Skin Cancer Risk Behaviors Among US Men: The Role of Sexual Orientation

The current study assessed skin cancer risk behaviors by sexual orientation in a nationally representative prospective sample of US men (n = 1767), sampled at ages 16 and 29 years. At age 16 years, sexual minority men were 3.9 times as likely as heterosexual men to indoor tan. Participants did not significantly differ in the use of sunscreen or the frequency of outdoor tanning. Thus, sexual minority men might be an at-risk group for developing skin cancers because of their indoor tanning behaviors.Skin cancers (i.e., melanoma, basal cell, and squamous cell carcinomas) disproportionally affect men in the United States. In 2013, the American Cancer Society estimated that men would have a 40% increased risk of being diagnosed with and have nearly a 100% increased risk of dying from skin cancers, compared with women.1 Despite awareness of these gender differences, to date, there have been limited investigations of demographic characteristic differences among men regarding skin cancer risk behaviors.Sexual minority (i.e., gay and bisexual) men may represent a group that is at increased risk for skin cancer. Behaviors such as indoor and outdoor tanning and use of sunscreen are strongly related to appearance concerns,2 and sexual minority men report elevated body dissatisfaction compared with heterosexual men.3 Our aim in the present study was to test, in a US nationally representative sample of men, differences in skin cancer risk behaviors as a function of sexual orientation. We hypothesized that sexual minority men would report greater skin cancer risk behaviors compared with heterosexual men.     

Skin Cancer Prevention Behaviors Among Parents of Young Children

We examined the relation between several relevant variables and parents' (n = 88) skin cancer prevention behaviors on behalf of their young children (ages 3 to 8 years). Results show that stable demographic factors (e.g., child age, socioeconomic status) are most predictive of parents' skin cancer knowledge and that healthier attitudes and perceptions about sun exposure are most predictive of effective sun protection behaviors by parents. These findings highlight the need for awareness and dissemi- nation of sun exposure and skin cancer information as well as for effective prevention behaviors.     

Skin Cancer Prevention Education: A National Survey of YMCAs

High skin cancer incidence and mortality rates have created a need for skin cancer prevention education. Children are an important target for this education, as overexposure to sun and sunburns at an early age have been linked to the development of skin cancer.This study identified the prevalence of skin cancer prevention education and the need for this education at YMCA swim classes. This study also assessed the feasibility of implementing Project SUNWISE, an existing skin cancer prevention curriculum, developed for YMCA swim classes. A 51-item survey was mailed to Aquatics Directors at all YMCAs with outdoor pools.Based on a 63% response rate (N = 208), only 28% of YMCAs thought the children in their swim classes were adequately protected from the sun, and only 28% offered skin protection or sun safety education in swim classes. Only 50% of YMCAs trained their swim instructors on skin cancer prevention. While 91% of YMCAs had one or more sun protection items near the pool (e.g., sunscreen, umbrella, covered area), 93% of YMCAs saw the need for additional protection. The majority of YMCAs (95%) were willing to incorporate a skin cancer prevention education curriculum, similar to Project SUNWISE, into their swim classes. This study emphasized the need for more skin cancer prevention education programs targeting children and examined the correlates of skin cancer prevention education at YMCAs. Geographic region, percent of possible sunshine, and ultraviolet radiation were significantly associated with the skin cancer prevention education program status at the YMCAs.     

A Web-Based Intervention to Reduce Indoor Tanning Motivations in Adolescents: a Randomized Controlled Trial

Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.     

Young Adults' Responses to News About Sunscreen and Skin Cancer: The Role of Framing and Social Comparison

Young adults read a news article about skin cancer that used a gain frame (e.g., using sunscreen keeps skin healthy) or a loss frame (e.g., not using sunscreen increases skin cancer risk), and included a personal exemplar (healthy or ill). Compared to a control group, both frames increased intentions to use sunscreen. Planned SPF was higher for men in the loss frame but was unaffected by framing for women. The framing manipulation had opposite effects on sun protection behaviors among individuals who were high versus low in perceived similarity to the exemplar. Overall, the gain frame was more effective for people who were high in similarity, whereas the loss frame was more effective for those low in similarity. In addition, individuals who felt more similar to the exemplar reported more personal risk in the loss frame but stronger intentions to use sun protection behaviors in the gain frame. Last, social comparison orientation was associated with more personal risk in the gain frame (suggesting upward comparison) but lower intentions to engage in sun protection behaviors regardless of the frame. Interpretations of the findings and implications for the use of exemplars in health messages are discussed.     

