Self-reported Sun Protection Research Articles

The risk information and skin-cancer education for undergraduate prevention (RISE-UP) study: Protocol for a trial of personalized sun protection interventions for skin cancer prevention among undergraduate students

BackgroundAddressing the increasing incidence of skin cancer among young adults is a priority. The objective of the Risk Information and Skin-cancer Education for Undergraduate Prevention (RISE-UP) study is to identify personalized intervention components to prevent sunburn, a clinically significant outcome highly associated with skin cancer, in college students. MethodsGuided by the Elaboration Likelihood Model, the study will use Multiphase Optimization Strategy (MOST) methodology to test three intervention components (ultraviolet photography, MC1R genetic testing, and action planning) each with two levels (yes v. no) in a full-factorial experiment to evaluate unique and combined effects of these components to improve outcomes over the longer-term, with seasonally timed follow-up. At-risk University of Utah students (N = 528) will be recruited. Eligibility criteria include self-reported sunburn or tanning in the past year, or not utilizing recommended sun protection. After baseline assessment, participants will be randomized to intervention group, stratified by sex. Assessments will be completed at (1) Baseline; (2) Intervention; (3) 1 month after intervention; (4) 4 months after intervention (the end of the first summer); and (5) 15 months after intervention (the end of the second summer). The primary outcome will be participants' self-reported number of sunburns. Secondary outcomes will include self-reported sun protection and tanning behaviors and, in a randomly selected subgroup, an objective measure of ultraviolet radiation (UVR) exposure. ConclusionThe RISE-UP study will determine the efficacy of different combinations of personalized skin cancer preventative interventions for young adults and determine the optimal combination of intervention components to prevent skin cancer.Clinical Trial Registration:NCT05634252

Rural-Urban Differences in Sun Exposure and Protection Behaviors in the United States.

Evidence regarding whether rural residence is a risk factor for skin cancer is mixed. We compared sun exposure and protection behaviors between rural and urban residents by ethno-racial group in the United States. We analyzed data from three (2013-2018) National Health and Nutrition Examination Survey cycles. We compared self-reported sun exposure and protection measures (sunburn, time spent outside, sunscreen use, wearing long sleeves, staying in shade) by rural-urban residential status using survey-weighted logistic regression models stratified by ethno-racial group, adjusting for age, sex, income, education, body mass index, and smoking. Hispanic rural versus urban residents more often reported sunburns in the past year [41.6% vs. 31.2%, adjusted OR (aOR): 1.46 (1.15-1.86)]. White rural versus urban residents more often spent 2+ hours outside on workdays [42.9% vs. 29.1%, aOR: 1.60 (1.27-2.01)] and non-workdays [72.2% vs. 64.8%, aOR: 1.45 (1.12-1.88)] and less often used sunscreen [26.0% vs. 35.1%, aOR: 0.74 (0.59-0.93)] and stayed in the shade [21.7% vs. 26.7%, aOR: 0.72 (0.57-0.89)]. Black rural versus urban residents stayed in the shade less often [31.6% vs. 43.9%, aOR: 0.60 (0.39-0.91)] but less often spent 2+ hours outside on non-workdays [47.6% vs. 56.8%, aOR: 0.67 (0.51-0.90)]. Across all ethno-racial groups included, rural residents reported greater sun risk behaviors than urban residents, with some nuances by ethno-racial identity, suggesting rural residence is a potential risk factor for skin cancer. Sun protection promotion programs should consider rural-urban settings while also accounting for ethno-racial identities.

UV arrows descend from above: lessons from a mass media campaign to improve sun protection behaviours among young adults.

