Continued Impact of SunSmart Advertising on Youth and Adults' Behaviors.

Introduction: Televised advertising campaigns play a central role in public education for skin cancer prevention in Australia. Continued impact on behavior is crucial to optimize these investments. This study examines whether exposure to increased intensity of summer campaigns in the past decade has continued to influence sun protection behaviors and to examine behavioral impact across age groups.

Methods: Cross-sectional weekly telephone surveys of Melbourne residents were conducted over summers from 1987-1988 to 2010-2011, and analyzed in 2012-2014. Respondents' sun-related attitudes and their sun protection and sunburn on the weekend prior to interview were assessed. Population exposure to campaign TV advertising was measured as cumulated weekly target audience rating points (TARPs) for 4 weeks prior to interviews. Multiple logistic and linear regression models examined the relationship of campaign advertising with tanning preference and behavioral outcomes (N=11,881).

Results: Respondents' attitudes and behaviors in 1987-2011 were associated with TARPs. Increasing TARPs were related to increased preference for no tan (OR=1.12, 95% CI=1.07, 1.17); sunscreen use (OR=1.09, 95% CI=1.02, 1.17); and overall reduced mean percentage of skin exposed to the sun (B=-0.01, 95% CI=-0.01, 0.00). These effects had limited interaction with time period, age group, gender, or skin type. There was evidence of diminishing returns at the highest TARP quartile for tan preference but not for behavioral outcomes.

Conclusions: Sustained youth-focused advertising campaigns (for adolescents and young adults), when broadcast with sufficient TARPs during the summer months, continue to provide consistent beneficial impact on sun protection behaviors population-wide.