Skin Cancer Prevention and Early Detection Practices in a Sample of Rural Women

Background.The incidence of skin cancer in the United States is rapidly increasing, and current estimates suggest that about one in five persons will be diagnosed with skin cancer in their lifetime. However, comparatively little is still known about the prevention and early detection behaviors of healthy individuals. This study presents information on prevention and early detection practices for a sample of non-Hispanic rural white women.Method.Interviews were conducted with 1,295 women age 20 or older who were patients in six public health departments and one primary-care clinic serving a low-income population, all located in rural western North Carolina.Results.Both prevention and early detection behaviors were found to be infrequent in this population. Low knowledge of skin cancer, younger and older ages, and low education characterized women least likely to practice prevention. Low knowledge, younger age, and low eductation characterized women least likely to practice early detection. Perceived barriers to cancer screening including cost, lack of symptoms, and denial also were predictive of a low likelihood of both prevention and early detection behavior. Fatalism and fear of the stigma associated with cancer also were predictive of lower participation in selected early detection behaviors. A summary general barriers score was significantly associated with all prevention and early detection behaviors examined in the study.Conclusions.The results indicate a need for skin cancer education among this population.     

Framing Indoor Tanning Warning Messages to Reduce Skin Cancer Risks Among Young Women: Implications for Research and Policy

Objectives. We investigated the impact of indoor tanning device warnings that communicate the risks associated with indoor tanning (i.e., loss framed) or the benefits of avoiding indoor tanning (i.e., gain framed).Methods. A convenience sample of non-Hispanic White women aged 18 to 30 years who tanned indoors at least once in the past year (n = 682) participated in a within-subjects experiment. Participants completed baseline measures and reported indoor tanning intentions and intentions to quit indoor tanning in response to 5 warning messages in random order. A text-only control warning was based on Food and Drug Administration–required warnings for indoor tanning devices. Experimental warnings included graphic content and were either gain or loss framed.Results. In multivariable analyses, gain-framed warnings did not differ from the control warning on women’s intentions to tan indoors, but they prompted stronger intentions to quit than the control message. Loss-framed warnings significantly reduced intentions to tan indoors and increased intentions to quit indoor tanning compared with control and gain-framed warnings.Conclusions. The public health impact of indoor tanning device warnings can be enhanced by incorporating graphic content and leveraging gain- and loss-framed messaging.Skin cancer is the most common malignancy in the United States, where approximately 3.5 million cases of nonmelanoma skin cancer and 75 000 cases of melanoma are diagnosed each year.1,2 Although most skin cancers are preventable by reducing ultraviolet radiation exposure, their incidence is increasing.3–6 An estimated 9000 deaths occur each year as a result of melanoma,2 and the costs of skin cancer treatment exceed $8 billion annually.7Indoor tanning is major concern for skin cancer prevention.4,8 Approximately 380 000 skin cancer cases are attributable to indoor tanning annually in the United States.9 Recent meta-analyses have indicated that indoor tanning increases lifetime risks of nonmelanoma skin cancer by 29% to 67% and melanoma by approximately 20%.10,11 Among US adults, the prevalence of indoor tanning is highest among young adult, non-Hispanic White women, with nearly 30% tanning each year and 15% tanning 10 or more times each year.12,13 Indoor tanning before age 30 years and tanning more frequently further increase lifetime skin cancer risks,10,11,14,15 and tanning at a young age is associated with early-onset skin cancer.16As in other areas of public health, policies are advocated as part of a comprehensive approach to skin cancer prevention.4,17 Until recently, the US Food and Drug Administration (FDA) regulated indoor tanning devices as class I medical devices presenting minimal risks and largely exempt from premarket controls.18 In part because of advocacy for tighter regulations,17 the FDA recently published a new rule changing indoor tanning devices to class II devices with additional premarket controls and revised labeling requirements. Now, indoor tanning devices are required to display a text-only warning reading “Attention: This sunlamp product should not be used on persons under the age of 18 years.”19 Consumer-facing information for indoor tanning devices is also required to include several contraindication and warning statements.19Unfortunately, the required warnings do not reflect evidence for skin cancer prevention messaging20,21 and are inconsistent with warnings for other FDA-regulated products with associated health risks, such as tobacco.22 The FDA’s strategic plan for regulatory science emphasizes designing evidence-based public health messages to empower consumers to make healthy decisions about regulated products.23 The public health impact of indoor tanning device warnings could be enhanced through additional research to determine how to best promote preventive behavior. Under federal rulemaking procedures, the FDA could issue new labeling requirements based on the available evidence, and this evidence could also inform state and local policies on indoor tanning. Unlike warnings for tobacco,24 little published research is available on how to design indoor tanning warnings to enhance their public health impact.According to prospect theory, framing health messages in terms of the costs of engaging in risky behavior (i.e., loss framed) or the benefits of avoiding risky behavior (i.e., gain framed) differentially affects behavioral outcomes.25,26 The message-framing concept draws from fundamental tenets of behavioral economics and communication science that postulate that health messages can be crafted around gains or losses to shape perceptions and motivate behavior.25 Although recent reviews have indicated that loss-framed skin cancer prevention messages can promote behavior change,20,21 2 meta-analyses drew different conclusions regarding gain- and loss-framed skin cancer prevention messages,27,28 and no study has tested message-framing effects for indoor tanning warnings. Research has also consistently demonstrated that graphic warnings incorporating imagery to depict the health risks of tobacco use are more effective for promoting behavior change than text-only warnings because they more effectively attract attention, evoke an emotional response, and affect perceived risks and attitudes toward tobacco use.24,29–32 Although the available evidence on skin cancer prevention messages has suggested that graphic messages can promote preventive behaviors,20,21 no study has investigated the effects of graphic content for indoor tanning warnings.Given the theoretical support and empirical evidence indicating that gain- and loss-framed messages incorporating graphic imagery may be important to prevent and reduce indoor tanning, we examined the impact of these message features on indoor tanning intentions and intentions to quit indoor tanning in a convenience sample of young adult women. We compared gain- and loss-framed warnings with graphic imagery with a text-only warning, such as those required by the FDA. We focused on young adult women because of the high prevalence of indoor tanning in this population and evidence that indoor tanning early in life further increases skin cancer risks.10,11 This makes young adult women a priority population for public health skin cancer prevention efforts. We hypothesized that graphic, loss-framed messages conveying the health risks associated with indoor tanning would produce the greatest impact.     

