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.     

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.     

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.     

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.     

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.     

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.     

‘It’s bit of an eye opener’ – A qualitative study of women’s attitudes towards tanning,sun protection and a facial morphing intervention

Objective: Skin cancer is to a large degree behaviourally preventable, meaning that evidence-based interventions have scope to make a difference. Previous research indicates that appearance-based interventions such as facial morphing may be more effective than health-based interventions, and that it can personalise the issue of skin cancer.

Method: This study examined attitudes to UV exposure, as well as reactions to a facial morphing intervention, through interviews with 25 women aged 35 years and older.

Results: Thematic analysis revealed four themes; two regarding attitudes to UV exposure (confusion and contradiction, and change and continuity), and two relating to the facial morphing intervention (negative reactions to UV-exposed photo and positive outcomes of the intervention). Women experienced a number of barriers to adopting safer behaviour in the sun; their current attitudes to UV exposure had been shaped by available information sources throughout their ageing. They expressed negative evaluations of the UV photo, which fed directly into motivation to reduce UV exposure.

Conclusions: These results can be interpreted along the lines of goal-directed behaviour. This type of intervention has the potential to reduce UV exposure among this participant group, something that needs to be further investigated with randomised control trials.     

Improving the efficacy of appearance-based sun exposure interventions with the terror management health model

The terror management health model (TMHM) suggests that when thoughts of death are accessible people become increasingly motivated to bolster their self-esteem relative to their health, because doing so offers psychological protection against mortality concerns. Two studies examined sun protection intentions as a function of mortality reminders and an appearance-based intervention. In Study 1, participants given a sun protection message that primed mortality and shown a UV-filtered photo of their face reported greater intentions to use sun protection on their face, and took more sunscreen samples than participants shown a regular photo of their face. In Study 2, reminders of mortality increased participants’ intentions to use facial sun protection when the UV photo was specifically framed as revealing appearance consequences of tanning, compared to when the photo was framed as revealing health consequences or when no photo was shown. These findings extend the TMHM, and provide preliminary evidence that appearance-based tanning interventions have a greater influence on sun protection intentions under conditions that prime thoughts of death. We discuss implications of the findings, and highlight the need for additional research examining the applicability to long-term tanning behaviour.     

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.     

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.     

Using UV photography to reduce use of tanning booths: a test of cognitive mediation.

Two laboratory studies were conducted in which a new type of intervention was used to reduce ultraviolet radiation (UV) exposure from tanning booth use among college students (Time 1 Ns=70 and 134). The intervention uses UV photography to highlight the damage to facial skin caused by previous UV exposure. When the authors controlled for baseline measures of booth use, students in both studies who viewed their UV photographs reported less booth use at a follow-up session 3-4 weeks later than did students not shown a copy of their photograph. Also, in both studies, the decline in use was significantly mediated by a Tanning Cognition Index composed of variables suggested by the prototype-willingness (prototype) model of health risk: tanning attitudes, tanner prototypes, and willingness to engage in risky UV exposure.     

Sun protection behaviour of children and their parents at the beach

Abstract

The present study observed the sun protection behaviour of 8–12 year old children and their parents on the beach. Interviews with children and parents were then conducted to examine possible influences on sun protection and the relationship between observed and self reported behaviour.

The sample consisted of 50 children and 68 parents. All 50 children were observed and interviewed. All the parents were observed and 33 were interviewed. Indices of sun protection cover were computed as a sum of clothing and sunscreen cover. Most parents and children were inadequately covered against the sun. Factors related to children's sun protection included parent's cover and the child's tan level. The relationship between attitude to sun protection and observed behaviour could not be examined as all children and parents indicated they thought it was important to protect their skin against the sun.

Inconsistencies between observed and self-reported sun protection were found for children who were not protecting themselves. The possibility that self-report may overestimate actual protective behaviour is discussed.     

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.     

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.     

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.     

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.