More than 95% of melanomas in Australia are caused by UV radiation from the sun. Young adults are particularly at risk, with 18-24-year-olds spending more time in the sun and protecting their skin less than older adults. A new mass media campaign was delivered in New South Wales, Australia, to motivate this hard-to-reach group to protect their skin from harmful UV radiation. This paper shares learnings from this campaign for public health educators working across diverse fields. Guided by audience research and testing, the campaign combined fear-based and self-efficacy messaging. UV radiation was portrayed as arrows descending from the sky, transforming it into a visible and ever-present threat. High-reach channels such as cinema, outdoor advertising, online videos, audio apps and social media were used to reach the audience. The campaign was evaluated through an online tracking survey (n = 750, 18-24-year-olds) measuring prompted recognition, message take-out, key diagnostics, and self-reported sun protection intentions and behaviours. The evaluation found that 57% of survey participants recognised the campaign when prompted. Among those that recognised the campaign, 76% said they had used sun protection when outdoors over the summer campaign period (vs 64% of non-recognisers, p < 0.05), and 45% said they had adopted at least three of the five sun protection behaviours (Slip, Slop, Slap, Seek and Slide) 'always' or 'often' (vs. 36% of non-recognisers, p < 0.05). A mass-media campaign that aimed to elicit emotional (fear) and cognitive (perceived efficacy) responses and which drew upon social and heuristic cues was associated with greater self-reported sun protection among the target audience. Delivering a combination of message strategies simultaneously within a campaign tailored to young adults may be more effective than adopting a more singular focus.

Digital Technology in Skin Cancer Prevention and Early Detection

Background Mobile teledermatology is increasingly being used in clinical practice and offers the opportunity to counsel the general public about sun protection and skin cancer early detection. Growing evidence suggests that SMS text messaging interventions are an effective way to reach a large number of people and promote sun protection behaviors. Many medical practices already have SMS text message systems in place to communicate with patients, especially for appointment reminders and information. However, could we use these systems for even better outcomes? If so, how? Objective This presentation will outline the results of the SunText study, a theory-based SMS text messaging intervention designed to evaluate how often and in what way we could communicate with people at risk of skin cancer to have a beneficial effect on sun protection behaviors, sunburn, and participant engagement. Methods The SunText study was conducted between February-July 2019 in Queensland, Australia. Volunteer participants aged 18 to 40 years were randomized to 4 different intervention schedules using a Latin square design. The schedules included personalized or interactive messages with constant frequency and personalized and interactive messages with either increasing or decreasing frequency. Outcomes measured were reduction in sunburn and engagement with interactive messages, defined as responding to messages by return text. Results Compared to baseline, the self-reported sun protection habits index was significantly higher in all 4 interventions (P&lt;.01). Overall, sunburn rates decreased from baseline to the end of the intervention (40.3% to 7.0%), and remained significantly below baseline levels (23.5%) at the 6-month follow-up (P&lt;.01). All 4 interventions achieved reductions in sunburn rates (18%-48% reduction) during the intervention period. The overall engagement rate with interactive messages was 71%. The intervention involving interactive messages with constant frequency achieved the highest engagement rate. The intervention with personalized and interactive messages with increasing frequency had the lowest engagement rate. Conclusions This study adds to the evidence that text messages targeting sun protection are effective in improving sun protection behaviors and reducing sunburn. Results also suggest higher engagement with constant or decreasing message frequency. Although many clinics already use SMS text messaging for scheduling, this presentation may encourage its extended use to raise awareness of sun protection. Interactive messages could also be integrated into sun protection mobile health apps, and provide an opportunity for engaging in health promotion content. Acknowledgments This study was funded by a research grant from the Harry J Lloyd Charitable Trust. Conflicts of Interest HPS is a shareholder of MoleMap NZ Limited and e-derm consult GmbH, and undertakes regular teledermatological reporting for both companies. HPS is a Medical Consultant for Canfield Scientific Inc, MoleMap Australia Pty Ltd, Blaze Bioscience Inc, Revenio Research Oy and a Medical Advisor for First Derm. All other authors declare no conflicts of interest.