Skin cancer preventative behaviors in state park workers: a pilot study

Objectives

Considering the potential for occupational sun exposure among state park workers, the purpose of this pilot study was to identify skin cancer knowledge, health beliefs, self-efficacy, and sun protection behaviors (SPBs) among state park employees.

Methods

The current study used a cross-sectional survey research design with state park workers in a Southern state. Of the 94 possible employees who could have participated in the study, 87 completed the survey.

Results

Assessment of the participants’ skin cancer knowledge demonstrated an average correct response rate of 68.8 %. While the vast majority (87.4 %) believed that skin cancer is a serious disease, a minority (42.5 %) believed they would develop skin cancer sometime during their lifetime, and even fewer (35.6 %) believed their risk was higher than average. Collectively, workers reported low levels of SPBs. The most commonly reported barriers to sun protection were “inconvenient,” “too hot to wear,” and “forget to protect.” Half of the participants (50.6 %) were highly confident in their ability to wear long pants while in the sun. About the same proportion of participants was highly confident they could wear a wide-brimmed hat (21.8 %) and sunscreen (20.7 %).

Conclusions

Based on available evidence, a need exists to develop individual and worksite programs and interventions to increase skin cancer prevention behaviors among this occupational group. This data could serve as a baseline to monitor and evaluate the efficacy of these interventions.     

A Randomized Trial of Tailored Skin Cancer Prevention Messages for Adults: Project SCAPE

