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My future’s so bright, I gotta wear shades:

A health promotion program designed to encourage the use of sunscreen

Elizabeth Cherson

Bryn Mawr College

 

 

 


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 (1-3pm) without wearing any sunscreen.  It is these unprotected hours that will constitute 80% of their lifetime sun exposure.  During these hours especially, the children must be protected from the ill effects of the sun’s ultraviolet rays.  Since the target group is so young, we must shift our attention to their parents, specifically the parents that are with the children when they go to the park, the soccer field, or any other outdoor place of activity.  The first step is to make the parents aware of the issue at hand.  This is best accomplished through billboards, signs, and other forms of advertisement in areas such as parks and soccer fields. These advertisements would first act to make parents aware of the fact that their children should be wearing sunscreen.  They would also act as a way of making sunscreen salient.  The salience of sunscreen is important because it facilitates the effectiveness of the psychosocial theories that will best alter parents’ attitudes and best increase the probability of the parents using sunscreen on themselves and their children. 

     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.


References

American Cancer Society. (1998) Cancer facts and figures. Atlanta, GA: American Cancer

     Society.

Banks, B.A., Silverman, R.A., Schwartz, R.H., Tunnessen, W.W. (1992).  Attitudes of teenagers

     toward sun exposure and sunscreen use.  Pediatrics, 89, 40-42.

Cokkinindes, V.E., Johnston-Davis, K., Weinstock, M., O’Connell, M.C., Kalsbeek, W., Thun,

     M.J., &Wingo, P.A. (2001) Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age.  Preventative Medicine, 33, 141-151.

Detwieler, J.B, Bedell, B.T., Salovey, P., Pronin, E., Rothman, A.J. (1999).  Message framing and

     sunscreen use:  Gain-framed messages motivate beach goers.  Health Psychology, 18,      189-196.

Greenlee, R.T., Murray, T., Bolden, S., & Wingo, P. (2000).  Cancer statistics.  CA Cancer J

     Clin, 50, 7-33.

Hebert, A.A. (1993).  Photoprotection in children.  In J.P. Callen, M.V. Dalh, L.E. Golitz, H.T.

     Greenway, & L.A. Schachner (Eds.), Advances in Dermatology (Vol. 8, (309-324)). St.      Louis, MO: Mosby Year Book.

Jackson, K.M., & Aiken, L.S. (2000).  A Psychological model of sun protection and sunbathing

     in young women: The impact of health beliefs, attitudes, norms, and self-efficacy for sun     protection.  Health Psychology, 19, 469-478.

Martin, S.C., Jacobsen, P.B., Lucas, D.J., Branch, K.A., & Ferron, J.M. (1999).  Predicting

     children’s sunscreen use:  Application of the theories of reasoned action and planned    behavior.  Preventative Medicine, 29, 37-44.

Mayer, J.A., Lewis, E.C., Eckhardt, L., Slymen, D., Belch, G., Elder, J., Engelberg, M.,

     Eichenfield, L., Achter, A., Nichols, T., Walker, K., Kwon, H., Talosig, M., & Gearen, C.    (2001).  Promoting sun safety among zoo visitors.  Preventative Medicine, 33, 162-169.

Rodrigue, J.R. (1996).  Promoting healthier behaviors, attitudes, and beliefs toward sun exposure

     in parents of young children.  Journal of Consulting and Clinical Psychology, 64, 1431-  1436.

Truhan, A.P. (1991).  Sun protection in childhood.  Clinical Pediatrics, 30, 676-681.