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Long-term Effects of a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

Long-term Effects of a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

Indoor tanning (IT) increases risk of developing melanoma, yet IT remains popular with some teen girls. Mothers can influence IT initiation. Dr. David Buller, Director of Research at Klein Buendel, presented long-term effects of a social media intervention for indoor tanning at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021.

Several states require parents to consent or accompany minor children using IT facilities. Health Chat, a social media campaign was tested that aimed to reduce mothers’ permissiveness for their teen daughters to indoor tan, decrease mothers’ and daughters’ IT behavior, and increase mothers’ support for bans on IT by minors. A sample of mothers (n=869) with daughters aged 14-17 in 34 states without bans on IT by minors were enrolled in a 12-month randomized trial.

All mothers received a campaign on adolescent health in Facebook private groups containing posts on a variety of health topics (for example, substance abuse or mental health) and mother-daughter communication. In the intervention group, the campaign included posts about preventing IT, whereas in the control group, it included posts about preventing prescription drug misuse. Long-term effects were assessed by comparing mothers’ responses at baseline to responses at 18-months post-randomization. Measures assessed permissiveness for daughters to indoor tan, self-efficacy for refusing permission for IT, communication with daughters about avoiding IT, attitudes and intentions toward IT, IT behavior, and support for state bans on IT by minors. The daughters (n=469) only completed baseline and follow-up assessments.

At the 18-month follow-up, intervention-group mothers were less permissive of IT by daughters, reported more communication with daughters about avoiding IT, had greater self-efficacy to refuse daughter’s request for IT, expressed less positive attitudes toward IT, had lower intentions to indoor tan, and were more supportive of bans on IT by minors under age 18 than control-group mothers. At 18-months, daughters in the intervention group had less positive attitudes toward IT than in the control group.

Social media may be an effective channel to convince mothers to withhold permission for IT by daughters and thus reduce IT by minors in states requiring parental permission provided IT facility operators request this permission. Increased support among mothers for bans on IT might facilitate efforts to place more restrictions on IT.

This research project is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborators on the conference presentation include Dr. Sherry Pagoto and Jessica Bibeau from the University of Connecticut; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Experiences from the Health Chat Intervention

Experiences from the Health Chat Intervention

Dr. David Buller, Director of Research at Klein Buendel, presented experiences from the Health Chat Intervention during a symposium at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021. Health Chat is a social media intervention for mothers and their teenage daughters designed to influence their decisions related to indoor tanning.

Despite declines in recent years, indoor tanning (IT) remains popular with some adolescent females. IT initiation can be influenced by mothers’ permissiveness toward IT and IT behavior. Social media is a popular channel with mothers for adolescent health information. Our research team developed a series of social media posts to prevent IT and evaluated their impact on mothers’ permissiveness, mothers’ and daughters’ IT attitudes, intentions, and behavior, and mothers’ support for bans on IT by minors. Investigators used an iterative method to develop theory-based social media posts, based on diffusion of innovations theory, social cognitive theory, and transportation theory of narratives.

Two innovative research techniques were employed. First, to stimulate engagement with the IT messaging, posts were embedded in a larger social media campaign on adolescent health (for example, substance abuse, diet and physical activity, and mental wellness), with 2-3 posts on IT (about 113 posts total) among the 14 health posts per week (about 710 posts total). Frequency and currency of IT posts were adjusted to avoid message fatigue and disengagement. Second, the campaign was delivered to in two Facebook private groups to create experimental separation, with control-group mother receiving posts on preventing prescription drug misuse. Recruitment was challenging with initial community-based techniques (such as schools, community groups/events, and out-calls) being largely unsuccessful.

The sample of mothers (n=869) was ultimately obtained from the Qualtrics Internet Panel from 34 states without bans IT by minors. They completed assessments at baseline and 12- and 18-months post randomization. Daughters were invited to complete baseline and follow-up assessments but just over half did so at baseline. Most mothers (87%) stayed in the private groups for the entire 12-month campaign and 277 mothers engaged with the IT posts. The effects of the IT posts in 12- and 18-months follow-ups were most evident in mothers’ reduced permissiveness and increased communication with daughters about the harms of IT. It also reduced mothers’ intentions to indoor tan. At the long-term follow-up, the campaign increased mothers’ support for bans on IT by minors and self-efficacy to refuse IT request from daughters. While there was no direct effect on mothers’ or daughters’ IT behavior, these changes may serve to prevent daughters from engaging in IT in the future. They also could help to support public policy efforts to curb further IT by minors.

