My future’s so bright, I gotta
wear shades:
A health promotion program designed to encourage the use of sunscreen
Elizabeth Cherson

My future’s so bright, I gotta
wear shades:
A health promotion program designed to encourage the use of sunscreen
Wow! Your skin looks amazing … !
Beautiful, clear, smooth, glowing skin; it’s what so many of us crave. Movie stars pay thousands for it, women of
all ages read about how to get it in countless magazines, and men slyly steal
skin care products from the women in their lives. Keeping one’s skin healthy is shockingly
easy, yet most Americans do not engage in the one behavior that can save their
skin: using sunscreen. With the incidence of skin
cancer rising each year in the American public to over 1 million diagnosed
cases annually, skin cancer is not only the most common form of cancer in the
United States it is also becoming an undeclared epidemic (American Cancer
Society, 1998 as cited in Martin, Jacobsen, Lucas, Branch, & Ferron, 1999; Greenlee, Murray, Bolden, Wingo,
2000 as cited in Cokkinindes, Johnston-Davis, Weinstock, O’Connell, Kalsbeek, Thun, &Wingo, 2001). But, if Americans
love healthy skin so much, why aren’t they using sunscreen to protect
themselves from the devastating effects the sun can have on their skin’s health
and appearance? The answer may lie in
our childhoods; not in the way that Freud used to refer to, but in the fact that
80% of a person’s lifetime sun exposure occurs before the age of 21 (Banks,
Silverman, Schwartz, & Tunnessen, 1992 as cited
in Martin, Jacobsen, Lucas, Branch, & Ferron,
1999; Herbert, 1993 and Truhan, 1991 as cited in Rodrigue, 1996). It
is during these tender years that we are out in the sun the most, yet are also
most dependent on others for access to, application of, attitudes concerning,
and even general knowledge of sunscreen.
Infants and very young children do not know the benefits of sunscreen nor how to use it, so the decision of whether to use it is
left to their parents. Older children
know how to use sunscreen, but do not fully comprehend its benefits, nor do
they have access to it unless a parent deems it valuable enough to
purchase. Pre-teens and teenagers fall
victim to the desire to be “cool;” if the cool kids aren’t doing it, then
neither are they, regardless of parental advice or mandates. But if “everyone
else is doing it,” then even this group of youths will liberally and frequently
apply sunscreen. The question remains, how do we get “everyone
else” do use sunscreen? How do we get
parents to use sunscreen on their children?
How do we make using sunscreen “cool?”
When did you start using sunscreen … ?
The answer lies within social psychological
theories, of which there are quite a few.
The Theory of Reasoned Action is one such theory. It states that “an
individual’s behavior can be explained by his or her intentions to engage in
specific behaviors, as well as by factors that influence those intentions. Such factors include the attitudes he or she
has toward performing a specific behavior (a positive or negative evaluation of
the behavior) and subjective norms (defined as perceptions of how important
others would feel about him or her if he or she preformed the behavior) (Martin
et al, 1999). The Theory of Planned
Behavior builds upon the Theory of Reasoned Action. It includes “an individual’s perceived
behavioral control over performing a given behavior. These perceptions of
control have been theorized to have direct effects on behaviors, as well as
indirect effects through intentions” (Martin et al, 1999). A third theory is the Health Belief Model,
which is a cognitive model of health behavior.
This theory states that individuals adopt a health
protective behavior, such as using sunscreen, to the extent that they perceive
themselves to be susceptible to a health threat (i.e. photo aging and skin
cancer), perceive the threat to be severe, perceive the benefits of the
proposed health action for mitigating the threat (i.e. using sunscreen will
decrease the likelihood of portaging and skin cancer) and can overcome perceived
barriers to the health behavior (i.e. using sunscreen is messy and will ruin my
clothes) (Jackson & Aiken, 2000).
The final theory, the Protection Motivation Theory, is a
value-expectancy theory of health behavior.
It extends the Health Belief Model in three manners: 1. it juxtaposes adaptive responses to a
particular health threat against maladaptive ones (i.e. using sunscreen v.
sunbathing without sunscreen). 2. within this theory,
perceptions of susceptibility to the health threat and the severity of the
threat lead to fear arousal, which, in turn, reduces the likelihood of the
maladaptive responses (i.e. not wearing sunscreen). 3. it also incorporates self-efficacy. Self-efficacy is the belief that one is
capable of carrying out or sustaining a prescribed health action, such as consistently
wearing sunscreen when going to the beach) (Jackson & Aiken, 2000).
I want my skin to look as outstanding as yours … !
Picture 1.
The goal of this health promotion program
is to increase the public’s use of sunscreen as a preventative measure against,
among other things, skin cancer. This is best accomplished by putting into action the psychosocial
theories previously mentioned. An area
of major concern is the fact that young children spend so much time out doors
during the peak ultraviolet hours (
Using the Health Belief Model, the next
step in the health promotion program is to educate parents as to how vulnerable
they and their children are the harmful rays of the sun. This is accomplished
through distributing brochures illustrating the damaging effects of the
ultraviolet rays, complete with personal anecdotes from persons of similar
race, age and socio-economic background to the targeted group of parents that
use the targeted facilities. The
personal tales will be of young mothers who discovered they had skin cancer and
even melanoma and the precautions they now wish they had taken for themselves
and their children. There will also be
stories of babies and children that have been hospitalized
with severe sunburns and even sun poisoning.
