Ms. Anna Mitarotondo, a Research Program Manager from Rutgers University, gave a Research Spotlight presentation on the Indoor Tanning Policy research project at the 45th Annual Sessions and Meeting of the Society of Behavioral Medicine in Philadelphia, PA, March 13-16, 2024. Dr. Carolyn Heckman from Rutgers and Dr. David Buller from Klein Buendel are the project’s Multiple Principal Investigators.
Ms. Anna Mitarotondo, Rutgers University
Five million Americans are treated for skin cancer annually with the incidence of melanoma tripling in the last 40 years. Even a single session of indoor tanning is a well-established cause of melanoma especially at younger ages. Indoor tanning is also associated with sunburn, another major risk factor. In addition to FDA safety regulations, 46 states restrict minor indoor tanning access. More stringent laws (such as age bans vs. parental consent or no law) have been associated with less youth indoor tanning. However, enforcement and compliance are essential for successful law implementation. This study investigates regulation stringency, behavior, facility compliance, and sunburns.
The research team conducted an online, nationally representative survey of 1000 individuals aged 18-29 who indoor tanned in the last three years. 82% identified as female, and 74% as white, non-Hispanic. A majority (89%) indoor tanned multiple times in the past three years. Participants reported being most likely to tan in indoor tanning salons, gyms, and beauty salons. They also reported indoor tanning in homes, spas, and apartment complexes, with participants indoor tanning in more types of facilities after age 18. Despite FDA recommendations, participants reported that only 16% of facilities prohibited daily or unlimited tanning. Nearly half (48%) of participants were not informed of time limits when indoor tanning. Half (50%) reported that over half of the time, they were able to avoid indoor tanning facility rules. Nearly two-thirds (61%) of participants reported burning from an indoor tanning device in the past three years, with 15% reporting a burn from their most recent session. Of participants who reported indoor tanning as minors, 61% reported burns and 30% reported getting medical attention.
This is the first study to show rates of indoor tanning at facilities other than tanning salons, both before and after age 18, in a representative national sample. Participants reported insufficient facility compliance with, and enforcement of, indoor tanning regulations, which in some cases may have led to severe burns. Analyses are underway to further investigate regulation stringency, enforcement, and compliance by type of facility and state, adjusting for demographic factors and additional key covariates. The goal is to inform future indoor tanning policies at the state and federal level.
This research was supported by a grant to Rutgers from the National Cancer Institute (CA244370; Dr. Carolyn Heckman and Dr. David Buller, Multiple Principal Investigators). Coauthors included and Ms. Maame Araba Assan from Rutgers University, Dr. Jerod Stapleton from the University of Kentucky, and Ms. Julia Berteletti from Klein Buendel.
Physical Activity, Motivation, and Social Media Content
Klein Buendel Scientist, Dr. Kayla Nuss, and her collaborators presented two groundbreaking posters on physical activity and exposure to social media physical activity content at the 45th Annual Sessions and Meeting of the Society of Behavioral Medicine in Philadelphia, PA, March 13-16, 2024. The research delved into three types of physical activity content: fitspiration, body positivity, and body neutrality.
Poster 1
Title: Associations Between Exposure to Fitspiration, Body Positive, and Body Neutral Social Media Content and Physical Activity Engagement: A Cross-Sectional Analysis
Dr. Kayla Nuss
Presenter: Dr. Kayla Nuss
In 2021, nearly 70% of Americans reported using social media, a statistic that has remained fairly constant since 2016. The fitspiration trend, which has become increasingly popular on most social media platforms, encourages users to share fitness inspiration content, including health and fitness tips and motivational posts. However fitspiration exposure has no significant effect on physical activity (PA) intentions or engagement.1
The body positivity movement emerged as a direct response to fitspiration, featuring a range of diverse body sizes and types, including fat and plus-sized influencers engaging in activities. Evidence indicates that exposure to body positive content is associated with greater intentions for physical activity and increased engagement when compared to fitspiration content. A third social media movement, body neutrality, focuses on the functionality and appreciation of the body for not how it looks, but rather what it can do. To our knowledge, no study has explored the association between body neutrality exposure and PA engagement. As such, the purpose of this study is to assess the associations among exposure to fitspiration, body positive, and body neutral social media content and PA behavior.
Two-hundred and thirty-seven (237) participants responded to a survey that included the validated Global Physical Activity Questionnaire (GPAQ) to assess weekly moderate to vigorous PA (MVPA) and sedentary time. In addition, the authors assessed participants’ exposure to social media fitspiration, body positive, and body neutral content. During data cleaning, they categorized exposure to the three content types into “no exposure,” “low exposure,” “moderate exposure”, and “high exposure”. The authors also collected demographic and anthropomorphic data. Using a series of analyses of variance tests, they investigated associations among different levels of exposure to fitspiration, body positive, and body neutral content, and PA engagement.
