Social media use in HPV-, cervical cancer-, and cervical screening-related research: A scoping review.

OBJECTIVE: In response to the World Health Organization's global call to eliminate cervical cancer, many countries have targets to implement human papillomavirus (HPV) primary screening. Social media may offer opportunities to promote uptake of HPV screening. We aimed to describe the extent of the scientific literature regarding social media research on HPV, cervical cancer and cervical screening. METHODS: Seven databases were searched for peer-reviewed English-language studies related to social media research and HPV, cervical cancer and cervical screening published up to November 2023. One reviewer completed the title/abstract screening and two reviewers independently reviewed full-text articles. Data extraction was carried out by one reviewer and verified by a second reviewer. Information such as the research topic, social media platform of interest, participant characteristics, methods, analysis type, outcome measures, and key findings were collected. RESULTS: In the 58 articles included, researchers used social media in the following ways: evaluate content, recruit participants or disseminate a survey/questionnaire, disseminate health communication content, examine the relationship between social media use and outcomes, and to conduct experiments testing the effects of social media content on outcomes. Twitter and Facebook were the most common platforms mentioned. Four articles explicitly mentioned theory. CONCLUSIONS: Opportunities for research are identified such as further exploration of how newer social media platforms such as Instagram and TikTok can be used to share HPV content, examination of appropriate images for effective communication, and determining key features of social media content to promote information sharing and improve cervical screening knowledge, attitudes and behaviours.

Public Health Messaging to Address Indoor Tanning: A Scoping Review.

Indoor tanning (IT) is an avoidable skin cancer risk. Although numerous communication interventions have been assessed for IT deterrence, less attention has been paid to the persuasive messages within these interventions. This scoping review summarizes the current peer-reviewed literature on persuasive messages for IT. Overall, 20 articles (21 studies) were included. Most were experimental or quasi-experimental and conducted in the US. Participants were mostly young women who had tanned indoors before. Few studies evaluated persuasive theme; in those that did, health and appearance themes were effective. Narrative and statistical evidence formats were also effective. The included studies also supported normative messages, loss-framed messages, and images. Improved reporting on message design and evaluation would be beneficial for future evidence synthesis. Our understanding of persuasive messages for IT has expanded in recent years, but more research is needed to optimize them.

An evaluation of the amount, type and use of shade at public playgrounds in Guelph, Ontario, Canada. / Évaluation de la superficie, du type et de la fréquentation des zones ombragées des terrains de jeu à Guelph (Ontario, Canada).

INTRODUCTION: The provision of shade at outdoor recreation sites such as playgrounds confers a variety of public health benefits. It can prevent overexposure to solar ultraviolet radiation, and, in turn, protect against skin cancer. Further, shade mitigates heat and may promote physical activity. In this study, we evaluate and describe the amount, type and use of shade at public playgrounds. METHODS: Using a modified shade audit tool, shade audits were conducted to visually evaluate shade coverage at 85 city-operated playgrounds in Guelph, Ontario, Canada, in summer 2019. RESULTS: The main play area of most playgrounds (68%) had no shade available. Although the areas surrounding playgrounds had more shade coverage than the main play areas, we also found minimal shade coverage (> 0% to 30%) in this area for many playgrounds (48%). All shade over main play areas was provided by trees (i.e. natural shade). Permanent, built shade structures were observed in the surrounding area of 13% of playgrounds. Shade coverage in the areas surrounding playgrounds was positively correlated with the number of individuals (rs = 0.259; p = 0.017), children (rs = 0.270; p = 0.012), and active individuals (rs = 0.253; p = 0.020) using the surrounding area. This suggests that individuals seek shade at playgrounds and may be more active in shaded areas. CONCLUSION: Children have limited protective shade available to them at playgrounds. Future research is needed to determine how to best increase shade provision and to further explore the impact it has on playground usage, activity levels, temperature and UVR exposure.

"I Think There Should Be Photos": Female Indoor Tanners' Perceptions of Health Warning Labels for Tanning Beds.

