Runninghead:HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN1

HealthProgramtoPromoteRegularUseofSunscreenAmongMiddleSchoolStudentsinOrder
toPreventSkinCancer
AnnieWold
PortlandStateUniversity


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

HealthProgramtoPromoteRegularUseofSunscreenAmongMiddleSchoolStudentsinOrder
toPreventSkinCancer
CanceristhesecondleadingcauseofdeathintheUnitedStates,accountingfor
approximately23%ofalldeathsannually(DiClemente,Salazar,&Crosby,2013).Themost
commontypeisskincancer,affecting3.3millionpeopleeachyear(AmericanCancerSociety,
2015).Themajorityofskincancercasesoccurinthetoplayerofskincalledtheepidermis,
whereithasbeenexposedtosunlight,butallskinissusceptiblethesecasesareeasiertotreat
andusuallywillnotspreadtootherpartsofthebody(NationalCancerInstituteattheNational
InstitutesofHealth,2016).However,melanomaoccursinthepartoftheskinthatisresponsible
foritscolorandissignificantlymoreaggressive,increasingthechanceofitspreadingtoother
tissues.Melanomaisresponsibleforthemajorityofdeathsduetoskincancer(NationalCancer
InstituteattheNIH,2016).Despitethedifferencesinseveritybetweennonmelanomaskin
cancersandmelanoma,theriskfactorsarethesame.Allskincancerislinkedtoexcessive
exposuretoUVrays,historyofsunburns,fairskin,andlivinginsunnyplacesneartheequatoror
athigherelevations(MayoClinic,2016).Familyhistoryofmelanomaandabnormalmolesare
riskfactorsaswell,butmanyoftheprimarydangersarerelatedtosunexposure(MayoClinic,
2016).Thisfactleadstothelogicalcallforpreventativemeasuresagainstthemostprevalent
typeofcancer.
Duetothehighrisksassociatedwithspendingextendedperiodsoftimeinthesun,a
beneficialhealthbehaviorindividualscanadoptisprotectingthemselvesfromtheharmful
effectsofUVraysontheirskin.Oneofthemosteffectivewaystodothiswhichstillallowsthe
individualtospendtimeinthesunisusingsunscreenwheneveroutside.Fromalongterm


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

preventativestandpoint,itisespeciallyimportantforchildrentolearnthisbehavior.Developing
thehabitofapplyingsunscreeniscriticalatayoungage,asmanychildrenswimandplay
outsidefreely.AgroupofcollegestudentsinArizonaworkedonaprojecttocreateaprogram
thattaughtmiddleschoolstudentsabouttheimportanceofsunprotection.Preandposttests
showedthestudentsdidlearnaboutwhyandhowtoprotecttheirskinandgainedanaversionto
overlytannedskin,aswellasincreasedknowledgeaboutskincancer(Davisetal.,2015).
Despitetheapparentsuccessofthisproject,itwasonlyusedinschoolsthisonetime.Itwouldbe
beneficialtoimplementasimilarprograminmiddleschoolsthattargetednotonlytheeducation
ofthestudents,buttheirparentsandsocialenvironmentaswell.Promotinghealthbehaviorsisa
complexprocessinvolvingnumerousfactorsthatmustbeconsidered.
HealthBehaviorAnalysis
Tobetterunderstandtheneedforahealthpromotionprogram,theissuemustbe
examinedfrommultipleperspectives.Ausefultooltouseinthisprocessisthesocioecological
model.Thislooksintotheindividual,interpersonal,community,andlargescalefactorsthat
influenceindividualmembersofasociety.Thelayeredcirclemodel(seeAppendix)
demonstrateshowfactorsateachlevelcanbeaffectedbyelementsofanotherlayer(Centersfor
DiseaseControlandPrevention,2015).Theindividuallevellooksintoaspectsofapersonslife
thataffecttheirabilitytopracticeabehavior.Theinterpersonallevelrelatestotheinfluenceof
family,friends,andpeersontheissue,whilethecommunitylevelincludeslocalorganizations
andresources.Theoutermostcircleencompassesalloftheselevelsandaffectsthemthrough
policy,culture,andclimate(AmericanCollegeHealthAssociation,2012).Althoughhealth


