Tanning, Skin Cancer Risk, and Prevention: A Content Analysis of Eight Popular Magazines That Target Female Readers, 1997–2006

Abstract

The majority of tanning bed users in the U.S. are women. Previous health communication research frequently focused on the risk of skin cancer, but few studies assessed the mediated communication environment that may surround women's beliefs and behaviors relevant to tanning. A content analysis of articles in 8 magazines targeting girls, young women, older women, and women who are interested in fitness during the 10-year period of 1997–2006 was conducted. The amount of coverage of tanning bed use consequences was less than 50% of the coverage of tanning benefits. About 40% of the tanning benefits coverage touted looking healthy. The coverage of prevention methods focused on sunscreen use (55%), whereas the more important methods (e.g., protective clothing use) were rarely featured. Longitudinally, the coverage of the risk- and prevention-relevant issues increased between 1997 and 2006. The data indicate that the coverage of tanning benefits also increased during the same period.

Significantly more women than men use tanning beds (Lillquist, Baptiste, Witzigman, & Nasca, 1994; Robinson, Rigel, & Amonette, 1997), and a growing number of studies have related tanning bed use with the risk of skin cancer (Pathak, 1991; Ting, Schultz, Cac, Peterson, & Walling, 2007; Whitmore, Morison, Potten, Chadwick, 2001).

A central factor that motivates women's tanning bed use is their beliefs about the benefits of a tan (e.g., looking healthy, looking better, looking more attractive; see Cokkinides, Weinstock, O'Connell, & Thun, 2002). Furthermore, research indicates that beliefs in tanning benefits are associated with unprotected sun exposure. Specifically, women who believe tanning to be beneficial are less likely to use sun protection and more likely to get sunburned during sunbathing (Geller et al., 2005; Jorgensen, Wayman, Green, & Gelb, 2000).

Previous health communication efforts frequently focused on the risk of skin cancer to promote prevention behavior (e.g., Buller, Borland, & Burgoon, 1998; Cho & Salmon, 2006; Stephenson & Witte, 1998). Although interventions addressing women's risk beliefs are important, concomitant efforts should be exerted to assess the contextual factors that may shape, modify, or reinforce those beliefs. Behaviors are determined not only by internal personal factors but also by external environmental factors, according to social cognitive theory (Bandura, 1986) and the theory of planned behavior (Ajzen, 1991).

Of environmental factors, the media, including popular magazines, serve as an important source of information on beauty, health, and lifestyle for women (Andsager & Powers, 2001; Warner & Procaccino, 2003). More important, a body of research has documented that magazine reading significantly influences women's health- and risk-relevant beliefs and behaviors such as body image and sexuality (Kim & Ward, 2004; Thomsen, McCoy, Gustafson, & Williams, 2002). Women's beliefs and behaviors involving their skin could also be influenced by magazines.

Despite theory and research pointing to the significance of mediated communication environment in influencing women's health, few studies are available to inform health communication efforts of what women are receiving from magazines about tanning, skin cancer risk, and prevention. This study is designed to obtain a first look at the landscape of coverage of skin cancer–relevant topics in magazines for female readers.

THEORY AND RESEARCH ON SKIN CANCER–RELATED MEDIA CONTENT

According to social cognitive theory (Bandura, 1986, 2001), human agency operates within the triadic determination among internal personal factors (e.g., beliefs), behavior, and external environmental factors (e.g., the media). Ample research has examined the beliefs and behaviors relevant to skin cancer prevention, and the relation between beliefs and behaviors (Saraiya et al., 2004). In contrast, little research has paid attention to the external environmental factors that influence both the internal personal factors and the behaviors.

