Dannielle Kelley

Testing a Social Cognitive Theory-Based Model of Indoor Tanning: Implications for Skin Cancer Prevention Messages

The lack of a theory-based understanding of indoor tanning is a major impediment to the development of effective messages to prevent or reduce this behavior. This study applied the Comprehensive Indoor Tanning Expectations (CITE) scale in an analysis of indoor tanning behavior among sorority women (total N = 775). Confirmatory factor analyses indicated that CITE positive and negative expectations were robust, multidimensional factors and that a hierarchical structure fit the data well. Social cognitive theory-based structural equation models demonstrated that appearance-oriented variables were significantly associated with outcome expectations. Outcome expectations were, in turn, significantly associated with temptations to tan, intention to tan indoors, and indoor tanning behavior. The implications of these findings for the development of messages to prevent and reduce indoor tanning behavior are discussed in two domains: (a) messages that attempt to change broader societal perceptions about tan skin, and (b) messages that focus more narrowly on indoor tanning—challenging positive expectations, enhancing negative expectations, and encouraging substitution of sunless tanning products.

Adolescent and Young Adult Perceptions of Hookah and Little Cigars/Cigarillos: Implications for Risk Messages

Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n = 47) and susceptible nonusers (n = 30). Transcripts were coded for emergent themes on participants’ perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects.

The Relationships Between Female Adolescents’ Media Use, Indoor Tanning Outcome Expectations, and Behavioral Intentions

Background. Unlike other types of cancer, skin cancer incidence rates are on the rise and adolescent females are particularly likely to tan indoors, a major risk factor. However, little research has examined the role of media use in encouraging or discouraging this dangerous behavior in this population. Aims. To empirically assess the links between media use, indoor tanning-related outcome expectations, and behavioral intentions. Method. A survey of adolescent females (N = 510) ages 15 to 18 in the Southeastern United States assessed demographics, types of media use, and indoor tanning intentions. Results. Significant correlations between media use and indoor tanning outcome expectations were found. Use of interpersonal and social media (i.e., talking on the phone, texting, and online social media) were positively associated with positive outcome expectations about indoor tanning and negatively associated with negative outcome expectations. A path analysis revealed that interpersonal/social media use had indirect associations with indoor tanning intentions via tanning outcome expectations. Mass media use (e.g., news media, entertainment media, and magazines) was not significantly associated with most indoor tanning outcome expectations but did have a direct negative association with behavioral intentions. Discussion. There are important relationships between media use, indoor tanning outcome expectations, and behavioral intentions. Interpersonal and social media use may help cultivate outcome expectations that encourage indoor tanning, which in turn may increase intentions to tan, while news media consumption in particular may reduce intentions to tan. Conclusion. These findings highlight the social nature of adolescent females and point to specific intervention channels for reducing indoor tanning among this population.

An Empirical Analysis of Indoor Tanners: Implications for Audience Segmentation in Campaigns

Tanning bed use before age 35 has been strongly associated with several types of skin cancer. The current study sought to advance an understanding of audience segmentation for indoor tanning among young women. Panhellenic sorority systems at two universities in the Southeastern United States participated in this study. A total of 1,481 young women took the survey; 421 (28%) had tanned indoors in the previous 12 months and were the focus of the analyses reported in this article. Results suggested two distinct tanner types: regular (n = 60) and irregular (n = 353) tanners. Regular tanners tanned more frequently (M = 36.2 vs. 8.6 times per year) and reported significantly higher positive outcome expectations (p < .001) and lower negative outcome expectations (p < .01) than irregular tanners, among other significant differences. Hierarchical logistic regression analysis revealed several significant (p < .001) predictors of regular tanning type, with tanning dependence emerging as the strongest predictor of this classification (OR = 2.25). Implications for developing anti-tanning messages directed at regular and irregular tanners are discussed.

A longitudinal test of the Comprehensive Indoor Tanning Expectations Scale: The importance of affective beliefs in predicting indoor tanning behavior

In order to better understand drivers of dangerous indoor tanning behaviors, researchers developed the Comprehensive Indoor Tanning Expectations scale. To examine the longitudinal effectiveness of Comprehensive Indoor Tanning Expectations, we surveyed young women in the Southeastern United States at two time points (N = 553). The scale demonstrated strong test–retest reliability. Participants who believed indoor tanning would improve their mood and afford social approval were significantly more likely to tan 6 months later, while participants who believed indoor tanning leads to psychological/physical discomfort were significantly less likely to tan 6 months later. Knowing the psychological bases for indoor tanning can inform intervention and message design.

