Suzanne Dobbinson

Weekend Sun Protection and Sunburn in Australia Trends (1987-2002) and Association with SunSmart Television Advertising

BACKGROUND The Australian state of Victoria has run a population-based skin cancer prevention program called SunSmart since 1988, incorporating substantial public education efforts and environmental change strategies. Trends over 15 years in behavioral risk factors for skin cancer were examined in a population exposed to the SunSmart program. Whether outcomes were associated with extent of SunSmart television advertising was then assessed. METHODS In nine cross-sectional surveys from 1987 to 2002, 11,589 adults were interviewed by telephone about their sun exposure and sun protection during outdoor activities on summer weekends. Analyses completed in 2007 adjusted for ambient temperature and ultraviolet radiation. RESULTS Sun protection and sunburn show substantial general improvement over time, but have stalled in recent years. Use of hats and sunscreens significantly increased over time and peaked during the mid to late 1990s, compared with the pre-SunSmart baseline. The mean proportion of unprotected skin was reduced and was lowest in the summer of 1997-1998. Summer sunburn incidence declined over time and was 9.1% in 2002, almost half baseline (OR=0.53; 95% CI=0.39-0.73). Higher exposure to SunSmart advertising in the 4 weeks before the interview increased: (1) preference for no tan, (2) hat and sunscreen use, and (3) proportion of body surface protected from the sun. CONCLUSIONS The general improvement in sun-protective behaviors over time highlight that a populations sun-protective behaviors are amenable to change. Population-based prevention programs incorporating substantial television advertising campaigns into the mix of strategies may be highly effective in improving a populations sun-protective behaviors.

Adolescents' use of purpose built shade in secondary schools : cluster randomised controlled trial

Objective To examine whether students use or avoid newly shaded areas created by shade sails installed at schools. Design Cluster randomised controlled trial with secondary schools as the unit of randomisation. Setting 51 secondary schools with limited available shade, in Australia, assessed over two spring and summer terms. Participants Students outside at lunch times. Intervention Purpose built shade sails were installed in winter 2005 at full sun study sites to increase available shade for students in the school grounds. Main outcome measure Mean number of students using the primary study sites during weekly observations at lunch time. Results Over the study period the mean change in students using the primary study site from pre-test to post-test was 2.63 (95% confidence interval 0.87 to 4.39) students in intervention schools and −0.03 (−1.16 to 1.09) students in control schools. The difference in mean change between groups was 2.67 (0.65 to 4.68) students (P=0.011). Conclusions Students used rather than avoided newly shaded areas provided by purpose built shade sails at secondary schools in this trial, suggesting a practical means of reducing adolescents’ exposure to ultraviolet radiation. Trial registration Exempt.

Seven-year trends in sun protection and sunburn among Australian adolescents and adults

Aims : To examine the change in sun protective behaviours and sunburn of Australians over a seven‐year period, in the context of sustained skin cancer prevention campaigns and programs.

Population and age-group trends in weekend sun protection and sunburn over two decades of the SunSmart programme in Melbourne, Australia

Background  In response to the high skin cancer burden in Australia, the multicomponent, community‐wide SunSmart programme has worked since 1988 to reduce excessive sun exposure.

Access to commercial indoor tanning facilities by adults with highly sensitive skin and by under-age youth: compliance tests at solarium centres in Melbourne, Australia.

The study aimed to establish solarium operators’ compliance with a newly revised voluntary code for the industry in 2002. The revisions incorporate guidelines to ensure customers are adequately informed of the risks associated with solarium use and that access by high-risk groups, such as customers with fair skin that does not tan (skin type 1) or those less than 18 years of age, is limited or barred. Compliance tests with the industry standard were conducted at 30 solarium centres in Melbourne, Australia. Compliance was tested by surveys and in-person visits from three research assistants, each presenting as potential customers but with different eligibility to attend a sunbed session: young adults eligible to attend a solarium, young adults with skin type 1 and under-age (16 year old) customers. This is the first study to assess solarium compliance using confederates with customer profiles that correspond to the required restrictions on sunbed access. Results showed poor compliance with specific aspects of the voluntary code. Fifty-two per cent of centres gave the underage teenagers access to sunbeds without written parental consent. Ninety per cent of centres provided sunbed access to clients with poor tanning ability and 75% of centres tried to reassure them about using the sunbeds. Seven per cent of centres did not provide any form of eye protection for customers and 7% provided sub-standard stickers for eye protection. The study suggests that there is much room for improvement in solarium centres’ current practices and further regulation may well be warranted.

Solarium use in Australia, recent trends and context

Objectives: To describe the prevalence of solarium use among representative samples of Australian adolescents (12–17 years) and adults (18–69 years).

