Skin-Cancer Educators Make A Beachhead In Behavioral Change

November 14, 1996

PROVIDENCE, R.I.--Health educators don't get sand kicked in their faces when they discuss skin cancer with sun worshipers.

A new study shows that beachgoers increased their sun-protective behaviors about 5 percent over two months after they were visited at the beach by skin-cancer prevention specialists. The specialists provided a sun-protection strategy to each beachgoer, based on the individual's stage of behavioral change. Those stages progressed from people who weren't considering adjusting their sun worship to those already maintaining a behavioral shift such as wearing sunscreen.

The study results indicate that the beach is a suitable site for reaching sunbathers at high risk for skin cancer and helping them change their behavior, said Dr. Martin Weinstock, the study's principal investigator. Weinstock is director of research in Brown University's Department of Dermatology and is head of the Dermatoepidemiology Unit at the Veterans Administration Medical Center in Providence.

The study is the first to show the usefulness of matching a sun-protection strategy to a sunbather's stage of behavioral change, said Joe Rossi, the study's lead author and director of research at the Cancer Prevention Research Center at the University of Rhode Island.

"At first we thought that sunbathers on the beach wouldn't want to talk with us, but more than 80 percent of the people we approached agreed to take part in the study," Rossi said "Beachgoers are willing to talk with you if you're reasonable."

The researchers and colleagues took to Rhode Island beaches in 1995, recruiting 2,324 sunbathers into two groups. People in the first group were interviewed about their attitudes and behaviors. In the second group, sunbathers received several items. These included educational pamphlets, SPF15 sunscreen, instant photographs that revealed skin injury, sun sensitivity assessments, on-the-spot feedback, and follow-up reports in the mail.

The computer-generated follow-up reports were based on survey data from thousands of people. The reports offered each sunbather a sun-protection strategy based on the individual's stage of behavioral change relative to sun exposure. Nearly 50 percent of those in the study said they were not thinking about changing their habits to reduce sun exposure. Less than 10 percent were either initiating a behavioral shift or sustaining one.

Two months after visiting the beaches, the researchers re-surveyed 1,922 of the sunbathers. They found that sunbathers who were provided a range of items had increased their sun-protective behaviors compared to beachgoers who were interviewed only. Changed behaviors included limiting outdoor activities during midday hours, seeking shade, wearing protective clothing and using SPF15 sunscreen.

The tactic of matching a cancer-prevention strategy to an individual's stage of behavioral change was developed at the University of Rhode Island several years ago. It has been used successfully to help people quit smoking, cut fat from their diets, start exercising and sign up for mammography screenings.

Skin cancer incidence equals that of all other cancers combined--about 1 million new U.S. cases per year. The primary cause of skin cancer is chronic unprotected exposure to the sun and intense irregular exposures such as those that occur at the beach.

"Our goal is to prevent skin cancers by helping people adopt sun-smart habits outdoors, particularly in environments like the beach where they are exposed to high intensity ultraviolet radiation," said Weinstock. "If you go to the beach, take adequate precautions. Keep your shirt on, wear a wide-brimmed hat, protect as much of your skin as possible with clothing, and use sunscreen - SPF 15 or greater."

Rossi said that the study allows the researchers to refine a skin-cancer prevention program based on a questionnaire and computer-generated follow-up report.

"All the system requires is that we send beachgoers a questionnaire to fill out and return at their leisure," Rossi said. "This is a non-invasive self-learning procedure that people can control themselves."

The researchers will present their findings at the annual meeting of the American Public Health Association in New York, Nov. 17-21.

This research was supported by the National Institute of Arthritis, Musculoskeletal and Skin Disease, the National Cancer Institute and the Department of Veterans Affairs.

Brown University

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