Objectives. We evaluated the impact of a mailed, tailored intervention on skin cancer prevention and skin self-examination behaviors of adults at moderate and high risk for skin cancer.Methods. Adults at moderate and high risk for skin cancer were recruited in primary health care settings in Honolulu, HI, and Long Island, NY. After completing a baseline survey, participants were randomized to 2 groups. The treatment group received tailored materials, including personalized risk feedback, and the control group received general educational materials. Multivariate analyses compared sun protection and skin self-examination between groups, controlling for location, risk level, gender, and age.Results. A total of 596 adults completed the trial. The tailored materials had a significant effect on overall sun-protection habits, the use of hats, the use of sunglasses, and the recency of skin self-examination. Some effects were moderated by location and risk level.Conclusions. Tailored communications including personalized risk feedback can improve sun-protection behaviors and skin self-examination among adults at increased risk for skin cancer. These convenient, low-cost interventions can be implemented in a variety of settings and should be tested further to assess their long-term effectiveness.Skin cancer is the most commonly diagnosed cancer in the United States,¹ with more than 1 million Americans diagnosed with skin cancer each year.² The incidence of skin cancer has increased dramatically worldwide in the last decade.³ Both main types of skin cancer—malignant melanoma and nonmelanoma skin cancer—are now significant and costly public health concerns.^2,4 Although skin cancer rates are increasing, it is considered one of the most preventable types of cancer. Prevention guidelines include reducing exposure to ultraviolet radiation (UVR); adopting sun-protection habits including the use of sunscreen, hats, shirts, and sunglasses^5,6; performing regular skin self-examination; and seeking professional evaluation of suspicious skin changes. Nevertheless, levels of knowledge, concern, and the practice of prevention and early detection remain relatively low.^7,8Risk factors for skin cancer include age, sun-sensitive phenotypes, excess sun exposure, family history, personal history of skin cancer or precancerous lesions, and other medical conditions.⁹ Most skin cancer prevention interventions reported to date are directed at the general population through school-based curricula and media campaigns,¹⁰ and some recent trials have targeted people who experience high sun exposure at work or during outdoor recreation.^11–15 Only 2 reported studies have targeted groups at high risk: patients who have been treated for nonmelanoma skin cancer,¹⁶ and siblings of melanoma patients.¹⁷ There is a need for low-cost, effective interventions to improve skin cancer prevention and early detection behaviors among a broader population of persons at moderate and high risk.Tailored, mailed communications hold great promise for skin cancer prevention and detection among individuals at increased risk, but these interventions have not been widely tested. Interventions that are tailored to individuals'' characteristics, behaviors, needs, and beliefs are more likely to be seen as personally relevant and thus may be more motivating.¹⁸ Tailored interventions have been shown to be effective in the past for other health behaviors, particularly for prevention and screening behaviors.¹⁹ The aim of Project SCAPE (Skin Cancer Awareness, Prevention and Education) was to evaluate the impact of tailored interventions on skin cancer prevention and skin self-examination among adults at high and moderate risk for skin cancer in a randomized trial.     

Multiple skin cancer risk behaviors in the U.S. population

BACKGROUND: The incidence of all types of skin cancer has increased over the past 3 decades in the United States. Increased skin cancer risk is associated with exposure to ultraviolet radiation. This study examined the age-stratified prevalence and correlates of multiple skin cancer risk behaviors (infrequent use of sun-protective clothing, staying in the sun when outside on a sunny day, infrequent use of sunscreen, indoor tanning, and receiving a sunburn) among U.S. adults. METHODS: 28,235 adults participating in the 2005 National Health Interview Survey (NHIS) answered questions regarding sun-protection behaviors, indoor tanning in the past year, and sunburns in the past year. Examined correlates included geographic location, demographics, healthcare access, BMI, physical activity, smoking, alcohol use, melanoma family history, perceived cancer risk, skin sensitivity to the sun, and receipt of a total skin exam. RESULTS: The most commonly reported skin cancer risk behaviors were infrequent use of sun-protective clothing and infrequent use of sunscreen. The majority of individuals reported multiple skin cancer risk behaviors. Although significant correlates varied according to age, individuals reporting more risk behaviors were more likely younger, residing in the Midwest, male, non-Hispanic white, less-educated, smokers, risky drinkers, and had skin that was less sun-sensitive. CONCLUSIONS: The majority of the U.S. population engage in multiple skin cancer risk behaviors. A comprehensive approach to skin cancer prevention requires attention to multiple skin cancer risk behaviors that are common in the U.S. population.     

Sun Exposure,Tanning Beds,and Herbs That Cure: An Examination of Skin Cancer on Pinterest

Skin cancer is the most common cancer affecting the U.S. population. Pinterest.com, a virtual bookmarking social media site, has the potential to disseminate skin cancer-related information among young women, the group with the fastest increase in skin cancer diagnosis. This article presents a quantitative content analysis of pins about skin cancer on Pinterest guided by agenda-setting theory and the health belief model. Overall, sun exposure and tanning beds were most frequently discussed as the causes of skin cancer, and alternative therapies such as herbal medicine were discussed more than traditional biomedical treatment or prevention. Highly repinned pins tend to include more information than regular pins. Different types of skin cancer (melanoma, squamous-cell carcinoma, and basal-cell carcinoma) received the same amount of coverage; however, pins about nonmelanoma skin cancer (such as squamous-cell carcinoma and basal-cell carcinoma) were often information-poor. They were less likely to include information on the causes, prevention, and the biomedical treatment of skin cancer and were less likely to include health belief constructs associated with the promotion of skin cancer prevention and treatment.     