Identifying principles for effective messages about chemicals in cigarette smoke

US law requires the Food and Drug Administration (FDA) to disclose information on harmful and potentially harmful chemicals in cigarette smoke (i.e., constituents) to the public. To inform this effort, we sought to identify principles for creating constituent messages that effectively discourage smoking. Participants were an online convenience sample of 1148 US smokers ages 18+. We developed a library of 76 messages about constituents only and constituents plus contextualizing information (i.e., toxic products that also contain the chemical, health effects, or both). We randomized smokers to receive 1 message from each of 7 message panels in a mixed between-/within-subjects experiment. Participants rated each message on perceived message effectiveness. Results indicated that smokers perceived messages about arsenic, formaldehyde, lead, uranium, and ammonia as more effective than messages about nitrosamines. Messages that contained information on toxic products, health effects, or both received higher effectiveness ratings than constituent-only messages. Among constituent-only messages, those that referenced multiple constituents received higher effectiveness ratings than those with fewer constituents. We conclude that chemical messages may have more impact if they pair known constituents with toxic product or health effect information. These message principles can be used to inform studies examining the impact of constituent messages on smoking beliefs and behavior.

Can a selfie promote public engagement with skin cancer

Social media may provide new opportunities to promote skin cancer prevention, but research to understand this potential is needed. In April of 2015, Kentucky native Tawny Willoughby (TW) shared a graphic skin cancer selfie on Facebook that subsequently went viral. We examined the volume of comments and shares of her original Facebook post; news volume of skin cancer from Google News; and search volume for skin cancer Google queries. We compared these latter metrics after TWs announcement against expected volumes based on forecasts of historical trends. TWs skin cancer story was picked up by the media on May 11, 2015 after the social media post had been shared approximately 50,000 times. All search queries for skin cancer increased 162% (95% CI 102 to 320) and 155% (95% CI 107 to 353) on May 13th and 14th, when news about TWs skin cancer selfie was at its peak, and remained higher through May 17th. Google searches about skin cancer prevention and tanning were also significantly higher than expected volumes. In practical terms, searches reached near-record levels - i.e., May 13th, 14th and 15th were respectively the 6th, 8th, and 40th most searched days for skin cancer since January 1, 2004 when Google began tracking searches. We conclude that an ordinary persons social media post caught the publics imagination and led to significant increases in public engagement with skin cancer prevention. Digital surveillance methods can rapidly detect these events in near real time, allowing public health practitioners to engage and potentially elevate positive effects.

Perceived Message Effectiveness Measures in Tobacco Education Campaigns: A Systematic Review

ABSTRACT Target audience ratings of the likely impact of persuasive messages, known as perceived message effectiveness (PME), are commonly used during message development and selection. PME is also used to examine receptivity of messages after they are fully developed or deployed. Despite this, we know little about the conceptual and methodological characteristics of extant PME measures used in the literature. We conducted a systematic review of tobacco education video, print, and audio campaign studies to examine conceptual and methodological characteristics of PME measures. One hundred twenty-six PME measures from 75 studies conducted in 21 countries with more than 61,000 participants were reviewed. Results indicated considerable variability in measures’ focus on general perceptions of a message (i.e., message perceptions) vs. perceptions of expected message effects (i.e., effects perceptions). Considerable variability was also found on underlying persuasive constructs, use of referents, and referencing of behavior in PME items and measures. We conclude with several recommendations for future research on PME measurement and validation.

Understanding Misinformation in the Pro-tanning Communication Environment: A Content Analysis

ABSTRACT Background: To respond to the Surgeon General’s call to develop, disseminate, and evaluate messages to reduce indoor tanning (IT) in the 2014 Call to Action to Prevent Skin Cancer, an understanding of the IT communication environment is necessary. Purpose: The purpose of this study was to identify the most prevalent false or misleading IT claims. Methods: Pro-tanning websites (N = 78) were identified in a Google search. Using systematic quantitative content analysis, website characteristics were coded, as well as claims regarding health, safety, appearance/social, and mood/relaxation benefits of IT. All text appearing on the websites was reviewed and coded. Results: Two prominent types of claims emerged: health (86%) and IT safety (90%) benefits of IT. Within health, the most common claims were: (1) prevent health conditions (73%) and (2) a base tan provides protection from the sun (41%). Within safety, the most common claims were: (1) safe because it is controlled (81%) and (2) government regulation ensures safety (56%). Discussion: An abundance of misleading claims were identified, prompting concern from a public health perspective, because tanners may use these claims to justify their tanning behavior. Translation to Health Education Practice: By understanding the prevalence of these claims, prevention efforts may be more effective in creating a disruptive association between IT and many advertised “benefits” of engaging in this dangerous behavior.