Evaluating SunSmart: a brief educational intervention promoting sun protection in young adult cancer survivors.

PURPOSE: Young adult cancer survivors (YACS) are at risk for secondary skin cancers but relevant interventions have not been validated in this population. To address this, we designed and tested SunSmart, a set of two educational videos designed to promote sun protection (SP). One provides SP education (Information) and the second combines SP education with content on negative appearance consequences of sun exposure (Information + Appearance). METHODS: One hundred ninety-three YACS (aged 18-35) were randomized to one of three groups: (1) Information, (2) Information + Appearance, or (3) control (sleep hygiene video). Participants completed measures on SP behaviors at baseline and follow-up. One-way ANCOVAs examined the intervention effect on follow-up SP behaviors controlling for baseline behaviors. RESULTS: The intervention did not significantly affect SP behaviors. However, secondary analyses limited to participants with the lowest baseline SP adherence found that the Information + Appearance group had significantly lower intentional sun exposure than the control group (p = 0.02) at follow-up. CONCLUSIONS: Contrary to hypotheses, the SunSmart intervention did not significantly improve sun protection in YACS, even when it presented information on negative appearance consequences of sun exposure. However, secondary analyses suggest SunSmart may be more effective in YACS with the lowest SP adherence. Future research is required to improve intervention efficacy with YACS (e.g., increased focus on secondary cancer risks). IMPLICATIONS FOR CANCER SURVIVORS: Despite their increased risk of secondary skin cancer, YACS in the current study reported significant sun exposure and inadequate SP. The need for development and validation of effective interventions to address these concerns remains.

Construction and Validation of a Self-report Subjective Emptiness Scale.

Subjective emptiness is a psychiatric symptom that is primarily assessed and studied as a criterion of borderline personality disorder, even though research suggests that it may have clinical importance beyond that diagnosis. The aim of this series of studies was to develop and validate a standalone self-report measure of subjective emptiness. A systematic, multistep approach to identifying test content was used to generate 88 items that were then trimmed to 53 via ratings of interviews with patients and experts. This preliminary scale was administered to a sample of 544 university students, and a trimmed version was given to two samples oversampled for clinical problems (n = 1,067; n = 1,016). A five-item measure fit a unidimensional model well and had satisfactory internal consistency across these samples. External validity analyses suggested that emptiness, as measured by the Subjective Emptiness Scale, is strongly related to a number of clinical constructs, particularly in the internalizing domain, indicating that emptiness is an important construct to consider in its own right, independent of its presence in the borderline criterion set.

Effects of interventions based on the theory of planned behavior on sugar-sweetened beverage consumption intentions and behavior.

There is increasing concern about the health risks of added dietary sugar, perhaps particularly when consumed in beverages that contain no essential nutrients (e.g., sodas). The purpose of this experiment was to examine the relative and combined efficacy of three interventions based on the theory of planned behavior (TPB) for motivating reductions in sugar sweetened beverage (SSB) consumption. Four-hundred-thirty undergraduates were randomised in a 2*2*2 factorial design. Participants received either information designed to increase awareness of the risks of SSB consumption or control information, and received either information about SSB consumption norms or no norms information, and either made plans to reduce their SSB consumption or engaged in a control planning task. Results demonstrated that the interventions, separately and in conjunction, resulted in greater intentions to reduce SSB consumption in the future, and there was evidence that these effects were mediated by the effects the interventions had on the TPB constructs. Further, the risks information resulted in more behaviors indicative of preparations to alter SSB consumption and those who engaged in the SSB planning task reported significantly lower SSB consumption at follow-up compared to controls. The three interventions utilized showed promise for altering SSB consumption intentions and behavior and, given their brevity and low cost, have potential to be developed into large scale community-based interventions that may lead to meaningful public health benefits.

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.

Using Appearance-Based Messages to Increase Sun Protection in Adolescent Young Adult Cancer Survivors: A Pilot Study of Ultraviolet Light Photography.

Despite risk for secondary skin cancers, many adolescent and young adult (AYA) cancer survivors do not practice recommended sun protection (SP). Ultraviolet light photography (UVP), which demonstrates the negative impact of sun exposure on physical appearance, has been shown to increase SP in community AYA samples. This study of 58 AYA cancer survivors demonstrates that UVP is acceptable and not distressing to this population. Follow-up data on 23 AYAs demonstrated that those given UVP significantly improve their SP behaviors, while those receiving standard educational materials do not. Results demonstrate UVP is a promising tool for increasing SP in AYA survivors.

Effects of Social Norms Information and Self-Affirmation on Sugar-Sweetened Beverage Consumption Intentions and Behaviors.