Previous Research

Only a limited number of studies have investigated media content relevant to skin cancer. These studies focus on news media and advertising content. Stryker, Solky, and Emmons (2005) analyzed the content of Associated Press news coverage between 1979 and 2003. The results indicated that the coverage of the risk, prevention, and detection of skin cancer has not increased since 1986. Whereas the treatment of skin cancer was mentioned frequently, prevention and detection were mentioned rarely. Another content analysis study examined tanning salon advertisements in high school newspapers and found that almost 50% of the sampled newspapers featured tanning salon ads (Freeman, Francis, Lundahl, Bowland, & Dellavalle, 2006). Moreover, about 50% of the ads provided discounts including unlimited tanning offers.

Lee and colleagues (2006) assessed the advertisements of sun protection products in a wide range of popular magazines, including those for men, women, teens, parents, travelers, and outdoor recreational users. Although most sun protection products were marketed in women's magazines, most of the ads were for cosmetics containing sun protection factor (SPF) rather than stand-alone sunscreen. None of the ads provided information for proper use of sunscreen.

Although magazines are an important source of health information for women, of particular importance is their editorial content. Media messages in editorial content may influence the audience by creating and maintaining context that provides normative support for health or risk behavior (Milkie, 1999; Park, 2005). Furthermore, exposure to editorial content of the media can positively predispose individuals to be more responsive to the advertisements that they are exposed to subsequently (Harris, 1998; Shrum, 2004). Exposure to magazine articles that imply tanning benefits, for example, can make women more receptive to tanning ad offers and more willing to engage in tanning. Thus, this investigation focuses on the content of women's magazine articles. The theoretical foundation of this investigation is outlined following.

A Theory of Planned Behavior Approach to Analyzing Women's Magazine Articles

The theory of planned behavior (Ajzen, 1991) postulates that beliefs about the outcomes of a behavior (i.e., behavioral beliefs) and beliefs in one's ability to carry out the recommended action (i.e., self-efficacy) are two of the significant predictors of behavior. The behavioral beliefs frequently concern physical or social outcomes (Bandura, 1997), whereas self-efficacy has frequently been operationalized as the provision of information and skills requisite to the recommended behavior (e.g., Maibach & Cotton, 1995; Strecher, DeVellis, Becker, & Rosenstock, 1986). The efficacy of these components in the promotion of behavior change has consistently been demonstrated by meta-analyses (e.g., Albarracin, Johnson, Fishbein, & Muellerleile, 2001; Armitage & Conner, 2001).

Applying the tenets of the theory of planned behavior to the contexts of tanning, skin cancer risk, and prevention, this study seeks to investigate what messages women are receiving from magazine articles with respect to the positive and negative, as well as physical and social outcomes of suntanning and tanning bed use. This study also examines magazine articles' coverage of information and skills relevant to skin cancer prevention and detection. Furthermore, to ground this inquiry in the specific context of skin cancer prevention, the following factors are incorporated into this investigation.

The Context of Skin Cancer Prevention

Some groups of women may be more vulnerable to the harmful effects of ultraviolet (UV) rays than others. For example, sunburns during adolescence are known to significantly increase the likelihood of skin cancer later in life (Elwood & Jopson, 1997; Whiteman & Green, 1994). Adolescents, including girls, should be appropriately informed about the risk so that they can protect themselves from harmful UV rays. Women who engage in outdoor exercise, sports, and leisure activities may also be more vulnerable than others to extended sun exposure and unintended sunburns (Graffunder et al., 1999). Thus, attention should be paid to the skin cancer information conveyed in girls' and fitness magazines.

Research should also examine women's magazines' coverage of skin cancer prevention methods. Particularly, it is important to evaluate whether magazines present the more important methods (i.e., wearing protective clothing, staying in shade, and avoiding the sun during peak hours) more frequently than the use of sunscreen. Previous research found that more women than men use sunscreen when in the sun (American Academy of Dermatology, 2005). Sunscreen use by itself, however, is inadequate because it is associated with a decrease in other forms of sun protection, an increase in time spent in the sun, and the probability of sunburns (Vainio & Bianchini, 2001).

