title: Compensation strategies in sun protection behaviors by a population with nonmelanoma skin cancer.
abstract: BACKGROUND
  Initiation of sun protection strategies can be promoted, to some extent, by educational efforts, but little is known about the merit of continuing education interventions in sustaining the desired behaviors or adding new behaviors. This prospective study clarifies the choices individuals make among the four strategies that allow them to maintain lifestyle changes.
  
  
  METHODS
  From 1983 to 1987, the population received education about sun protection coupled with the removal of a nonmelanoma skin cancer. One year later, their choice of sun protection methods was determined. Then annually from 1985 to 1989, they received written recommendations about sun protection for a period of 2-6 years after the initial education. The maintenance, cessation, and addition to the initial sun protection behaviors were ascertained by a questionnaire, as was the intention to change. Frequency of physician visits and development of subsequent nonmelanoma skin cancer were evaluated by medical chart review for the 2-6 year phase of continued education.
  
  
  RESULTS
  One percent of the population consisting mostly of women described ceasing tanning after 2-6 years of education. The population related a greater use of protective clothing and/or sunscreen with an SPF of 15 or greater as their reported restrictions on outdoor activities ceased. An emerging new strategy of some of the population (n = 185) was the use of sunscreens with an SPF less than 15 in association with attempts to deliberately tan and longer daily outdoor exposure. Neither frequency of physician visits nor numbers of subsequent nonmelanoma skin cancers influenced continuation or addition of sun protection behaviors.
  
  
  CONCLUSIONS
  While the greatest reported change in behavior was temporarily associated with educational intervention linked to removal of the skin cancer, continued educational efforts may have recruited some individuals to cease tanning and encouraged others to adopt the use of protective clothing or more frequent sunscreen use as they were unable to maintain the limitations on outdoor activities. It is not possible to structure a control group restricted from mass media education; therefore, the effectiveness of specific behavior-directed education cannot be precisely determined. Nonetheless, the population described using knowledge to develop compensation sun protection strategies that preserved lifestyle.
authors.affiliation: Department of Dermatology, Northwestern University Medical School, Chicago, Illinois 60611.
authors.forename: J K
authors.initials: JK
authors.lastname: Robinson
mesh_terms: D002755:Choice Behavior; D003663:Decision Trees; D005260:Female; D015438:Health Behavior; D006801:Humans; D007087:Illinois; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010353:Patient Education as Topic / Q000592:standards*; D011446:Prospective Studies; D011481:Protective Clothing / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000517:prevention & control* / Q000523:psychology / Q000601:surgery; D013472:Sunlight / Q000009:adverse effects*; D013473:Sunscreening Agents / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D013473:Sunscreening Agents