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

behaviorsarepracticedbyanindividual,theiractionsaredeterminedbyfactorsateachofthese
levels.
Individual
Financialstatus,personalbeliefs,andknowledgedirectlyrelatetothewayanindividual
usessunscreenasmeanstopreventskincancer.Theincomeofanindividualmaynotallowthem
toaccessthesunprotectiontheyneed,bothintermsofpurchasingtheproductitselfandbeing
abletoaffordtransportationtothestoretomakethepurchase(Raphael,2015).Anotherfactor
thatinfluencessunscreenuseisthelevelofknowledgethepersonhasaboutsunscreenandskin
cancer.AccordingtoKenkel(1991)thereisacorrelationbetweenmoreeducationandpeople
livinghealthierlives.Understandingnotonlyhowtopracticeahealthbehavior,butwhyitis
importantwillincreasethelikelihoodofthemparticipating.Thefinalindividualaspectrelating
toregularuseofsunscreenispersonalbeliefregardingit.Thisinvolvesbeliefsbothabouthow
importanttheythinkitis,andhoweasyordifficultthebehaviorwillbe(Godin&Kok,1996).
Thesethreefactorsmayinfluenceeachother,butultimatelytheydeterminetheindividuals
abilityanddesiretousesunscreen.
Interpersonal
Healthbehaviorsareaffectedbycloserelationships,includingfamilyandfriends.
Interpersonalrelationshipshavebeenfoundtocorrelatewithhealth(Cohen,2004).Ifpeers
practiceabehavior,theindividualismorelikelytoaswell.Asharedbehaviorsuchasusing
sunscreenaidsincreatingasociallysupportiveenvironmentinwhichtopracticeit.Additionally,
encouragementfromfamilyisimportant.AcrosssectionalstudycompletedbyBuller,Callister,
&Reichert(1995)foundparentalinvolvementwasinsufficientwhenitcametoencouragingand


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

teachingtheirchildrenaboutsunprotection.Whenanindividualisworkingtoimplementanew
healthbehaviorintotheirlife,familialassistancethroughverbalandbehavioralaffirmationsare
crucial.Whenbothfriendsandclosefamilyareshowsupport,itcanlessenanxietiesthe
individualmayhaveaboutthebehavior(Sallis,Grossman,Pinski,Patterson,&Nader,1987).
Finally,awarenessofgeneticsandanyfamilyhistoryofskincancermayincreasethechancesof
anindividualtakingpreventativemeasurestolowertheirownrisk.Manybehaviorsareaffected
bythepeopleclosesttoanindividual.
Community
Althoughmanyaspectsofcommunitiesareinfluencedbysocietalpolicies,localfactors
stillaffectthehealthbehaviorsofanindividual.Basedonthesizeofthetownorthelocationof
theneighborhood,nearbystoresmayhavedifferentproductsavailable.Thisisalsoinfluencedby
thenumberofaccessiblestores(Hernandez,Calero,Robinson,Mermelstein,&Robinson,2012).
Secondly,localhealtheducationprogramscanhelppeoplelearnabouthealthconcerns,risk
factors,andhowtopreventitfromhappeningtothem.Communityhealthprogramscanbeused
toreachpeopleatthecity,state,andregionallevelstoteachthemaboutvariousissues(CDC,
2016a).Athirdfactorthatwouldmakeusingsunscreeneasierisifitisavailableatplaceswhere
itwouldbeneeded.Thiscouldincludecommunitypools,schoolsandplaygrounds,oroutdoor
camps.Theseareallplaceswherepeoplespendtimeinthesun,sohavingsunscreenprovided
wouldeliminatetheneedtopurchaseandcarryitindividually.Theenvironmentinwhicha
personlivessignificantlyinfluencestheirhealthbehaviors.


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

Societal
Oneofthemostsignificantfactorsrelatedtoskinprotectionistheattempttomeetor
maintainbeautystandards.IntheUnitedStatesinparticular,peopleofallagestendtoprefer
tanningtomaketheirskindarker,oftenresultingintheindividualspendingextendedperiodsof
timeindirectsunlightwithoutusingsunscreen(Sarnoff,2011).Anothersocietallevelfactoris
thepriceforsunscreenthatisdecidedbythecompaniesthatsellit.Cosmeticneedsperpetuated
bymarketingallowsthesecompaniestochargesignificantlymorefortheirproductsthanthey
arereallyworth,makingthemlessaccessibleformanypeople(Anneli,2010).Finally,policy
regardingthedepthandqualityofhealtheducationinschoolscangreatlyinfluencethe
informationandresourcesstudentsreceiveaboutskincancerandprevention(CDC,2016b).
HealthPromotionProgram
Thesocialcognitivetheory(SCT)referstoabehavioralmodelbasedonlearningthrough
theobservationofothers(Connor&Norman,2005).Whenappliedtochangingabehavior,SCT
guidesthetargetpopulationalongacontinuumofchangeandtheconstructsofthetheorycanbe
usedtoaddressfactorsateachsocioecologicallevel(Denler,Wolters,&Benzon,2015).In
orderforthismodeltobeputtousesomeassumptionsabouthumanbehaviorhavetobemade.
Interactionsbetweenanindividualandbehavioralandenvironmentalfactorsarereciprocal.The
secondassumptionisthatpeopleareabletocontroltheirbehaviors.Finallyitisconcludedthat
learningcanstilloccurevenifthebehavioralchangeisnotimmediate(Denler,Wolters,&
Benzon,2015).Becauseitcanaddressallfactorsthatinfluencebehaviors,incorporatingthe
socialcognitivetheoryintoahealthpromotionprogramstrengthensitsefficiency.