Such stories will demonstrate that even if the parents have not yet felt
the ill effects of their own prolonged, unprotected sun exposure, they are
still at risk and the risk is severe.
The brochure will also point out that it is not too late to help their
children. A website address will be mentioned numerous times in the brochure as the
location where parents can go to print out a coupon for a free bottle of
sunscreen.
The website will serve to illustrate the
benefits of sunscreen use through pictures of older people (possibly 60’s –
80’s) that look amazingly young because they took care of their skin and used
sunscreen. It will also tell of the
medical benefits that come from using sunscreen, such as prevention of skin
cancer, photo aging and sunburns. This
will show how the health behavior of using sunscreen mitigates the health
threats that are skin cancer, photo aging and sunburn. In order to receive the coupon that was the
original purpose of going to the website, the parents will be
asked to input their names and email addresses. They will be told
that their email addresses will only be used to provide them with other
opportunities to receive free sunscreen and helpful tips regarding how to
better
Picture 2.
protect themselves and their families.
To bring the health
belief model full circle, there will be a display at all local stores that sell
sunscreen. The display will show
parents a new product that is not only easy to use, but is also less
messy: sunscreen wipes. Since companies are always looking for ways
to attract new customers, it will not be hard to find a company that is willing
to donate sunscreen wipes to our health promotion program. Parents will find that the self-contained
portability of the wipes will eliminate the barrier of transportability that
one encounters when one puts a tube of sunscreen in a purse or backpack and
opens it to find that the sunscreen has exploded all over the contents of the
purse or backpack. Another barrier that
the parents will find is no longer a problem is the issue of greasy hands and
white faces after applying sunscreen.
The wipes eradicate these problems through their easy application and
quick disposal. In this manner, the
parents will be shown that they can over come perceived
barriers to implementing the health behavior completing the Health Belief
Model. Finally, as a follow up measure,
the parents will be sent an email offering free group
seminars and discussions in their town about sun safety and the benefits of
sunscreen. These groups will also serve
as a type of parental support group whose goal is to educate parents and show
them that there are other parents who are concerned about sun safety who are
like them and doing something about it.
Another manner of attacking the problem of
how to get young children to wear sunscreen lies within the schools. American children spend more time at school most
days than they do at home with their parents.
Our health promotion program can use this to its advantage. By giving teachers a protocol to follow
regarding skin care ideas that children can use, we can start our children on
the right track early. Such a head start
would be valuable in many ways. Through
teachers’ requirement that children must put on sunscreen before going out to
play for recess, the children will have the opportunity to alter their attitude
regarding the application of sunscreen. This “change of heart” will occur for a
variety of reasons. First, the children
will be seeing peers and teachers, two categories of people whose opinions and
behaviors are to be valued and mimicked, applying
sunscreen regularly. The desire to feel
as if they “belong” and are true members of their in-groups will give the
children reason to reevaluate their attitude toward sunscreen application if
they have had a negative or neutral attitude toward it before. Also, the
repetitiveness of the behavior will make it automatic and habitual, instead of
contingent on the health threat or fear of punishment from the teacher. In an effort to make the children’s
self-efficacy salient, each child will be given his or
her own small bottle of sunscreen. This
will give the children a feeling of power over their own actions and will
encourage them to use sunscreen on their
Picture 3.
own at times other than at the behest of their
teachers.
The measure of a program lies in the amount
of behavioral and attitude change it brings about. Fortunately, both aspects of the health
promotion programs hold variables that are easily measured and are accurate
reflections of the level of success that the program is enjoying. In the program that focuses on parents, the
target parents go to a website to receive a coupon. The website is a good indicator of the
effectiveness of the program if we look at the number of unique hits the site
gets. This would measure the number of
parents that are affected by our brochure. While browsing the website, the parents can
give their email addresses and receive a coupon for a free container of
sunscreen. The use of this coupon is a
great measure of the effectiveness of the parental focus program. Not only does it reflect the number of
parents who were affected by the brochure to the extent that they wanted to get
sunscreen for free, but if we look at the number of
coupons redeemed, we can also see how many parents followed their new attitudes
to the extent that they went to the store and used the coupon. The sign up rate for the email list is a final
factor that could be measured to determine our
program’s success. If the parents were
affected enough by our program to sign up for more
tips about sun safety, and use the coupon, then their attitudes may have truly
been changed with regard to this health behavior. If the parents on the
mailing list choose to attend the group and participate in the discussions
facilitated there, then we would most likely be able to say that their
susceptibility to the heath threat had been perceived and the threat was
severe, the benefits of following through with the health action were
perceived, and the barriers were proven to be easily overcome, thus
facilitating a change in attitude and likelihood of sunscreen use increased.
There are a few options regarding
how to measure the success of the second program, which targeted young school children. One
of the options is to give the teachers a survey to fill out at the onset of the
program asking questions about the children’s level of reluctance to engage in
the health behavior. After a month of
the sunscreen program, if the surveys were to be given a second time to the
teachers, the difference between the levels of the children’s reluctance would
demonstrate the effectiveness of the program.
Another manner of success measure would be to look at the children’s initiation
of using sunscreen. At the beginning of
the program, the teachers would most likely have to assist the children and
supervise them to make sure that they actually engaged in the behavior. After a couple months, the children might
begin to initiate the routine of putting on sunscreen before going out to play
without the initial mandate of the teachers.
This would be the ultimate measure of the program’s success, as it would
have resulted in the health behavior becoming customary and automatic for the
children.
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