The separate and combined efficacy of a social norms and a self-affirmation intervention to motivate decreased sugar-sweetened beverage (SSB) consumption was examined in two experiments. College students were randomly assigned to receive information about SSB consumption risks, norms, both, or neither. In addition, participants performed either a self-affirmation or control task. Self-affirmation only weakly affected SSB consumption intentions and behaviors. However, participants in Experiment 2 who received risks information, norms information, or both reported greater SSB reduction intentions than did those who received no information. Two-weeks later, those who received both types of information reported more frequent behavior change preparations, and it appears this effect may have been partially mediated by the changes in intentions to reduce SSB consumption.

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.

Sun exposure in young adult cancer survivors on and off the beach: results from Project REACH.

BACKGROUND: Although cancer survivors are at risk for future skin cancers, many do not practice recommended sun protection. Studies have demonstrated poor adherence to specific behaviors (e.g., sunscreen, artificial tanning) during sunbathing, but less is known about survivors' typical amount of sun exposure during activities other than sunbathing. METHODS: We conducted a mailed survey of 153 adults (median age = 26.1) diagnosed with a non-skin cancer before age 30. Information on recent sunbathing and incidental sun exposures, protective behaviors, and perceived vulnerability was collected. Analyses focused on characterizing survivors with the lowest levels of recommended sun protection. RESULTS: Twenty-nine percent of participants exhibited low sun protection adherence during sunbathing and 31% during incidental exposure. Younger age was associated with low adherence, but this difference was significant only for sunbathing (OR=0.4; 95% CI, 0.2-0.9). Women were more likely than men to have low adherence during sunbathing (34.0% vs. 20.3%; OR = 2.44; 95% CI, 1.1-5.5). Survivors treated with radiation did not differ on exposures, adherence, or perceived vulnerability to the sun, despite feeling more susceptible to skin cancers (p = 0.03). CONCLUSIONS: Despite known skin cancer risks, many young cancer survivors receive significant sun exposure. Assessment of sunbathing alone fails to capture sun exposure behaviors, particularly in men. Survivors treated with radiation may recognize their increased risk of skin cancer, but not the role of sun protection in modifying that risk.

Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: a randomized, controlled experiment.

This experiment examined the impact of adding upward and/or downward social comparison information on the efficacy of an appearance-based sun protection intervention (UV photos and photoaging information). Southern California college students (N = 126) were randomly assigned to one of four conditions: control, intervention, intervention plus upward social comparison, intervention plus downward social comparison. The results demonstrated that all those who received the basic UV photo/photoaging intervention reported greater perceived susceptibility to photoaging (d = .74), less favorable tanning cognitions (d = .44), and greater intentions to sun protect (d = 1.32) relative to controls. Of more interest, while the basic intervention increased sun protective behavior during the subsequent 5 weeks relative to controls (d = .44), the addition of downward comparison information completely negated this benefit. Upward comparison information produced sun protection levels that were only slightly (and nonsignificantly) greater than in the basic intervention condition and, as such, does not appear to be a cost-effective addition. Possible mechanisms that may have reduced the benefits of upward comparison information and contributed to the undermining effects of downward comparison information are discussed.

Sun protection intervention for highway workers: long-term efficacy of UV photography and skin cancer information on men's protective cognitions and behavior.

BACKGROUND: The risk for skin cancer is increased among older males and outdoor workers who have high levels of ultraviolet (UV) exposure. PURPOSE: This study was designed to examine the long-term efficacy of UV photography interventions on male outdoor workers, the potential mediators of its impact, and the efficacy of UV photography and skin cancer vs. aging information with this population. METHODS: One hundred forty-eight male outdoor workers were randomly assigned to one of four intervention conditions or a control condition in a two by two plus one factorial design. The men in the intervention conditions received or did not receive a UV photo of their face and watched either a photoaging or skin cancer educational video. Participants completed pre-intervention, immediate post-intervention, and 2-month and 1-year follow-up assessments. RESULTS: Analysis of covariance and structural equation modeling revealed that participants in the UV photography and cancer information interventions reported higher levels of sun protection cognitions, which were significant partial mediators of increases in sun protection behaviors and decreases in skin color. CONCLUSIONS: This study provides evidence for effective sun protection interventions on male outdoor workers that may help reduce skin cancer risk.

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.

Long-term effects of appearance-based interventions on sun protection behaviors.

OBJECTIVES: To examine the longer term efficacies of exposure to UV photographs and photoaging information (e.g., wrinkles and age spots) for increasing sun protection intentions and behaviors of young adults. DESIGN: Randomized controlled trial with 4- to 5-month and 12-month follow-ups. MAIN OUTCOME MEASURES: Participants' self-reported sun protection intentions assessed immediately after the interventions, and both self-reported sun protection behaviors and an objective assessment (via spectrophotometry) of skin color change measured at the end of summer (4-5 months following interventions) and 1 year following interventions. RESULTS: Both interventions resulted in immediate positive effects on future sun protection intentions. Both interventions showed objective evidence of less skin darkening at the postsummer follow-up, with those in the photoaging information condition also reporting more sun protective behavior and continuing to show less skin darkening 1 year after intervention. There was also evidence that effects of photoaging information on subsequent skin color change were mediated by the earlier positive effect photoaging information had on participants' intentions to sun protect and their subsequent sun protection behaviors. CONCLUSIONS: UV photo and photoaging-information interventions each show promise as a brief and relatively inexpensive approach for motivating sun protection practices that may reduce skin cancer risk.

