The first objective of this study was to analyze the differences between adolescents who use sunscreen frequently and those who do not. The second objective was to explore the importance of specific action plans when planning sunscreen use. Data was gathered among 602 Belgian secondary school students. Frequent and infrequent users of sunscreen were compared on several determinants related with sunscreen use, and a regression analysis on sunscreen use was done. Frequent users of sunscreen measures had significantly higher scores on attitudes, social influence, self-efficacy, some awareness factors, intention, and action plans. The integrated model for exploring motivational and behavioral change (I-Change model) explained 57% of the total variance of using sunscreen every 2 hours. Frequent sunscreen use was most strongly predicted by action plans, followed by positive intentions to use sunscreen, wearing protective clothing, seeking shade, attitude toward sunscreen use, education, social influence, and exposure to the sun. Our results suggest that skin cancer prevention programs aimed at promoting sunscreen use need to emphasize the advantages of sunscreen to infrequent users and to increase feelings of self-efficacy. Moreover, support by friends and parents should be stimulated. Finally, developing specific action plans for the use of sunscreen should be promoted to more effectively translate general intentions into actual sunscreen use.(Cancer Epidemiol Biomarkers Prev 2006;15(7):1360-6).

OBJECTIVE: Early detection of melanomas might increase survival chance. Patients can usually see primary lesions while inspecting their skin. Skin self-examination (SSE) is therefore the recommended pre-screening method. To maximize the likelihood that SSE will be performed, it is important to distinguish those factors that increase the chance of performance. The aim is to examine motivational differences between (a) melanoma-prone persons who perform SSE once every 2-3 months, and (b) melanoma-prone persons with a lower SSE frequency. METHODS: A survey to assess socio-demographic factors, attitude, social influence, self-efficacy and intention to perform SSE. RESULTS: Members (n=71) of 18 familial atypical multiple mole melanoma (FAMMM) families participated; 70% performed SSE at least once every 2-3 months. Adequate performers were more likely to have a partner, had a more positive attitude toward SSE, perceived SSE as less difficult to perform and had a stronger intention to perform SSE compared to poor performers. Logistic regression indicated attitude as the only reliable predictor of SSE performance. CONCLUSION: We found that about one third of our genetically predisposed population did not report an adequate frequency of performing SSE. PRACTICE IMPLICATIONS: Deficiencies in SSE practices in a genetically predisposed population are indicated.

ABSTRACT: BACKGROUND: A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit, vegetable and fat intake. Interventions are needed to improve these health behaviors. Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change. The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45-70. This paper describes the design of the Vitalum study. METHODS: Dutch general medical practices (N = 23) were recruited via a registration network or by personal invitation. The participants were then enrolled through these general practices using an invitational letter. They (n = 2,881) received a written baseline questionnaire to assess health behaviors, and potential psychosocial and socio-demographic behavioral determinants. A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed. Eligible participants were stratified based on hypertension status and randomized into one of four intervention groups: tailored print communication, telephone motivational interviewing, combined, and control. The first two groups either received four letters or took part in four interviews, whereas the combined group received two letters and took part in two interviews in turns at 5, 13, 30 and 43 weeks after returning the baseline questionnaire. Each letter and interview focused on physical activity or nutrition behavior. The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring. There were two follow-up questionnaires, at 47 and 73 weeks after baseline, to measure short- and long-term effects. The control group received a tailored letter after the last posttest. The process, efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression, cost-effectiveness analyses and process evaluation. DISCUSSION: The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing, and their combined use for multiple behaviors and people with different motivational stages and education levels. The results can be used by policymakers to contribute to evidence-based prevention of chronic diseases. Trial Registration Dutch Trial Register NTR1068.

The present article describes the application of a theory-based framework to understand current public knowledge of genetic risk factors of multifactorial diseases. The main innovative aspect is the application of E. M. Rogers' knowledge framework which distinguishes three types of knowledge:"awareness knowledge,""how-to knowledge," and "principles knowledge." We argue that distinguishing these types of knowledge allows for a more sophisticated overview of the general public. To illustrate the application of Rogers' framework, we performed a literature review of current public knowledge of genetic risk factors of multifactorial genetic diseases. Relevant articles were identified by searching the Pubmed, Web of Science, Embase, CINAHL, ERIC, and PsycINFO databases from January 1990 until January 2007 and by performing reference list and author searches. Although this review showed that current public knowledge is limited, it also showed that the knowledge framework may be a useful tool for assessing different types of public knowledge and pinpointing flaws or caveats in public knowledge with more precision and subsequently develop public health campaigns to remedy such flaws. Implications for genetic education are discussed.