Biological sex had a significant main effect on weekly minutes of MVPA, and was included it in the models. Exposure to fitspiration had no significant effect, but exposure to both body positive content and body neutrality content did. Post-hoc comparisons revealed that in both contexts, participants who reported high exposure to either body positive or body neutral content had significantly more minutes of weekly MVPA than those who reported no exposure levels and low exposure levels, respectively.
The authors concluded that whereas fitspiration content is intended to inspire physical activity and fitness, there is no association between it and engagement. Interventionists may consider creating programs leveraging body positive or body neutral content to increase PA among social media users.
This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Coauthors included Dr. Dani Arrigo from Rowan University and Ms. Julia Berteletti from Klein Buendel.
Poster 2
Title: Interaction Effects of Amotivation for Physical Activity and Fitness Social Media Exposure on Physical Activity Intentions
Presenter: Dr. Kayla Nuss
Nearly half of Americans seek fitness, physical activity (PA), and health advice from social media platforms like Facebook and Instagram. Further, nearly 20% have changed a component of their wellness regimen based on that advice. There are three main categories of physical and activity content on social media, each with its own content themes:
Fitspiration features mostly white, thin, Women, unengaged in PA and has no discernable association with motivation or PA engagement.1
Body positive content features diverse bodies, including fat and plus-sized influencers engaged in PA,and has been associated with greater intentions for PA. Associations with motivation and engagement are unknown.
Body neutrality is centered on the functionality of the body, rather than appearance.
To date, no study has examined its associations with PA motivation, intention, or engagement. The purpose of this study is to examine cross-sectional associations of exposure to fitness social media content with Self-Determination Theory motivational subtypes, and PA intention and engagement.
A total of 237 participants responded to a survey that included the validated Global Physical Activity Questionnaire (GPAQ) to assess weekly moderate to vigorous PA (MVPA). The authors examined intention for PA using the Behavioral Intentions Scale and assessed motivation for PA using the Behavioral Regulations in Exercise Scale. The authors also assessed participants’ exposure to social media fitspiration, body positive, and body neutral content. They categorized exposure to the three content types into “no exposure,” “low exposure,” “moderate exposure”, and “high exposure.” They also collected demographic and anthropomorphic data. Using a series of analyses of variance tests, the authors investigated associations among different levels of exposure to fitspiration, body positive, and body neutral content, and motivation, PA intention, and engagement.
For the reporting of results, the authors first examined interaction effects between exposure to fitness content and each of the motivational subtypes on PA intention and behavior. They identified a significant interaction of amotivation (having no drive for the behavior) and exposure to both fitspiration and body positive content on PA intentions, but not engagement. Specifically, highly amotivated individuals who also reported high exposure to these social media types reported greater intentions for PA than those who reported moderate, low, or no exposure. There was no significant interaction effect between amotivation and body neutral exposure on PA intentions nor engagement.
The authors concluded that interventionists may consider exposing highly amotivated individuals to fitspiration or body positive social media to potentially increase intentions for PA. However, the intention-behavior gap must also be addressed in this population.
This research was sponsored by Klein Buendel and led by Dr. Kayla Nuss. Coauthors included Dr. Dani Arrigo from Rowan University and Ms. Julia Berteletti from Klein Buendel.
References
Nuss K, Coulter R, Liu S. Content of social media fitspiration and its effect on physical activity-related behavior: A systematic review. Psychology of Popular Media. Published online 2023.
#4Corners4Health: Protocol for a Randomized Stepped-Wedge Trial
Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are leading a large multiple state research team on the design, implementation, and evaluation of #4Corners4Health. The research study aims to decrease cancer risk factors among emerging adults (ages 18-26) living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah using a targeted social media campaign. The team has published a full description of their study procedures in JMIR Research Protocols.
Many emerging adults are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among emerging adults delivered over social media is limited. Cancer prevention information and recommendations may reach emerging adults more effectively over social media than in settings such as health care, schools, and workplaces, particularly for emerging adults residing in rural areas.
Specifically, the research team will recruit a sample of 1000 emerging adults aged 18 to 26 years residing in rural counties in the Four Corners states from the Qualtrics’ research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and HPV vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and emerging adults and focus groups with emerging adults. The emerging adults will complete assessments at baseline and five additional data after randomization. Assessments will measure six cancer risk behaviors, theoretical mediators, and participants’ engagement with the social media campaign.
The trial is being led by a steering committee. Team members are working in three subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by emerging adults, and community resources available. A framework for the social media intervention with topics, format, and theoretical mediators has been created, along with protocols for social media management.
In summary, the researchers believe that social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among emerging adults. Because of the popularity of web-based information sources among emerging adults, an innovative, multiple risk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.
This research is supported by a 5-year R01 grant from the National Cancer Institute (CA268037) to Klein Buendel. Dr. David Buller from Klein Buendel and Dr. Andrew Sussman from the University of New Mexico are the project’s Multiple Principal Investigators. The JMIR publication has 24 collaborating authors from multiple institutions.