This study explores female indoor tanners' perceptions of the current, text-only Canadian health warning label (HWL) for tanning equipment, as well as pictorial, evidence-based alternative HWLs. We created 10 test HWLs that depicted skin health effects, eye damage, premature aging, and death. Young women who had tanned indoors in the past year discussed these and the current federal HWL in focus groups. Although the current Canadian HWL was seen as informative, several participants did not recognize it, and many said that they would not read it due to the small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text was important for encouraging reading, many participants expressed a desire for more information in the test HWLs. Premature aging was of great concern to many participants, but the images selected for these HWLs were not perceived as effective. Although the text was seen as effective in the death HWLs, most participants dismissed the images. This research has implications for IT HWLs in Canada and globally. These results suggest that graphic images may be impactful in IT HWLs. Images must be supplemented with informative text that increases believability, relatability, and comprehensibility. These modifications would create HWLs that are engaging, informative, and that form part of a wider effort to spread awareness about the harmful effects of IT.

Understanding Incoming Canadian and US Veterinary Students' Attitudes and Perceptions of Their Dietary Habits and Levels of Physical Activity.

As critical components of individual well-being, nutrition and physical activity have important physical and psychological implications. Veterinary students face demanding schedules and potentially high rates of psychological distress. Though veterinary students' strategies for healthy eating have been explored, factors influencing their ability to achieve a healthy diet are less understood. This study assesses incoming veterinary students' perceived attitudes to their dietary habits and physical activity levels. Incoming students (n = 322) at five Canadian and five randomly selected US veterinary schools completed a questionnaire inquiring about demographic information, dietary attitudes and habits, and activity levels. More than half (58%) of students perceived their diet to be moderately healthy. A desire to feel better and have more energy was the most reported (79%) motivating factor to modifying personal eating habits and was significantly associated with improved odds of having a perceived healthy diet (OR = 2.22, p < .024). A busy lifestyle was perceived as a barrier to changing current eating habits by 92% of respondents. Students reporting a desire to maintain their health (OR = 3.42, p < .001) and moderate (OR = 2.81, p < .003) or high (OR = 2.30, p < .044) routine physical activity levels were also more likely to perceive their diet as healthy. Findings show that incoming veterinary students' perceptions may influence their goals of achieving a healthy lifestyle. An understanding of incoming veterinary students' barriers and motivators could be applied in future research to assist students in achieving personalized goals.

A Process Evaluation of the Skin Cancer Prevention Act (Tanning Beds): A Survey of Ontario Public Health Units.

Evidence of the dangers of indoor tanning and its popularity, including among youth, led the Government of Ontario to pass the Skin Cancer Prevention Act (Tanning Beds) (SCPA) in 2014. This legislation includes prohibiting the sale of indoor tanning services to individuals under 18, requiring warning signs be posted, and other safety regulations. We collected information from Ontario Public Health Units to conduct a process evaluation of the SCPA to: understand legislation implementation; assess available evidence about compliance, inspection, and enforcement; and, note barriers and facilitators related to inspection and enforcement. Data was collected March-April 2018. All 36 Ontario Public Health Units were invited to participate in an online questionnaire about the SCPA. Questions covered complaints, inspection, and enforcement, and used both close- and open-ended questions. Participants from 20 Public Health Units responded to the questionnaire; a response rate of 56%. These agencies reported 485 facilities offer indoor tanning. Since 2014, there have been 242 infractions by tanning facility owner/operators related to the SCPA, with most being uncovered during non-mandatory routine inspections (n = 234, 97%), rather than mandatory complaint-based inspections (n = 8, 3%). Most infractions were related to warning signs (n = 201, 83%). No charges were issued for any infractions. Instead, providing education (n = 90, 62%) and issuing warnings (n = 33, 23%) were the most common enforcement strategies. SCPA amendments are needed, including mandatory, routinely scheduled inspections. In addition to providing education, fines may improve compliance. More resources are required for inspection and enforcement of the SCPA.

Impact of legislation on youth indoor tanning behaviour: A systematic review.