OBJECTIVE: To determine whether formulating specific plans with regard to sunscreen use can influence parental sun protection behavior (i.e., applying sunscreen to their child). METHOD: In the spring of 2005, an electronic survey on sun protection behavior was performed among 436 parents in the Netherlands. Participants were randomly allocated to a 'questionnaire-only' control group or an experimental group, in which they were asked to formulate implementation intentions, i.e., specific action plans detailing when, where and how they would use sunscreen to protect their child from the sun in the upcoming summer. Parental sunscreen use was assessed at a 5-month follow-up. RESULTS: Although the intervention had no overall effect, a significant groupxintention interaction effect existed (p=0.02). Implementation intentions were effective in the subgroup of highly motivated participants, increasing adequate parental sunscreen use by 13.5%. Implementation intentions did not increase parents' intentions towards sunscreen use, indicating that their behavioral effect was not due to heightened motivation. CONCLUSIONS: This is the first study to report on the efficacy of implementation intentions in the area of sun protection behavior and skin cancer prevention. The results add further support to the growing body of evidence that implementation intention formation can be an important strategy to facilitate behavioral enactment, particularly in motivated respondents.

The present study describes the short- and long-term efficacy and program evaluation of a Quit and Win smoking cessation campaign, organized in The Netherlands. To be able to fine-tune smoking cessation contests to the needs of the target population, utilization, appreciation and efficacy of various contest elements were investigated. Data from 1551 Quit and Win participants and 244 control respondents were collected by web-based surveys at baseline (pre-contest) and 1 and 12 months after the contest. Demographic and contest predictors of successful quitting were determined by logistic regression analyses. Quit and Win proved to be an effective as well as highly appreciated program among participants. Conservative 1-month (35%) and continuous 12-month abstinence (12%) rates were significantly higher in Quit and Win participants than in the control group (1 month: 11%; continuous: 3%). Use of a supportive e-mail message service predicted short- and long-term abstinence. A buddy support system was the most used and highly appreciated cessation aid, and its use significantly predicted short-term abstinence. Radio commercials and Internet advertisements were the most effective recruitment channels. Although non-exhaustive, implementation of the results and recommendations discussed in this study could lead to an increased use, appreciation and efficacy of future smoking cessation campaigns.

We compared 1,335 adolescent smokers and quitters from six European countries with regard to attitudes toward smoking, self-efficacy, social influences, and intentions to quit smoking. At 6-month follow-up, occasional, weekly, and daily smokers who had quit indicated less social influence of friends and siblings toward smoking, acknowledged more disadvantages of smoking, and expressed more confidence that they would be able not to smoke in various tempting situations. Logistic regression analyses revealed that smoking status at baseline and social influence of peers were the main predictors of cessation. Although no large cultural differences were found, the pattern of predictors was not similar for all six countries. As adolescents who smoke regularly are less likely to quit, strategies to prevent them from taking up the habit are important. The influence of peers calls for inclusion of peer groups in cessation strategies.

The present study examined the possible pathways of effect of genetic testing for relatively "low-risk" conditions by exploring positive as well as negative effects of anticipated test results on the intention to restrict salt intake. In a cross-sectional within-subjects design, patients being tested for genetic predispositions to salt sensitivity reported higher overall intentions to restrict their salt intake when anticipating positive test results, confirming the value of genetic testing for low-risk conditions. However, participants in the precontemplation and preparation stages of change reported lower intentions when anticipating negative test results. This result suggests that negative test results have a negative impact on the motivation to perform preventive behavior among those who have not yet considered, and those who are planning to perform, the preventive behavior. Although the results show that, overall, genetic testing for low-risk conditions has a positive impact on the motivation to engage in preventive behavior, one needs to be aware of the potential negative effect of receiving negative test results. Consequently, individuals receiving negative test results should be carefully counseled on the meaning of the results and the consequences for preventive behavior.

ObjectivesThe aim of the present study was to investigate the efficacy of a brief coping planning intervention to prevent smoking relapse in the context of a national smoking cessation contest ('Quit & Win').DesignA controlled trial with three measurements was used to evaluate the efficacy of the coping planning intervention.MethodsThree on-line surveys were conducted among 1,566 participants in Quit & Win. Contest participants were alternately assigned to a control and planning group, the latter of which completed a planning intervention that included the formation of three coping plans on how to refrain from smoking in personal risk situations.ResultsThe coping planning intervention increased conservative 7-month continuous abstinence rates from 10.5 to 13.4%, indicating that, if implemented correctly, coping planning can significantly reduce long-term smoking relapse.ConclusionsIn addition to growing evidence for the efficacy of self-regulatory planning in the promotion of health behaviour, the results of the present study indicate that planning can also be effective in the prevention of unwanted behaviour. The results may stimulate research and application of coping planning in its current form.