This research project is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators).

Listen to the Health Chat presentation:

Investigation of Indoor Tanning Policy Enactment

Investigation of Indoor Tanning Policy Enactment

Klein Buendel is collaborating with Dr. Carolyn Heckman and her team from Rutgers University on a new research project to study the process of translating indoor tanning policy efforts into stringent legislation and compliance, and the effects of the legislation on reduced indoor tanning by minors in the United States.

Indoor tanning is a well-established cause of skin cancer (1-8,10). Most tanners begin indoor tanning as teens or young adults (22). In order to reduce indoor tanning and protect this at-risk population, indoor tanning is currently being regulated in two ways. First, some states restrict access by minors or require parental consent or accompaniment (11). Second, the Food and Drug Administration (FDA) attempts to minimize harm from indoor tanning devices with precautions like protective eyewear and session duration limits (12).  Recent evidence suggests that more stringent indoor tanning laws such as age bans (vs. parent consent laws or no law) are associated with less youth indoor tanning (15,16). Unfortunately, enforcement and compliance with laws are variable and inadequate (9,17-21). Although underutilized (13), legislation such as age restrictions and taxation has been quite successful in decreasing engagement in other risky behaviors such as smoking (14).

The goals of this five-year research project are to (1) clarify the indoor tanning legislation adoption process, (2) employ a pseudo-patron assessment, national survey, and archival data to investigate legislation implementation, and (3) integrate data from the first two aims and external data to assess economic effects relevant to policy sustainability of indoor tanning stringency, enforcement, and compliance.

Health-related policy adoption and promotion is an effective, yet underutilized, strategy for health promotion. To protect the public from melanoma and non-melanoma skin cancer, government bodies have begun to enact legislation to restrict minor access to indoor tanning and minimize harm from indoor tanning devices. In order to contribute to the currently limited evidence base for future policy decision making and sustainability and to accelerate reductions in indoor tanning and sunburn, this project will address policy characteristics associated with regulation compliance, cost-benefits of these policies, and barriers and facilitators of policy adoption.

This research project is funded by the National Cancer Institute (CA244370; Dr. Carolyn Heckman, Rutgers University, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Collaborators include Dr. Rich Meenan from the Kaiser Permanente Center for Health Research; Dr. Jared Stapleton from the University of Kentucky; Dr. Shawna Hudson, Dr. Cristine Delnevo, and Dr. Kevin Schroth from Rutgers University; and Julia Berteletti from Klein Buendel.