Cultural Effects on Cancer Prevention Behaviors: Fatalistic Cancer Beliefs and Risk Optimism Among Asians in Singapore

Although culture is acknowledged as an important factor that influences health, little is known about cultural differences pertaining to cancer-related beliefs and prevention behaviors. This study examines two culturally influenced beliefs—fatalistic beliefs about cancer prevention, and optimistic beliefs about cancer risk—to identify reasons for cultural disparity in the engagement of cancer prevention behaviors. We utilized data from national surveys of European Americans in the United States (Health Information National Trends Survey 4, Cycle3; N = 1,139) and Asians in Singapore (N = 1,200) to make cultural comparisons. The odds of an Asian adhering to prevention recommendations were less than half the odds of a European American, with the exception of smoking avoidance. Compared to European Americans, Asians were more optimistic about their cancer risk both in an absolute and a comparative sense, and held stronger fatalistic beliefs about cancer prevention. Mediation analyses revealed that fatalistic beliefs and absolute risk optimism among Asians partially explain their lower engagement in prevention behaviors, whereas comparative risk optimism increases their likelihood of adhering to prevention behaviors. Our findings underscore the need for developing culturally targeted interventions in communicating cancer causes and prevention.     

Tanning behavior among young frequent tanners is related to attitudes and not lack of knowledge about the dangers

OBJECTIVE: To examine the importance of tanning among students in relation to attitudes and knowledge regarding skin cancer prevention. DESIGN: A cross-sectional survey. SETTING: College students at a major Midwestern university METHODS: Students were recruited to complete a self-administered questionnaire that included information on sun-sensitivity, knowledge and tanning attitudes and behaviors. Survey sampling statistical techniques that account for clustering among the 163 students recruited were used. RESULTS: We found a high level of skin cancer prevention knowledge; however knowledge was not related to a reduction in the importance of tanning. In many cases, higher levels of knowledge corresponded to a greater emphasis on the importance of tanning. Sunscreen use was low among this population. Those who placed an importance on tanning more often checked that they believed that "sunless tanning creams are safer than the sun". CONCLUSIONS: This population's belief that they look healthier and feel better with a tan strongly influences the desire to tan. Therefore, future cancer information campaigns or other prevention efforts should directly address the desire to tan by encouraging the use of sunless tanning products as an alternative method of tanning.     

Las Mujeres Saludables: Reaching Latinas for Breast, Cervical and Colorectal Cancer Prevention and Screening

Community health advisors have effectively promoted breast and cervical cancer prevention and screening among low-income Latina women. Specific elements of such programs, such as enhanced social support, may explain successes. Promotion of colorectal cancer screening has been less studied. Promotoras de Salud (i.e., Latina health advisors) implemented a 12-week program among women recruited from community-based organizations. The program educated 366 Latinas in breast, cervical and colorectal cancer prevention and screening and emphasized social support among class members. Pre-and post-intervention assessments demonstrated significant increases for fruit and vegetable consumption (3.05 to 3.60 servings/day), and physical activity (65.15 to 122.40 minutes/week). Of women previously non-compliant, 39 percent, 31 percent and 4 percent received Pap tests, mammography, and fecal occult blood test (FOBT), respectively. A culturally aligned education program using community health advisors and emphasizing social support among participants may improve prevention and selected screening behaviors, but more intensive interventions may be required for colorectal cancer screening compliance. Supported by a grant from St. Luke’s Charitable Health Trust, Phoenix, Arizona.     