The present study explored the performance and psychosocial determinants of passive cancer detection behavior, that is, attentiveness to cancer symptoms, and medical help seeking, and investigated potential dependency between these two behaviors. A detailed telephone survey was conducted among 459 respondents, aged 55 years or older. The survey assessed passive detection behavior and appropriately timed medical help seeking, regarding 14 cancer symptoms. Knowledge of cancer symptoms and various other psychosocial determinants were also measured. Knowledge of cancer symptoms and adequate passive detection behavior was low to moderate. Timely medical help-seeking behavior was low to moderate for urgent symptoms but relatively high for prolonged symptoms. Overall, women had higher knowledge levels, paid more attention to cancer symptoms, and performed more timely help seeking than men. Passive detection behavior was positively associated with premotivational awareness factors (knowledge and awareness), female gender, and perceived advantages. Timely medical help seeking was positively related to cognitive motivational factors (perceived advantages, self-efficacy expectations, and intention) and negatively related to educational level and perceived susceptibility to cancer. Furthermore, a strong positive association was found between the performance of passive detection behavior and timely medical help seeking. The suboptimal levels of knowledge and performance of early cancer detection behaviors found in this study emphasize a need for educational efforts in the area of early cancer detection. The effectiveness of these efforts may benefit from considering the distinct sets of determinants of passive detection behavior and medical help seeking.

This study presents nationally representative trends (1998-2004) and patterns in skin cancer risk behaviors, including sunburns, sun protection, and indoor tanning behaviors, and attitudes regarding ultraviolet radiation exposure among parents of U.S. adolescents. Data were from the American Cancer Society Sun Surveys I and II, telephone-based random digit dialed cross-sectional surveys of U.S. adolescents and their parents conducted in the summers of 1998 and 2004. Between 1998 and 2004, use of sunscreen, wide-brimmed hats and composite use of three to five behaviors increased significantly; concurrently, indoor tanning use increased significantly and sunburn prevalence changed a little. In 2004, 47% reported summer sunburns and more than half of those received painful sunburns. Parents continued to report low compliance with recommended behaviors; sunscreen use was most frequently reported, but many followed inappropriate application practices. About 13% practiced indoor tanning in the past year. Parents reported high levels of positive attitudes toward sun protection benefit, but at the same time, significant proportions reported positive tan appeal and outdoor sun exposure attitudes. The low rates and mixed progress in safe ultraviolet radiation exposure behaviors demand more attention for primary skin cancer prevention among parents of adolescents that focuses on changing beliefs about tanning appeal and promotes comprehensive ultraviolet radiation exposure protection.

INTRODUCTION: Extended sun exposure may lead to serious health problems, and evidence of this is in the increase in skin cancer and malignant melanoma worldwide. Extended sun exposure during childhood or adolescence increases the probability of skin cancer in adulthood. The aim of the study was to identify and examine the knowledge, attitude, behaviour and beliefs of Greek adolescents (high school students) related to sun exposure and its adverse effects on health. The majority of participants (89.7%) were of Greek nationality. METHODS: The study took place in 5 schools in the prefecture of Korinthos, and 816 of the total 925 students aged 15-18 years participated. The questionnaire was pilot tested and assessed for validity and reliability, both of which were adequate (Cronbach's α= 0.70 and r_s= 0.78); SPSS 13.0 software was used for analysis. RESULTS: Only 37.9% of participants knew that melanoma was a type of skin cancer; 50% said they did not know what melanoma was. Regarding behavior, 35.5% reported that during the last summer they went to the beach on 20 to 50 occasions, and only 50% reported that they wore a sunhat or stayed in the shade. The frequency of sunscreen use was alarmingly low, with the majority of the adolescents unfamiliar with its proper use, and 50% not using a sunscreen with sufficient sun protection factor. Television was an important source of information about protection from sun exposure, while the family was the most important provider of advice. CONCLUSIONS: Participants' knowledge of sun exposure was insufficient and they reported risky behaviours in the summer months. Despite health promotion and community education programs focusing on sun smart strategies, these young people still associated suntans with beauty. Health promotion and education programs need to challenge such beliefs. However, as a sole approach to health promotion, teaching protective measures and appropriate ways for youth to protect themselves against the harmful effects of sunbathing may be insufficient to reduce the epidemic of skin cancer.

