Summary of the impact

The impact of the research described in this case study lies in its ability to identify, appraise, select and synthesise skin cancer prevention interventions, and identify the main predictors of ultra-violet (UV) behaviour. The findings have been used to highlight the power of a `tanned appearance', and to develop an appearance-based intervention, in order to bring about behavioural change in relation to UV tanning in the UK. The target audience for this research impact is both the general public, and health professionals, with the message that interventions aimed at knowledge are likely to be less successful than those focussed on appearance.

Underpinning research

The two research projects that form the foundation of this submission were conducted in response to the relatively high rates of skin cancer within the UK. This is widely considered to be due to the increase in UV exposure from the sun and other sources, and the lack of success in previous UV prevention interventions.

The first research project (Dodd & Forshaw, 2010) involved a systematic evaluation of the efficacy of appearance-based interventions in modifying UV exposure and/or protection from baseline to the end of the intervention period or at follow-up. This was the first review internationally to evaluate such interventions. The findings revealed that such interventions are a breakthrough alternative for modifying UV intentions, protection behaviours and UV behaviour.

The second research project (Dodd, Forshaw and Williams, 2013) followed on from the findings of the systematic review, which had focussed heavily on young adults. Whilst appearance-based interventions may be a breakthrough alternative to health consequence interventions, there was no comprehensive picture of the factors that influence the decisions to engage in indoor tanning by young people within the UK. The project examined the UV intentions and behaviour of young people living within the UK using an extended Theory of Planned Behaviour (TPB) model that included variables on `appearance reasons to tan', `perceived susceptibility to damaging appearance', `perceived susceptibility to health consequences', and `tanning knowledge'. A prospective questionnaire self-report survey design was conducted. The TPB was successful in predicting indoor tanning intentions and behaviour within a UK sample. Furthermore, a current tanned appearance seemed to outweigh any adverse future appearance or health consequences caused by UV exposure. This outcome supports the notion of appearance-based interventions to reduce such behaviour.

This research was all carried out at Newman University between 2009 and 2011. Both projects were carried out with members of the Psychology team, including Stella Williams, and were led by Dr Lorna Dodd, Acting Head of Psychology during this period at Newman University. Both projects were also collaborations with the University of Staffordshire, specifically with Dr Mark Forshaw.

Both projects resulted in journal publications and conference presentations (poster and oral). The findings have had regional and national impact. In 2011, the findings were described and discussed in the Sunday Times Magazine (27 November 2011), and as a current affairs item on BBC London radio (28 November 2011). This research presents a clear exposition of the extent of UV exposure worldwide but specifically within the UK, and clearly highlights the need for appearance-based interventions emphasising the negative effects of UV exposure on appearance. It further highlights the importance of a tanned appearance within a UK sample, signifying the importance of appearance-based interventions.

The outputs around this case study have led to an increase in awareness about the risks of tanning, particularly through coverage in national print media and associated online reporting. Both projects raise important contextual issues and questions, especially with regard to the power of appearance in today's current climate.

References to the research

Details of the impact

In 2011, The Sunday Times Magazine published an article titled 'I want to be lighter. She wants to be darker' (27 November 2011), thereby reaching a potential readership of over 2.5 million nationally. The article was also made available online, and remains accessible on the internet to the present day (http://www.thesundaytimes.co.uk/sto/Magazine/Features/article824391.ece). This article focussed on Dr Dodd's findings, emphasising that whilst young people are knowledgeable about the risk of tanning and the link between UV rays and cancer, they still prioritise tanning over any adverse future appearance or health consequences.

The research findings were then discussed as a current affairs item on BBC London Radio 94.9 (28 November 2011). BBC London Radio had listener figures of 474,000 in late 2011 (http://www.mediauk.com). Such media coverage at both regional and national levels will have led to an increase in awareness amongst the general population of the risks of tanning, with a consequent impact upon attitudes and hopefully tanning behaviour. Dr Lorna Dodd has since gone on to develop the first UK based appearance-based intervention.

In addition, Dr Dodd presented this research as part of a presentation at Primary Care and Public Health 2013, Birmingham (Dodd, L. & Forshaw, M.J. "Indoor Tanning and Young Adults — How to Change Behaviour and Prevent Skin Cancer"). This is the UK's leading event for GPs, commissioning groups and all healthcare professionals working in primary and community care. 130 people registered to attend the presentation given by Dr Dodd. As a result, the findings of the research have reached both the general public and a professional audience of GPs and allied healthcare professionals.

Findings from this project were also presented at the following conferences:

Appearance Matters, 5^th Conference, July 2012, Bristol (Dodd, L., Bergin, K., Blackwell Young, J. & Hogan, K. The impact of an appearance-based workbook intervention on young adult's indoor tanning intention).

Division of Health Psychology Conference, 14-16 September 2011, Southampton University (Dodd, L., Forshaw, M. & Williams, S. Utility of an extended theory of planned behaviour model for understanding indoor tanning within UK young adults).

British Psychological Society Annual Conference, 14-16 April 2010, Stratford-upon-Avon (Dodd, L. & Forshaw, M. Preventing skin cancer: A systematic review of appearance focused interventions).

Sources to corroborate the impact

1. Professor of Public Health, The College of Public Health, East Tennessee State University.
2. Link to Sunday Times article online:
   http://www.thesundaytimes.co.uk/sto/Magazine/Features/article824391.ece
3. Conference Manager, Sterling Events: http://www.primarycare2013.co.uk/