Does the Portrayal of Tanning in Australian Women’s Magazines Relate to Real Women’s Tanning Beliefs and Behavior?:

Content analysis data on the tans of 4,422 female Caucasian models sampled from spring and summer magazine issues were combined with readership data to generate indices of potential exposure to social modeling of tanning via popular women’s magazines over a 15-year period (1987 to 2002). Associations between these indices and cross-sectional telephone survey data from the same period on 5,675 female teenagers’ and adults’ tanning attitudes, beliefs, and behavior were examined using logistic regression models. Among young women, greater exposure to tanning in young women’s magazines was associated with increased likelihood of endorsing pro-tan attitudes and beliefs. Among women of all ages, greater exposure to tanned models via the most popular women’s magazines was associated with increased likelihood of attempting to get a tan but lower likelihood of endorsing pro-tan attitudes. Popular women’s magazines may promote and reflect real women’s tanning beliefs and behavior.

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 publics attitudes and beliefs about tanning and skin cancer. Vitamin D stories appeared most influential, particularly among young adults.

Patterns and causes of sun exposing and sun protecting behavior

Sun-related behavior increases or decreases exposure of the skin or eyes to solar ultraviolet radiation and may significantly alter skin cancer risk. Sun exposing behavior may be intentional or incidental. Intentional sun-exposing behavior is exposure to the sun with the primary purpose of achieving a biological response, such as a tan [1] usually with limited attention to sun protection and maximal concern for extended exposure. Wearing brief clothing and use of sunscreens with a low sun protection factor (SPF), or no sunscreen, when outdoors characterizes intentional exposure. Incidental sun-exposure occurs as a result of being outdoors without adequate protection whilst pursuing activities not directed exclusively at obtaining a suntan, such as in occupational sun exposure. In contrast, “sun protective behavior” (SPB) minimizes the skin’s exposure to ultraviolet radiation. It includes employing personal protective aids to minimize skin exposure when outdoors using covering clothing, a sunscreen of SPF ≥ 15, sunglasses, or umbrellas; and, or, seeking shade. People may also reduce exposure through minimizing outdoor activity when UV levels are raised, such as around solar noon, at high altitudes, or latitudes near the equator.

The increase in solariums in Australia, 1992–2006

Re: Wigglesworth E. Occupational injuries by hour of day and day of week: a 20-year study. Published in the December 2006 issue of the Australian and New Zealand Journal of Public Health, pages 505-8. I read this paper with some concern. If the paper was purely an analysis of historical data, perhaps as an example of the sort of exercise that occupational health and safety (OHS) practitioners undertook at the time relating to the data, then it is an interesting historical piece. However, Dr Wigglesworth implies in the final paragraph that he sees this analysis as potentially useful for today’s OHS practitioner to assist them in improving safety within the workplace. I am surprised that an experienced researcher as Dr Wigglesworth would imply this. There are two specific issues that make this implication very difficult. First, in the 20 years since the last of these data were collected, and certainly since the first data were collected nearly 40 years ago, the Australian workplace and worker have undergone quite dramatic changes. The important ones with some relevance to injury causation include changes to industry type, OHS regulation, composition of the workforce, availability of OHS information, industrial relations, unionisation, and type of employment. I am not implying that all these changes work towards a reduction or otherwise of injuries or improvement in safety, only that these are uncontrolled variables in relation to the 1968-88 data that will have an impact on current OHS. Their effect will need to be examined if trying to extrapolate from this set of past data. Second, OHS legislation today requires employers to identify and reduce risk within the workplace to ‘acceptable levels’. There is no indication within the paper that the inherent risk of the job (necessarily covering all jobs in Queensland in the data examined) varied with time of day or day of week. Dr Wigglesworth rightly examines the possibility of fatigue and points out that there would appear to be no intra-day or intra-week effect from fatigue (in fact, the opposite is suggested). Perhaps as employees ‘warm up’ to their tasks (both physically and mentally), they are likely to have fewer injuries. However, there is no direct evidence of this. The point is that these data do not provide any direction for today’s OHS advisers and operating managers on how to reduce risk in the workplace. The courts have determined employees will make operating mistakes from lack of concentration or other factors, and that employers have to structure the workplace to be safe in spite of such human errors. Moreover, there is a large body of research from the quality movement that has identified that the majority of errors are caused by the work system itself (insufficient training, inadequate supervision, resources, etc), rather than by ‘careless’ workers. Quality processes such as Six-Sigma are designed specifically to find and correct such system errors. I am not suggesting that Dr Wigglesworth is blaming careless workers, but that inference can be made from the paper and could be seized on by employers seeking to avoid their legislated responsibilities. That would not be helpful from the point of view of furthering OHS research within Australia. There are pitifully few OHS researchers and too little OHS research done in Australia. It seems a pity that a researcher of Dr Wigglesworth’s stature is wasting his time on such outdated material.