Skin cancer is a major concern in the United States. There is currently an estimated 3.5 million cases along with around 2 million new cases each year, comprising nearly half of all cancer cases in the United States (Ahmedin, et al., 2006) (Pols, Williams, Pandeya, Logan, & Green, 2006). The incidence rate of both melanoma and non-melanoma skin cancer is currently increasing (Planta, 2011)(Rigel, 2014). With the use of protective behaviors, both of these types of skin cancer are largely preventable (“Recommendations”, 2004). The most effective and efficient way to decrease skin cancer incidence is through the use of sunscreen (Pols, Williams, Pandeya, Logan, & Green, 2006). Health behavior theories have been developed to predict, influence, and change health-related behaviors (Glanz, Rimer, & Lewis, 2008). The theory of planned behavior uses the constructs of attitudes, subjective norms, and perceived behavioral control to influence intention to act (Ajzen, 1991). Perceived behavioral control and intention influence the behavior (Ajzen, 1991). Through focusing and modifying these constructs, this health behavior program aims to increase sunscreen use in adolescents and young adults.
The approach of this program is the integration of a weekly course given in the seventh grade at public schools. Research suggests the ideal time to implement a sun protection intervention is 6th through 8th grade. During this time, attitudes and behaviors become less favorable toward sun protection, parental influence decreases, and sun burn rates increase (Dixon, Borland & Hill, 1999). Another reason for the timing of this intervention is the impact high-level sun exposure has on children. A study analyzed the effect of high-level sun exposure at different age periods throughout life. Researchers found high-level sun exposure at a young age to be a strong determinant of melanoma later in life, although adult sun exposure also plays a role (Dixon, Borland & Hill, 1999). Through education, the sun protection course aims to influence the attitudes of the individual, his/her peers, and his/her parents. While influencing attitudes of the child and individuals surrounding the child, individual subjective norms will also be influenced. Lastly, the course will aim to increase perceived ease of wearing sunscreen as well as decrease the perceived difficulty of wearing it.
Attitudes are assessments of multiple aspects of the social world which lead to an established way of thinking or feeling about something (“Attitude.”, n.d.). Attitudes are shaped from childhood to early adult years and are fairly resistant to change. While the children are developing personal attitudes, it is important to mold their beliefs to promote positive health behaviors. One way to do this, which was successful at changing teenager’s attitudes towards engaging in sunscreen use, is through imagery of the consequences of not wearing sunscreen. The study found this to have more influence over sunscreen use than health-based videos with regards to usefulness of educational content and message appeal (Tuong & Armstrong, 2015). The sunscreen promotion course will include images of images of all types of sun burn as well as images of skin cancer which individuals have developed from not protecting themselves. Along with these images, education about what is actually happening to the skin and the body when a burn or cancer develops will be implemented.
Education is another way to change attitudes about a health behavior. Through the use of education following a set of surveys, one study found an 83% reduction in tanning bed use (Rogers, Franko, Gottlieb & Daynard, 2015). This course will educate 7th graders about what happens to the skin (both short and long term consequences) following a sun burn. Children will also be taught how to properly protect themselves from the sun by teaching them when to apply, how often to reapply, and which sunscreen to use. Through education and images of the consequences of not wearing sunscreen, children will develop a more positive attitude toward sunscreen use. While changing individual’s attitudes toward sunscreen use, there is hopes this change will transcend from individual to societal beliefs.
Subjective norms is the next major construct to modify in order to promote sunscreen use. Subjective norms are concerned with opinions, held by people influential to the individual, towards the behavior. The individual’s motivation to comply with the influential person’s opinions is the weight held by the subjective norms construct (Connor & Sparks, 1995, p. 171). One major way to do this in the 7th grade population is to change (or influence) parental opinions about sunscreen use. Parental attitudes toward tanning and sunscreen use play a large role in shaping children’s attitudes and behaviors. One study quantified parental attitudes toward their child tanning and found many parents have a neutral opinion. A surprising 30% of responders believed their child looked healthier with a tan, while 40% said they would allow their child to tan in the coming year (Whiteman, Whiteman & Green, 2001). The sunscreen promotion course will attempt to positively influence parental opinions with education in two forms.
