Choose You Blog
I get daily email alerts from a variety of health groups, including HHS. Imagine how my antennae perked up when I read about a study by Sherry Pagoto, PhD, associate professor at UMASS Medical School that researched efficacy of educating women about skin protection. In short, by directly educating women, they saw encouraging improvement in women caring for their skin. I had to know more, so I quickly found a contact for Dr. Pagoto at UMASS, and reached out to ask if she’d be willing to share more details. I am so honored and appreciative that she was willing to take her valuable time and explain more about her research. You’ll enjoy all she has to share, and she has even more information from her incredible preventive and behavioral medicine research.
Question: One of our Choose You pledges is “protect my skin” because that’s one of the cornerstones to preventing cancer. You conducted a study that found that the lessons learned in one day at a beach (information about sunless tanning products, education about skin cancer, and special photos that showed skin damage) affected women’s behavior as much as a year later. The women sunbathed less. Tell me a little more about this study and what you learned.
Dr. Pagoto’s Answer: In the study we randomized public beaches to two groups: a brief intervention or a survey only control group. The brief intervention involved
1) raising awareness of skin cancer risk via UV photos which reveals melanin deposits (sun damage) on the skin that can’t be seen with the naked eye,
2) educating people on the importance of staying out of the sun and using sun protection when in the sun, and
3) encouraging people to use sunless tanning products if they really feel the need to be tan.
In addition to encouraging sunless tanning products, participants were given a free sample, information about sunless tanning, and instructions for proper use. The overall message of the intervention was that sunbathing is dangerous and should be avoided, however if one has the desire to be tan, sunless tanning products should be used as a substitute for sunbathing. Results revealed that intervention participants decreased their sunbathing more than control at 2 months and 1 year later. Use of sunless tanning also increased in the year following the intervention. Participants also showed fewer sunburns and more use of protective clothing at 2 months, but no differences in these variables were observed at 1 year. We were encouraged that sunbathing declined in the intervention group and this difference was maintained through to the next summer.
Question: The big question I had after reading the HHS article was: okay so the women sunbathed less and used sunless tanning products more, but did they use sun protection such as SPF lotion and protective clothing? And was it year round protection or only summer?
Dr. Pagoto’s Answer: We did not find an effect on sunscreen between the intervention and control group at 2 months or 1 year, however we did find an effect on protective clothing at 2 months. We are not sure why sunscreen use was not affected. Our focus for sunscreen and protective clothing use was during summer rather than year round.
Question: Information about protecting your skin from the sun has been around commonly for at least two decades. And yet, many people still don’t protect their skin. Why do you think this is and how can we educate and convince, not to mention motivate, women to take better care?
Dr. Pagoto’s Answer: One reason people don’t protect their skin is because they like to be tan. Many people feel that a tan makes them look healthier, more attractive, and even thinner. Many people still have a strong desire to be tan and will tan in spite of awareness of the risks. The reason I was interested in including sunless tanning into our intervention is to offer tan seekers an alternative. In previous research, we have found it difficult to convince people who want to be tan to not tan. All of the press about the importance of vitamin D may be misinterpreted by tan seekers too, they feel like tanning is healthy again. The health messages are confusing right now. One message says we don’t get enough sun and another says we should protect ourselves from the sun.
Question: A lot of people, mainly women, chiefly moms, that I’ve spoken to expressed concern about Vitamin D deficiency from sunblock use. Many had concocted elaborate workarounds (such as outdoors in low UV times only, sunblock only during high sun times and months, protective clothing instead, etc.). Did you get any feedback about this during your study? If so, how did you address it?
Dr. Pagoto’s Answer: Yes, and I find the people who are the most concerned about vitamin D are often the people who most want to be tan. The health messages about vitamin D seem to have a disinhibiting effect on sun exposure. When people expressed concerns regarding vitamin D deficiency, I emphasized to them the importance of having their vitamin D levels tested before taking measures to increase vitamin D. Most people have not had their vitamin D levels tested but still assume they are low and take precautions, mostly involving more time in the sun. The Institute of Medicine released a report last month stating that the majority of Americans get adequate vitamin D and do not need to take measures to increase their vitamin D levels. Even among people who are vitamin D deficient, only a few minutes of sun each day is recommended which is not enough to achieve a tan. I am not sure that people understand that prolonged sun exposure for the purpose of tanning is not necessary to obtain vitamin D and is not safe.
Question: You’ve got broad research background and interests, which also include health, diet, exercise, and lifestyle interventions. Choose You is all about convincing and supporting women to alter their lifestyle, and take better care of themselves. What hints and advice would you offer to us and to women, to get them to take that leap? Has your research suggested any particular factors crucial to success?
Dr. Pagoto’s Answer: Our lifestyles shape our health, even more so than our genes in many cases. Your weight, risk for diabetes, heart disease, and many other diseases is a largely a function of your lifestyle. This means we have a lot of control over our health. I think the key to success is in your environment. Surround yourself with healthy options and healthy people. For example, your home should be conducive to a healthy lifestyle by being plentiful in healthy foods and opportunities to be physically active. On the flipside, you should also eliminate the unhealthy options. If there are foods that you struggle with overeating, do not store them in your home, it only makes the struggle worse. If you have chips, cookies, ice cream, candy, and other high fat, high sugar foods in your home, you will consume them far more than if you do not. It doesn’t mean you can never eat these foods, it only means that you should not live with these foods. Also, if there are healthy foods you do not eat enough of, make sure they are well stocked in your home. The same goes for people, surround yourself with people who have healthy habits and it will be easier to have healthy habits yourself. Changing your environment is one of the most important steps to changing your lifestyle.
Question: What’s your main message about healthcare for women? What would you like to see on the patient and health care provider side?
Dr. Pagoto’s Answer: Obesity has clearly reached epidemic proportions which has significant implications for the health of our country. Healthy lifestyle and weight management are essential to disease prevention. Weight loss of as little as 7% through lifestyle changes has been shown to have substantial effects on health, including preventing diabetes, lowering cholesterol, and reducing risk for heart disease. However, such interventions are not covered by health insurance and therefore are not widely available in medical centers. The only weight management intervention covered by health insurance is bariatric surgery, which is appropriate for only a small portion of people with obesity. I would like to see lifestyle interventions to become a part of the national health care plan. Also, weight management counseling should be standard in physician and nurse training so that they are equipped to counsel their patients on their weight. Obesity has become a serious health issue in recent decades, but our health care system has yet to respond.
Question: What lead you to your work?
Dr. Pagoto’s Answer: I became a psychologist because I was fascinated about how our behavior, the way we think, our emotions, and our mind have a tremendous influence on our physical health. You can live a longer and higher quality life by making healthy choices. I pursued a career in research because so many unanswered questions exist about what a healthy lifestyle is and how to motivate people to make the healthiest choices.
About Sherry Pagoto, PhD: I am a clinical psychologist and an Associate Professor of Medicine at the University of Massachusetts Medical School with an expertise in health, nutrition, fitness, weight management, and diabetes prevention. Although I am primarily a researcher, I also see patients in the UMass Weight Center in our behavioral lifestyle intervention program. I have published over 50 papers and have a book coming out in 2011 about how psychological health impacts physical health. I host a blog that aims to make research findings relevant to the community, it is called Healthy Worcester!