Issue addressed: The study investigates whether the perceived sun protective practices of the peer group during a day-time recreational boat trip were associated with the sun protective attitudes and behaviours of individuals on the same boat. Methods: Cross-sectional survey of recreational boat users conducted in Townsville, North Queensland, during the summer of 2003. One hundred and twenty-four of 134 boat users returning from a day trip agreed to participate, with 10 later excluded from analysis due to either being the sole person on the boat or because they were in the sun for less than an hour between 9 am and 3 pm (n=114, response rate=92%). Results: The more positively respondents perceived the sun protective behaviours of other people on the boat, the more likely they were to report that they: did not enjoy exposing their unprotected skin to the sun (p=0.004); believed an occasional sunburn is not an acceptable risk (p=0.006); wore sunglasses on the trip (p=0.002); wore a wide-brimmed hat together with a long-sleeved shirt and sunscreen (p=0.006); and did not report reasons for neglecting to use sun protection (p=0.019). Conclusions: The perceived sun protection practices of the peer group majority were significantly associated with the sun protection practices of the observer.

This study first assessed workers' inhalatory and dermal exposures to polycyclic aromatic hydrocarbons (PAHs) contained in oil mists. Then, their resultant lung cancer and skin cancer risks were estimated. Finally, control strategies were initiated from the health-risk management aspect. All threading workers in a fastener manufacturing plant were included. 16 inhalatory and 88 dermal PAH exposure samples were collected. Results show that the inhalatory gas phase total PAH exposure level (8.60x10(4) ng/m(3)) was much higher than that of particle phase (2.30x10(3) ng/m(3)). Workers' mean inhalatory exposure level (8.83x10(4) ng/m(3)) was lower, but its corresponding 1-sided upper 95% confidence level (UCL(1,95%)=1.02x10(5) ng/m(3)) was higher than the time-weighted average permissible exposure level (PEL-TWA) regulated in Taiwan for PAHs (1.00x10(5) ng/m(3)). The mean whole body total PAHs dermal exposure levels was 5.44x10(6) ng/day and the top five exposed surface areas were lower arm, hand, upper arm, neck, and head/front. The estimated lifetime skin cancer risk (9.72x10(-3)) was lower than that of lung cancer risk (1.64x10(-2)), but both were higher than the significant risk level (10(-3)) defined by the US Supreme Court in 1980. The installation of a local exhaust ventilation system at the threading machine should be considered as the first priority measurement because both lung and skin cancer risks can be reduced simultaneously. If the personal protection equipment would be adopted in the future, both respiratory protection equipment and protective clothing should be used simultaneously.

OBJECTIVE: To determine whether formulating specific plans with regard to sunscreen use can influence parental sun protection behavior (i.e., applying sunscreen to their child). METHOD: In the spring of 2005, an electronic survey on sun protection behavior was performed among 436 parents in the Netherlands. Participants were randomly allocated to a 'questionnaire-only' control group or an experimental group, in which they were asked to formulate implementation intentions, i.e., specific action plans detailing when, where and how they would use sunscreen to protect their child from the sun in the upcoming summer. Parental sunscreen use was assessed at a 5-month follow-up. RESULTS: Although the intervention had no overall effect, a significant groupxintention interaction effect existed (p=0.02). Implementation intentions were effective in the subgroup of highly motivated participants, increasing adequate parental sunscreen use by 13.5%. Implementation intentions did not increase parents' intentions towards sunscreen use, indicating that their behavioral effect was not due to heightened motivation. CONCLUSIONS: This is the first study to report on the efficacy of implementation intentions in the area of sun protection behavior and skin cancer prevention. The results add further support to the growing body of evidence that implementation intention formation can be an important strategy to facilitate behavioral enactment, particularly in motivated respondents.

The dangers of overexposure to sunlight have been well publicised, but less attention has been given to an acknowledged benefit of exposure to ultraviolet radiation: cutaneous synthesis of vitamin D3. Here we define a standard vitamin D dose based upon recently recommended requirements for vitamin D that take account of its risk reduction role in a variety of diseases, and present a web-based tool that enables the reader to calculate associated exposure times for any time and place using either default values or user selected conditions. Vitamin D3 synthesis is not possible at high latitudes in the winter season, or the exposure time required to reach a standard dose is sometimes impractical. Where solar UV is sufficient, a risk benefit analysis of sunburn vs. vitamin D3 synthesis shows that the best time for brief sun exposure is in the middle of the day. For low solar elevation angles common at high latitudes, a fine line exists between adequate UV exposure for vitamin D3 synthesis and a risk of sun burn.(http://nadir.nilu.no/~olaeng/fastrt/VitD_quartMED.html and (http://nadir.nilu.no/~olaeng/fastrt/VitD-ez_quartMED.html).