References

  1. Lergenmuller S, Ghiasvand R, Robsahm TE, et al. Association of Lifetime Indoor Tanning and Subsequent Risk of Cutaneous Squamous Cell Carcinoma. JAMA dermatology. 2019:1-9.
  2. O’Sullivan DE, Brenner DR, Villeneuve PJ, et al. Estimates of the current and future burden of melanoma attributable to ultraviolet radiation in Canada. Preventive medicine. 2019;122:81-90.
  3. Gandini S, Dore JF, Autier P, Greinert R, Boniol M. Epidemiological evidence of carcinogenicity of sunbed use and of efficacy of preventive measures. Journal of the European Academy of Dermatology and Venereology : JEADV. 2019;33 Suppl 2:57-62.
  4. Suppa M, Gandini S. Sunbeds and melanoma risk: time to close the debate. Current opinion in oncology. 2019;31(2):65-71.
  5. O’Sullivan DE, Brenner DR, Demers PA, Villeneuve PJ, Friedenreich CM, King WD. Indoor tanning and skin cancer in Canada: A meta-analysis and attributable burden estimation. Cancer epidemiology. 2019;59:1-7.
  6. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ : British Medical Journal. 2012;345:e4757.
  7. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: Systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2014;70(5):847-857.e818.
  8. El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens–part D: radiation. The Lancet Oncology. 2009;10(8):751-752.
  9. Reimann J, McWhirter JE, Papadopoulos A, Dewey C. A systematic review of compliance with indoor tanning legislation. BMC public health. 2018;18(1):1096.
  10. Burgard B, Schoepe J, Holzschuh I, et al. Solarium use and risk for malignant melanoma: meta-analysis and evidence-based medicine systematic review. Anticancer research. 2018;38(2):1187-1199.
  11. National Council of State Legislatures. Indoor Tanning Restrictions for Minors: A State by State Comparison. http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Published 2018. Updated 11/2/2018. Accessed.
  12. Food and Drug Administration. Sunlamp products and ultraviolet lamps intended for use in sunlamp products. In. Vol 8. Silver Spring, MD: Food and Drug Administration; 2018.
  13. Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. American journal of preventive medicine. 2010;38(3 Suppl):S351-363. PMCID: PMC4515751.
  14. Brownson RC, Haire-Joshu D, Luke DA. SHAPING THE CONTEXT OF HEALTH: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases. Annual Review of Public Health. 2006;27(1):341-370.
  15. Guy GP, Berkowitz Z, Jones SE, Holman DM, Garnett E, Watson M. Trends in indoor tanning among US high school students, 2009-2013. JAMA dermatology. 2015;151(4):448-450.
  16. Qin J, Holman DM, Jones SE, Berkowitz Z, Guy Jr GP. State Indoor Tanning Laws and Prevalence of Indoor Tanning Among US High School Students, 2009–2015. American journal of public health. 2018;108(7):951-956.
  17. Driscoll DW, Darcy J. Indoor Tanning Legislation: Shaping Policy and Nursing Practice. Pediatric nursing. 2015;41(2).
  18. Gosis B, Sampson BP, Seidenberg AB, Balk SJ, Gottlieb M, Geller AC. Comprehensive evaluation of indoor tanning regulations: a 50-state analysis, 2012. Journal of Investigative Dermatology. 2014;134(3):620-627.
  19. Mayer JA, Hoerster KD, Pichon LC, Rubio DA, Woodruff SI, Forster JL. Peer Reviewed: Enforcement of State Indoor Tanning Laws in the United States. Preventing chronic disease. 2008;5(4).
  20. Williams MS, Buhalog B, Blumenthal L, Stratman EJ. Tanning salon compliance rates in states with legislation to protect youth access to UV tanning. JAMA dermatology. 2018;154(1):67-72.
  21. Woodruff SI, Pichon LC, Hoerster KD, Forster JL, Gilmer T, Mayer JA. Measuring the stringency of states’ indoor tanning regulations: instrument development and outcomes. Journal of the American Academy of Dermatology. 2007;56(5):774-780.
  22. Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: the time is now. CA: a cancer journal for clinicians. 2016;66(6):460-480.

Mothers’ Support for Laws Restricting Indoor Tanning by Minors

Mothers’ Support for Laws Restricting Indoor Tanning by Minors

The Health Chat research team published some findings related to indoor tanning from their Facebook-delivered cancer risk reduction intervention and randomized trial with mothers and teen daughters as an abstract in the Annals of Behavioral Medicine. The research team would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

Indoor tanning is associated with increased risk for melanoma, especially in young women. Several states restrict indoor tanning by minors or require parental permission. The authors of this abstract hypothesize that mothers’ awareness of state laws related to indoor tanning by youth may reduce their permissiveness for daughters to use tanning facilities.

A total of 777 mothers (and their daughters) from 34 states that do not ban indoor tanning participated in the trial. Less than 20% of mothers (and fewer daughters) accurately reported whether their state has an age restriction or parental permission requirement for minors to indoor tan. More than 50% of the mothers supported banning indoor tanning by minors. However, the mothers reported varying levels of advocacy that they would be willing to demonstrate related to enacting state-level policy to restrict indoor tanning by minors (e.g., sign a petition, contact an elected representative, testify to a state legislative committee). 

The authors conclude that: “Efforts to inform mothers and daughters may be needed to create a norm against indoor tanning, to prevent moms from permitting indoor tanning by daughters, and to build support for further restrictions on minors’ access.”

