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?

Visual Tailoring and Skin Cancer Prevention: Comparing Personalized, Stock, and Non-Ultraviolet Images

Past research has demonstrated that ultraviolet (UV) photos - which reveal skin damage as dark patches - can increase preventive behaviors. Emerging camera technology facilitates personalized UV photos for interventions, yet little is known about how personalized photos compare to other visuals and what cognitive or affective mechanism explains their persuasive impact. To engage this research line, the current study compared the impact of personalized UV (PUV), stock UV (SUV), and non-UV (NUV) photos and, to advance theorizing on fear appeals, explored underlying affective mechanisms including physiological fear. A sample of 169 undergraduate students participated in a 3 (Visual conditions: PUV, SUV, NUV) × 2 (Efficacy conditions: No efficacy and Efficacy) between-participants message experiment on a computer equipped with iMotions 6.4 that tracked real-time physiological responses (facial expression and skin conductance). Results demonstrated that PUV skin damage photos produced significantly greater self-reported fear and positive valence (detected by facial expression analysis) than NUV and SUV visuals. Mediation analysis demonstrated that fear had a significant indirect effect on the relationship between exposure to PUV skin damage visuals and behavior expectations.

Do ultraviolet photos increase sun safe behavior expectations via fear? A randomized controlled trial in a sample of U.S. adults

Ultraviolet (UV) photos reveal the world in a different light spectrum, including damage that is caused by UV light. In the context of skin cancer control, UV photos have the potential to communicate fear because they reveal underlying skin damage. U.S. adults (N = 2219) were assigned to a 5 (visual: UV skin damage, sun exposure, sunburn, photoaging, and mole removal) × 3 (replication: three examples of each visual condition) × 4 (efficacy: no efficacy, text only, visual, visual + text) randomized controlled trial. Compared to all other visual conditions combined, UV skin damage visuals generated greater fear which triggered increased sun safe behavior expectations. Compared with other visual conditions separately, only mole removal visuals produced equivalent fear as UV skin damage visuals. Visual efficacy conditions appeared to nullify rather than magnify the indirect path through fear. The results suggest one way UV images impact sun safe behavioral expectations is via fear and that researchers should continue to examine the position of fear in fear appeal theories.

Patients' sun practices, perceptions of skin cancer and their risk of skin cancer in rural Australia

ISSUE ADDRESSED

Skin cancer affects nearly one in three Australians. As a preventable disease there have been many public awareness campaigns targeting skin cancer knowledge and sun protection in Australia in the last 30 years to increase knowledge of the disease and how to prevent it. Despite higher incidence and mortality of skin cancer in regional Australia and adults over 65 years though, little research exists examining this high-risk population's skin cancer knowledge and sun behaviours, with most previous research conducted in urban Australia or overseas. This study aimed to examine adults' skin cancer knowledge, sun behaviours and demographic factors in a regional Australian town.

METHODS

Cross-sectional study design was utilised. Adult patients of a Mudgee General Practice (n = 179, 18-89 years) completed a survey based on their skin cancer knowledge and sun behaviours. Chi-squared tests were used to analyse responses.

RESULTS

Poor non-melanoma skin cancer awareness, risky sun behaviours and inadequate sun protection behaviours were found. Males and those at greatest current risk of skin cancer in Australia, those over 60 years, had the poorest skin cancer knowledge and were least likely to recognise skin cancer or use some sun protection measures.

CONCLUSIONS

Greater non-melanoma skin cancer and sun protection education and research is needed, particularly targeting older and male Australians. SO WHAT?: The findings suggest rural men and older Australians would benefit from more targeted campaigns and education to increase their skin cancer awareness and use of sun protection in order to minimise future skin cancer.

Skin cancer interventions across the cancer control continuum: Review of technology, environment, and theory

The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.

Effects of multiple viewings of an ultraviolet photo on sun protection behaviors

OBJECTIVES

To determine whether multiple viewings of one's ultraviolet (UV) facial photo differentially affects subsequent sun protection behaviors relative to a single viewing.

STUDY DESIGN

Pretest-posttest control group.

METHODS

Southern California college students (N = 151) were randomly assigned to be shown their UV facial photo one time, multiple times over the course of 2 weeks, or not at all. Emotional reactions, perceived susceptibility to skin damage, and sun protection intentions were assessed immediately, and sun protection behaviors were assessed during a surprise telephonic follow-up 1 month later.

RESULTS

Immediately after viewing a UV photo of their face, participants reported significantly greater perceived susceptibility to skin damage, greater intentions to engage in future sun protection, and more negative emotions than those who had not seen a UV photo. Moreover, 1 month later, those who had viewed their UV photo were less likely to report having sunbathed and reported significantly greater sun protection than did controls. There were no differences in sun protection behaviors between those who had been shown their UV photo only once during the initial intervention session and those who had been sent their UV photo several times thereafter. However, among those who had been sent their UV photo several times, those who reported having viewed their photo on additional occasions reported significantly greater sun protection behaviors than those who had not.

CONCLUSIONS

Being randomly assigned to view a UV facial photo multiple times generally neither strengthened nor weakened effects on subsequent sun protection behaviors relative to being shown the photo just once. However, among those who were sent their photo and thus had the option of viewing it more often than they had been assigned to, those who chose to view their photo more frequently also engaged in more sun protection behaviors.

The relative role of cognitive and emotional reactions in mediating the effects of a social comparison sun protection intervention

OBJECTIVE

This experiment examined the cognitive and emotional impact of two social comparison-based sun protection interventions in a sample of Southern California college students (N = 223). One of the interventions employed comparison UV photos of peers who had either much more (downward social comparison) or much less (upward social comparison) skin damage than did participants themselves. The second intervention consisted of descriptive norms information suggesting that a large majority of the participants' peer group regularly protect their skin from the sun.

DESIGN

Participants were randomly assigned to one of eight conditions in a 4 (Social Comparison Information: no photo vs. no comparison photos vs. upward comparison photos vs. downward comparison photos) × 2 (Descriptive Norms Information: Received vs. not received) design.

MAIN OUTCOME MEASURES

Emotional reactions (e.g. worry, embarrassment, relief) and sun-related cognitive reactions (perceived susceptibility, sun protection intentions) were assessed immediately. Sun protection behaviours were assessed in a surprise telephone follow-up five weeks following the intervention.

RESULTS

The results demonstrated that the combination of seeing photos of peers who had very little sun damage and learning that a majority of one's peers engage in regular sun protection resulted in reliably greater subsequent sun protection than all other conditions. Further, there was relatively direct evidence that both negative emotional reactions and sun protection intentions mediated this effect.

CONCLUSIONS

These findings add to the growing literature suggesting the importance of thoroughly examining the role of emotions in health behaviour decisions. Both theory and intervention efficacy would benefit from a better understanding of the relative role of cognitions and emotions in behaviour change.