Jurisdictions around the world have implemented indoor tanning legislations, which aim to protect all individuals, especially youth, from dangers of artificial ultraviolet radiation exposure. The objective of this study was to conduct a systematic review to synthesize the available peer-reviewed literature to determine whether indoor tanning legislation has impacted the prevalence of youth indoor tanning. Following PRISMA guidelines, six databases were searched in 2016. Reference lists from relevant articles were also searched. An updated literature search was conducted in 2018. Each article was critically appraised using a merged checklist created from two previously validated checklists. All articles meeting the inclusion criteria were retained after appraisal. Seven studies, all conducted in the U.S., met the inclusion criteria. All studies used an observational, cross-sectional design. There were small absolute decreases in youth indoor tanning prevalence after legislation vs before (n = 3, mean = 3% decrease, range = 1%-6% decrease). Prevalence of youth indoor tanning was significantly lower in states with indoor tanning legislation vs states without legislation (n = 4, mean = 5% lower, range = 1%-18% lower). Prevalence of youth indoor tanning was lower in states with longer standing indoor tanning legislation vs states with more recently implemented legislation (n = 2, mean = 9% lower, range = 2%-20% lower). Indoor tanning legislation is generally associated with lower indoor tanning prevalence among youth. The small percent differences equate to millions of youth at the population level. Longer time lapses from legislation implementation to evaluation, coupled with greater enforcement, compliance, legislative stringency, and public education may result in even more pronounced declines in youth indoor tanning prevalence.

Assessing the content and comprehensiveness of provincial and territorial indoor tanning legislation in Canada. / Évaluation du contenu et de l'exhaustivité de la législation provinciale et territoriale sur le bronzage artificiel au Canada.

INTRODUCTION: Canadian provincial and territorial governments have enacted legislation in response to health risks of artificial ultraviolet radiation from indoor tanning. This legislation, which differs from jurisdiction to jurisdiction, regulates the operation of indoor tanning facilities. The content and comprehensiveness of such legislation-and its differences across jurisdictions-have not been analyzed. To address this research gap, we conducted a systematic, comprehensive scan and content analysis on provincial and territorial indoor tanning legislation, including regulations and supplementary information. METHODS: Legislative information was collected from the Canadian Legal Information Institute database and an environmental scan was conducted to locate supplementary information. Through a process informed by the content of the legislation, previous research and health authority recommendations, we developed a 59-variable codebook. Descriptive statistics were calculated. RESULTS: All provinces and one of three territories have legislation regulating indoor tanning. Areas of strength across jurisdictions are youth access restrictions (n = 11), posting of warning signs (n = 11), penalties (n = 11) and restrictions on advertising and marketing targeted to youth (n = 7). Few jurisdictions, however, cover areas such as protective eyewear (n = 4), unsupervised tanning (n = 4), provisions for inspection frequency (n = 4), misleading health claims in advertisements directed toward the general public (n = 2) and screening of high-risk clients (n = 0). CONCLUSION: All provinces and one territory have made progress in regulating the indoor tanning industry, particularly by prohibiting youth and using warning labels to communicate risk. Legislative gaps should be addressed in order to better protect Canadians from this avoidable skin cancer risk.

Availability of tanning salons in Ontario relative to indoor tanning policy (2001-2017).

Ultraviolet (UV) radiation from indoor tanning equipment is a known cause of skin cancer; however, little is known about how the availability of indoor tanning salons has been impacted by indoor tanning legislation, including Ontario's Skin Cancer Prevention Act: Tanning Beds (SCPA). Tanning salon listings were obtained from the 2001 to 2017 editions of InfoCanada's Ontario Business to Business Sales and Marketing directories. Using descriptive statistics and regression analysis, we assessed the number of tanning salons before and after: 1) the 2006 International Agency for Research on Cancer (IARC) report on indoor tanning and skin cancer; 2) the 2009 World Health Organization (WHO) reclassification of artificial UV radiation as carcinogenic; and 3) the passing and enactment of Ontario's SCPA in 2013 and 2014, respectively. There were fewer tanning salon listings in the years after vs. before the IARC report, the WHO reclassification, and the passing and enactment of the SCPA. The number of tanning salons in Ontario, Canada has been declining since 2006, which may reflect a decline in indoor tanning bed use. Key public health policy instruments, including legislation and public education, appear to be associated with this trend, suggesting they may contribute to deterring indoor tanning.