Along with prevention, the American Cancer Society encourages early detection through skin examination either by a doctor or by self (American Cancer Society, 2007a; Shah et al., 2007). Research also found that partner assistance is an effective means of increasing skin self-examination performances (Robinson, Turrisi, & Stapleton, 2007). Little is known about whether and to what extent women's magazines provide information on skin cancer detection methods to their readers.

This study is designed to explore women's magazines' coverage of skin cancer–relevant issues. This initial investigation will employ a range of magazines targeting female readers, including adolescent girls, young women, older women, and women who are interested in fitness, in order to obtain a comprehensive look. Considering the recent increase in the incidence of skin cancer among women below 40 years of age (Christenson et al., 2005), this study will also assess whether the magazines' coverage of skin cancer relevant issues has increased over time.

METHODS

Eight magazines were selected for this study, two for each of the four female reader types. The magazines were chosen because of their large circulation (Audit Bureaus of Circulation, 2006). Within the adolescent girls' magazine category, Seventeen has a circulation of 2.0 million, and Cosmo Girl has a circulation of 1.4 million. Within the young women's category, Cosmopolitan has a circulation of 2.9 million, and Glamour has a circulation of 2.2 million.

Within the older women's category, Good Housekeeping has a circulation of 4.7 million, and Redbook has a circulation of 2.3 million. Of note, Good Housekeeping bills itself as a magazine that reports on all topics that are important to women, including health. Given its large circulation, Good Housekeeping may serve as a resource book for many women, and women who read the magazine for other topics may also be exposed to coverage about skin cancer issues.

Shape and Self focus on fitness and health and have a strong readership among women ages 20 to 40. Women who read these magazines may treat them as a reliable source of health information. These magazines have circulations of 1.7 million and 1.4 million, respectively. All eight magazines are published monthly, with equivalent page numbers.

The unit of analysis was one article. Articles were identified using the Readers' Guide to Periodical Literature and ProQuest Research Library. The searched headings included skin cancer, melanoma, basal cell cancer, squamous cell cancer, sun tan, sun tanning, tanning bed/booth/salon, sun protection, sun safety, and sunscreen, skin cancer prevention, and skin cancer detection. All articles under each of these major headings or subsequent subheadings were included in the analysis.

Existing skin cancer educational materials of the American Cancer Society (2007b) and Centers for Disease Control and Prevention (2007), as well as the literature reviewed previously, served as the initial framework for developing a coding scheme. Next, open coding, which is the process of identifying any additional concepts present in the data, was used to achieve a comprehensive coding scheme (Neuendorf, 2002).

Tanning Risks

The presence (1) or absence (0) of references to consequences associated with sun tanning and tanning bed use was coded for aged skin (i.e., rough skin, leathery skin, wrinkles), discolored skin (i.e., freckles, skin spots, tan lines), burns, skin cancer, and death.

Tanning Benefits

The presence or absence of references to benefits of tanning was coded. Category items included looking healthy/having a healthy glow, looking sexy, looking attractive, looking thinner, looking younger, looking rich/looking wealthy, and having fun.

Skin Cancer Prevention Methods

The presence or absence of the references to skin cancer prevention methods was coded. Category items included use of sunscreen with SPF15 or higher, avoidance of peak sun hours, seeking shade, use of artificial tanning products only, avoidance of indoor tanning, and wearing of protective clothing (i.e., long-sleeved shirts, long skirts/pants, wide-brimmed hat, sunglasses).

Skin Cancer Detection Methods

The presence or absence of references to skin cancer detection methods was coded. Category items included asking a dermatologist, performing a skin self-examination, information on how to perform a skin self-examination, and partner assistance.

Article Photographs

Whether each photograph in an article (1) encouraged UV exposure (e.g., woman sunbathing), (2) encouraged safer UV exposure (e.g., woman applying sunscreen), (3) discouraged UV exposure (e.g., woman applying self-tanner), or was (4) neutral to UV exposure (e.g., photograph of an apple) was assessed. For articles with more than one photograph, the following additional categories were identified: (5) encouraged safer UV exposure and discouraged UV exposure, (6) encouraged UV exposure and encouraged safer UV exposure, (7) encouraged and discouraged UV exposure, and (8) encouraged UV exposure, encouraged safer UV exposure, and discouraged UV exposure. The additional categories (6) through (8) were merged into a “mixed message” category.