Conjunctival ultraviolet autofluorescence area decreases with age and sunglasses use

BackgroundConjunctival ultraviolet autofluorescence (CUVAF) is a method of detecting conjunctival damage related to ultraviolet radiation exposure. In cross-sectional studies, CUVAF area is positively associated with self-reported time spent outdoors and...

Optimizing Texting Interventions for Melanoma Prevention and Early Detection: A Latin Square Crossover RCT

Text messaging is an effective way to reach large populations with health promotion support. This study aims to establish the optimal text messaging intervention to achieve behavior change in young adults at risk of skin cancer. Latin square crossover RCT. Participants were women and men aged 18-40 years living in Queensland, Australia who owned a smartphone and had ≥2 skin cancer risk factors. Participants were enrolled from December 2018 to February 2019 and completed an eligibility survey. Eligible participants were randomized to 4 different text message interventions using a Latin square design with varying personalization, interactivity, and message frequency (February 2019‒July 2019). Each intervention lasted for 1 month; between interventions, participants had a 1-week washout period in which they completed an online questionnaire. Participants completed a 6-month follow-up online survey in January 2020. Measures included self-reported sun protection habits and sunburns. A total of 277 (71.2% response rate) participants completed the 6-month follow-up. The sun protection habits index was significantly higher in all the 4 text messaging interventions (p<0.01 for each intervention) than at baseline, with similar sun protection habits improvements among all interventions (p=0.27). Sunburn rates decreased significantly over time (p<0.01 each intervention), with all the 4 interventions achieving reductions in sunburn rates during the intervention periods (p=0.78). Overall, the sunburn rates decreased from 40.3% at baseline to 7.0% at the end of the intervention, and at 6-month follow-up, it remained significantly below baseline levels at 23.5% (p<0.01). Regular text messaging interventions result in significantly increased sun protection and decreased sunburn in young adults. This study is registered at the Australian and New Zealand Clinical Trials Registry ACTRN12618001299291.

The Melanoma Genomics Managing Your Risk Study randomised controlled trial: statistical analysis plan

BackgroundThe Melanoma Genomics Managing Your Risk Study is a randomised controlled trial that aims to evaluate the efficacy of providing information on personal genomic risk of melanoma in reducing ultraviolet radiation (UV) exposure, stratified by traditional risk group (low or high phenotypic risk) in the general population. The primary outcome is objectively measured total daily Standard Erythemal Doses at 12 months. Secondary outcomes include UV exposure at specific time periods, self-reported sun protection and skin-examination behaviours, psychosocial outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the cost-effectiveness of the intervention.ObjectiveTo publish the pre-determined statistical analysis plan (SAP) before database lock and the start of analysis.MethodsThis SAP describes the data synthesis, analysis principles and statistical procedures for analysing the outcomes from this trial. The SAP was approved after closure of recruitment and before completion of patient follow-up. It outlines the planned primary analyses and a range of subgroup and sensitivity analyses. Health economic outcomes are not included in this plan but will be analysed separately. The SAP will be adhered to for the final data analysis of this trial to avoid potential analysis bias that may arise from knowledge of the outcome data.ResultsThis SAP is consistent with best practice and should enable transparent reporting.ConclusionThis SAP has been developed for the Melanoma Genomics Managing Your Risk Study and will be followed to ensure high-quality standards of internal validity and to minimise analysis bias.Trial registrationProspectively registered with the Australian New Zealand Clinical Trials Registry, ID: ACTR N12617000691347. Registered on 15 May 2017.

Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma.

Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.

Protection-adjusted UV dose estimated for body areas: Daily self-reported sun protection modification of wearable UV sensor dose.