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

Toaddresstheneedforanincreaseinsunscreenuse,aneducationalprograminmiddle
schoolsusingSCTwouldbeeffectiveinencouragingthishealthbehavior.Middleschool
studentsareanidealtargetpopulationforseveralreasons.Preventionofskincancerthrough
sunscreenuseismostefficientattheyoungestagepossibleparentsareoftendiligentin
protectingtheirbabiesandyoungchildrenfromthesun,thenbecomelessattentiveasthekids
getolderandspendlesstimeunderadultsupervision.Atthispointintimechildrenneedto
becomeselfmotivatedtopracticetheirownhealthybehaviors.Theoldertheyget,themore
likelydevelopingskincancerbecomes.Thisriskcanbereducedbyincorporatingamandatory
educationalcourseintoallmiddleschoolhealthclasses.Thiscoursewouldreplaceonedayof
regularhealthclasseachyearandwouldberepeatedeveryyeartoensurestudentsreceivethe
information.Healthteacherswillprovideinformationaboutskincancerandhowitdevelops,the
importanceofreducingratesofthedisease,anddifferentmethodsofsunprotection,focusingon
sunscreenuse.Whilethestudentsaretheprimaryrecipientsoftheprogram,theirparentsreceive
secondaryinformationthroughpamphletsgiventothestudentstotakehome.Complimentary
bottlesofsunscreenwillbegiventostudentsaswell.Byprovidingknowledgeandresourcesto
students,thisprogramcanbeusedtoincreasesunscreenusageandleadtodecreasedratesof
skincancer.
Thegoalsoftheprogramaremorecomplexthanincreasingknowledgeaboutskincancer
andsunscreenitwilladdressspecificfactorsfromthesocioecologicalmodel.Thefirstfactor
existsattheinterpersonallevel.Animportantpartofanindividualpracticingabehavioristhe
socialsupporttheyreceive.Ifapersonhaspeersandfamilymemberswhosharethesame
mindsetsaboutthebehavior,practiceitthemselves,andprovidethematerialsneededto


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

completeit,theindividualissignificantlymorelikelytothemselves.Expandingtothe
communitylevel,behaviorscanbeencouragedbylocalprogramsandavailabilityofresources.
Finally,atthesocietallevel,institutionalizedwaysofthinkingandsocialnormsstrongly
influencethebehaviorsofindividuals.Studentsmaybelievebeingtanismoreattractivedueto
advertisingandpressurefromtheirpeerssotheywillnottakeproperprecautionstoprotecttheir
skinfromthesun,aswellaswearmorerevealingclothingtheoldertheybecome.
Toillustratetheeffectivenessofthisprogram,thefactorsinfluencingthehealthbehavior
canberelatedtoconstructsofthesocialcognitivetheory.Instrumentalsocialsupportforusing
sunscreenwilladdresstheconstructofinterpersonalenvironment.Teachingeverystudentand
theirparentsabouttherisksofskincancerandtheimportanceofusingsunscreenwillleadtoa
sharedhealthorientedmindsettheywillencourageeachothertousesunscreenbothinand
outsideofschool.Thesecondconstruct,knowledge,willbeaddressedatacommunallevel
throughtheschoolprogram.Providinglearningmaterialandresourcestostudentswillallow
themtomakewellinformedhealthdecisionsandcontributetoahealthiercommunity.Thefinal
constructtheprogramwilladdressissituationalperceptionrelatingtosocietalstandardsof
beauty.Alteringthebeliefsstudentshaveaboutwhatwillhelpthemfitinorwhatisidealinthe
eyesofsociety,specificallyregardingtanningandtakingtimetoprotecttheirskin,willhavea
significantimpactontheirhealthbehaviors.
Conclusion
Thishealthpromotionprogramwillnotonlyprovidemiddleschoolstudentswith
informationaboutskincancer,riskfactors,andpreventionthroughsunscreenuse,itwillprovide
theresourcestodoso.Itwillalsoworktoaddressthefactorsthatinfluenceanindividuals


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

abilitytousesunscreenregularlyfrommultipleangles.Thisisahealthbehaviorthatdoesnot
becomeroutineovernightusingthesocialcognitivetheoryintheprogramwillhelpmovethe
studentstowardsthebehaviorgradually.Whenitcomestoalifethreateningdiseaseasprevalent
asskincancer,preventativestepsmustbetakentodecreasetherateofnewcases.Asimple
programsuchasthiscangoalongwayinsavinglives.


