Joel Hillhouse

Examination of the efficacy of an appearance-focused intervention to reduce UV exposure.

This study designed and implemented an appearance-based skin cancer prevention intervention in college-aged females. One hundred and forty-seven respondents were randomly assigned to treatment or control groups. Treatment respondents received a short workbook describing the appearance damaging effects of indoor tanning. At short-term follow-up (2 weeks later) treatment respondents had significantly more negative attitudes toward indoor tanning, and reported fewer intentions to indoor tan. At 2-month follow-up, treatment respondents reported indoor tanning one-half as much as control respondents in the previous 2 months. This appearance-based intervention was able to produce clinically significant changes in indoor tanning use tendencies that could have a beneficial effect on the future development of skin cancer.

Application of Azjen's theory of planned behavior to predict sunbathing, tanning salon use, and sunscreen use intentions and behaviors.

Ajzens (1988) theory of planned behavior (TOPB) was used to examine psychological determinants of high-risk UV radiation exposure-related behaviors (sunbathing, tanning salon use, and sunscreen use). Undergraduates at a midsized southeastern university were assessed on their psychological and behavioral tendencies toward high-risk UV radiation exposure-related behaviors. The results generally supported the utility of the TOPB as an explanatory model for high-risk behavior. Attitudes were strongly associated with high-risk intentions (e.g., not utilize sunscreen, use salons), whereas subjective norms were less so. Perceived behavioral control was found to moderate the relationship among attitudes, norms, and intentions to sunbathe and tan at a salon. Implications for intervention strategies and future model building in this area are discussed.

Investigating stress effect patterns in hospital staff nurses: Results of a cluster analysis

A comprehensive and reliable assessment of work stress, burnout, affective, and physical symptomatology was conducted with 260 hospital nurses. As previous attempts to categorize nursing stress and burnout by ward type have yielded inconsistent results, an alternative method for grouping nursing stress effects was sought. Cluster analysis was chosen as it offers a statistically sound means of delineating natural groupings within data. Sets of questionnaires measuring burnout, work stressors, and physical and emotional symptomatology were sent to all staff nurses at a large university hospital. Of 709 nurses employed there, a total of 260 nurses returned completed questionnaire packets. These nurses were separated into two equal groups using random sampling procedures. Cluster analysis of this data revealed groupings which were based on nursing stressors (particularly workload and conflict with physicians), social support, and patient loads. These cluster-analytic findings were replicated on both samples, and validated using data not used in the original cluster analysis. Results suggest that the effects of stress have more to do with the characteristics of the work environment and overall workload than with the degree of specialization on the unit. Results also suggest that intraprofessional conflict (i.e. with other nurses) is less psychologically damaging than is interprofessional conflict (i.e. conflict with physicians). Findings are discussed with respect to the burnout process and possible interventions.

Predictors of sunbathing and sunscreen use in college undergraduates.

Sunbathing and sunscreen use, as well as related intentions, attitudes, beliefs, and knowledge, were assessed in 90 Southern Appalachian undergraduates. A large majority (75%) reported sunbathing, with more than half reporting sun lamp use. A slight majority (56.7%) reported some use of sunscreen. Subjects reporting an intention to tan spent more time sunbathing, both outside and under a sun lamp. Individuals reporting a sun protection intention had lighter tans and spent less time sunbathing. Sunbathing was predicted by perceptions of sunbathing as relaxing, while sun lamp use was predicted by more positive views of suntatns. Sunscreen use was predicted by more positive sun protection attitudes and less negative sunscreen attitudes.

A randomized controlled trial of an appearance‐focused intervention to prevent skin cancer

Skin cancer represents a significant health threat with over 1.3 million diagnoses, 8000 melanoma deaths, and more than

An Examination of Psychological Variables Relevant to Artificial Tanning Tendencies

1 billion spent annually for skin cancer healthcare in the US. Despite findings from laboratory, case‐control, and prospective studies that indicate a link between youthful indoor tanning (IT) and skin cancer, IT is increasing among US youth. Appearance‐focused interventions represent a promising method to counteract these trends.

Examination of cognitive variables relevant to sunbathing.