Marital quality predicts hospital stay following coronary artery bypass surgery for women but not men.

This study examined how two indices of spouse support, one relatively general and chronic (perceived overall marital quality), and one relatively situation-specific and acute (spouse support while in the hospital), separately and in interaction with patient gender, predict postoperative length of stays following major (coronary bypass) surgery. In a sample of 226 male and 70 female patients drawn from three hospitals in the San Diego area, California, the results indicated that marital quality, in combination with patient gender, predicted postoperative lengths of stay, such that relatively poor marital relationships elevated risk for longer stays for female but not male patients. Lengths of stay for female patients with higher quality marital relationships were similar to those of male patients (regardless of marital quality). These results were not attributable to any assessed preoperative differences in patient health and were independent of perceptions of spouse support received while in the hospital, which did not independently predict patients' lengths of stay.

Using UV photography to reduce use of tanning booths: a test of cognitive mediation.

Two laboratory studies were conducted in which a new type of intervention was used to reduce ultraviolet radiation (UV) exposure from tanning booth use among college students (Time 1 Ns=70 and 134). The intervention uses UV photography to highlight the damage to facial skin caused by previous UV exposure. When the authors controlled for baseline measures of booth use, students in both studies who viewed their UV photographs reported less booth use at a follow-up session 3-4 weeks later than did students not shown a copy of their photograph. Also, in both studies, the decline in use was significantly mediated by a Tanning Cognition Index composed of variables suggested by the prototype-willingness (prototype) model of health risk: tanning attitudes, tanner prototypes, and willingness to engage in risky UV exposure.

Effects of UV photographs, photoaging information, and use of sunless tanning lotion on sun protection behaviors.

OBJECTIVES: To examine the efficacy of UV photographs and information about photoaging (eg, wrinkles and age spots) for increasing the sun protection intentions and behaviors of young adults and to determine whether any effects of this appearance-based intervention could be enhanced by providing a non-UV alternative for achieving a tan (ie, sunless tanning lotion). DESIGN: Randomized control trial with 1-month follow-up. SETTING: Two universities in Southern California. PARTICIPANTS: A volunteer sample of 146 college students, 91.1% of whom completed the "surprise" 1-month follow-up. INTERVENTION: A UV facial photograph and a brief videotape describing the causes and consequences of photoaging. The study tested the effects of the photoaging information/UV photographic intervention only, the intervention plus use of sunless tanning lotion, and a control condition. MAIN OUTCOME MEASURES: Participants sun protection intentions as assessed immediately after the intervention and sun protection behaviors during the month after the intervention as assessed during a surprise telephone follow-up. RESULTS: The intervention resulted in significantly stronger sun protection intentions (P<.001) and greater sun protection behaviors (P<.05) relative to controls. Furthermore, the group that also used sunless tanning lotion tended to engage in greater sun protection behaviors than the group that received the intervention alone (P<.08). CONCLUSION: The UV photographic intervention holds promise as a cost-effective approach to motivate practices that may ultimately result in health benefits (ie, reduced skin cancer rates).

Effects of appearance-based interventions on sun protection intentions and self-reported behaviors.

Two appearance-based interventions designed to increase sun protection intentions and behaviors were evaluated. Sixty-eight college students in Experiment 1 and 76 beachgoers in Experiment 2 were randomly assigned to receive or not receive a photoaging (premature wrinkling and age spots) information intervention and, separately, to receive or not receive a novel ultraviolet (UV) photo intervention that makes the negative-appearance consequences of UV exposure more salient. Both experiments indicated that the UV photo intervention significantly increased intentions to use sunscreen in the future. A follow-up conducted with the beach sample indicated that UV photo information also produced greater protective behaviors for incidental sun exposure and that the combination of UV photo and photoaging information resulted in substantially lower reported sunbathing.

Effects of a videotape information intervention for spouses on spouse distress and patient recovery from surgery.

Shortly before hospital release, the spouses of 226 male and 70 female coronary artery bypass graft patients were randomly assigned to view an optimistically slanted information tape, a tape that featured coping with more ups and downs, or no tape at all. Results indicated that women, whether as patients or as caregivers, were at elevated risk for a variety of negative outcomes during the subsequent 6 months. However, female patients who had spouses in the optimistic, mastery-tape condition were protected from the elevated levels of problems that characterized women whose spouses received only standard discharge preparation. Results are discussed in relation to research on optimism effects and work that suggests men may generally be less effective caregivers than women.