SunSmart Programme 2002-2004

Background


Skin cancer is by far the most common cancer affecting New Zealanders.



Between 250 and 300 New Zealanders die from skin cancer every year and most of these deaths (231[1] in 1999) are from melanoma. Melanoma is the most serious form of skin cancer and, worryingly, New Zealand has one of the highest melanoma death rates in the world[2]. (Approximately 18,000 cases of melanoma are diagnosed in New Zealand each year compared with 7,000 in the United Kingdom � where the population is 15 times larger).



The high prevalence of skin cancer in New Zealand is consistent with aspects of this country�s geography. Countries in the southern hemisphere lie closer to the sun than countries in the northern hemisphere so we receive more UV radiation, and New Zealand�s unpolluted atmosphere plus the hole in the ozone layer reduce the extent to which harmful UV rays are blocked.



There are two main national organisations working in skin cancer prevention in New Zealand: the Cancer Society of New Zealand and the Health Sponsorship Council.



The Cancer Society of New Zealand is a charitable non-governmental organisation that has a focus on reducing the incidence of, and harm caused by, cancer. The Cancer Society started working in skin cancer prevention and early detection in the mid-1980s. This work consisted, initially, of advocacy and public relations, however, over the late 1980s to mid-1990s this work extended to include a series of communication campaigns.



The Health Sponsorship Council (HSC) is a crown entity with a mandate to promote health and encourage healthy lifestyles. The HSC started working in skin cancer prevention in 1993, with a campaign focused on promoting skin cancer prevention to 12-17 year olds. This multi-media campaign utilised a social marketing approach and included development of the New Zealand SunSmart brand, public relations activities and sponsorship of selected outdoor activities.



Since 2001 the Cancer Society of New Zealand and the Health Sponsorship Council have worked together on skin cancer prevention.



In addition, a number of regional health promotion organisations undertake some skin cancer prevention activities.



In 2001 the New Zealand Skin Cancer Control Steering Group (which included representatives of the New Zealand Cancer Society, HSC, NIWA, University of Otago Social and Behavioural Research in Cancer Group, as well as a number of other experts in the field) met to develop the New Zealand Skin Cancer Prevention and Early Detection Action Plan.







Formative Research


The Action Plan was informed by a number of key pieces of New Zealand and international research, including:



Reeder, Anthony I. (2001). Skin cancer prevention in New Zealand: A discussion document to help guide future SunSmart programme directions. Prepared for the Cancer Society and Health Sponsorship Council Joint Working Group, Otago School of Medicine, Social and Behavioural Research in Cancer Group.
O�Dea, Des. (2000). The Cost of Skin Cancer to New Zealand. Cancer Update in Practice 2.
Reports on New Zealanders� sun-safety attitudes and behaviours, based on population monitors carried out in 1994, 1997 and 2000.


The Skin Cancer Control Steering Group identified five priority areas for action, the first and largest of which was the promotion of primary prevention of skin cancer. The SunSmart partnership between the Cancer Society National Office and the HSC was formalised in 2001 to address this crucial area.



This partnership was to work together to develop a SunSmart programme that would represent the combined skin cancer prevention efforts of the SunSmart partners. The programme would have one priority audience, one set of goals and objectives, one set of key messages and strategies, and one brand. SunSmart was also to be managed by one individual who would represent the interests of both the Cancer Society National office and the HSC.



Priority audience(s)



On the basis of research highlighting the influence of early-years sunlight exposure on melanoma incidence children aged 12 years and under, and their care-givers, are identified as the priority audience for SunSmart work.



Goal


The goal of the SunSmart programme is to increase the uptake of sun protective behaviours by New Zealand children aged 12 years and under and their care-givers.



Objectives


Specifically, the programme aims to:

Increase the uptake of sun protective behaviours by New Zealand children aged 12 years and under.
Increase awareness and understanding of the threat posed by the sun in New Zealand.
Increase knowledge of all of the SunSmart behaviours (slip, slop, slap and wrap) and when they should be used.
Increased adherence to SunSmart behaviours (specifically applying 30+ sunscreen and reapplying regularly, wearing a hat, loose fitting clothes and sunglasses and seeking shade).




