DESCRIPTION (provided by applicant): Skin cancer prevention is a national priority, particularly for young adults. Over 2 million cases of non- melanoma skin cancers occur annually and melanoma increased 4% each year for decades, burdening the nation's health system. Skin cancer can be prevented by decreasing the primary risk factor - exposure to ultraviolet radiation (UVR). Yet, despite numerous public health campaigns to promote skin cancer prevention, rates continue to rise. Many adults do not follow recommended comprehensive sun safety practices such as applying sunscreen before exposure, reapplying when outdoors for over 2 hours, using clothing that physically blocks UVR, wearing wide-brimmed hats, or seeking shade when available. Sun safety practices are particularly low in young adults. It is well established that continued efforts to promote skin cancer prevention are needed. We propose to develop Sun Safety INK! (SSI!), a skin cancer prevention program targeted to clients of licensed tattoo salons. Many American adults (25%) now have a tattoo with younger adults more likely to be tattooed than older adults. Tattoo salons have been selected as the unique venue for this study because tattoo aftercare recommendations can include sun protection, and salons offer an opportunity to reach younger adults who are significantly less likely to practice sun safety. Individuals with tattoos need to take precautions not only to protec their skin from harmful UVR but also to reduce tattoo damage. Thus, salons provide a potentially effective environment because comprehensive skin cancer prevention practices are compatible with tattoo aftercare recommendations. Successful health promotions have been conducted in similar venues such as beauty parlors and barbershops. However, limited information is available on the sun safety practices of the tattooed population, the consistency of
tattoo aftercare recommendations, and effective methods for promoting sun safety through tattoo salons. Consequently, the aims of this exploratory study are to: (1) determine the most effective means to reach clients of tattoo salons, (2) develop measures to assess sun protection practices of tattooed individuals, and (3) create and evaluate prototype materials for promotion of comprehensive skin cancer prevention in this venue. The exploratory research we propose includes: the establishment of an Expert Advisory Board of skin cancer experts and tattoo salon owners to provide advice on the development and implementation of SSI; semi-structured interviews with tattoo artists on strategies for recommending sun safety to their clientele; and, focus groups with tattooed individuals about their sun safety practices. We will also develop measures to assess sun safety practices and attitudes among the tattooed population with an online survey. Prototype materials will be developed and a pilot test will be implemented in two tattoo parlors; we will survey clients to evaluate program materials and assess changes in knowledge, behaviors, and attitudes about sun safety. This important and necessary exploratory research will provide us with the requisite information to develop an R01 application to test SSI! in a future randomized controlled trial.
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