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Susan Rask M.S., R.S. Environmental Health Specialist

Developing An Adolescent Sun Safety Project: Education, Risk Perception and Behavior Presentation for Massachusetts Health Officers Association Annual Conference 2010. Susan Rask M.S., R.S. Environmental Health Specialist Barnstable County Department of Health and Environment

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Susan Rask M.S., R.S. Environmental Health Specialist

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  1. Developing An Adolescent Sun Safety Project: Education, Risk Perception and BehaviorPresentation for Massachusetts Health Officers Association Annual Conference 2010 Susan Rask M.S., R.S. Environmental Health Specialist Barnstable County Department of Health and Environment Jean M Roma MSN, APRN-BC Director, Cape Cod and Martha’s Vineyard Medical Reserve Corps

  2. Developing Adolescent Sun Safety 2010 • Build funding and organizational partnerships • Conceptual framework • Simple Sun Safety messages • Deliver messages to where behavior is occurring • Entice adolescents to participate • Assess program effectiveness • Lessons learned

  3. It is during childhood that much of one’s lifetime sun exposure occurs!CDC Sun Safety for America’s Youth Toolkit-2009

  4. Protecting young people from UV exposure and teaching them how to practice lifelong sun safety behaviors is critical to reducing the rates of skin cancer in our country.

  5. We built a partnership Cape Cod and Martha’s Vineyard Medical Reserve Corps Barnstable County Department of Health and Environment MDPH/UMass School of Public Health—intern Local Health Departments and Recreation/Beach Departments on Cape Cod and Martha’s Vineyard Funding Partner: Cape Cod Healthcare

  6. Conceptual framework What is Healthy People ? • Healthy People is a comprehensive set of national ten year health promotion and objectives aimed at improving the health of the American people • Grounded in the notion that establishing objectives and providing benchmarks to track and monitor progress over time can motivate, guide and focus actions. • Defines vision and strategy for building a healthier Nation • Framework uses risk factors and determinants of health to guide improvements • Revised every 10 years-Now in the third decade

  7. Healthy People 2010 Goals • 3.9 Increase the proportion of persons who use at least one of the following protective measures that may reduce the risk of skin cancer: avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing when exposed to sunlight, use sunscreen with a sun-protective factor (SPF) of 15 or higher, and avoid artificial sources of ultraviolet light. • 3.9a Increase the proportion of adolescents in grades 9 through 12 who follow protective measures that may reduce skin cancer.

  8. Proposed Healthy People 2020 Goals • Objective Retained but Modified From Healthy People 2010 • New objective HP 2020-12 • Reduce the rate of sunburn a. Reduce the rate of sunburn among adolescents in grades 9-12. b. Reduce the rate of sunburn among adults aged 18 years and older. c. Reduce the proportion of adolescents that use artificial sources of ultraviolet light for tanning. Data Sources: Youth Behavior At Risk Survey Surveillance System, CDC, National Health Interview Survey

  9. Health Belief Model • Used as Conceptual Framework for project • Components • Perceived seriousness • Perceived susceptibility • Perceived benefits • Perceived barriers • Modifying variables • Cues to action • Self-Efficacy

  10. Health Belief Model Individual Perceptions Modifying Factors Likelihood of Action Age, Sex, Ethnicity, Personality, Socioeconomic, Knowledge Perceived Benefits minus Perceived Barriers Perceived Susceptibility/ Perceived Severity Perceived Threat Likelihood of Behavior Cues to Action Source: Stretcher, V. and Rosenstock, I.M., 1997

  11. Based on Healthy People and using theHealth Belief Model We set the following project goals • Target population: Adolescents age 13-18 • Simple Sun Safety messages to reduce UV exposure • Assess change in knowledge and risk perception • Assess whether change in risk perception might lead to changes in adolescent behavior

  12. Developing the Educational Messages • A literature review was done identifying articles related to sun exposure and melanoma in children 18 years of age or younger. • Studies generally indicated there was an increased melanoma risk in individuals who spent their childhood in sunny locations near the equator or close to the coast. • The majority of the sunburn studies suggest a positive association between early age sunburn and the subsequent risk of melanoma. Source: Arch Dis Child: 2006 Feb 9 (2) 131-8

