Health communication scholars have a responsibility to be certain that both healthcare practitioners and government agencies accurately communicate health information to the public. In order to carry out this duty, health communication scholars must assess how messages are being received and if they are being received at all by the public. This paper details a two part study which assesses this phenomenon within the context of skin cancer. Study 1 utilized 29 in depth qualitative interviews to identify subcultures among college students whose communication puts them at risk for skin cancer by encouraging poor sun exposure behaviors. The results indicate that farmers, African Americans, and individuals who regularly participate in outdoor athletics are at risk groups. Study 2 reports a content analysis of the known population of skin cancer Public Service Announcements (PSAs) available via the internet in 2013. The aforementioned groups were not present in any of the PSAs. Detailed results and implications are discussed.
Health communication scholars have a responsibility to be certain that both healthcare practitioners and government agencies communicate health information to the public accurately [
High risk/marginalized groups include demographics that “often have difficulty affording or gaining access to healthcare, and they are often targets of discrimination due to the prevalence of ageist, sexist, and racist beliefs in our culture” [
PSAs are a form of government funded social marketing campaigns [
The overarching purpose of the present study is twofold. The first purpose is to identify groups among whose cultural communication encourages risky behaviors regarding sun exposure. Assuming such groups exist, the second purpose of the study is to assess the presence of the identified groups in current PSAs.
The second leading cause of death in the United States as of 2010 is cancer, accounting for 567,628 yearly mortalities [
Particularly for women, exposure to ultra-violet radiation up to age 20 is linked more closely to developing melanoma than exposure after age 30 [
No one is immune to skin cancer [
If individuals do not realize that they are at risk for developing skin cancer, they are unlikely to seek out information on preventative behaviors or actively process information presented to them on these behaviors. The phenomenon of information seeking in the face of cancer is a topic that has intrigued health communication scholars for years [
Given the numerous preventative measures that can be taken to avoid cancer [
Undergraduate college students are often in the unique position of making their own health decisions for the first time; thus, these individuals are forced to evaluate their prior beliefs and behaviors regarding healthcare in order to form their own beliefs and make independent decisions. Communication and culture reflect and mold one another [ Are there groups of college students whose communication within self-identified subcultures indicate that they are at risk regarding sun exposure and sun care?
Twenty-nine undergraduate students from a moderate sized southeastern university participated in this study (14 males and 15 females). Participants were between 18 and 25 years of age. These participants were recruited in exchange for five points of extra credit in an introductory public relations course that was not taught by the researchers.
The interviews were semistructured. An interview guide was utilized. Sample items included “Tell me about your skin care bahviours,” and “Do you think about the sun’s influence?” Participants were encouraged to lead the interviews, narrating the rationale for their behaviors in the fashion that made most sense to them. Redundancy occurred at 20 interviews; however, interviewers collected 9 additional participants to verify that redundancy had indeed been reached. All interviews were performed by the same two researchers for consistency.
When interviews were complete, the interviewing researchers transcribed the interviews. A thematic analysis was performed on the transcripts. Interviews were searched for indications of ethnicity, self-identified cultures (i.e., families, organizations, teams, occupations, etc.), activities, and sun care. Unfortunately, not all participants self-identified their ethnicity. As such, it was not always accounted for. The themes that arose involved race, occupation, and participants’ levels of physical activity. Individuals in subcultures that revolved around physical activity were categorized as an outdoor athlete, indoor athlete, or outdoorsman/outdoorswoman. However, some participants self-identified themselves with more than one of these groups. This was resolved by categorizing participants according to the activity that they related to most highly. For instance, if a participant commented that sometimes they fish, but elaborated on playing baseball, then even though fishing falls under the outdoorsman/outdoorswoman category, the participant self-identified more thoroughly with outdoor athletics, meaning that their identity is more heavily influenced by outdoor athletics.
The findings indicated that there were three subcultures among our participants whose group communication encouraged poor sun exposure behaviors in regard to wearing sun block. Among this group were farmers, African Americans, and outdoor athletes. The following paragraphs represent the themes as well as direct quotes from the interviews to support their existence. To reiterate, since the interviews were semistructured and the interviewees were encouraged to guide the interviews, the quotes supporting each theme were not always responses to a direct question. Interviews began by prompting participants to talk about themselves, particularly about hobbies and favorite activities. When participants brought up a reference to tanning or being outside, the interviewer prompted the participant by asking them to elaborate on that topic. The following quotes are the result of such prompts.
Not all of the individuals who fall into the “farmers” category actually self-proclaimed themselves to be a farmer. Yet, each individual at least made a special point to mention how much they valued spending time on the family farm as a child. Some participants even used this time spent on the family farm as justification for poor sun exposure behaviors now.
As such, 100 percent of the participants who mentioned farming in any way self-proclaimed that they do not regularly use sun block. This rationale was based on a lifetime of observing family members who did not wear sun block as well as a fatalistic mentality that given the amount of sun exposure they had experienced up to this point in their life, changing their behaviors at the present time seemed unlikely to reduce their likelihood of developing cancer.
Another subculture that expressed poor sun care behaviors were the African American participants. Only three individuals identified themselves as African Americans among the participants. However, when asked about their skin care habits, their responses were uniform.
It is particularly concerning that one of the participants explicitly stated that he did not use sun block because he is an African American. Even the participant who tried to avoid being outdoors in the summer to avoid tanning did not report using any form of preventative skin care when outside.
Outdoor athletes were classified as any person who plays team or recreational sports outdoors including soccer, baseball, softball, football, or running track. This did not include leisure sports such as hiking or fishing. Although each athlete recognized the need to wear sunscreen, it was not a habit he or she proclaimed to practice.
