received little empirical attention. A growing body of literature, primarily in other health contexts, has demonstrated that behavior is sometimes more strongly predicted by emotions than cognitions, and that processes outside of conscious awareness may affect behavior change. It is suggested that both future sun protection interventions, and health promotion theories in general, could benefit from a thorough examination of the role that emotions and autonomic reactions may play in intervention efficacy.     

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.     

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.     

Sun protective behaviour,optimism bias,and the transtheoretical model of behaviour change

This study investigated the relationship between sun protective behaviours and three psychological variables influencing health behaviour: decisional balance, optimism bias, and the transtheoretical model of behaviour change. Two hundred participants completed the ‘Readiness to Alter Sun Protective Behaviour’ questionnaire, and a short questionnaire investigating optimism bias, decisional balance, attitudes, and experiences of sun protection and skin cancer. Participants were evenly distributed between the precontemplation, contemplation, and action stages. Participants in the action stage were significantly more likely to endorse the perceived advantages associated with sun protective behaviour than participants in the precontemplation and contemplation stages. They also reported sunbathing significantly less—and being more concerned about contracting skin cancer—than participants in the earlier stages. Decisional balance and optimism bias scores varied systematically across the stages of change; however, decisional balance was the only significant psychological predictor of sun protective behaviours. Optimism bias was greatest in the precontemplation stage, whereas the action stage was characterised by more positive attitudes to sun protection. This suggests that knowledge of the real risks of skin cancer might be a precursor to behaviour change, but only a change in attitudes results in a move to the action stage and measurable behaviour change.     

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.     

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.     

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.     

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.     

The Survivor Health and Resilience Education (SHARE) Program: Development and Evaluation of a Health Behavior Intervention for Adolescent Survivors of Childhood Cancer

Few evidence-based health behavior interventions for adolescent survivors of childhood cancer currently exist. These interventions are necessary to address a range of lifestyle and behavioral factors (e.g., diet and physical activity, tobacco and alcohol use, excessive sun exposure) that may place survivors at increased risk for secondary cancers other chronic diseases. To address this need, the development and evaluation of a health promotion and disease prevention program for childhood cancer survivors is described, with an emphasis on the steps leading up to conducting a randomized controlled trial to test its efficacy. Data gathered from trial participants suggest the preliminary evaluation of the intervention is favorable. Trends and future directions in behavioral intervention research with childhood cancer survivors are discussed, along with the role of behavioral research in health promotion and disease prevention.     

Examining direct and indirect pathways to health behaviour: The influence of cognitive and affective probability beliefs

This study aimed to extricate the influence of rational (e.g. ‘I think …’) and intuitive (e.g. ‘I feel …’) probability beliefs in the behavioural decision-making process regarding skin cancer prevention practices. Structural equation modelling was used in two longitudinal surveys (sun protection during winter sports [N?=?491]; sun protection during summer [N?=?277]) to examine direct and indirect behavioural effects of affective and cognitive likelihood (i.e. unmediated or mediated by intention), controlled for attitude, social influence and self-efficacy. Affective likelihood was directly related to sun protection in both studies, whereas no direct effects were found for cognitive likelihood. After accounting for past sun protective behaviour, affective likelihood was only directly related to sun protection in Study 1. No support was found for the indirect effects of affective and cognitive likelihood through intention. The findings underscore the importance of feelings of (cancer) risk in the decision-making process and should be acknowledged by health behaviour theories and risk communication practices. Suggestions for future research are discussed.     