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

10

Appendix


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

11

References
AmericanCancerSociety.(2015).
Skincancerfacts.
Retrievedfrom
http://www.cancer.org/cancer/cancercauses/sunanduvexposure/skincancerfacts
AmericanCollegeHealthAssociation.(2012).
Ecologicalmodel.
Retrievedfrom
https://www.acha.org/HealthyCampus/Implement/Ecological_Model/HealthyCampus/Ec
ological_Model.aspx?hkey=f5defc87662e43738402baf78d569c78
Anneli,R.(2010).
Thecosmeticsracket:Whythebeautyindustrycangetawaywithcharginga
fortuneformakeup.
Retrievedfrom
http://www.alternet.org/story/148140/the_cosmetics_racket%3A_why_the_beauty_indust
ry_can_get_away_with_charging_a_fortune_for_makeup
Buller,D.B.,Callister,M.A.,&
Reichert,T
.(1995).Skincancerpreventionbyparentsofyoung
children:healthinformationsources,skincancerknowledge,andsunprotection
practices.
OncologyNursingForum,22
(10),15591566
.
Retrievedfrom
http://europepmc.org/abstract/med/8577624
CentersforDiseaseControlandPrevention.(2016a).
Divisionofcommunityhealth.
Retrieved
fromhttp://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/
CentersforDiseaseControlandPrevention.(2016b).
Schoolhealthpolicy.
Retrievedfrom
http://www.cdc.gov/healthyyouth/about/policy.htm
CentersforDiseaseControlandPrevention.(2015).
Thesocialecologicalmodel:Aframework
forprevention.
Retrievedfrom
http://www.cdc.gov/violenceprevention/overview/socialecologicalmodel.html
Cohen,S.(2004).Socialrelationshipsandhealth.
AmericanPsychology,59
(8),676684
.


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

12

Connor,M.,&Norman,P.(Ed.).(2005).
Predictinghealthbehavior
[Monograph].Retrieved
fromhttp://www.instructionaldesign.duroroller.com/docs/health_behavior.pdf#page=144
Davis,R.,Loescher,L.J.,Rogers,J.,Spartonos,D.,Snyder,A.,Koch,S.,&Harris,R.B.(2015).
Evaluationofprojectstudentsaresunsafe(SASS):Auniversitystudentdeliveredskin
cancerpreventionprogramforschools.
JournalofCancerEducation,30
(4),734742
.
doi:10.1007/s1318701407427
Denler,H.,Wolters,C.,&Benzon,M.(2015).Socialcognitivetheory.
Education.com,Inc.
Retrievedfromhttp://www.education.com/reference/article/socialcognitivetheory/
DiClemente,R.J.,Salazar,L.F.,&Crosby,R.A.(2013).Healthbehaviorinthenewpublic
health.
Healthbehaviortheoryforpublichealth:Principles,foundations,and
applications
(pp.443)
.
Burlington,MA:Jones&BartlettLearning,LLC.
Godin,G.,&Kok,G.(1996).Thetheoryofplannedbehavior:Areviewofitsapplicationto
healthrelatedbehaviors.
AmericanJournalofHealthPromotion,11
(2),8798.doi:
10.4278/08901171.11.2.87
Hernandez,C.,Calero,D.,Robinson,G.,Mermelstein,R.,&Robinson,J.K.(2012).
ComparisonofsunscreenavailabilityinChicagoHispanicandnonHispanic
neighborhoods.
PhotodermatolPhotoimmunolPhotomed,28
(5),244249.doi:
10.1111/j.16000781.2012.00688.x.
Kenkel,D.S.(1991).Healthbehavior,healthknowledge,andschooling.
JournalofPolitical
Economy,99
(2),287305.Retrievedfrom
http://www.jstor.org/stable/2937682?seq=2#page_scan_tab_contents


HEALTHPROGRAMTOPROMOTEREGULARUSEOFSUNSCREEN

13

MayoClinic.(2016).
Melanoma.
Retrievedfrom
http://www.mayoclinic.org/diseasesconditions/melanoma/basics/riskfactors/con200260
09
NationalCancerInstituteattheNationalInstitutesofHealth.(2016).
Skincancer(including
melanoma)Patientversion.
Retrievedfrom
http://www.cancer.gov/types/commoncancers
Raphael,D.(2015).Socialdeterminantsofhealth.
PublicHealthAgencyofCanada.
Retrieved
fromhttp://www.avdha.nshealth.ca/sites/default/files/socialdeterminantsoh.pdf
Sallis,J.F.,Grossman,R.M.,Pinski,R.B.,Patterson,T.L.,&Nader,P.R.(1987).The
developmentofscalestomeasuresocialsupportfordietandexercisebehaviors.
PreventativeMedicine,16
(6),825836.doi:10.1016/00917435(87)900223
Sarnoff,D.S.(2011).Thetaleoftanning.
SkinCancerFoundation.
Retrievedfrom
http://www.skincancer.org/prevention/tanning/taleoftanning