Application of the Health Belief Model to U.S. Magazine Text and Image Coverage of Skin Cancer and Recreational Tanning (2000–2012)

The health belief model (HBM) has been widely used to inform health education, social marketing, and health communication campaigns. Although the HBM can explain and predict an individual’s willingness to engage in positive health behaviors, its application to, and penetration of the underlying constructs into, mass media content has not been well characterized. We examined 574 articles and 905 images about skin cancer and tanning risks, behaviors, and screening from 20 U.S. women’s and men’s magazines (2000–2012) for the presence of HBM constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Susceptibility (48.1%) and severity (60.3%) information was common in text. Perceived benefits (36.4%) and barriers (41.5%) to prevention of skin cancer were fairly equally mentioned in articles. Self-efficacy (48.4%) focused on sunscreen use. There was little emphasis on HBM constructs related to early detection. Few explicit cues to action about skin cancer appeared in text (12.0%) or images (0.1%). HBM constructs were present to a significantly greater extent in text versus images (e.g., severity, 60.3% vs. 11.3%, respectively, χ² = 399.51, p < .0001; benefits prevention, 36.4% vs. 8.0%, respectively, χ² = 184.80, p < .0001), suggesting that readers are not visually messaged in ways that would effectively promote skin cancer prevention and early detection behaviors.     

A Culture of Health and Alcohol-Permitted Events at a U.S. University

We examined event organizers’ understandings and management of alcohol-related risk and accommodation of people in recovery from substance use disorders and other non-drinkers, when organizing alcohol-permitted events that primarily involved faculty, staff, and graduate students. We interviewed 31 event organizers at a large, public university in California. Organizers were most concerned about avoiding legal liabilities, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax and socialize), drinkers (e.g., only undergraduate students engage in risky alcohol consumption), and people in recovery (e.g., they lack self-control). Organizers over-relied on informal control to shape attendees’ behavior, failing to acknowledge contextual factors. They need education on how they can shape the event context to better promote healthy behaviors, avoid exclusively focusing on informal control and prevention of unhealthy behaviors, and promote better inclusion of people who do not drink alcohol. There is fertile ground for infusing a culture of health into events in higher education.

     

Agenda-Setting Effects of Sun-Related News Coverage on Public Attitudes and Beliefs About Tanning and Skin Cancer

The topics and framing of news stories relevant to skin cancer prevention have shifted over time. This study examined agenda-setting effects of such news stories on public attitudes and beliefs about tanning and skin cancer. Content analysis data on 516 articles published in two major daily newspapers in Melbourne, Australia, from 1994 to 2007 were combined with circulation data to generate indices of potential news exposure. Associations between these indices and cross-sectional telephone survey data from the same period on 6,244 adults’ tanning attitudes and perceived susceptibility to skin cancer were examined using logistic regression models, accounting for the temporal precedence of news content. Pro-sun protection stories on attitudes and behavior were associated with older adults not thinking a tan looks healthy. Pro-sun protection stories on solaria were associated with less preference for a deep tan among young adults who like to suntan. Stories on vitamin D that were unsupportive of or ambiguous about sun protection were associated with a number of pro-tan attitudes among younger adults. Results indicate news coverage during 1994–2007 served an important agenda-setting role in explaining the public's attitudes and beliefs about tanning and skin cancer. Vitamin D stories appeared most influential, particularly among young adults.     

A Three-Factor Cancer-Related Mental Condition Model and Its Relationship With Cancer Information Use,Cancer Information Avoidance,and Screening Intention

Cancer-related affect and cognition, such as cancer fear, cancer worry, and cancer risk perception, are important predictors of cancer prevention and communication behaviors. However, they have not been clearly conceptualized in cancer communication literature, and in particular, the role of affect (i.e., cancer fear) in cancer prevention and communication has not been fully investigated. The present study developed a 3-factor cancer-related mental condition model encompassing affective (cancer fear), cognitive (cancer risk perception), and affective-cognitive (cancer worry) conditions. Two studies were conducted. Study 1 developed the model with Sample 1 (U.S. undergraduates, N = 309), and subsequently validated the model with Sample 2 (Korean general population, ages 40 years or older, N = 1,130). Study 2, using Sample 2, tested the model's relationship with cancer information use, cancer information avoidance, and screening intention. While Sample 1 participants were asked about cancer in general, Sample 2 participants were asked specifically about stomach cancer. Thus, the model derived from the specific sample in a general context was confirmed via the general sample in a specific context. The results showed that both cancer worry and cancer risk perception are positively associated with cancer information use and screening intention, but they are negatively associated with cancer information avoidance. Cancer fear was positively associated with cancer information use, but it was also positively related to cancer information avoidance. Moreover, cancer fear was negatively associated with screening intention. Although the three components of the model are positively related to one another, they function differently in the cancer context.