Cognitions relevant to tanning salon decision making were studied using Jaccards Theory of Alternative Behavior (J. Jaccard. Journal of Experimental Social Psychology1981; 17: 286–307). Questionnaires were administered assessing tanning salon use, attitudes toward tanning salon use, attitudes toward reasonable behavioral alternatives, and cognitive variables underlying these variables. Tanning salon use reports were very high in this sample. The results support the notion that young people make decisions regarding using tanning salons based on the behavioral alternatives available to them. Specifically, subjects with stronger preferences for using clothing to enhance appearance were less likely to use tanning salons. Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention is discussed.

Measuring Nonsolar Tanning Behavior : Indoor and Sunless Tanning

This study examined cognitions relevant to sunbathing decision-making in college-aged subjects. Using Jaccards (1981) theory of alternative behavior as a guiding model, 263 subjects were recruited from psychology classes and administered questionnaires assessing their sunbathing behavioral tendencies, attitudes toward sunbathing, attitudes toward reasonable behavioral alternatives to sunbathing, and cognitive variables underlying these attitudinal variables. The fits of models predicting sunbathing attitudes and sunbathing behavioral tendencies (evaluated using covariate structural equations modeling techniques; LISREL VIII) were good for all models tested. In contrast to previous work, the results of this study support the notion that young people will make their decisions regarding sunbathing based on the behavioral alternatives available to them (i.e., generally the one that they prefer most). Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention interventions is discussed.

Appearance Motives to Tan and Not Tan: Evidence for Validity and Reliability of a New Scale

OBJECTIVE To develop items to measure indoor tanning and sunless tanning that can be used to monitor trends in population surveys or to assess changes in behavior in intervention studies. DESIGN A group of experts on indoor tanning convened in December 2005, as part of a national workshop to review the state of the evidence, define measurement issues, and develop items for ever tanned indoors, lifetime frequency, and past-year frequency for both indoor tanning and sunless tanning. Each item was subsequently assessed via in-person interviews for clarity, specificity, recall, and appropriateness of wording. SETTING Universities in Tennessee and Virginia, a medical center in Massachusetts, and a high school in New Hampshire. PARTICIPANTS The study population comprised 24 adults and 7 adolescents. RESULTS Participants understood indoor tanning to represent tanning from beds, booths, and lamps that emit artificial UV radiation, rather than sunless tanning, even though both can be obtained from a booth. Two items were required to distinguish manually applied from booth-applied sunless tanning products. Frequency of use was easier for participants to recall in the past year than for a lifetime. CONCLUSIONS While indoor tanning items may be recommended with confidence for clarity, sunless tanning items require additional testing. Memory aids may be necessary to facilitate recall of lifetime use of nonsolar tanning. In addition, studies that assess reliability and validity of these measures are needed. Since study participants were primarily young and female, testing in other populations should also be considered.

Examination of Cognitive Variables Relevant to Sunscreen Use

BackgroundRisk for skin cancer is increased by UV exposure and decreased by sun protection. Appearance reasons to tan and not tan have consistently been shown to be related to intentions and behaviors to UV exposure and protection.PurposeThis study was designed to determine the factor structure of appearance motives to tan and not tan, evaluate the extent to which this factor structure is gender invariant, test for mean differences in the identified factors, and evaluate internal consistency, temporal stability, and criterion-related validity.MethodFive-hundred eighty-nine females and 335 male college students were used to test confirmatory factor analysis models within and across gender groups, estimate latent mean differences, and use the correlation coefficient and Cronbach’s alpha to further evaluate the reliability and validity of the identified factors.ResultsA measurement invariant (i.e., factor-loading invariant) model was identified with three higher-order factors: sociocultural influences to tan (lower order factors: media, friends, family, significant others), appearance reasons to tan (general, acne, body shape), and appearance reasons not to tan (skin aging, immediate skin damage). Females had significantly higher means than males on all higher-order factors. All subscales had evidence of internal consistency, temporal stability, and criterion-related validity.ConclusionsThis study offers a framework and measurement instrument that has evidence of validity and reliability for evaluating appearance-based motives to tan and not tan.