Three coders were trained and worked together to establish intercoder reliability. The training involved articles not used in the sample. The training articles were coded and discussed by all three coders until they felt comfortable with the coding scheme. After the training, about 10% of the sample, 30 articles, was used to assess intercoder reliability. Scott's pi values ranged between .85 and 1.00.

RESULTS

Overview

During the 10-year period examined, 1997 to 2006, a total of 250 articles related to skin cancer were featured in eight magazines that target female readers. Of the total, 29.2% (n = 73) were featured in magazines for older women (Good Housekeeping, n = 29; Redbook n = 45); 28.4% (n = 71) in fitness magazines (Shape, n = 51; Self, n = 20); 27.2% (n = 68) in magazines for young women (Cosmopolitan, n = 51; Glamour, n = 17); and 15.2% (n = 38) in magazines for girls (Seventeen, n = 22; Cosmo Girl, n = 15).

Across the magazines, there were 257 mentions of suntanning consequences, 46 mentions of tanning bed use consequences, 98 mentions of tanning benefits, 260 mentions of skin cancer prevention methods, and 80 mentions of skin cancer detection methods. Apparently, the magazines' coverage concentrated on suntanning consequences and skin cancer prevention methods. The coverage of tanning bed use consequences was less than 20% of the coverage of suntanning consequences (n = 46 vs. 257). Also, the coverage of tanning bed use consequences was less than 50% the coverage of tanning benefits (n = 46 vs. 98).

Consequences of Suntanning

Of the total 257 mentions of suntanning consequences across the magazines, 27.6% of the mentions were about aged skin (n = 69). The coverage also addressed skin cancer (24.4%, n = 61), sunburn (21.0%, n = 54), skin discoloration (18.7%, n = 48), and death (9.7%, n = 25).

With respect to magazine types, 31.5% (n = 81) of the coverage came from fitness, 28.0% (n = 72) from older women's, 26.8% (n = 69) from young women's, and 13.6% (n = 35) from girls' magazines. Thus, girls' magazines' coverage of the issue is approximately 50% less than the coverage of the other magazine categories. Table 1 presents the details of the magazines' coverage of the issue.

TABLE 1 Magazines' Coverage of Consequences of Suntanning

Target/Magazine	Aged Skin	Discoloration	Burn	Cancer	Death	Magazine Totals
Girls
Cosmo Girl	2	2	3	5	3	15 (5.8)
Seventeen	6	4	5	3	2	20 (7.8)
Subtotal girls	8	6	8	8	5	35 (13.6)
Young women
Cosmopolitan	13	9	7	10	5	44 (17.1)
Glamour	9	3	6	6	1	25 (9.7)
Subtotal young women	22	12	13	16	6	69 (26.8)
Older women
Good Housekeeping	10	4	7	8	2	31 (12.1)
Redbook	8	11	9	10	3	41 (16.0)
Subtotal older women	18	15	16	18	5	72 (28.0)
Fitness
Self	9	6	9	10	5	39 (15.1)
Shape	12	9	8	9	4	42 (16.3)
Subtotal fitness	21	15	17	19	9	81 (31.5)
Variable totals	69 (26.8)	48 (18.7)	54 (21.0)	61 (23.7)	25 (9.7)	257
Note. Numbers in parentheses are percentages of column and row totals.

Consequences of Tanning Bed Use

Of the total 46 mentions of tanning bed use consequences across the magazines, 41% concerned skin cancer (n = 19). The coverage also addressed aged skin (30.4%, n = 14), skin discoloration (10.9%, n = 5), death (10.9%, n = 5), and burns (6.5%, n = 3).

