Guidelines for the development of social marketing programmes for sun protection among adolescents and young adults

The role of community pharmacists in primary and secondary prevention of skin cancer: an evaluation of a Flemish skin cancer prevention campaign

BACKGROUND

Skin cancer is a leading form of cancer in Belgium. Prevention of skin cancer by community pharmacists can play a role in increasing awareness and promoting sun protection. However, which persons could be reached by community pharmacists for skin cancer awareness in Belgium and whether this increased awareness is associated with increased sun protection and early detection remains unclear.

METHODS

Demographics of approached persons in Flemish community pharmacies during the months of May-June 2022 and the content of the skin cancer counseling were retrieved from the pharmacy database. Sunscreen purchases and dermatologist visits were evaluated up to 180 days after the skin cancer counseling.

RESULTS

Community pharmacists provided skin cancer counseling to a broad population of visitors (n = 822, 69% females, median age of 59 years Q1-Q3: 44-71 years). During the campaign, 822 visitors received a leaflet with skin cancer prevalence and sunscreen importance. On top of that, 335 visitors (41%) received additional counseling: skin type sensitivity was checked for 198 visitors (24%), typical characteristics of melanoma were discussed with 100 visitors (12%) and 37 visitors (5%) were referred to a physician for further information or concerns regarding a skin spot. Overall, one out of three visitors purchased sunscreen on the day of the counseling (33%, increasing up to 38% after 180 days). Among people under 20 years, this was even higher (51%). Additional counseling increased the likelihood of a dermatologist visit within 180 days (OR = 1.80; 95%CI: 1.12-2.88).

CONCLUSIONS

By providing skin cancer counseling in Belgian community pharmacies, a broad range of citizens was reached and triggered to purchase sunscreen, often on the same day as the counseling. Notably, young people were likely to purchase sunscreen. Citizens receiving additional counseling were more likely to visit a dermatologist within 180 days.

Efficacy of an appearance-based and a health-based sun protection intervention on summer vacationers' behaviours, PRISME cluster randomized crossover trial, France

OBJECTIVES

Sun-seeking vacationers are particularly vulnerable to melanoma. Appearance-based interventions (ABi) showing skin damage of ultraviolet exposure may be a promising prevention tool to improve skin protection. This study aimed to measure and compare the efficacy of an ABi and a health-based intervention (HBi) on French summer vacationers' behaviours and to identify differences between subpopulations.

DESIGN

A cluster randomized crossover trial with three intervention groups (control, ABi, HBi) was conducted in eight campsites on the French Mediterranean coast in summer 2019.

METHODS

1355 vacationers of both sexes and aged 12-55 years were included and followed up after 4 days (T1) and 14 months (T2). Efficacy of interventions was evaluated using multilevel mixed-effect models comparing groups on three outcomes: self-reported sun protection behaviours, sunbathing and skin colour measures. Protection behaviours were analysed according to subpopulations.

RESULTS

Compared to controls, the ABi group had a higher protection and sunbathed for fewer hours at T1 and T2. In the HBi group, the skin colour was lighter than controls at T1. When comparing ABi to HBi, ABi participants had lower exposure than HBi at T1 and T2. The protection of people with a 3-years university degree was higher in the HBi group than in others groups while that of people with a secondary school certificate was higher in the ABi group.

CONCLUSIONS

Our study provides further evidence of individual sun protection interventions effect in a touristic setting and highlights the relevance of ABi messages to supplement HBi messages, particularly in certain subpopulations with low to intermediate education levels.

A Photoaging Intervention Delivered to Adolescents in Secondary Schools: A Feasibility Study

Excessive exposure to ultraviolet radiation during adolescence can have a lasting effect on long-term skin cancer risk. Skin cancer prevention interventions for adolescents have been less commonly investigated than those for children and adults. The study objectives were to develop and evaluate the feasibility of a secondary school-based appearance focused intervention, including the development and testing of protocols and instruments, as a resource module that could be efficiently integrated into the secondary school science curriculum. This longitudinal study was conducted with a convenience sample of 38 13–14 year-old students attending one New Zealand (NZ) urban secondary school. The recruitment rate was excellent with only one student not participating because of parental concern. In terms of the implementation practicality, the intervention, as it stands, was extremely resource intensive, involving four research staff to deliver. This will not work if delivered in a classroom setting by a single teacher. However, the intervention was well received by students, so it shows promise if a less resource intensive version could be produced. The acceptability of the intervention with the students was good with the majority (61%) having no suggestions for improvements. Suggested improvements were minor and could be easily addressed.