Application of the Health Belief Model to U.S. Magazine Text and Image Coverage of Skin Cancer and Recreational Tanning (2000-2012).

The health belief model (HBM) has been widely used to inform health education, social marketing, and health communication campaigns. Although the HBM can explain and predict an individual's willingness to engage in positive health behaviors, its application to, and penetration of the underlying constructs into, mass media content has not been well characterized. We examined 574 articles and 905 images about skin cancer and tanning risks, behaviors, and screening from 20 U.S. women's and men's magazines (2000-2012) for the presence of HBM constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Susceptibility (48.1%) and severity (60.3%) information was common in text. Perceived benefits (36.4%) and barriers (41.5%) to prevention of skin cancer were fairly equally mentioned in articles. Self-efficacy (48.4%) focused on sunscreen use. There was little emphasis on HBM constructs related to early detection. Few explicit cues to action about skin cancer appeared in text (12.0%) or images (0.1%). HBM constructs were present to a significantly greater extent in text versus images (e.g., severity, 60.3% vs. 11.3%, respectively, χ(2) = 399.51, p < .0001; benefits prevention, 36.4% vs. 8.0%, respectively, χ(2) = 184.80, p < .0001), suggesting that readers are not visually messaged in ways that would effectively promote skin cancer prevention and early detection behaviors.

Coverage of Skin Cancer Risk Factors and UV Behaviors in Popular U.S. Magazines from 2000 to 2012.

Mass media is an influential source of skin cancer and tanning information for the public, but we know little about its content or emphasis. The objective of this research was to describe the volume and nature of skin cancer and tanning messages in 20 popular U.S. men's and women's magazines (2000-2012). We used a directed content analysis to determine frequency information about risk factors and ultraviolet (UV) behaviors in 608 articles and 930 images. Chi-square and Fisher's exact tests determined coverage differences based on content type (text vs. image) and target audience (women vs. men). UV exposure was the most common risk factor mentioned (37.7 %) and sunscreen use the most common behavior encouraged (60.0 %); information about other risk factors and protective behaviors was uncommon. Both articles (25.2 %) and images (36.9 %) promoted the tanned look as attractive. In most cases, images infrequently contained helpful information on skin cancer risk factors and prevention, except for high-SPF sunscreens. Women's magazines published more articles on skin cancer and tanning than men's magazines (456 vs. 159, χ(2) = 143.43, P < .01), and the nature of the messages differed between them. Magazine skin cancer and tanning content may contribute to inaccurate public understanding of risks and prevention. These findings are relevant to cancer educators, who may wish to counter potentially harmful messages and enhance positive ones through cancer education efforts.

Skin deep: Coverage of skin cancer and recreational tanning in Canadian women's magazines (2000-2012).

OBJECTIVE: Skin cancer is a significant public health problem among Canadians. Knowledge and attitudes about health are informed by mass media. The aim of our study was to describe the volume and nature of coverage of skin cancer and recreational tanning in Canadian women's magazines. METHODS: Directed content analysis on article text and images in six popular Canadian women's magazines (Chatelaine, Canadian Living, Homemakers, Flare, FASHION, ELLE Canada) from 2000-2012 with attention to risk factors, ultraviolet radiation (UV) exposure and protection behaviours, and early detection. Six popular American women's magazines were used for a between-country comparison. RESULTS: There were 154 articles (221 images) about skin cancer and tanning published over 13 years. Volume of coverage did not increase in a linear fashion over time. The most common risk factor reported on was UV exposure (39%), with other risk factors less frequently identified. Although 72% of articles promoted sunscreen use, little content encouraged other protection behaviours. Only 15% of articles and 1% of images discouraged indoor tanning, while 41% of articles and 53% of images promoted the tanned look as attractive. Few articles (<11%) reported on early detection. Relative to American magazines, Canadian magazines had a greater proportion of content that encouraged sunscreen use and promoted the tanned look and a lesser proportion of content on risk factors and early detection. CONCLUSION: Skin cancer and tanning messages in Canadian women's magazines had a narrow focus and provided limited information on risk factors or screening. Conflicting messages about prevention (text vs. images) may contribute to harmful UV behaviours among Canadian women.