At first, these themes could be construed to imply that people who play team sports in general practice poor sun exposure behaviors. However, this notion was contradicted by the presence of indoor athletes and outdoorsmen/outdoorswomen.
Indoor athletes were categorized as anyone who claimed to enjoy playing sports indoors, particularly basketball players and indoor track runners. These individuals self-reported that they wore sun block on a regular basis.
To further support the notion that not all athletes have poor tanning behaviors, a third group of athletes emerged from the interviews.
Outdoorsmen/Outdoorswomen included anyone who rather than identifying a sport qualified that they enjoyed nature through hiking, backpacking, rock climbing, or fishing. This group reported being very aware of the sun, with some participants even volunteering their armor of protective clothing.
The presence of outdoorsmen/outdoorswomen’s and indoor athletes’ health conscious sun exposure behaviors implies that athletes who play team sports outdoors are the only emergent group of athletes who practice poor sun exposure behaviors.
The findings of this study imply that undergraduate farmers, African Americans, and outdoor athletes exist within subcultures whose communication encourages poor sun exposure behaviors. This places these students into high risk groups. These findings were supported in that African Americans are known to be a marginalized group, who are reported to be low information seekers regarding health information [
Robinson et al. [
The results of Study 1 have indicated that African Americans, farmers, and outdoor athletes are groups of college students who exist in subcultures that are unaware of the salience of skin cancer and/or preventative care. PSAs are necessary to further drive home the importance of preventative skin care behaviors. The purpose of PSAs is to enlighten people through exposure to beneficial, unbiased information, often pertaining to health concerns, and direct them towards preventative health behaviors [ Who is portrayed in current skin cancer-related PSAs? What activities are the individuals featured in current skin cancer-related PSAs engaged in? If the individuals featured in the skin cancer-related PSAs were not engaged in an activity, are they wearing apparel that is indicative of a particular occupation or activity? Who is the target audience of current skin cancer-related PSAs? Where are the skin cancer-related PSAs being posted/shared?
Because the internet is the most frequently accessed resource for health information [
The PSAs were coded by two of the researchers for sex (male, female, both, and indeterminate); ethnicity (Caucasian, African American, Asian, multiple races, and other); presence of a beach (present, not present), occupational activity (present and not present), or athletic activity (present and not present); age (0–8, 9–16, 17–25, 26–33, 34–42, 43≤, or indeterminate); and target audience. To establish inner coder reliability, five of the PSAs were randomly selected and pilot coded by the researchers separately. The researchers reconvened and discussed their differences until they reached consensus. The data set was then independently coded by both coders. Inner coder reliability was calculated by Cohen’s kappa. Reliability was deemed accepted if and only if
Research question 2 asked who was featured in current PSAs. Of the 39 PSAs coded, only 33 (85.6%) featured a pictorial element which included a person. Of these 33 PSAs, 20 featured only females, 4 featured only males, 2 featured both males and females, and 7 featured models of indeterminate sex. One hundred percent of the people portrayed in the PSAs were Caucasian. Age was the most diverse characteristic displayed within the sample; 6 of the people were no older than 8 years old, 8 were between 16 and 25 years old, 6 were between 34 and 42 years old, and 13 were of indeterminate age because their faces were not visible.
Research question three asked what activities individuals depicted in PSAs were engaged in or what activity-related apparel they were wearing. None of the individuals depicted were working or wearing apparel indicative of an occupation nor were they engaged in athletics or wearing athletic apparel. However, 10 of the people in the PSAs were shown at a beach.
Next, research question four addressed the target audience. The purpose of this question was to identify if the tanner was being addressed in the PSA or someone connected to the tanner. Among all sampled PSAs, 34 targeted the tanner and 5 targeted someone connected to the tanner, specifically the parents of the tanner.
Finally, RQ5 asked where the PSAs were being shared/posted. The purpose of this question is to understand where consumers would have to go to in order to be exposed to these PSA messages. Google Images was particularly useful in addressing this question because in addition to providing the PSA, it also provided the link to any websites that currently hosted it. The PSAs in the sample of this study were available from The American Cancer Society, American Academy of Dermatology, The Melanoma Foundation, The Skin Cancer Foundation, Sun Smart, The World Skin Cancer Foundation, and a preventative treatment website sponsored by the Australian government at
Overall, the majority of PSAs depicted only Caucasian females less than 42 years old. None of the PSAs feature athletes, people working outside, or any ethnicity other than Caucasian. Furthermore, 87.2% of the PSAs messages targeted the tanner and 58.8% of the tanner targeted PSAs were presented as relevant only to young, Caucasian women. The results of this study imply that a range of ages and ethnicities are being ignored in skin cancer PSA construction. Additionally, the PSAs promote preventative skin care behavior at leisure, but not at work or during athletic activities.
African Americans, farmers, and outdoor athletes self-identified as subcultures whose cultural communication creates healthcare norms that leave individuals unaware of the value and necessity of preventative skin care behaviors. The fact that these same groups were not present in a year’s worth of PSAs is unlikely a coincidence and more likely representative of the norm in construction of these PSAs. It is of particular concern that only Caucasians are being depicted in these studies, especially considering that African Americans die more frequently of melanoma than Caucasians [
Equally concerning as the limited target audience depicted, was the limited media range through which the PSAs were shared. The PSAs were only available through government sponsored websites dedicated to skin cancer prevention. Given that PSAs are created through government funding, their presence on these websites was not surprising. What is concerning, however, about the PSAs being available
In short, preventative sun exposure PSAs are available, but the groups most at risk of skin cancer deaths are being ignored in the pictorial element. Additionally, the PSAs are not being distributed to the target audience. To effectively communicate the preventative messages to individuals who need it, future PSAs need to be designed to include at risk groups and then disseminated among multiple media channels.
The authors declare that there is no conflict of interests regarding the publication of this paper.