Amy Watson placed a mason jar filled with colored liquid on the counter.

“This is a representation of the number of new cases of breast cancer each year, 255,000,” she told the audience. Other mason jars of colored liquid soon followed.

Lung cancer: 220,000.

Prostate cancer: 165,000.

Colorectal cancer: 135,000.

Then she pulled out five, gallon-sized milk jugs.

“This is the representation of how many skin cancers are diagnosed each year: 5.5 million,” she said. “I don’t know what the color for skin cancer awareness is, but nothing turns pink like it does for the month of October.”

Watson, a marketing professor at OSU-Cascades, has been examining how sun safety messaging is marketed to consumers. The idea of looking into sunscreen marketing was literally born lounging around the pool with family and friends. Watson was shocked to see the number of the skin cancer diagnoses each year, and equally stunned that the government’s response to it consisted mainly of adding a new drug facts panel to sunscreen containers.

“Something doesn’t seem quite right about this,” she recalls thinking. “This doesn’t seem like it’s going to have the impact that I think they’re hoping it’s going to have.”

Watson and two colleagues surveyed college students on their sun-safety knowledge and behaviors. Most had a failing grade when it came to understanding of SPF, sun tanning risks and protection behaviors. But even those who scored high on sun knowledge didn’t necessarily improve their sun-safety behaviors.

“There is zero statistical relationship between knowledge of skin cancer and the sun safety behavior,” Watson said.

The survey showed that few of the students knew they needed to apply an ounce of sunscreen — about the size of a shot glass — for proper coverage, or that they need to reapply it every 80 minutes.

“We have some people who are using sunscreen but not nearly enough,” she said. “If you’re stocking up on sunscreen for the summer, you need to be buying way more than a bottle.”

Watson had recently moved to Bend when she met Dawn Fletcher, a teller at the bank where Watson had opened an account. Fletcher, 45, had been diagnosed with basal cell and squamous cell carcinoma in 2010.

She underwent MOHS surgery, a procedure in which doctors remove cancerous skin layer by layer, then check the removed tissue under a microscope to ensure they haven’t left any behind.

“You are awake. They give you a local. They keep numbing you and numbing you and numbing you until they have clean margins,” Fletcher said. “I went through that for 12 hours.”

Five years after her surgery, the cancer returned. In 2016, they removed her sinuses. She appears to be cancer-free now, but will go back for a head-to-waist CT scan in May.

“If you look at me, I look like I was in a car accident. I have scarring all across my forehead, I have no cartilage in my ears, from reconstructive surgery,” she said.

Fletcher had tanned regularly since her teenage years, tanning everyday, sometimes twice a day. “People need to know,” she said. “People think skin cancer only affects the elderly. It’s not the case at all.”

Cautionary tales such as Fletcher’s don’t seem to have an impact on young tanners who don’t believe such things will happen to them, said Richard Lindsay, a physician assistant with The Leffel Center in Bend. He sees many patients whose tanning from years ago left them with lines, wrinkles and age spots they now want to remove.

“Prevention is always the hardest at younger ages for anything. It’s not going to happen to me. I’m immune. I’m invincible,” he said.

Watson’s survey suggests that simply providing education about the risks of tanning and ways to protect against skin cancer aren’t likely to be effective in the adolescent and young adult age groups that are tanning.

“We know there is a large segment of consumers that make decisions not from a rational cognitive processing model but rather from an emotional, hedonistic, pleasure-seeking model,” she said. “And the younger generations are much more susceptible to that sort of decision making.”

Previous studies have found that people with low self-esteem are more likely to engage in risky behaviors, such as tanning, to improve self-image.

Watson’s survey found similar results. A large portion of those who engaged in frequent tanning had low self-esteem and exhibited high levels of narcissism.

According to Watson’s survey, about a third of frequent tanning behavior was explained by the students’ emotional responses to tanning. They said they feel more confident, sexier when they tan. Those sorts of drivers outweighed any warnings about the risks of getting skin cancer.

“That tactic is not going to work with this particular demographic,” Watson said. “So we will be developing communications strategies that are emotion-based. We’re working to create a new social and cultural perspective that tanned skin is damaged skin, and damaged skin is ugly.”

Watson and her colleagues hope to recreate the success of other recent health campaigns, such as the push against texting and driving or to reduce sugar consumption.

“They started shifting the cultural perception of what it means to text and drive, from being cool and acceptable to being really taboo,” Watson said. “At that point, the pressure is coming from the social peers, rather than a governmental agency.” •

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