Terry Slevin

Background: Skin cancer is one of the most common types of cancer in the world and incidence rates are increasing globally. Efforts to encourage individuals to engage in sun protection behaviors that minimize their risk of skin cancer are therefore urgently needed. In Australia, the context of the current study, UV radiation levels are particularly intense and public health campaigns have been successful in encouraging behaviors such as using sunscreen and wearing a hat. However, recent years have seen a plateau in engagement in such behaviors and new approaches are required to facilitate further gains. Encouraging people to check their skin for signs of skin cancer may be one such approach as it has the potential to increase the salience of skin cancer and the need to protect oneself from UV radiation. Aim: To assess the relationship between skin checking and sun protection behaviors to inform skin cancer prevention campaigns. Methods: Computer-assisted telephone interviewing was used to survey nearly 700 adults. Frequency of engagement in various sun protection behaviors (wearing a hat, wearing protective clothing, using sunscreen) was assessed. Respondents were also asked whether they had checked their skin for skin cancer and how confident they were in their ability to spot the signs of skin cancer. Results: Path analysis revealed greater confidence in one's ability to detect the signs of skin cancer to be associated with skin checking. In turn, skin checking was found to be associated with more frequent engagement in all of the assessed sun protection behaviors. Conclusions: Public health campaigns that increase people's confidence in their ability to detect the signs of skin cancer have the potential to encourage skin cancer reduction behaviors in the form of both skin checking and sun protection and perhaps shift the plateau in engagement of sun protection behaviors observed in recent years.

Background: Although alcoholic beverages were classed as a Group 1 carcinogen over a quarter of a century ago, there is a lack of public awareness of this cancer risk relative to other alcohol-related risks. Increasing drinkers’ awareness of the cancer risk associated with alcohol consumption has therefore been identified as an important component of alcohol harm minimization strategies, with mandatory health warning labels on alcoholic beverage containers considered an important component of such strategies. Aim: To assess the overall effectiveness of a warning statement advising of the cancer risk associated with alcohol consumption and effectiveness relative to statements advising of other health risks. Methods: An online survey was administered to 364 Australians (72% male) who reported drinking at levels associated with long-term risk of harm. Respondents were randomly exposed to one of five statements relating to the risks associated with alcohol consumption (cancer, liver damage, diabetes, mental illness, heart disease). Pre and post measures of risk beliefs and drinking intentions were taken. Results: Exposure to a warning statement advising of the cancer risk associated with alcohol consumption resulted in (i) a significant increase in the extent to which respondents exposed to that statement believed alcohol to be a risk factor for cancer and (ii) a significant reduction in consumption intentions. Exposure to the cancer risk statement was associated with the second largest pre to post change in consumption intentions behind the diabetes risk statement. Conclusion: Warning statements informing drinkers of the cancer risk associated with alcohol consumption can produce (i) increases in the awareness of alcohol-related cancer risk and (ii) favorable changes in drinking intentions.

Excessive sun exposure and sunburn increase individuals’ risk of skin cancer. It is especially important to prevent sunburn in childhood due to the higher relative risk of skin cancer across the life span compared to risk associated with sunburn episodes experienced later in life. This study examined demographic and attitudinal factors associated with engagement in a range of sun protection behaviours (wearing a hat, wearing protective clothing, staying in the shade, and staying indoors during the middle of the day) and the frequency of sunburn among Western Australian adolescents to provide insights of relevance for future sun protection campaigns. Cross-sectional telephone surveys were conducted annually with Western Australians between 2005/06 and 2014/15. The results from 4150 adolescents aged 14–17 years were used to conduct a path analysis of factors predicting various sun protection behaviours and sunburn. Significant primary predictors of the sun protection behaviours included in the study were skin type (sun sensitivity), gender, tanning-related attitudes and behaviours, and perceived relevance of public service advertisements that advocate sun protection. Of the four sun protection behaviours investigated, staying in the shade and staying indoors during the middle of the day were associated with a lower frequency of sunburn. There is a particular need to target sun protection messages at adolescent males who are less likely to engage in the most effective sun protection behaviours and demonstrate an increased propensity to experience sunburn. The results suggest that such future sun protection messages should include a focus on the importance of staying in the shade or indoors during periods of high UV radiation to increase awareness of the efficacy of these methods of avoiding skin cancer.

The evidence surrounding the value of workplace health promotion in positively influencing employees’ health and wellbeing via changes to their health behaviours is growing. The aim of the study was to explore employers’ views on the promotion of workplace health and wellbeing and the factors affecting these views. Using a qualitative phenomenological approach, 10 focus groups were conducted with employers selected from a range of industries and geographical locations within Western Australia. The total sample size was 79. Three factors were identified: employers’ conceptualization of workplace health and wellbeing; employers’ descriptions of (un)healthy workers and perceptions surrounding the importance of healthy workers; and employers’ beliefs around the role the workplace should play in influencing health. Progress may be viable in promoting health and wellbeing if a multifaceted approach is employed taking into account the complex factors influencing employers’ views. This could include an education campaign providing information about what constitutes health and wellbeing beyond the scope of occupational health and safety paradigms along with information on the benefits of workplace health and wellbeing aligned with perceptions relating to healthy and unhealthy workers.

Adults living in the sunny Australian climate are at high risk of skin cancer, but vitamin D deficiency (defined here as a serum 25-hydroxyvitamin D (25(OH)D) concentration of less than 50 nmol/L) is also common. Vitamin D deficiency may be a risk factor for a range of diseases. However, the optimal strategies to achieve and maintain vitamin D adequacy (sun exposure, vitamin D supplementation or both), and whether sun exposure itself has benefits over and above initiating synthesis of vitamin D, remain unclear. The Sun Exposure and Vitamin D Supplementation (SEDS) Study aims to compare the effectiveness of sun exposure and vitamin D supplementation for the management of vitamin D insufficiency, and to test whether these management strategies differentially affect markers of immune and cardio-metabolic function. The SEDS Study is a multi-centre, randomised controlled trial of two different daily doses of vitamin D supplementation, and placebo, in conjunction with guidance on two different patterns of sun exposure. Participants recruited from across Australia are aged 18–64 years and have a recent vitamin D test result showing a serum 25(OH)D level of 40–60 nmol/L. This paper discusses the rationale behind the study design, and considers the challenges but necessity of data collection within a non-institutionalised adult population, in order to address the study aims. We also discuss the challenges of participant recruitment and retention, ongoing engagement of referring medical practitioners and address issues of compliance and participant retention. Australia New Zealand Clinical Trials Registry: ACTRN12613000290796 Registered 14 March 2013.

Objectives: To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening Program (NBCSP) on the number of bowel cancer deaths prevented; and to investigate the impact ...