Together for Sun Safety

Although 90% of skin cancers are preventable, the disease has reached epidemic proportions in the United States. Children are particularly at-risk because lifetime sun exposure and severe sunburns before age 20 may substantially elevate the risk of developing skin cancer. Well-known behaviors can significantly reduce the risk, such as the use of shade, sunscreens, and protective clothing; yet, people are often unwilling to comply with this advice. Effective strategies for enhancing compliance with prevention and control recommendations are needed.

The Together for Sun Safety program is a solar protection program for parents with elementary school-aged children. The program aims not only to give parents proper information on safe sun behavior, but also to convey that information using appropriate language and sentence structure that can help facilitate compliance. Together for Sun Safety is based on the Language Expectancy Theory (LET), and consists of mailed newsletters, brochures, and magnetic tip cards written in high language intensity, deductive logical argument style. The program stresses health outcomes of solar protection, parental values and responsibilities for child health, and the importance of physical appearance of the skin. Based on behavioral recommendations from the American Academy of Dermatology and the American Cancer Society, the messages presented include encouraging the use of sunscreen, wearing protective clothing, conducting self-examinations, and limiting exposure to the sun.

Delivery time varies because the intervention is self-administered.

Participants were parents of children aged 5 to 11 years in the Tucson, Arizona, metropolitan area.

The intervention is suitable for implementation in the home.

Four 4-page newsletters, three brochures and three mailed 3 X 5 inch magnetic tip cards are required. Costs associated with the program's implementation are not provided.

Almost 2,000 parents with children aged 5 to11 years were identified for participation from pediatric offices and public school districts in the Tucson, Arizona metropolitan area. Consenting parents (N = 853) were pretested via telephone and randomly assigned to one of the cells in the factorial design: 2 (language intensity: high vs. low) x 2 (logical structure: deductive vs. inductive). Three persuasive prevention messages presented arguments on health outcomes of sun protection, parental values and responsibilities for own and child's health, and importance of physical appearance of skin. Parents received experimental messages in three newsletters and three brochures. Parents also received an introductory newsletter and three magnetic tip cards; language intensity and logical structure were not altered in these materials. Program effects were measured at posttest and at a 6-month follow-up.

Results indicated:

• At posttest, compared with parents receiving low-intensity messages, parents who received the high-intensity messages:
   
  • decreased the frequency of their own midday sun exposure.
  • were more likely to say that they, in general, planned to protect themselves and their children more the following summer and planned to protect themselves and their children more in the upcoming winter.
  • reported a larger increase in their planned frequency of applying sunscreen, using protective clothing and limiting midday sun exposure with their children in the upcoming winter. 
     
• At posttest, parents receiving high-intensity deductive messages showed the largest increase in their planned frequency of applying sunscreen, wearing protective clothing, staying in the shade, and in their plans to protect themselves from the sun in the upcoming winter. 
   
• At posttest, high-intensity inductive messages reduced compliance with recommendations to protect themselves in the upcoming winter. 
   
• At 6-month follow-up, parents receiving high-intensity deductive messages reported more improved solar protection than parents receiving all other messages.