Strategies


1. Communications

To reach the priority audience (children 12 years and under and their care-givers) it was decided that a mass media campaign (television, radio, print) was required. The creative brief described the dual need to communicate the risk associated with New Zealand�s summer conditions as well as to communicate the need for a range of behaviours in order to be SunSmart. This was in response to research that showed that many underestimate the risk and/or believe that undertaking one or two behaviours (such as applying sunscreen) provides sufficient protection.



The creative selection and development process resulted in the birth of �Tiger� � a tiger prawn character that became the �spokesprawn� for the campaign.



PR activities included the launch of the campaign in November 2002 (SunSmart Week) and the introduction of �Tiger� by the Minister of Health at a parliamentary function attended by a representation of the priority audience � under 12 year olds.



A range of merchandise items were developed and distributed in support of the campaign � delivery points included local and regional health promotion personnel, selected sponsorship and community activities (see below) and sales.



In addition to television, radio and print the SunSmart website was redesigned to reflect the new images, with links to other relevant sites, and incorporating UVI (ultraviolet index) information provided by NIWA (National Institute of Water and Atmospheric Research).



A texting facility was also developed providing free UVI TXT line for mobile phones. This enabled texters to identify the UVI rating for their region at anytime.



2. Summer Settings

A range of sporting and recreational activities were assessed for their ability to economically provide SunSmart information to the priority audience as well as model the desired behaviours through policies and environments. A number, including the Surf Life Saving Association, cricket and �Whopper Chopper� community events, were then sponsored in order to achieve this.



In addition, a number of community events and activities were resourced with SunSmart communication materials, sunscreen, etc to encourage the inclusion of SunSmart information at outdoor summer activities.



3. Partnerships

SunSmart Week, held in November every year, provides a national focus on sun safety at the start of each summer. Partners include:

The Pharmacy Guild (undertake to send out SunSmart health promotion resources to member pharmacies and support a �best SunSmart window display� competition)
The MetService (promote the use of the UVI)
NIWA (provide UVI information and scientific support for sun safety).


4. Resources

Health education resources were developed and a �library� of readily available print resources maintained on a range of sun safety issues.



Research and Evaluation


The mass media campaign and all new resources were pre-tested with the priority audience.



The HSC/Cancer Society 3 yearly sun protection population monitor (first established in 1996) provides a way of tracking changes in New Zealanders� sun safety awareness, attitudes and behaviours. In addition, a communications survey has been conducted over the two �Tiger� summers, assessing the reach and impact of the communications strategy and a number of sponsored activities have been evaluated.



A reduction in skin cancer incidence and deaths would be the ultimate affirmation of the effectiveness of the SunSmart Programme. However, there is no way of establishing a causative link between the SunSmart Programme and skin cancer statistics (a range of factors contribute to changes in skin cancer prevalence so it is difficult to isolate the contribution made by the SunSmart programme). Furthermore, the time lag between interventions and downstream results � SunSmart focuses on children under 12 years whereas skin cancer tends to present much later in life - means it�s too early to see any change in cancer statistics as a result of the SunSmart Programme.



However, indicators are that the message is being seen and understood - the SunSmart profile is growing at community, national and international levels, and there is increasing awareness of SunSmart communications and understanding of SunSmart messages amongst New Zealanders.



Furthermore, sun protection population monitors undertaken in 2000 and 2003 suggest increased uptake of sun protection behaviours in this period:

� An increase in the proportion of people who wore a hat in the weekend prior to being interviewed.

� An increase in the proportion of people who wore sunscreen in the weekend prior to being interviewed � this is especially evident among 12-14 year olds.

� An increase in the proportion of people who used SPF 30+ sunscreen in the weekend prior to being interviewed.

� An increase in the proportion of people who said they had NEVER been sunburnt.



Lessons learned


It is vital to have a national overview and focus, with a clear direction for the future of the issue. This is particularly important where the budget available is very small and unable to sustain multiple target audiences.



Equally, as New Zealand is largely one communications environment there must be collaboration at the delivery end so that messages are consistent and not competing. It is important to engage organisations outside health that play a significant role in the issue � in sun safety NIWA and the media weather facilities (television, radio and newspapers) are very important in determining what is said, how it is said and what importance is given to the information.



Agencies used


Chrissy Pettman Creative

Cluster Creative
TNS Research

Social and Behavioural Research in Cancer Group � Otago University



More information


The Health Sponsorship Council

Cancer Society National Office

Website: www.sunsmart.co.nz