With respect to magazine types, 37.0% (n = 17) of the coverage came from young women's, 30.4% (n = 14) from girls', 19.6% (n = 9) from fitness, and 13.0% (n = 6) from older women's magazines. Thus, both young women's and girls' magazines mentioned the issue twice as frequently as did older women's magazines. Also, the number of mentions by young women's magazines was twice that of the fitness magazines.

The majority of the coverage by fitness and older women's magazines was featured in Shape (n = 8) and Redbook (n = 5), respectively. The mentions by Self (n = 1) and Good Housekeeping were minimal (n = 1).

Benefits of Tanning

Of the total 98 mentions of tanning benefits across the magazines, 40.8% concerned “looking healthy” (n = 40). The coverage also concerned “looking attractive” (22.4%, n = 22), “having fun” (16.3%, n = 16), “looking sexy” (9.2%, n = 9), “looking thin” (7.1%, n = 7), “looking younger” (3.1%, n = 3), and “looking rich” (1.0%, n = 1).

With respect to magazine types, 33.7% (n = 33) of the coverage came from young women's, 28.6% (n = 28) from fitness, 20.4% (n = 20) from girls', and 17.3% (n = 17) from older women's magazines. Noticeable variations within each magazine type should be noted. Of young women's magazines, Cosmopolitan mentioned tanning benefits more frequently than Glamour (n = 29 vs. 4); of older women's magazines, Redbook mentioned tanning benefits more than Good Housekeeping (n = 15 vs. 2); of adolescent girls' magazines, Seventeen mentioned tanning benefits more than Cosmo Girl (n = 13 vs. 7). There was no difference between Self and Shape in the fitness magazine category (both ns = 14).

Notably, Cosmopolitan mentioned (n = 29) tanning benefits at least twice as many times as any of the other magazines. This magazine's mention of tanning benefits accounted for approximately 30% of all eight magazines' coverage of the issue. Over 86% of Cosmopolitan's coverage of tanning benefits concerned looking healthy, sexy, and attractive. Table 2 presents the details of the magazines' coverage of the issue.

TABLE 2 Tanning Benefits Featured in Magazines

Target/Magazine	LookingHealthy	LookingAttractive	LookingSexy	LookingThin	LookingYounger	LookingRich	HavingFun	Magazine Totals
Girls
Cosmo Girl	2	3	0	0	0	0	2	7 (7.1)
Seventeen	8	2	0	0	0	0	3	13 (13.3)
Subtotal girls	10	5	0	0	0	0	5	20 (20.4)
Young women
Cosmopolitan	9	9	7	0	1	1	2	29 (29.6)
Glamour	1	1	0	1	1	0	0	4 (4.1)
Subtotal young women	10	10	7	1	2	1	2	33 (33.7)
Older women
Good Housekeeping	1	0	0	1	0	0	0	2 (2.0)
Redbook	10	3	1	1	0	0	0	15 (15.3)
Subtotal older women	11	3	1	2	0	0	0	17 (17.3)
Fitness
Self	6	1	0	1	0	6	6	14 (14.3)
Shape	3	3	1	3	1	3	3	14 (14.3)
Subtotal fitness	9	4	1	4	1	9	9	28 (28.6)
Variable totals	40 (40.8)	22 (22.4)	9 (9.2)	7 (7.1)	3 (3.1)	1 (1.0)	16 (16.3)	98
Note. Numbers in parentheses are percentages of column and row totals.

Methods of Skin Cancer Prevention

Of the total 260 mentions of skin cancer prevention methods across the magazines, 55% concerned the use of sunscreen with SPF 15 or higher (n = 143). Of the total coverage, 12.7% (n = 33) addressed wearing protective clothing, 10.4% (n = 27) addressed avoiding tanning bed use, and 8.8% (n = 23) addressed avoiding the sun. The methods of seeking shade and artificial tanning were mentioned only 6.5% (n = 17) of the total, respectively.