During the last 20years, 50% of adults with sun-sensitive skin have sunburned annually. Reducing the proportion of people who sunburn requires understanding the circumstances and outdoor activities during which at-risk people sunburn. A 7-day observational study of melanoma survivors (n=20) and young adult first-degree relatives of melanoma survivors (FDRs) (n=20) captured daily UV exposure, sun protection, and sunburns during spring and summer in the Midwest of the United States (latitude 41.8°N). Participants wore UV and physical activity sensors and completed a daily self-reported survey of sun protection, sunburn, and physical activities. The estimated protection-adjusted UV dose was calculated for each body area by integrating self-reported sun protection with UV sensor dose. In 254days, at least one body area in 9 of 20 (45%) melanoma survivors and 11 of 20 (55%) FDRs was sunburned (erythema at 24hours). Sunburns were associated with spring and walking for transportation or leisure, especially walking the dog. Melanoma survivors used sunscreen daily on the face; however, forearms and lower legs were not protected during walking. Young adults did not use sun protection on the face, forearms or lower legs during walking for transportation and use was ineffective during sports. The sun protection patterns of daily living identified in this study may promote recognition of erythema as sunburn and inform the development of tailored sun protection mobile applications promoting self-monitoring with wearable UV sensors.

The melanoma genomics managing your risk study: A protocol for a randomized controlled trial evaluating the impact of personal genomic risk information on skin cancer prevention behaviors

BackgroundReducing ultraviolet radiation (UV) exposure and improving early detection may reduce melanoma incidence, mortality and health system costs. This study aims to evaluate the efficacy and cost-effectiveness of providing information on personal genomic risk of melanoma in reducing UV exposure at 12 months, according to low and high traditional risk. MethodsIn this randomized controlled trial, participants (target sample = 892) will be recruited from the general population, and randomized (1:1 ratio, intervention versus control). Intervention arm participants provide a saliva sample, receive personalized melanoma genomic risk information, a genetic counselor phone call, and an educational booklet on melanoma prevention. Control arm participants receive only the educational booklet. Eligible participants are aged 18–69 years, have European ancestry and no personal history of melanoma. All participants will complete a questionnaire and wear a UV dosimeter to objectively measure their sun exposure at baseline, 1- and 12-month time-points, except 1-month UV dosimetry will be limited to ~250 participants. The primary outcome is total daily Standard Erythemal Doses at 12 months. Secondary outcomes include objectively measured UV exposure for specific time periods (e.g. midday hours), self-reported sun protection and skin-examination behaviors, psycho-social outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the intervention costs and outcomes. DiscussionThis trial will inform the clinical and personal utility of introducing genomic testing into the health system for melanoma prevention and early detection at a population-level.Trial registration.Australian New Zealand Clinical Trials Registry ACTRN12617000691347.

To protect or not to protect: examining reasons for sun protection among young women at risk for skin cancer.

We aimed to further the understanding of the low rates of sun protection in young women at risk for skin cancer. Six-hundred-sixty-one daily diary entries were received via text message over 14days from 56 young women at moderate to high risk of developing skin cancer. Women reported whether or not they used sun protection and also listed what their reasons were for using protection or not using sun protection each day. Multi-level modeling was used to examine the influence of study variables when predicting daily sun protection or lack of protection. The number of days in which sun protection was reported was positively associated with "habit" and "prevention" as reasons for protection and negatively associated with "not-needed" and "unprepared" as reasons for non-protection. Self-reported sun protection increased over the 14-day study period. Results of this study suggest the potential value of interventions aimed at motives for sun-protection behaviors.

Abstract B56: Adapting SunSafe: A skin cancer prevention intervention for use with multiethnic high school students