Coverage of skin cancer and recreational tanning in North American magazines before and after the landmark 2006 International Agency for Research on Cancer report.

BACKGROUND: Skin cancer is an increasingly important global public health problem. Mass media is a key source of skin cancer information. We examined how media coverage of skin cancer has changed over time as a consequence of the release of a key public health report from the International Agency for Research on Cancer (IARC) in 2006, which linked ultraviolet (UV) radiation from indoor tanning and skin cancer. METHODS: A directed content analysis of skin cancer and tanning coverage in 29 popular North American magazines (2001-2012) examined reporting of skin cancer risk factors, UV behaviors, and early detection in article text (n = 761) and images (n = 1267). Chi-square and correlational analyses were used determine whether coverage changed in relation to the 2006 IARC report. RESULTS: The total volume of articles about skin cancer and tanning increased modestly after the IARC report (χ (2) = 4.57, df = 1, p < .05); however, key IARC report messages (e.g., avoid indoor tanning, UV as a risk factor) were no more likely to be reported after compared to before the report. There were virtually no changes in the percentage of coverage for both risk factors and early detection information over time. There were some changes in the percentage of coverage about UV behaviors after the IARC report, but these variables were not directly related to the report. Magazines were more likely to encourage sunscreen use (χ (2) = 11.55, df = 1, p < .01) and less likely to promote the tanned look as attractive (χ (2) = 9.72, df = 1, p < .01) after the IARC report. It also became less common for magazines to promote sun avoidance (χ (2) = 6.82, df = 1, p < .01) and use of sunless tanners (χ (2) = 7.46, df = 1, p < .01) after the report. CONCLUSIONS: Despite a modest increase in volume of coverage post-IARC report, key messages from the report were not taken up by the media. While there have been some improvements in magazine reporting, there is a need for more effective dissemination of public health messages about skin cancer and tanning.

North American Magazine Coverage of Skin Cancer and Recreational Tanning Before and After the WHO/IARC 2009 Classification of Indoor Tanning Devices as Carcinogenic.

The mass media is an influential source of skin cancer information for the public. In 2009, the World Health Organization's International Agency for Research on Cancer classified UV radiation from tanning devices as carcinogenic. Our objective was to determine if media coverage of skin cancer and recreational tanning increased in volume or changed in nature after this classification. We conducted a directed content analysis on 29 North American popular magazines (2007-2012) to investigate the overall volume of articles on skin cancer and recreational tanning and, more specifically, the presence of skin cancer risk factors, UV behaviors, and early detection information in article text (n = 410) and images (n = 714). The volume of coverage on skin cancer and recreational tanning did not increase significantly after the 2009 classification of tanning beds as carcinogenic. Key-related messages, including that UV exposure is a risk factor for skin cancer and that indoor tanning should be avoided, were not reported more frequently after the classification, but the promotion of the tanned look as attractive was conveyed more often in images afterwards (p < .01). Content promoting high-SPF sunscreen use increased after the classification (p < .01), but there were no significant positive changes in the frequency of coverage of skin cancer risk factors, other UV behaviors, or early detection information over time. The classification of indoor tanning beds as carcinogenic had no significant impact on the volume or nature of skin cancer and recreational tanning coverage in magazines.

Systematic review of population-based studies on the impact of images on UV attitudes and behaviours.

