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Abstract
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.
Acknowledgements
This research was supported by a grant from the National Cancer Institute. The authors thank Jody Harrell, Alma Correa, Emily Gray, Karen Lee, Crystal Winters, Angela Gorezman, Jaimi Martsoff, Heather Butler, Anthony Daggett and Veronica Sanchez for their help in carrying out this project. We also thank Richard E. Fitzpatrick, M.D. and Betsy Fizpatrick for their advice and assistance with this project.
Notes
1. Sample size was based on power analysis: with alpha set at .05 (two tailed) and d at 1.03 based on the UV photo intervention vs. control effect on sun protection intentions in our previous studies, an n of 25 per group would be needed to have power greater than .93. Thus, we recruited at least 50 per condition at each site to allow for some attrition across follow-ups, and to provide enhanced power for cross-regional comparisons and spectrometer data.
2. The differences in size, gender and ethnic composition of the samples across site are a reflection of the participant pools (and student enrollment) at each site/university.
3. Although providing these brochures could dilute the intervention effects, from an ethical standpoint, we felt it was important that all participants be provided with sun exposure risk and protection information. Given that it was not likely that all participants could be retained throughout the entire study, it was not feasible to provide this information at the end of the one-year follow-up.
4. Three percent of the sample at the three-month follow-up and 5.5% of the sample at the one-year follow-up were interviewed by telephone, because they no longer lived in the area. For these people, self-reported sun protection reports were obtained but not spectrophotometry readings.
5. Like others (e.g. Buller, Buller, Beach, & Ertl, Citation1996; Mayer et al., Citation1997), we did not use a third (a∗ scale) measure, because it indicates skin erythema or redness (i.e., sunburn). Skin darkening is considered a better measure of cumulative UV exposure from baseline to follow-up, because cumulative exposure is more likely to produce changes in tanning. Also, skin reddening (sunburn) typically subsides within 48–72 hours following UV exposure (Muizzuddin et al., Citation1990).
6. Responses regarding the amount of sunscreen needed to cover the body were coded as either incorrect (0) or correct (1). Because the goal was to determine whether participants had paid attention to the information provided in the photoaging video, we adopted a very strict accuracy criterion. Specifically, in order for an answer to be coded as correct, participants had to indicate one of the following: (a) 1.2 ounces; (b) one shot glass full; or (c) a palm full.
7. It should be noted that the same pattern of results is obtained when gender and ethnicity (Caucasian vs. Noncaucasian), on which the samples from the two sites differed, are controlled for in the analyses.
8. This may in part be due to females’ greater likelihood of using moisturisers and make-up that contain sun protection (SPF).
9. This was a counter-intuitive and unexpected finding. Moreover, the pattern of this particular finding is unique and not consistent with the rest of the data (e.g., Iowa students reported less incidental exposure and had lighter skin color if they had seen the UV photo than if they had not). Thus, one must be very cautious when interpreting this one aberrant finding. However, one possibility for why Iowa students who had seen their UV photo showed more yellow saturation (i.e., more tan) at the post-summer follow-up is that they may have reacted to the photo with greater defensiveness. That is, recent work has shown that young adults may demonstrate greater defensiveness in response to appearance-based interventions (Good & Abraham, Citation2011), perhaps because the sun exposure-photoaging link has traditionally received less attention in the media and, therefore, seems less well established than the sun exposure-skin cancer link. The generally colder and less sunny climate of Iowa relative to Southern California may mean even less local media attention devoted to sun exposure risks, thus making it easier for Iowa participants to deny or question appearance-based messages. (Note. We would like to thank Associate Editor Armitage for suggesting this interesting possible explanation.)