Parents will be invited to a class meeting before the semester starts to inform them about course material and the aim of the course. The parents will also be educated about the importance of sunscreen use and consequences of not using sunscreen. Parents will basically receive a shorten version of the class with hopes to positively change their opinions about sunscreen use. Another way this course will attempt to influence parental sunscreen opinions is through monthly handouts. During the first week of each month, students will receive a handout to deliver to their parents. This handout will contain information which their children will be learning and other helpful tips about sunscreen. The monthly handouts are an attempt to influence their opinions through repetition. If the parent reads about the importance of sunscreen monthly, there is a higher chance of positively and permanently influencing their sunscreen opinion. Along with parental opinions, peer opinions also influence the subjective norms construct.
The course, itself, will be able to influence peer opinions about sunscreen use. During the sixth through the eighth grade, parental influence begins to decrease and peer influence increases (Dixon, Borland & Hill, 1999). With all 7th graders in public schools having to take this course, the opinions of the majority of children will change. Considering the weight 7th graders put on their peer’s opinions, as peer opinions begin to change there should be a chain reaction of changed beliefs. By influencing the opinions of both the individual’s parents and peers, the individual’s subjective norms about sunscreen use will theoretically be positively influenced. Individual’s subjective norms and attitudes are important, but perhaps most important, the individual must believe he/she has the ability use sunscreen.
Perceived behavioral control is the third and final construct of the theory of planned behavior. It is simply defined as perceived ease versus perceived difficulty. In order to promote sunscreen use in children, this program is going to increase the perceived ease of wearing sunscreen while at the same time decrease perceived difficulty. To increase the children’s perceived ease of wearing sun screen, each child will receive a small bottle of sunscreen with a clip on it. Children will be encouraged to clip it onto their backpacks and apply it when they are on their way to school. This is a relatively simple way to develop a habit of applying sunscreen daily. From a financial point of view, this would not be overly straining. Our organization will contact some of the major sunscreen companies and ask them for sponsorship. This helps us financially and allows sunscreen brands to advertise to a young population, which in turn helps the sponsoring company.
In order to help decrease children’s perceived difficulty of wearing sunscreen, we will integrate technology into the intervention plan. Prior studies have shown text message reminders to improve sunscreen use (Armstrong, et al., 2009). We plan to set up a service which sends out text messages to children each morning reminding them to apply sunscreen. Prior studies have also found one of the leading reasons that people do not use sunscreen is that they forget (Hillhouse, Adler, Drinnon, & Turrissi, 1997). The integration of technology into this intervention eliminates this barrier to sunscreen use and has shown to be an effective way to increasing use. After modifying all of the constructs to more efficiently influence sunscreen use, our program plans to track behavioral change in order to assure our program is effective.
Before the start of the sunscreen promotion course, our program will have the students complete a survey. The survey will ask questions with regards to each of the constructs in order to better understand their current attitudes, subjective norms, and perceived behavioral control about sunscreen use. The survey will also enquire about children’s actual sunscreen use. This will also help us understand which construct needs more (or less) emphasis during the course. The students will then take the same survey at the end of the course. This will allow us to see if the course changed the way they think about sunscreen use. These results will also help us to tweak the sunscreen promotion class for future years. The students will then take the survey one final time at the end of their 8th grade year. The reason for this survey is to explore the long term results of the course. The goal is to improve sunscreen use in children with lasting effects.
Through the integration on the theory of planed behavior, our program plans to increase sunscreen use by modifying the constructs which lead to behavior. In order to change attitude toward sunscreen use, our program will use imagery and education. The subjective norms of the individual will be modified by changing the individuals peer`s and parental opinions toward sunscreen use. Our program will modify the perceived behavioral control construct in two ways. It will increase perceived ease of sunscreen use by providing children with a clip on sunscreen bottle. Lastly, the program will decrease the perceived difficulty of the behavior by using a daily text message service to remind the children to use sunscreen. The program will be monitored and changed yearly in order to make the course more efficient at bringing behavior change. To continue to explore the need for this intervention as well as find additional resources, check out the resources page of this website!
Safety On Sunscreen 