Visual images have been shown to influence health behaviours. The effectiveness of population interventions, which use visual images to influence skin cancer prevention behaviours, has not been systematically evaluated. We, therefore, undertook a systematic review of peer-reviewed, health education and health promotion research on skin cancer and tanning to examine the outcomes of studies, which used visual images as part of their methodology. Our objective was to describe the impact of visual images on UV protection and exposure attitudes and behaviours across the studies. Twenty-three studies met the inclusion criteria. Images positively impact knowledge, attitudes and behaviours related to UV exposure and UV protection. Images also influence the perceived attractiveness of untanned or tanned skin, which in turn, influences UV exposure attitudes and behaviours. Implications for future health promotion research and practice are discussed.

A systematic review of visual image theory, assessment, and use in skin cancer and tanning research.

Visual images increase attention, comprehension, and recall of health information and influence health behaviors. Health communication campaigns on skin cancer and tanning often use visual images, but little is known about how such images are selected or evaluated. A systematic review of peer-reviewed, published literature on skin cancer and tanning was conducted to determine (a) what visual communication theories were used, (b) how visual images were evaluated, and (c) how visual images were used in the research studies. Seven databases were searched (PubMed/MEDLINE, EMBASE, PsycINFO, Sociological Abstracts, Social Sciences Full Text, ERIC, and ABI/INFORM) resulting in 5,330 citations. Of those, 47 met the inclusion criteria. Only one study specifically identified a visual communication theory guiding the research. No standard instruments for assessing visual images were reported. Most studies lacked, to varying degrees, comprehensive image description, image pretesting, full reporting of image source details, adequate explanation of image selection or development, and example images. The results highlight the need for greater theoretical and methodological attention to visual images in health communication research in the future. To this end, the authors propose a working definition of visual health communication.

Visual images for patient skin self-examination and melanoma detection: a systematic review of published studies.

BACKGROUND: Early detection of skin cancer by patients is an important strategy for reducing morbidity and mortality caused by melanoma. However, the effectiveness of interventions or educational aids that use visual images to promote skin self-examination (SSE) and early melanoma detection has not been systematically investigated. OBJECTIVE: We undertook a systematic review of peer-reviewed research on SSE for skin cancer to examine the outcomes of studies that used visual images as part of their methodology. Our objective was to describe the impact of visual images on patient SSE knowledge, attitudes, behaviors, and accuracy. METHODS: Seven databases were searched resulting in 5330 citations. A total of 25 studies met the inclusion criteria. RESULTS: Images positively affected knowledge and self-efficacy related to SSE. Images motivated the performance of SSE and increased the accuracy of SSE and melanoma detection. The types of visual images that were effective are described and the implications are discussed. LIMITATIONS: Articles not uncovered by the search strategy may have been unintentionally excluded. Lack of image description in the studies made specific recommendations challenging. CONCLUSION: The use of visual images to promote accurate and frequent SSE is encouraged.

Visual images for skin cancer prevention: a systematic review of qualitative studies.

Visual images play an important role in educating the public about skin cancer prevention. The objectives of this systematic review were to: 1) determine how visual images are evaluated in skin cancer and tanning qualitative research studies (including theoretical and methodological approaches) and 2) summarize and discuss the image-related findings of the studies with respect to cancer education and public health. Seven databases were searched (PubMed-MEDLINE, EMBASE, PsycINFO, Sociological Abstracts, Social Sciences Full Text, ERIC, and ABI/INFORM) using multiple search terms, including MeSH terms, resulting in 5330 citations. Studies were included if they were in English, peer-reviewed, qualitative in design or methodology, dealt with skin cancer or UV exposure, used visual images, and had a focus on the public or patients (i.e., not medical professionals). Eight studies met the inclusion criteria: seven content analyses and one focus group study. Content analysis studies in this review suggest the mass media portray Caucasian men and women as unprotected from the sun and with tanned skin, and thus, may inform behaviors related to skin cancer risk. The focus group study suggests visible minorities may benefit from the incorporation of images of melanoma on ethnic skin in cancer education materials. None of the studies used visual communication theory to explicitly guide the research, nor were standardized tools used for image assessment. The lack of guiding theory and standardized assessment instruments can introduce bias in how images are selected and used in research on skin cancer education.