Abstract Skin cancers are one of the most preventable types of cancer. However, since 2004, skin cancer incidence rates have increased 3% each year in the U.S. In 2015, more than 3 million Americans will develop skin cancer and 76,000 will need treatment for the most deadly form, melanoma. More than $2.4 billion is spent annually on therapies, which does not consider the morbidity from disfiguring treatments. Increased exposure to ultraviolet radiation (UVR) from the sun or artificial sources is a primary risk factor and half the lifetime skin damage from UVR overexposure occurs before age 20. Recently, skin cancer prevention interventions delivered in U.S. primary and middle schools have demonstrated effectiveness. However, there is deficiency in interventions for high school students, whose health behaviors are transitioning from the purview of parents or caretakers. Changes in social norms, risk-taking and the desire for sexual appeal affect this group's UVR exposure patterns and their perceived skin cancer risk. Few studies have addressed sun protection in multiethnic high school students, who underestimate their skin cancer risk. To address this gap we conducted a pilot study using both qualitative and quasi-experimental designs to investigate whether a school-based intervention entitled, SunSafe In the Middle School Years (SunSafe), could be adapted for use in a multiethnic high school in Honolulu, HI. We used qualitative research methods to incorporate information from discussions with students, parents, teachers and community members to adapt the program. Discussion themes provided strategies that were integrated into the existing SunSafe program. The adapted SunSafe intervention was then delivered to 250, 10th grade students. The curriculum consisted of a 30-minute presentation, modeling of sun protection apparel, and a Q&amp;A component. Branded resources were created and included a UVR-sensitive wristband that changed color to provide a visible cue of students' UVR exposure levels. A quasi-experimental pretest/posttest design was used to assess changes in students' knowledge, attitudes, and self-reported and observed sun protection behaviors, relative to the intervention's implementation. A 28-item standardized survey assessed students' self-reported sun protection knowledge and attitude changes. A field assessment instrument, the Systematic Observation of Sun Protection Factors, measured observed changes in students' collective use of headwear, sunglasses, protective clothing, and shade. A total of 208 students provided parental consent and were assented to the study. The students' ethnic distribution was 51.6 % Asian, 30.4% Native Hawaiian/Pacific Islander, 8.4% White, 3.5 % Hispanic, 2.7 % Black, and 3.2% two or more ethnicities. Significant increases were found in students' knowledge, attitudes, and intended sun protection behaviors at posttest, compared to pretest (T-test p &amp;lt; 0.05). One item measuring attitudes toward tanning did not show significant improvement. At baseline, 12.5% of students wore hats, 4% sunglasses, 10.1% had long sleeves, 33.4 % had full lower body coverage, and 67.8% used shade. At 12 months, 13.1% used hats, 1.9% sunglasses, 16.3% had long sleeves, 39.4% had full lower body coverage, and 81% used shade. Our pilot study found it feasible to adapt SunSafe in Middle School Years for multiethnic high schools students at risk for UVR overexposures and skin cancer. Lack of improvement in attitudes towards tanning may have been biased by students' self-perceptions regarding their own skin tone, with 90-80% having medium or darker complexions. Further investigations are needed to assess the active components of the adapted SunSafe program, the possible geographic differences in the program's utility and the role of skin complexion in attitudes towards tanning and sun exposure in multiethnic students. Citation Format: Kevin Cassel, Anh Tran, Lynn Murakami-Akasuka, Jodi Tanabe-Hanzawa, Terrilea Burnett, Christopher Lum. Adapting SunSafe: A skin cancer prevention intervention for use with multiethnic high school students. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B56.

Skin Cancer Beliefs, Knowledge, and Prevention Practices: A Comparison of Farmers and Nonfarmers in a Midwestern Population