This study compared the sun exposure and sun protection behaviours of adolescent students between 1993 and 1999.Schools from all Australian states and the two territories participated in each of the 1993, 1996, and 1999 surveys and a sample of students from years 7 to 12 were surveyed. In each of the states and territories a random sample of schools was selected within each education sector (government, Catholic, independent). The questionnaire was a self-completed booklet with questions about sunburn history during the previous summer, tan preferences, skin-type, and usual reported behaviour. Data from a total of 78,032 students were available for analysis.From 1993 to 1999 there was a significant increase in the number of students reporting sunburn during the previous summer (chi(2)= 225.77, df = 2, P < 0.01). However, the percentage of students who preferred no tan at all increased over the same period (chi(2)= 184.47, df = 2, P < 0.01). The percentage of students who usually or always wore clothing that covered most of their body decreased between 1993 and 1999 (chi(2)= 20.46, df = 2, P < 0.01); the percentage of students usually or always wearing maximum protection sunscreen decreased over time (chi(2)= 27.71, df = 2, P < 0.01). Staying in the shade increased from 1993 (26%) to 1996 (32%) but decreased slightly in 1999 (30%). Across all survey years, only 11% of students routinely followed all three protective behaviours of wearing a hat, sunscreen, and clothes that cover the body.Sun protection practices among adolescents are still below optimal levels. Future educational programs require innovative approaches that aims to change attitudes toward tanning as being healthy and attractive and modify adolescent behaviours in relation to sun exposure.

This report describes spectator recall of SunSmart skin cancer prevention advertising displayed on the Brisbane Cricket Ground scoreboard at intermittent periods throughout the 1999/2000 cricket season and the sun-protective behaviors of these spectators. Two hundred and thirty-one spectators were asked a series of five questions about their recall of SunSmart advertising and their present sunscreen usage. Respondents' sun-protective behavior observed at the time of questioning was also recorded. The SunSmart advertising was seen by 15.6% of respondents. Recall of the SunSmart advertising was higher amongst spectators observed to have high levels of sun protection than amongst spectators with low levels of sun protection. Females were more likely than males to recall the SunSmart advertising. The efficacy of health-promoting advertising in the sports setting has yet to be established and therefore results cannot be compared against accepted benchmarks. This study contributes baseline data that will enable such comparisons to be made. The increase in recent years of health-promoting advertising at sports events, often as part of a comprehensive sponsorship program, necessitates the need for further research in this area.

The U.S. Environmental Protection Agency (EPA) has developed an estimate of the human cancer risk from dioxin, using the standard low-dose linear extrapolation approach. This estimate has been controversial because of concern that it may overestimate the cancer risk. An alternative approach has been published and was presented to the U.S. EPA Science Advisory Board's Dioxin Review Panel in November 2000. That approach suggests that dioxin is a threshold carcinogen and that the threshold is an order of magnitude above the exposure levels of the general population. We have reexamined the threshold analysis and found that the data have been incorrectly weighted by cohort size. In our reanalysis, without the incorrect weighting, the threshold effect disappears.

BACKGROUND: Public health campaigns encourage the public to protect themselves against skin cancer by using sunscreens and taking other protective measures. However, it is difficult to estimate the level of awareness among the general public. METHODS: This study explores the prevalence and predictors of solar protection behavior in a community sample of beachgoers. During the months of May, June, July and August 2001 a total of 360 participants (145 men and 215 women) were randomly selected from several Belgian beaches in and around the city of Ostend, Belgium. The solar protection behavior of each participant was assessed by direct observation and interview. RESULTS: The risk awareness percentages were 70.6% for skin cancer, 60.8% for sunburn and 25.0% for skin aging. These percentages were considerably higher in the female participant group than in the male group. Sunscreen cream was the most popular preventive behavior, especially in the female population, whereas the alternative protective measures (limited exposure during peak sun hours, the use of shade and the use of protective clothing and hats) were more popular in the male group. CONCLUSIONS: While solar protection has become part of routine beach behavior, there is room for improvement by more frequent application of sunscreen cream, the use of a higher sun protection factor (SPF)(15+), timed sunbathing, more use of clothing and hats and more seeking of shade. The results of this study can assist in evaluating the effectiveness of current sun-protection campaigns and health education programs.