Case Study Series - ‘Dark Side of Tanning’: Advertising to Change Tanning Attitudes and Behaviours (Cancer Institute NSW)

7 August 2013Behavioural Insights Unit

Categorycase study

Tagsbehavioural insights, case study, nsw

The objective was to reduce overexposure to ultraviolet radiation and promote greater use of sun protection behaviours through a public mass media campaign.

dark side of tanning

Issue: Australia has the highest incidence of skin cancer in the world. Simple behaviours such as using sun-screen can help reduce the incidence of cancer substantially.

Campaign: The ‘Dark Side of Tanning’ advertisements highlight the damaging health effects of overexposure to the sun, even when these effects cannot be seen immediately.

Behaviour: The advertisements target young people with salient images, and use emotional messages to attempt to challenge social norms relating to tanning and sun exposure.

Outcome: Results suggest significant changes in attitudes towards tanning, including an increased perception of the danger and severity of skin cancer.

The Policy Issue

Each year, 1,600 Australians die from skin cancer, which is the highest incidence in the world[1]. Two in three Australians will be diagnosed with skin cancer by the time they are 70[2]. The direct cost of skin cancer in New South Wales alone is estimated to be $420 million annually[3], which does not include other indirect costs such as lost productivity through illness.  These high rates are primarily caused by overexposure, which is estimated to be responsible for between 95-99% of skin cancers in Australia[4]. However, skin cancer is one of the most preventable of all cancers. Simple behaviours, such as applying sun screen and avoiding the sun at mid-day, can reduce skin cancer rates substantially.

The Policy Objective was to reduce overexposure to ultraviolet radiation and promote greater use of sun protection behaviours through a public mass media campaign.

Behavioural Analysis of the Policy Issue

The following cognitive factors play a role in understanding tanning behaviour in young people and must be addressed through knowledge and attitude based interventions:

  • Young people tend to suffer from an "illusion of immortality"[5]. Simply informing young people that their behaviour is unhealthy will only produce lasting behaviour change in a small percentage, especially when they are not inclined or ready to change their behaviour.
  • Young people tend to display an optimism bias (although to some extent this problem is one which all age groups suffer from). Optimism bias is commonly defined as the mistaken belief that a person’s chances of experiencing a negative event are lower than that of their peers. In health, the optimism bias tends to prevent individuals from taking on preventative measures for good health, such as sun protection or dieting.
  • There appears to be a battle in young people’s minds between two social norms. The first is that ‘Sunbathing is bad because it damages your skin’, and the other is ‘Being tanned makes a person more attractive’.

Although a great deal of time and resources have been put into educating people about the damaging effects of UV rays, education alone is unlikely to solve the problem. This is because academics have found that even when knowledge of UV radiation and skin cancer is high, this in itself does not affect sun-protection habits or the intention to change them[6]. A comprehensive approach is required, as seen in the area of tobacco control, where there has been work in education, policy development and the provision of healthy environments to ensure changes in social norms and long-term behaviour change. 

The Campaign

There is a long history of dedicated efforts to prevent skin cancer in NSW and Australia. The Cancer Institute NSW has taken the lead role in the development of the NSW Skin Cancer Prevention Strategy 2012-15 (the Strategy), launched by the Minister for Health and Minister for Medical Research in November 2012.

The Institute is committed to the development and implementation of skin cancer prevention public education mass media campaigns, as well as complementary activities to improve knowledge, beliefs and attitudes about the risks associated with UVR exposure and encourage the adoption of sun protection. A sustained, well-resourced and comprehensive program that includes strategies targeting where people live, learn, work and play can prevent skin cancers. Accordingly, the purpose of the Strategy is to provide a framework for a coordinated comprehensive, community-wide approach to reducing over-exposure to UV radiation for the next four years in NSW.

The Skin Cancer Prevention Program created the ‘Dark Side of Tanning’ campaign, and the television commercials have been shown every summer since 2007/08. The advertisements feature young people engaging in normal activities; including tanning on the beach and playing sports. Through animation, the advertisements demonstrate how overexposure to ultraviolet radiation damages skin cells even before signs of burning. They show how melanoma can spread through the body as a result, using graphic and realistic images. The specific aims of the campaign are to:

  • Increase understanding of the severity of melanoma as a health issue.
  • Reduce pro-tanning attitudes.
  • Increase understanding of the health consequences of unsafe exposure to the sun.
  • Increase the number of people frequently using sun protection, as well as the range of sun protection measures used.