ABSTRACTFarmers have substantial sun exposure and increased skin cancer risk but poor sun protection practices. There are few studies regarding the underlying factors that contribute to inadequate skin cancer prevention practices in the farming population, and minimal data to guide skin cancer awareness and educational interventions for this population. The purpose of this study was to assess skin cancer knowledge, sun protection behaviors and barriers, health care information sources, and the impact of skin cancer screening among midwestern farmers and nonfarmers. Individuals attending a free skin cancer screening during 2011 Wisconsin Farm Technology Days were surveyed for self-reported sun protection use, extent of sun exposure, and skin cancer and sun protection beliefs and knowledge. A total of 476 individuals participated in the study, including 194 farmers. Although farmers identified sun protection benefits, few reported optimal practices, with only 23% of farmers reporting sunscreen use always or frequently when out in the sun for 15 minutes or more. Common barriers to sun protection included discomfort with wearing long pants and long shirts, forgetfulness with sunscreen use, and inconvenience with wearing wide-brimmed hats. Higher knowledge scores in farmers were associated with better sun protection. Farmers utilized different sources of health care information compared with nonfarmers, including farm magazines and newspapers, radio, and farm organizations. Providers should consider the unique characteristics of the farming population to provide skin cancer prevention education that is tailored to the needs of this population, such as reminders for sunscreen use and resources for sun-protective hats that do not interfere with work. Among individuals without prior history of skin cancer, 34% of farmers and 22% of nonfarmers (P = .0127) were referred for additional evaluation due to identification of a concerning lesion at the screening event. Thus, farmers may preferentially benefit from skin cancer screening events, and this population should be targeted for additional screening events in the future. This study identifies unique characteristics of the farming population that can assist providers in caring for this population and guide the future development of skin cancer awareness, prevention, and screening initiatives to benefit farmers.

The role of emotions in UV protection intentions and behaviors

Two studies examined the role of emotions, relative to cognitions, in predicting sun protection intentions and practices. In Study 1, 106 females were assessed for baseline sun protection, ultraviolet (UV) radiation exposure-related cognitions (perceived susceptibility to skin damage, self-efficacy for regular sunscreen use, perceived costs of sun protection use, perceived rewards of tanning), anticipated negative mood following future risky UV behavior, and future sun protection intentions. Self-reported sun protection behavior was then assessed in the same participants five weeks later. The results of Study 1 demonstrated that the extent to which participants’ expected to experience negative feelings if they engaged in future risky UV behavior predicted their intentions to sun protect and their subsequent sun protection behaviors independent of their UV radiation exposure-related cognitions. In Study 2, in addition to the assessments collected in Study 1, participants were exposed to an appearance-based intervention that included visual images of their existing skin damage and were then assessed for their emotional reactions to the intervention. The results replicated those of Study 1 and, in addition, showed that negative emotional reactions to the intervention predicted future sun protection intentions and self-reported behaviors at follow-up, independent of the various cognitive factors that are central to prominent models of health behavior. These studies provide preliminary support for the development of expanded health behavior models that incorporate anticipated and experienced emotions.

Effects of photoaging information and UV photo on sun protection intentions and behaviours: A cross-regional comparison

There is limited empirical evidence regarding differences in sun protection practices in different regions of the USA. This study examined whether there are regional differences in the efficacy of exposure to UV photographs and photoaging information (e.g. wrinkles and age spots) for increasing sun protection behaviours. Students attending a public university in either the Midwestern (Iowa) or Southwestern (Southern California) US reported baseline sun exposure and protection practices and were then randomly assigned to either receive information about photoaging, have a UV photo taken, both receive photoaging information and have a UV photo taken, or to receive neither intervention. Sun protection intentions were assessed immediately after the interventions, and both self-reported sun protection behaviours and an objective assessment (via spectrophotometry) of skin colour change were measured at the end of summer and one year following the interventions. The results showed a pervasive pattern of more risky UV exposure and less sun protection use at the Iowa site than at the Southern California site both prior to and following the interventions. Both interventions increased future sun protection intentions regardless of region. However, the intervention effects on skin colour and UV exposure differed across region, with generally more reliable effects at the Iowa site.

Determinants of self-reported sun protection practices among Moroccan population

PurposeTo estimate the prevalence of sunlight exposure and sun protection behaviors and to identify the main determinants of sun protection in a representative sample of the Moroccan population. MethodsCross-sectional survey was carried out during May 2008 among Moroccan adults aged 18 and over, using stratified cluster sampling in origin and sex. ResultsA total of 2896 subjects were included. More than half (52.1%) of the participants were regularly exposed to the sun during midday hours (11–16h) for more than 2h per day. Among those exposed to the sun during midday hours, 16.4% didn't use any means of protection. The subjects who were more protected were women (odds ratio=0.47, 95% confidence interval=[0.35–0.64]), rural residents (odds ratio=2.33, 95% confidence interval=[1.97–2.77]) and worker subjects and students (p<0.0001). ConclusionThis survey has highlighted a high prevalence of sun exposure in the Moroccan population with few protection practices. It is therefore important to promote sun protection in order to maintain the incidence rate of skin cancer at its lower level.