This research is funded by a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Co-authors include Dr. Katie Baker, Dr. Joel Hillhouse, and Jessica Bibeau from East Tennessee State University; Dr. Kim Henry from Colorado State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Collaborator Spotlight:
Dr. Kimberly Henry

Collaborator Spotlight:
Dr. Kimberly Henry

Kimberly Henry, Ph.D., is a Professor at the Colorado State University Department of Psychology in Fort Collins, Colorado. She received her Ph.D. in biobehavioral health from The Pennsylvania State University.  Her areas of research expertise include school disengagement, adolescent and young adult development, drug use, delinquency and longitudinal methodology. Her focus is on the psychological and social factors that produce or mitigate the health-risking behaviors of adolescents and young adults. Her goal is to develop and test theoretical models in order to understand the complex interactions of risk, promotive, and protective factors that influence risky behaviors and to create and test methods for prevention.

Currently, Dr. Henry is collaborating with Dr. David Buller, Principal Investigator from Klein Buendel, on the research study Likes Pins and Views: Engaging Moms on Teen Indoor Tanning Thru Social Media (CA192652). This study focuses on the use of a social media campaign for mothers on the health and wellness of adolescent daughters. The intervention included theory-based messaging advocating adolescent girls avoid indoor tanning delivered through private Facebook groups. Overall, the research is evaluating the effectiveness of social media indoor tanning messages at decreasing mothers’ permissiveness for daughters to indoor tan. The research is also assessing daughters’ perceptions of their mothers’ permissiveness, prevalence of indoor tanning by mothers and daughters, and mothers’ support for bans on indoor tanning by minors.

In addition to research, Dr. Henry serves on the editorial boards for the Journal of Youth and Adolescence, the Journal of Primary Prevention, Adolescent Research Reviews, and Occupational Health Science. She serves as an ad hoc reviewer for multiple journals, and for the William T. Grant Foundation and the National Institutes of Health.

Health Chat Presentation for NCI

Health Chat Presentation for NCI

Dr. David Buller from Klein Buendel presented initial findings from an ongoing social media campaign for mothers to improve adolescent health and reduce indoor tanning, called Health Chat, via webinar to the Health Communication and Informatics Research Branch of the National Cancer Institute on December 10, 2019.

Despite the substantial risk of skin cancer from indoor tanning, it remains popular among older adolescent females aged 14-17 and mothers aged 27-45. The CDC1 and the Surgeon General2 have set a national goal of reducing indoor tanning by teens and public policies restricting indoor tanning are increasing. However, many states still allow minors to indoor tanning, with varying forms of restriction.3 

Because mothers’ permissiveness of indoor tanning and her own indoor tanning are strong predictors of adolescent daughters indoor tanning, and many daughters initiate indoor tanning with their mother, the research team developed a program aimed at moms in an effort to reduce indoor tanning by minors. A multi-faceted adolescent health and wellness campaign was created to be delivered through Facebook private groups that included messages on indoor tanning prevention, prescription drug misuse, vaccinations, healthy lifestyles, substance use, mother-daughter communication, and more. Mothers (n=869) were in the groups for one year and received messages daily. Mothers and their daughters completed surveys at baseline and 12-month follow-up, and 18-month follow-up surveys are currently underway.

Dr. Buller reported on how the Health Chat program was created, the potential of using social media for research, campaign engagement measures, and initial findings from the 12-month follow-up survey of mothers and daughters. He shared methodological challenges that arose from using Facebook private groups such as Facebook algorithms changing, the inability for participants to share content outside of the groups, and logistical barriers of adding participants to groups. He also shared plans for coding user-generated content,4 including hundreds of comments left by mothers on the Facebook posts. Full results should be published in 2020.

This research was funded by a grant to Klein Buendel from the National Cancer Institute [CA192652; Dr. David Buller and Dr. Sherry Pagoto (from the University of Connecticut), Multiple Principal Investigators]. Co-Investigators include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, and Dr. Kimberly Henry from Colorado State University.

References

1. Healthy People 2020 – topics & objectives. Office of Disease Prevention and Health Promotion Web site. Available at: https://www.healthypeople.gov/2020/topics-objectives. Published 2012. Accessed December 17, 2019.

2. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General; 2014.

3. National Conference of State Legislatures. Indoor tanning restrictions for minors: A state-by-state comparison. National Conference of State Legislatures Web site. Available at: http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Published May 20, 2019. Accessed December 17, 2019.

4. Buller D, Walkosz B, Berteletti J, et al. Insights on HPV vaccination in the United States from mothers’ comments on Facebook posts in a randomized trial. Hum Vaccin Immunother. 2019;15(7-8):1479-1487. doi: 10.1080/21645515.2019.1581555