With respect to magazine type, 32.7% (n = 85) of the coverage came from fitness, 30.4% (n = 79) from young women's, 23.8% (n = 62) from older women's, and 13.1% (n = 34) from girls' magazines. Imbalance within each magazine category was observed. Within the young women's magazine category, Cosmopolitan mentioned the issue approximately three times as many times as Glamour (n = 61 vs. 18). Within the older women's category, Redbook's mentioned the issue almost twice as many times as Good Housekeeping (n = 40 vs. 22). Table 3 presents the details of the magazines' coverage of the issue.

TABLE 3 Magazines' Coverage of Skin Cancer Prevention Methods

Target/Magazine	SunscreenSPF 15+	ProtectiveClothing	SeekShade	Avoid the Sun	Avoid Tanning Beds	ArtificialTanning Only	Magazine Totals
Girls
Cosmo Girl	8	0	3	0	1	1	13 (5.0)
Seventeen	15	1	1	1	3	0	21 (8.1)
Subtotal girls	23	1	4	1	4	1	34 (13.1)
Young women
Cosmopolitan	30	6	3	8	7	7	61 (23.5)
Glamour	9	2	0	2	4	1	18 (6.9)
Subtotal young women	39	8	3	10	11	8	79 (30.4)
Older women
Good Housekeeping	16	3	2	0	1	0	22 (8.5)
Redbook	22	6	2	2	4	4	40 (15.4)
Subtotal older women	38	9	4	2	5	4	62 (23.8)
Fitness
Self	14	8	3	5	3	0	33 (12.7)
Shape	29	7	3	5	4	4	52 (20.0)
Subtotal fitness	43	15	6	10	7	4	85 (32.7)
Variable totals	143 (55.0)	33 (12.7)	17 (6.5)	23 (8.8)	27 (10.4)	17 (6.5)	260
Note. Numbers in parentheses are percentages of column and row totals.

Methods of Skin Cancer Detection

Of the total 80 mentions of skin cancer detection methods across the magazines, 50% directed readers to ask a dermatologist (n = 40). Approximately 30% of the coverage concerned skin self-examination (31.3%, n = 25), whereas about 16.3% featured information on how to perform a skin self-examination (n = 13). Partner assistance in skin examination was mentioned minimally: 0.2% (n = 2).

Approximately one third of the total coverage of skin cancer detection methods came from fitness (35%, n = 28), young women's (32.5%, n = 26), and older women's magazines (31.3%, n = 25), respectively. Imbalance emerged within each of the three magazine categories. Cosmopolitan's coverage was twice as frequent compared with Glamour's (n = 19 vs. 7). Similar imbalance was observed between Shape and Self (n = 18 vs. 10), and between Redbook and Good Housekeeping (n = 16 vs. 9). Girls' magazines' coverage of skin cancer detection methods was minimal (1.3%, n = 1). Table 4 presents the details of the magazines' coverage.

TABLE 4 Magazines' Coverage of Skin Cancer Detection Methods

Target/Magazine	Dermatologist	SSE	How to SSE	Partner Assistance	Magazine Totals
Girls
Cosmo Girl	1	0	0	0	1 (1.3)
Seventeen	0	0	0	0	0 (0.0)
Subtotal girls	1	0	0	0	1 (1.3)
Young women's
Cosmopolitan	6	8	5	0	19 (23.8)
Glamour	4	2	1	0	7 (8.8)
Subtotal young women	10	10	6	0	26 (32.5)
Older women's
Good Housekeeping	4	3	2	0	9 (11.3)
Redbook	12	2	2	0	16 (20.0)
Subtotal older women	16	5	4	0	25 (31.3)
Fitness
Self	6	3	1	0	10 (12.5)
Shape	7	7	2	2	18 (22.5)
Subtotal fitness	13	10	3	2	28 (35.0)
Variable totals	40 (50.0)	25 (31.3)	13 (16.3)	2 (0.2)	80
Note. Numbers in parentheses are percentages of column and row totals. SSE, skin self-exam.