  13. Skin Cancer Facts • Skin cancer is the most common type of cancer in the US (CDC). • Since 1973,new cases of the most serious form of skin cancer, melanoma, have increased approximately 150% (MMWR). • The deaths from melanoma have increased by 44% in the same period of time (MMWR). • 65% to 90% of melanomas are caused by ultraviolet radiation (CDC). • Exposure to ultraviolet radiation during childhood and adolescents plays an important role in the development of skin cancer. • Persons with a history of one or more blistering sunburns during childhood and adolescence are two times likely to develop melanoma than those that did not have the exposure (MMWR). • One person dies from melanoma every hour (EPA). • One out of every four will develop skin cancer in their lifetime (American Cancer Society).

  14. Very effective for older teens and young adults

  15. Education about UV index

  16. Why did we target the beaches of Cape Cod ? • Relaxing • Fun • Refreshing • Cool • Go to where adolescents are engaging in behavior we want to change

  17. How did we recruit adolescents to participate? • Short intervention • Invitation to participate • Public health research study • Contributing to the good of the community • Repeated often/no waiting • Peer involvement

  18. We used Incentives! • Gallons of sunscreen with 1-2 oz cups -- free samples! • Beach Balls with Safe Sun Messages for younger than target group • Lip Balm SPF 30 • Individual packets of sunscreen • Tee-shirts with Safe Sun messages

  19. Adolescents will participate in almost anything if you give them a free T-shirt

  20. T-shirts were an expensive incentive but worth the money in terms of teen response

  21. Assessing effectiveness of Sun Safety messages 3-5 minutes of Sun Safety Education All participants completed pre- and post- education survey of knowledge and risk perception

  22. Assessing effectiveness of Sun Safety messages • Each participant completed a Pre- and Post- Education Survey that measured perceived risk for skin cancer, cataracts, and use of artificial tanning • Pre- and Post- Education answers were compared to see if there was a measurable change in risk perception

  23. Demographics of population sampled 485 surveys completed Gender 77 % female 33 % male Race Caucasian 93.2 % African-American 1.2 % Hispanic 2.1 % Native American 1.1 % Asian 1.1 % Other 1.3 %

  24. Demographics • 485 Surveys completed, Ages 10-25 • Age 10-13 30 % “tweens” • Age 14-16 31 % young teens • Age 17-19 25 % older teens • Age 20-25 14 % young adults Target Population: Ages 13-18 70% of all sampled

  25. Demographics Self-Reported Hours of Sun Exposure per Week 1% <2 hours/week 10 % 2-4 hours/week 20 % 5-8 hours/week 22 % 9-12 hours/week 46 % >12 hours/week • We emphasized that: • 80% of a person’s lifetime sun exposure occurs before age 18 • Lifetime risk of skin cancer may be largely dependent on amount of unprotected sun exposure before age 18

  26. Measuring change in Risk Perception • Using results of surveys, statistically analyzed difference in perceived risk (pre- vs. post- education) for each question using the Wilcoxon Signed Rank test (non-parametric statistic analogous to paired t-test) • All results shown are statistically significant at the p<.001 level

  27. Risk PerceptionSkin Cancer • Question 1: What do you think is your risk for developing skin cancer from sun exposure? • 1. Don’t know • 2. No risk • 3. Very low risk • 4. Low risk • 5. Moderate risk • 6. High risk • 7. Very high risk

  28. Measuring Change in Risk Perception—Skin Cancer

  29. Measuring Change in Risk Perception—Skin Cancer N=152

  30. Measuring Change in Risk Perception—Skin Cancer

  31. Measuring Change in Risk Perception—Skin Cancer

  32. Risk PerceptionCataracts • Question 2: What do you think is your risk for developing cataracts ( a clouding of the lens of the eye that can result in impaired vision or blindness) from sun exposure? • 1. Don’t know • 2. No risk • 3. Very low risk • 4. Low risk • 5. Moderate risk • 6. High risk • 7. Very high risk