Systematic Review of Interventions to Increase Awareness of Ultraviolet Radiation-Induced Harm and Protective Behaviors in Post-Secondary School Adults

College and university students are a group known for excessive sun exposure and indoor tanning. Health education campaigns for avoidance of ultraviolet (UV) radiation have been relatively unsuccessful in this population. This systematic review examines interventions aimed at post-secondary school young adults on college and university campuses for skin cancer awareness, photoprotection, and change in UV-exposure-related behavior. Fifty-nine studies were identified for inclusion according to predetermined criteria. Study heterogeneity was high; methods of intervention were individual or group-based, and were mostly visually delivered and/or passive learning. Most interventions occurred at a single time point. Intervention success was assessed by evaluating subject behavior, intention, attitudes, knowledge, and emotion. Multicomponent interventions, generally consisting of UV photography and a passively delivered educational component, may be more effective than a single component alone. Overall, study quality was poor. Sample size of the majority of studies was <150 subjects. Most studies used self-report of behavior and had a short follow-up time. Generalizability of findings may be impacted as women, particularly white/Caucasian women, were overrepresented in the studies identified by this systematic review. For this specific target population, themes arising from the review include the importance of self-relevance and message framing. Self-affirmation was identified as a potential challenge in designing interventions for this target group, which can lead to defensiveness and a negative reaction to the health message. The findings of this systematic review may inform future research in this field, as well as guide planning of effective interventions in this target population.

Effect of an Appearance-Based vs. a Health-Based Sun-Protective Intervention on French Summer Tourists' Behaviors in a Cluster Randomized Crossover Trial: The PRISME Protocol

Background: Sun exposure has short- and long-term adverse effects on eyes, skin, and the immune system. The most serious effect, melanoma, is largely attributable to natural ultraviolet radiation. Its prevalence is steadily increasing in fair-skinned populations in most European countries. Despite annual prevention campaigns, the French population continues to be overexposed to the sun and under-protected. Social and psychosocial characteristics may play an important role in sun protection determinants. Overexposure is partially motivated by a desire to tan oneself for aesthetic reasons. During summer, intense exposure constitutes a major risk factor for melanoma, making tourists a particularly high-risk population. Literature reviews concluded that appearance-based interventions highlighting the aesthetic effects of sun exposure on skin photoaging showed promise in terms of improving sun-exposure and sun-protection behaviors, especially among younger people, but that more rigorous studies were needed. In this context, we implemented the PRISME study to: - identify the determinants, in particular social and psychosocial, of sun-protection of French summer tourists visiting the Mediterranean coastline; - design two prevention interventions grounded in psychosocial theories; - compare the impact of both interventions on tourists' sun-protection behaviors, and identify the determinants influencing this impact. This paper presents the methodology of the PRISME study. Methods: During summer 2019, we conducted a cluster randomized crossover trial to compare two prevention interventions, one based on health-related messages (health effects information, phototype calculation), the other on appearance-related messages (photoaging information, ultraviolet photography), among French tourists aged 12-55 years old in coastline campsites in the French region of Occitanie. Both interventions were anchored in the theory of planned behavior and in the transtheoretical model. The interventions' impact was measured using face-to-face questionnaires and skin color measurements both immediately before and 4 days after the interventions. A second follow-up, using an online questionnaire, will be conducted in September 2020 to measure the longer-term effects of both interventions. Discussion: Despite certain study limitations, PRISME take into consideration several known methodological gaps. The study's results will enable to evaluate the efficacy of the promising appearance-based approach in France, and to identify vulnerable sub-populations and mechanisms to improve sun-protection behaviors of French tourists.

The Potential of Ultraviolet Radiation Meters in Secondary Schools as a Sun Protection Intervention Mechanism for Adolescents

The aim of this pilot study was to assess whether the installation of ultraviolet radiation (UVR) meters in secondary schools has the potential to improve adolescents’ sun protection-related knowledge, attitudes, and behaviours and reduce their exposure to UVR during school hours. Data were collected from students at two schools via online pre- and post-intervention surveys, measurement of sunscreen usage, polysulfone UVR exposure badges, and photographs of the schoolyards to assess hat and shade use. Several operational issues limited the quantity and quality of data that could be collected, and findings were mixed. While there were no significant changes in either self-reported or observed sun protection behaviours, there were significant improvements in UVR knowledge among students at the intervention school, and reactions to the meter were highly favourable. Students reported consulting the meter regularly and using it to make decisions about their sun protection behaviours. Overall, the study results offer some support for the use of UVR meters in areas frequented by adolescents and provide insights into the process issues that are likely to need to be addressed when attempting to trial sun protection interventions in schools.

Improving understanding about tanning behaviors in college students: a pilot study

OBJECTIVE

Melanoma is the second most common cancer diagnosed among 15- to 29-year-olds. This pilot study assessed behaviors, barriers, and beliefs relevant to sun exposure and protective behaviors.

PARTICIPANTS

The sample comprised 153 undergraduate students at a large state university in western New York.

METHODS

Participants completed an online survey about sun safety habits, barriers to using sunblock, and beliefs about tanning and sun exposure.

RESULTS

Response rate was 90.8% (n = 139). Most students (87.8%) reportedly spent ≥ 3 hours per day outside in the summer, but only 17.3% reported always using sunblock during this time. Sixty percent reported recent indoor tanning and 41% reported more than 10 lifetime sunburns. The greatest barrier to using sunblock was forgetting (84.2%).

CONCLUSIONS

Demographics coupled with inconsistent and low levels of sunblock use, high annual prevalence of indoor tanning, and multiple lifetime sunburns indicate that this sample is at high risk for skin cancer.