Do ultraviolet photos increase sun safe behavior expectations via fear? A randomized controlled trial in a sample of U.S. adults
Ultraviolet (UV) photos reveal the world in a different light spectrum, including damage that is caused by UV light. In the context of skin cancer control, UV photos have the potential to communicate fear because they reveal underlying skin damage. U.S. adults (N = 2219) were assigned to a 5 (visual: UV skin damage, sun exposure, sunburn, photoaging, and mole removal) × 3 (replication: three examples of each visual condition) × 4 (efficacy: no efficacy, text only, visual, visual + text) randomized controlled trial. Compared to all other visual conditions combined, UV skin damage visuals generated greater fear which triggered increased sun safe behavior expectations. Compared with other visual conditions separately, only mole removal visuals produced equivalent fear as UV skin damage visuals. Visual efficacy conditions appeared to nullify rather than magnify the indirect path through fear. The results suggest one way UV images impact sun safe behavioral expectations is via fear and that researchers should continue to examine the position of fear in fear appeal theories.
KeywordsSkin cancer Sun-safe behaviors Fear appeal UV photo Visuals EPPM
This research was funded by a New Innovator grant (#DP2EB022360) from the National Institutes of Health (NIH) (PI: JDJ; Co-I: KKJ) and in part by the National Cancer Institute of the National Institutes of Health (K07CA196985 to YPW). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with ethical standards
Conflict of interest
Manusheela Pokharel, Katheryn R. Christy, Jakob D. Jensen, Elizabeth A. Giorgi, Kevin K. John, Yelena P. Wu have no conflicts of interest to declare.
Human and animal rights and Informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.
- Demierre, M. F., Maguire-Eisen, M., O’Connell, N., Sorenson, K., Berger, J., Williams, C., et al. (2009). A sun protection community intervention in Quincy middle schools: Insights from the use of ultraviolet photography and its impact on sunburn. Journal of the Dermatology Nurses’ Association, 1, 111–118.CrossRefGoogle Scholar
- Emmons, K. M., Geller, A. C., Puleo, E., Savadatti, S. S., Hu, S. W., Gorham, S., et al. (2011). Skin cancer education and early detection at the beach: A randomized trial of dermatologist examination and biometric feedback. Journal of the American Academy of Dermatology, 64(2), 282–289. https://doi.org/10.1016/j.jaad.2010.01.040 CrossRefPubMedGoogle Scholar
- Gamble, R. G., Asdigian, N. L., Aalborg, J., Gonzalez, V., Box, N. F., Huff, L. S., et al. (2012). Sun damage in ultraviolet photographs correlates with phenotypic melanoma risk factors in 12-year-old children. Journal of the American Academy of Dermatology, 67, 587–597. https://doi.org/10.1016/j.jaad.2011.11.922 CrossRefPubMedPubMedCentralGoogle Scholar
- Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
- Heckman, C. J., Handorf, E., Darlow, S. D., Yaroch, A. L., & Raivitch, S. (2017). Refinement of measures to assess psychosocial constructs associated with skin cancer risk and protective behaviors of young adults. Journal of Behavioral Medicine, 40, 574–582. https://doi.org/10.1007/s10865-017-9825-3 CrossRefPubMedPubMedCentralGoogle Scholar
- King, A. J. (2015a). Visual messaging and risk communication. In H. Cho, T. Reimer, & K. A. McComas (Eds.), Sage handbook of risk communication (pp. 193–205). Thousand Oaks, CA: Sage.Google Scholar
- Mahler, H. I. (2015). Interventions to promote sun protection behaviors: What do we know about the efficacy of health- and appearance-based messages and the role of cognitions and emotions? Social and Personality Psychology Compass, 9, 238–251. https://doi.org/10.1111/spc3.12173 CrossRefGoogle Scholar
- McCambridge, J., Kypri, K., & Elbourne, D. (2014). In randomization we trust? There are overlooked problems in experimenting with people in behavioral intervention trials. Journal of Clinical Epidemiology, 67, 247–253. https://doi.org/10.1016/j.jclinepi.2013.09.004 CrossRefPubMedPubMedCentralGoogle Scholar
- O’Keefe, D. J. (2003). Message properties, mediating states, and manipulation checks: Claims, evidence, and data analysis in experimental persuasive message effects research. Communication Theory, 13, 251–274. https://doi.org/10.1111/j.1468-2885.2003.tb00292.x CrossRefGoogle Scholar
- Stock, M. L., Gerrard, M., Gibbons, F. X., Dykstra, J. L., Weng, C.-Y., Mahler, H. I. M., et al. (2010). Sun protection intervention for highway workers: Long-term efficacy of UV photography and skin cancer information on men’s protective cognitions and behavior: Erratum. Annals of Behavioral Medicine, 39, 100. https://doi.org/10.1007/s12160-010-9179-3 CrossRefPubMedCentralGoogle Scholar
- Taylor, M. F., Westbrook, D., & Chang, P. (2016). Using UV photoaged photography to better understand Western Australian teenagers’ attitudes towards adopting sun-protective behaviors. International Journal of Adolescent Medicine and Health, 28, 45–53. https://doi.org/10.1515/ijamh-2014-0071 CrossRefPubMedGoogle Scholar
- Williams, A. L., Grogan, S., Clark-Carter, D., & Buckley, E. (2013). Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: A systematic review and meta-analyses. British Journal of Health Psychology, 18, 182–217. https://doi.org/10.1111/j.2044-8287.2012.02089.x CrossRefPubMedGoogle Scholar
- Witte, K. (2000). EPPM: Examples of items. Retrieved November 29, 2018 from https://msu.edu/~wittek/scale.htm