  33. Measuring Change in Risk Perception—Cataracts

  34. Measuring Change in Risk Perception—Use of Artificial Tanning • Question: What do you think the health risk from using artificial tanning beds is? • 1. Don’t know • 2. No risk • 3. Very low risk • 4. Low risk • 5. Moderate risk • 6. High risk • 7. Very high risk

  35. GOOD NEWS! Measuring Change in Risk Perception—Use of Artificial Tanning

  36. Measuring Change in Risk Perception—Use of Artificial Tanning For individuals who initially perceived artificial tanning as “Don’t Know” to “Low Risk”, education was extremely effective in changing risk perception

  37. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors? • Pre-Education Question 4: When you go to the beach or participate in outdoor activities, what do you do to protect yourself from the sun? (select all that apply) • Wear sunscreen SPF>15 • Reapply sunscreen frequently • Wear sunglasses • Wear a hat • Wear dark clothing • None of the above

  38. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors? • Post-Education Question 4: What will you do now, that you have not previously done, to protect yourself from the sun (select all that apply) • Post-Education options were: • Wear sunscreen SPF>15 • Reapply sunscreen frequently • Wear sunglasses • Wear a hat • Wear dark clothing • Seek shade between 10 and 4 pm • Refrain from using artificial tanning beds • Decrease amount of times you use tanning beds

  39. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors? • Question 4: When you go to the beach or participate in outdoor activities, what do you do to protect yourself from the sun? (select all that apply) • Pre-Education: most respondents indicated they used 1 to 3 sun-protective measures. In order of frequency chosen, these were generally: • wear sunscreen SPF>15 • wear sunglasses • reapply sunscreen frequently • wear a hat

  40. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors? • Question 4: When you go to the beach or participate in outdoor activities, what do you do to protect yourself from the sun? (select all that apply) • Post-Education: most respondents indicated that in the future they would use 3 to 5 (or more) sun-protective measures. In order of frequency chosen, these were generally: • wear sunscreen SPF>15 • wear sunglasses • reapply sunscreen frequently • wear a hat • seek shade between 10 and 4 pm • wear dark clothing • refrain from using artificial tanning beds • decrease amount of times you use tanning beds

  41. GOOD NEWS!Almost all wear sunscreen Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors?

  42. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors?

  43. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors?

  44. Will Change in Risk Perception Alter Teens’Sun-Protective Behaviors?

  45. Conclusion We believe the Sun Safety program was successful in changing adolescent's perception of risk about exposure to UV radiation There is strong indication that it might result in changes to adolescent sun-protective behaviors.

  46. Health Belief Model Individual Perceptions Modifying Factors Likelihood of Action Age, Sex, Ethnicity, Personality, Socioeconomic, Knowledge Perceived Benefits minus Perceived Barriers Perceived Susceptibility/ Perceived Severity Perceived Threat Likelihood of Behavior Cues to Action Source: Stretcher, V. and Rosenstock, I.M., 1997

  47. Healthy People 2010 Goals • 3.9 Increase the proportion of persons who use at least one of the following protective measures that may reduce the risk of skin cancer: avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing when exposed to sunlight, use sunscreen with a sun-protective factor (SPF) of 15 or higher, and avoid artificial sources of ultraviolet light. • 3.9a Increase the proportion of adolescents in grades 9 through 12 who follow protective measures that may reduce skin cancer.

  48. Proposed Healthy People 2020 Goals • Objective Retained but Modified From Healthy People 2010 • New objective HP 2020-12 • Reduce the rate of sunburn a. Reduce the rate of sunburn among adolescents in grades 9-12. b. Reduce the rate of sunburn among adults aged 18 years and older. c. Reduce the proportion of adolescents that use artificial sources of ultraviolet light for tanning. Data Sources: Youth Behavior At Risk Survey Surveillance System, CDC, National Health Interview Survey

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