Article Photographs

Of the total 250 articles, about 20.8% contained no photographs (n = 56), and 28.4% contained one photo (n = 71). The number of photos contained in the remaining 50.8% of the articles ranged from two to 14, but the vast majority (88%) of the articles contained five or fewer photos.

Of the 200 articles with photos, approximately 13% of them contained photos that discouraged UV exposure (n = 26), whereas about 5% of the articles contained photos that discouraged UV exposure and encouraged safer UV exposure (n = 10). About 20.5% of the articles contained photos that encouraged safer UV exposure (n = 41).

Approximately 21% of the articles featured photos that encouraged UV exposure (n = 42), whereas about 23% of the articles included photos that sent mixed messages to women by featuring photos that encouraged and discouraged UV exposure (n = 46). About 17.5% of the articles featured photos that neither discourages nor encouraged UV exposure (n = 35). Table 5 shows the details of article photos.

TABLE 5 Article Photographs

Target/Magazine	EncouragedUV Exposure	Safer UV Exposure	Safer/NoUV Exposure	DiscouragedUV Exposure	MixedMessages	Neutral	Magazine totals
Girls
Cosmo Girl	0	3	1	2	1	0	7 (3.5)
Seventeen	3	5	2	3	6	2	21 (10.5)
Subtotal girl	3	8	3	5	7	2	28 (14.0)
Young women
Cosmopolitan	9	10	0	3	8	11	41 (20.5)
Glamour	4	3	0	4	2	4	17 (8.5)
Subtotal young women	13	13	0	7	10	15	58 (29.0)
Older women
Good Housekeeping	2	3	3	1	3	2	18 (9.0)
Redbook	7	3	3	4	9	4	30 (15.0)
Subtotal older women	9	6	6	5	12	6	48 (24.0)
Fitness
Self	2	3	1	3	7	2	18 (9.0)
Shape	15	7	0	6	10	10	48 (24.0)
Subtotal fitness	17	10	1	9	17	12	66 (33.0)
Variable totals	42 (21.0)	41 (20.5)	10 (5.0)	26 (13.0)	46 (23.0)	35 (17.5)	200
Note. Numbers in parentheses are percentages of column and row totals.

Coverage Trend Over Time

The magazines' coverage of the skin cancer–relevant issues over the period of 1997 to 2006 was examined. Correlation analyses between years and the articles reporting each of the issues detected positive relationships. Specifically, as the year progressed, the magazines' coverage of consequences of suntanning (r = .66) and tanning bed use (r = .79), benefits of tanning (r = .76), and methods of prevention (r = .68) and detection (r = .74) increased (all ps < .05). Figure 1 provides a representation of the magazines' coverage of skin cancer–relevant issues over time. ¹

FIGURE 1 Coverage of skin cancer relevant issues in wommen' magazines.

DISCUSSION

During the period of 1997 to 2006, the magazines' coverage of skin cancer–related issues focused on consequences of suntanning and methods of skin cancer prevention. The magazines' relatively frequent coverage of suntanning consequences and skin cancer prevention methods is positive. Continuous coverage of these issues may inform and remind women of the importance of sun protection.

Girls' magazines covered consequences of suntanning only half as frequently compared with the other magazines, however. This is a cause for concern because adolescents are especially vulnerable to the harmful effects of intermittent but intense sunburns (Elwood & Jopson, 1997; Whiteman & Green, 1994). Research has shown that during adolescence magazines are an important source of information on health and risk (e.g., Brown, 2002; Harrison, 2000). Thus, girls' magazines may be uniquely positioned to be a provider of information on suntanning consequences. The results suggest that the magazines have yet to take up this opportunity. Girls' magazines would need to increase their coverage of the issue.

The amount of coverage of the consequences of tanning bed use was about 20% of the coverage of consequences of suntanning. Considering that women are the majority of tanning bed users in the United States (Lillquist et al., 1994; Robinson et al., 1997), the low coverage of tanning bed use consequences by women's magazines is disappointing. Increased coverage of tanning bed use consequences would be desirable.

