1. A mixed-method approach to mass media content about skin cancer and recreational tanning in teen girls’ magazines (2000-2012) Jennifer McWhirter PhD Candidate Laurie Hoffman-Goetz PhD, MPH

2. Skin Cancer, Tanning, and Mass Media 1 in 5

3. Skin Cancer, Tanning, and Mass Media

4. IARC & WHO Reports 2006 IARC Report 2009 WHO Report

5. Objective & Methods Evaluate volume & nature of skin cancer and tanning coverage in teen girls’ magazines (2000-2012) risk factors UV attitudes/behaviours early detection  time frame  content type

6. Methods Directed content analysis: 47 articles, 170 images Two magazines: Seventeen, Teen Vogue

7. Results: Time frame comparisons 2006 IARC Report: – increase in volume of coverage – mostly no change in skin cancer content 2009 WHO Report: – no change in volume of coverage – no change in skin cancer content

8. Results: Content type comparisons Text (vs images) more often: conveyed risk factors promoted UV protection/avoidance encouraged early detection Both text and images: promoted tanned look “Jamie wanted a ‘killer’ tan, and that’s what she got. She died when she was just 20.” Teen Vogue, 2010

9. Conclusions & Implications Minimal impact of landmark skin cancer & UV exposure reports Discordant messages between text and images Teen girls receiving mixed messages about skin cancer and tanning Funding Sources:

10. For cells with n < 5 expected cell count, Fisher’s exact test was used in place of the Chi- square test. Jennifer McWhirter, PhD Candidate & Laurie Hoffman-Goetz, PhD, MPH School of Public Health and Health Systems, University of Waterloo (Waterloo ON, Canada) A mixed-method approach to mass media content about skin cancer and recreational tanning in teen girls’ magazines (2000-2012) Objective Background Methods Results Conclusions and Implications To evaluate the volume and nature of skin cancer and tanning coverage in teen girls’ magazines (2000-2012) with regards to risk factors, UV attitudes and behaviours, and early detection information. The presence of these variables was compared by: 1) content type (text vs images); and 2) time frame (before vs after 2006 IARC and 2009 WHO reports). Research Orientation: Directed content analysis. Codes developed based on American Academy of Dermatology/Canadian Cancer Society risk factors, prevention behaviours, and early detection information for skin cancer, and prior research by authors. Data Collection: Highest-circulating North American female youth magazines – Teen Vogue (2,025,299), Seventeen (1,018,242) – identified; article text and images obtained for 2000- 2012 Coding Reliability: Inter-coder kappa scores were high ranging from 0.85 (e.g., protective clothing) to 1.00 (e.g., UV exposure). Statistical Analyses: Chi-square (  2 ) and Fisher’s exact test using SPSS v21; p<0.05 considered significant Data: 47 articles about skin cancer or tanning published between 2000 and 2012; 170 images within these articles (range=1-17 images per article; mean=4, SD=3) Melanoma is the most common cancer among 15-34 year olds in Canada; the incidence of skin cancer is increasing among young women. Skin cancer is largely preventable, with a high likelihood of survival when caught early. Mass media is an important and influential source of information about skin cancer and tanning. Indoor tanning is common among teen girls; primary reasons related to appearance. Two major international reports link skin cancer and recreational tanning (Group 1 carcinogen): 2006 International Agency for Research on Cancer (IARC) report and 2009 World Health Organization (WHO) report. Jamie wanted a “killer” tan, and that’s what she got. She died when she was just 20. Teen Vogue, 2010 With skin cancer on the rise among teen girls, there’s no excuse for skipping sunscreen. Seventeen, 2012 You don’t have to stop lying out altogether, but protection is a must. Seventeen, 2004 Summertime means showing off a glowing complexion, but you don’t need to hit the beach to achieve it. Teen Vogue, 2009 If you have chronic, unprotected sun exposure, your risk of developing skin cancer increases. Teen Vogue, 2008 Funding Sources: Text and Image Comparisons: Risk factors, except for UV exposure, were mentioned/depicted infrequently; conveyed more through text than images Text discouraged indoor tanning and promoted sunscreen use more frequently than images; other ways of protecting oneself from UV exposure were mentioned/depicted infrequently Little emphasis on screening (early detection) of skin cancer, but more so in text than images Both text and images promoted tanned look as cosmetically desirable Comparison of Skin Cancer Risk Factors Between Text & Images Comparison of UV Attitudes & Behaviours Between Text & Images Comparison of Screening Variables Between Text & Images Before and After 2006 IARC Report Before and After 2009 WHO Report Significantly more articles on skin cancer and tanning appeared after (65%) compared to before (35%) 2006 IARC Report (  2 =3.93, df=1, p=0.05) Only 3 articles mentioned the 2006 IARC report No significant differences for risk factors, UV attitudes & behaviours, or early detection variables in text or images before vs after this report, except for encouraging sunscreen use in text, which increased after 2006 (  2 =4.20, df=1, p=0.04) No significant difference in volume of articles appearing after (54%) compared to before (46%) 2009 WHO Report (  2 =0.14, df=1, not significant) No significant differences for risk factors, UV attitudes & behaviours, or early detection variables in text or images before vs after this report VariableTextImagesTest and Significance UV exposure46% (21)4% (7)  2 =55.36, df=1, p=0.00 Light skin/hair/eyes13% (6)14% (23)  2 =0.01, df=1, n.s. Moles (>50 or abnormal)15% (7)3% (5)2-sided Fisher’s, p=0.00 Personal/family history9% (4)0% (0)2-sided Fisher’s, p=0.00 Sunburns9% (4)0% (0)2-sided Fisher’s, p=0.00 VariableTextImagesTest and Significance Promotes tanned look74% (34)54% (92)  2 =5.84, df=1, p=0.02 Promotes self-tanners63% (29)30% (51)  2 =16.95, df=1, p=0.00 Promotes UV sun avoidance17% (8)15% (26)  2 =0.12, df=1, n.s. Discourages indoor tanning44% (20)0% (0)2-sided Fisher’s, p=0.00 Promotes shade9% (4)3.5% (6)2-sided Fisher’s, n.s. Promotes protective clothes15% (7)14% (23)2-sided Fisher’s, n.s. Promotes sunscreen65% (30)18% (31)  2 =39.43, df=1, p=0.00 VariableTextImagesTest and Significance ABCD criteria9% (4)1% (2)  2 =7.29, df=1, p=0.01 Skin self-examination13% (6)5% (8)2-sided Fisher’s, n.s. Physician skin examination20% (9)0% (0)2-sided Fisher’s, p=0.00 For cells with n < 5 expected cell count, Fisher’s exact test was used in place of the Chi- square test. Time Frame Comparisons: IARC report, but not WHO report, had a small but significant impact on frequency of media coverage of skin cancer and tanning geared toward teenage girls, but the content of that coverage (risk factors, attitudes and behaviours, screening) generally did not improve Implications: Teen girls receiving mixed messages from popular magazines: UV exposure is dangerous, but a tan is attractive Public health professionals should consider ways to work effectively with media and develop health communication and social marketing campaigns to counteract these mixed messages n.s. = not significant