“It's a Beautiful Day for Cancer”: An Innovative Communication Strategy to Engage Youth in Skin Cancer Prevention

Despite 3 decades of traditional media campaigns to raise awareness about skin cancer, Australian youth continue to exhibit poor sun protection behaviors. This article reports on a creative promotional strategy that used entertainment-education and social media marketing to stimulate dialogue and address barriers to sun protection. The campaign centered on an ironic music video launched across multiple media channels, with a focus on social media sites. Process evaluation included campaign reach; and online surveys and thematic analysis of online conversations appraised sun protection attitudes and behaviors. The video received 250,000 views in 4 months, and online surveys identified positive differences between those exposed and not exposed to the video in attitudes toward skin cancer risk, perceived ability to avoid skin cancer by regularly using sun protection, and several self-reported sun protection behaviors, but no differences in peer perceptions of tanning. Of those who watched the video, 25% forwarded the video to friends, 44% reported that the video changed the way they felt about sun protection, and 19% of spontaneous online comments reported an intention to change behavior. The campaign results suggest that entertaining, peer-to-peer messages can be used to engage youth with an important health message for skin cancer prevention.

Predictors of Sun Protection Behaviors and Severe Sunburn in an International Online Study

The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behavior. The aim of this study was to examine the prevalence of self-reported sun protection behaviors and sunburn in users of the Internet, and to identify the demographic, clinical, and attitudinal/motivational correlates of sun protection behaviors. Self-report data were gathered on behalf of the GenoMEL consortium using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the United States, 2% from Israel, and 6% from other countries. Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behavior were perceived barriers to protection (beta = -0.44/beta = -0.37), and respondents who reported a positive attitude toward suntans were less likely to protect (beta = -0.16/beta = -0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use. Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviors resulting in severe sunburn. Future strategies to decrease sunburn should target the practical, social, and psychological barriers associated with nonuptake of sun protection.

Social norms information enhances the efficacy of an appearance-based sun protection intervention

This experiment examined whether the efficacy of an appearance-based sun protection intervention could be enhanced by the addition of social norms information. Southern California college students ( N = 125, predominantly female) were randomly assigned to either an appearance-based sun protection intervention that consisted of a photograph depicting underlying sun damage to their skin (UV photo) and information about photoaging or to a control condition. Those assigned to the intervention were further randomized to receive information about what one should do to prevent photoaging (injunctive norms information), information about the number of their peers who currently use regular sun protection (descriptive norms information), both injunctive and descriptive norms information, or neither type of norms information. The results demonstrated that those who received the UV photo/photoaging information intervention expressed greater sun protection intentions and subsequently reported greater sun protection behaviors than did controls. Further, the addition of both injunctive and descriptive norms information increased self-reported sun protection behaviors during the subsequent month.

Randomized Trial Evaluating Computer-Based Sun Safety Education for Children in Elementary School

Interactive multimedia programs derived from the Sunny Days, Healthy Ways (SDHW) sun safety curriculum were evaluated with children aged 5-13. A randomized pretest to posttest 3-group study was conducted with 871 students in 12 primary schools in the western United States comparing computer programs alone, teacher-led presentation, or both combined. Computer programs with teacher-led presentation improved knowledge over either treatment individually (P = .001). The combination improved self-reported sun protection in lower but not higher grades over teacher-led presentation (P = .005). Computer-based sun safety instruction used with teacher instruction in primary schools may improve sun safety, especially with younger children.