Also, the amount of coverage of tanning bed use consequences was about 50% of the coverage of tanning benefits. The magazines would need to address the imbalance. The majority of the magazines' coverage of benefits of tanning concerned looking healthy (40%). To the extent that UV rays are carcinogenic, the association of tanning with health is ironic. To the extent that the magazines associate tanning with health, their efforts to inform women about consequences of tanning and methods of protection could be compromised.

The majority of the magazines' coverage of methods of skin cancer prevention concerned the use of sunscreen with SPF 15 or higher (55%). Although the magazines should continue to encourage their readers to use sunscreen, simultaneously, they should inform them of other methods of sun protection and encourage the use of multiple methods. The International Agency for Research on Cancer of the World Health Organization recommends avoiding the sun, staying in the shade, and wearing protective clothing as the primary means, with sunscreen use as an adjunct, to protect against skin cancer (Vainio & Bianchini, 2001).

The majority of the magazines' coverage of methods of skin cancer detection concerned asking a dermatologist (50%). About 31% of the coverage mentioned skin self-examination, whereas 16% provided information on how to perform a skin self-examination. More provision of information on how to perform skin self-examination would be desirable.

Concerning individual magazines, the results suggest that Glamour, Good Housekeeping, and Self could increase their coverage of skin cancer–relevant issues. Although Glamour claims that one of its editorial foci is health, its coverage of both prevention and detection of skin cancer was less than half of Cosmopolitan's. Good Housekeeping's skin cancer–related coverage was lower than Redbook's (i.e., tanning bed use consequences, skin cancer prevention and detection). Increasing information on skin cancer may enhance the magazines' utility to their readers. It should be pointed out that Glamour and Good Housekeeping mentioned fewer tanning benefits than Cosmopolitan and Redbook.

Although Self and Shape featured tanning benefits at the same level, Self's coverage of tanning bed use consequences and skin cancer prevention and detection methods was lower than Shape's. In its position statement Self promotes itself as focusing on total well-being, including health, of women. To this end, decreasing tanning benefit coverage and increasing skin cancer prevention coverage would be needed.

The results suggest that Cosmopolitan should make more consistent editorial efforts with respect to its skin cancer–related coverage. On one hand, the magazine's coverage of prevention and detection of skin cancer was twice and three times, respectively, that of Glamour's. On the other hand, its coverage of tanning benefits was seven times that of Glamour. Cosmopolitan would need to reduce its mentions of tanning benefits to convey consistent skin cancer information to its readers. Otherwise, this magazine may be sending mixed messages, and its editorial efforts related to other skin cancer issues could be undermined.

Longitudinally, the data show that the magazines' coverage of all five topics of this study has increased over the 10 years from 1997 to 2006. The finding that coverage of consequences of tanning and methods of prevention and detection has increased is positive; however, coverage of the benefits of tanning also increased. The magazines would need to make more consistent editorial efforts to validate the value of prevention as compared to tanning.

Limitations and Suggestions for Future Research

The limitations of this study should be noted. First, content analysis in and of itself does not provide insights into individuals' use of content. Content analysis, however, is a valuable method for examining the context of risk/health behavior such as media's coverage of skin cancer–relevant issues.

Second, the eight magazines represent only a portion of the number of total magazines targeting the full spectrum of female readers. Although this study selected the two magazines that have the largest circulations in each of the four types of audiences, future research should examine a larger number of magazines.

Finally, this study did not examine specific predictions. The purpose of the study was exploratory in nature, however. It sought to offer a first look at the landscape of coverage of skin cancer–relevant topics in magazines for female readers. Few, if any, previous studies investigated magazines' editorial content related to skin cancer. It is hoped that this study will serve as a foundation and benchmark for future content analysis efforts on these important issues.

ACKNOWLEDGMENTS

This project was supported in part by grant 1RO3CA128438 from the National Cancer Institute to the first author. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Notes

¹Additional information on the relations between variables is available upon request.