Out in the midday Sun: Risk behaviour and optimistic beliefs among residents and visitors on tenerife

Abstract

A questionnaire was distributed to 107 local residents on a beach on the island of Tenerife and to 108 visitors from Britain and continental Europe. Measures included perceived danger of sun exposure. environmental concern. value of a suntan, optimism regarding personal risk of skin damage relative to others of one's age and gender, amount of midday sun exposure, sunscreen use and skin type. Use of sunscreen protection was greatly below recommended levels, though higher for women (N = 103). Among visitors, the British (N = 54) showed the riskiest behaviour. Relationship between behaviour. beliefs and background variables varied between groups. Overall there was a significant optimistic bias. This was stronger for the British, and for men. The relationships between optimism and other measures varied between the different national groups. In particular, among the British. greater optimism was associated with placing a higher value on a suntan, with having a more sensitive skin type, with using less adequate sunscreen protection, and with spending a (nonsignificantly) greater proportion of time exposed to the sun in the middle of the day. Among locals and visitors from continental Europe, optimism was associated with less midday exposure. It is concluded that these data offer evidence for two complementary interpretations of the relationship between optimism and health behaviour. On the one hand, those who perceive themselves to be at greater risk may be motivated to take more precautions. while risk-taking may be greater among those regard themselves as less vulnerable. On the other hand. those who take more precautions may infer that their own relative risk is lower. It is argued that research should not assume a single process relating perceived risk to behaviour, but consider factors that might predict the relative importance of alternative processes.     

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.     

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.     

Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks.

This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective.     

Multiple risk expert systems interventions: impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of parents.

Three stage-based expert system interventions for smoking, high-fat diet, and unsafe sun exposure were evaluated in a sample of 2,460 parents of teenagers. Eighty-four percent of the eligible parents were enrolled in a 2-arm randomized control trial, with the treatment group receiving individualized feedback reports for each of their relevant behaviors at 0, 6, and 12 months as well as a multiple behavior manual. At 24 months, the expert system outperformed the comparison condition across all 3 risk behaviors, resulting in 22% of the participants in action or maintenance for smoking (vs. 16% for the comparison condition), 34% for diet (vs. 26%), and 30% for sun exposure (vs. 22%). Proactive, home-based, and stage-matched expert systems can produce significant multiple behavior changes in at-risk populations where the majority of participants are not prepared to change.     

Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk

This study evaluates the contents of representations of skin cancer risk and their associations with risk appraisals, worry, and protection intentions and behaviors. The Assessment of Illness Risk Representations (AIRR) was used to measure conceptual and imagery contents of risk representations, as delineated by the Common-Sense Model. University students (N?=?120) completed the AIRR; measures of likelihood and severity appraisals, and worry; and measures of skin self-examination, clinical skin examination, and sun protection intentions and behaviors. Beliefs about identity, causal, and timeline risk were positively associated with likelihood appraisals, whereas consequences and timeline risk beliefs were positively associated with severity appraisals. Identity and timeline risk independently predicted worry. Representational attributes, including imagery vividness and valence, independently predicted intentions and behaviors, whereas likelihood and severity appraisals did not. Symptom imagery interacted with worry to predict detection and prevention intentions: worry predicted greater intentions for participants with symptom imagery but not for those without symptom imagery. The findings support the utility of the AIRR for assessing risk representations and identify ways in which risk representations may guide protective behavior.     

Skin cancer: Assessing perceived risk and behavioural attitudes

Abstract

Measures of attitude concerning exposure to the sun, and judgements of risk and other beliefs concerning skin cancer and four other problems (stomach cancer, deafness, AIDS and sunstroke) were obtained from a questionnaire completed by 176 university students. Subjects also estimated the incidence of each problem using one of three response formats. The highest incidence estimates were obtained when subjects were asked to guess at an absolute number, and the lowest when they used a scale which differentiated between lower frequencies, while grouping higher frequencies into a single response category. The effect of the response scale format, however, did not generalize to other ratings of personal risk. Subjects' ratings of their personal risk, compared with their peers, showed an optimistic bias over the five problems as a whole, particularly for AIDS, but not reliably so in the case of skin cancer. Optimism was inversely related to the amount of thought given to each problem. Men and women did not differ overall in their optimism regarding their own risk of skin cancer. However, differences as a function of gender and optimism were found on various behavioural attitudes. The results are discussed in relation to a tendency of disregard base-rates in subjective risk judgements, unrealistic optimism, and implications for health education.