The primary target audience for this campaign has been young adults, aged 18-24 years old.  The secondary audience is youth, aged 13-17 years old. Television has been used as the primary medium for both commercials, and this has been supported by outdoor, press and digital strategies. The use of multiple media channels is an important supporting component to the campaign, given the fragmented television consumption habits of the 13-24 year old target audience.

The advert used single headline messages to convey complex information. People are unlikely to remember the full message of any information campaign being run; therefore it is important to highlight key messages upfront, as was done in these adverts with messages like “You don’t have to get a tan to get melanoma”.

Within the MINDSPACE framework, the three concepts that are primarily used in the campaign are: SALIENCE, AFFECT and NORMS, with MESSENGER also used, but to a lesser extent.

SALIENCE: The ‘Dark Side of Tanning’ campaign was targeted specifically at young people (13-24) by using people of that age group in the advertisements to increase the audience’s sense of familiarity with the group.

Displaying the advertisements over the summer months helps to keep the message active during National Skin Cancer Action week (late November), build sufficient campaign recognition prior to peak UV months of the year, and maintain campaign recognition throughout peak UV months.

AFFECT: The ads are persuasive through their use of negative emotional material; including vivid imagery of black, gruesome cancer cells spreading quickly through a person’s bloodstream, without their awareness. Specifically the messages highlight the dangers of tanning at a cellular level, and that even when skin cancer is cut out, the damage and consequences remain.

NORMS: The advertisements challenge the existing belief among many young people that a tan is healthy, by framing the message using a shocking statement across images of young people doing ‘normal’, everyday activities. This shocking messaging helps to create new social norms around tanning and sun protection behaviours. For example, the message “there’s nothing healthy about a tan” helps to break down the traditional associations between tanning and good health.

MESSENGER: Using the logo of the Cancer Institute alongside the NSW government authorisation tag in the adverts helps on one hand to validate the authenticity of the advertisements appeal, as well as highlighting the expertise behind the message. This has long been known to be a significant factor in the degree to which people accept and act upon information.  Research has shown that for certain other types of campaigns (i.e. testimonial campaigns or peer to peer campaigns), receptiveness to the campaign issue is higher without the use of government branding; however, in this instance, co-branding serves to reinforce the authority and expertise behind the campaign.

Outcome and Results

The Cancer Institute conducts an online weekly tracking survey of 100 people per week (during periods of campaign activity) in NSW aged 13-54 years, plus a two week pre-campaign sample of 300 people each year. During summer 2011/12 the Dark Side of Tanning commercials reached 90% of the target audience and returned an average prompted recognition score of 71%. Further results indicated:

  • The proportion of respondents who desire a tan has decreased significantly from 61% in 2006/07 to 40% in 2011/12
  • There has been a shift in agreement with the statement ‘Melanoma can be easily treated because it can be cut out' from 36% pre-campaign in 2007/08 to 31% in 2011/12.
  • 90% of people aged 13 - 29 agreed the commercials made them think that someone their age can die from melanoma.
  • 87% of people agreed that the ads made them think that by protecting themselves from the sun they can avoid melanoma.

These results suggest the campaign had a positive impact; however, it should be noted that they rely on self-report measures so there may be a recall bias, and results cannot be causally linked to exposure to the Dark Side of Tanning campaign.

References
  1. Australian Institute of Health and Welfare. Australia’s Health; 2006. 2006, AIHW, Canberra.
  2. Staples M., et. al. (2006). Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Medical Journal of Australia 2006; 184: 6-10.
  3. Jones, S., Rees, L., Johnson, K., and Tang, A., (2005) Improving sun protection behaviour through evidence-based campaigns. NSW Public Health Bull, 16(11-12): p. 189-91. Armstrong, B.K., Kricker, A. How much melanoma is caused by sun exposure? Melanoma Research, 1993, 3, 395-401.
  4. Dobbinson, S. J. et al. Weekend Sun Protection and Sunburn in Australia: Trends (1987-2002) and Association with SunSmart Television Advertising. American Journal of Preventative Medicine, 2008, 34, 94-101.
  5. Hayes D, Ross CE. Concern with appearance, health beliefs, and eating habits. Journal of Health and Social Behavior 1987; 28: 120-130.
  6. Mermelstein RJ, Riesenberg LA. Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychology 1992; 11: 371-376.

This case study is part of a series of behavioural insights (BI) case studies compiled by the Department of Premier and Cabinet (DPC). While DPC is working with the UK Cabinet Office to push forward the use of BI in NSW, these case studies show how the NSW Government has already successfully applied BI techniques in a number of programs.