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

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

Skin Cancer, Tanning, and Mass Media

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Skin Cancer, Tanning, and Mass Media

IARC & WHO Reports2006 IARC Report 2009 WHO Report

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

Methods

Directed content analysis: 47 articles, 170 images

Two magazines: Seventeen, Teen Vogue

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

Results: Content type comparisonsText (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

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:

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

Variable Text Images Test and Significance

UV exposure 46% (21) 4% (7) 2 =55.36, df=1, p=0.00

Light skin/hair/eyes 13% (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 history 9% (4) 0% (0) 2-sided Fisher’s, p=0.00

Sunburns 9% (4) 0% (0) 2-sided Fisher’s, p=0.00

Variable Text Images Test and Significance

Promotes tanned look 74% (34) 54% (92) 2 =5.84, df=1, p=0.02

Promotes self-tanners 63% (29) 30% (51) 2 =16.95, df=1, p=0.00

Promotes UV sun avoidance 17% (8) 15% (26) 2 =0.12, df=1, n.s.

Discourages indoor tanning 44% (20) 0% (0) 2-sided Fisher’s, p=0.00

Promotes shade 9% (4) 3.5% (6) 2-sided Fisher’s, n.s.

Promotes protective clothes 15% (7) 14% (23) 2-sided Fisher’s, n.s.

Promotes sunscreen 65% (30) 18% (31) 2 =39.43, df=1, p=0.00

Variable Text Images Test and Significance

ABCD criteria 9% (4) 1% (2) 2 =7.29, df=1, p=0.01

Skin self-examination 13% (6) 5% (8) 2-sided Fisher’s, n.s.

Physician skin examination 20% (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.

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

n.s. = not significant

n.s. = not significant