From strategy to results

5 years of working with

skin cancer prevention in Denmark

2012

The challenge in 2006

Reference: Special calculation based on The Danish Cancer Registry. National Board of Health; Tal og Analyse: Cancerregisteret 2010 (in Danish).

0

5

10

15

20

25

1980

19

82

1984

19

86

1988

19

90

1992

19

94

1996

19

98

2000

20

02

2004

20

06

rate

per

100

.000

Malignant Melanoma (MM) Age Standardised Incidence Rate (World)

MM - Male age 0-85+

MM - Female age 0-85+

Knowledge that gave hope 85-90% of skin cancer can be prevented through: •  Less sunburn •  Reduced lifetime exposure to

UV rays What was needed? •  Attitude change •  Behaviour change

Reference: Lucas,R.M. et al: Estimating the global disease burden due to ultraviolet radiation exposure. Int.J.Epidemiol. 2008; 37(3): 654-667.

But how? Foundation of project •  The Danish Cancer Society

was the campaign driver •  Knowledge gathering from

abroad •  Financing Strategy •  Clear vision and mission •  10-year plan with defined

goals, target groups, and messages

•  Strategic partners

•  Integration of evaluation - campaign messages - activities - attitude and behaviour

changes among the Danes

Solid financing •  TrygFonden: a long-term

partnership with shared values and goals

•  Commercial partners

Strategy

Documentation Knowledge

Partnerships - Commercial -  Affiliates

-  Campaigns -  Dialogue marketing -  Press - Information -  Education -  Events

Government agencies Ministries Interest organisations

Policy Legislation Strategic partnership

Sun protection: - Increased accessibility -  Better quality -  Web shop

Awareness of increased risk: - Individual - Collective

Local sun policy: - Institutions - Workplaces -  Municipalities

Fewer incidences of skin cancer - Fewer sunburns - Reduced UV exposure

Evaluation and monitoring (Center of Excellence)

Communicators: - Drugstores - Journalists - Health professionals - Life guards - Volunteers - Teachers - Ambassadors

Municipalities

Structural changes

Strategic partnerships

Behavioural change communication

Attitude and behaviour

Reduced risk

Culture Norms Changed behaviour

Secondary*target*

groups*

Municipali3es/*

poli3cians*

SUN SAFETY CAMPAIGN – OVERALL CHANGE THEORY FORANDRINGSTEORI

!!!!!!!!!Budget!!Resources!!!Partners!!!

SUMMER!

SUNSHINE!HOLIDAYS!!!!

The*general*

public*TURN!OFF!THE!SUNBED!•  Social*media*

•  Dialogue*flows*

•  Media*

campaigns*

•  Press*•  Educa3on*•  Pocket*films*

•  Municipal*

work*

•  Poli3cal*lobbying*

•  Info*materials*

Fewer*Danes*are*

diagnosed*with*

melanoma*or*

regular*skin*

cancer**

(Increased)*awareness*of*the*

campaign,*slogan*and*message*

15H25Hyear*olds*

Fewer*people*expect*to*

use*a*sunbed*(intended*

use)**

12H14Hyear*olds*

Awareness/knowledge*of*health*risk*of*

(own)*sunbed*use*

40H50Hyear*old*

women/mothers*

with*children*

living*at*home*

Structural*changes:*

Sunbed*ban*for*under*18s*

(legisla3on)*

OUTPUTS!Ac>vi>es !!!!!!!!!!!Target!groups!

OUTCOMES/IMPACT!–!RESULTS/EFFECTS!ShortFterm !!!!!!!!!!!!!!!!! !!!!!!!MediumFterm!!!!!!!! !LongFterm !

! ! ! !!

Structural*changes:*Municipali3es*

remove*sunbeds*in*public*places*

AQtude:*Mothers*increasingly*against*

their*children*using*sunbeds*

*

AQtude:*Increased*support*for*a*

sunbed*ban*

Fewer*people*use*sunbeds*

Reduced*life3me*

exposure*to*UV*

rays*from*the*

sun*and*sunbeds*

Reduc3on*in*cost*

of*skin*cancer*

treatment*

Structural*changes:*No*

sunbeds*in*public*

buildings*

Fewer*Danes*die*

of*skin*cancer*

Sun safety vision & mission •  Vision: No skin cancer in

Denmark

•  Mission: To get Danes to treat the sun with common sense

Campaign communication –balanced messages

REDUCE YOUR SUN BETWEEN 12 & 3PM •  SIESTA

Give the sun a break between 12 and 3 pm when the UV index is 3 or more

•  SUNHAT Avoid sunburn. Cover up with clothes and a hat when the sun is highest

•  SUNSCREEN Apply factor 15 liberally and remember that regardless of the amount you use, you should never sunbathe excessively

•  TURN OFF THE SUN BED Artificial UV rays significantly increase the risk of skin cancer. And the younger you are, the more exposed your skin is

The three programmes

Sun holiday Year round

Summer May-August

Sunbed November- December

Strategic partners

•  Strategic partners •  Good ambassadors •  HRH Crown Princess

Mary, patron of the sun safety campaign

Integration of evaluation

•  Evidence-based research and recommendations

•  The intelligent campaign evaluation of: - campaign messages - activities - knowledge, attitude and

behaviour changes

Integrated communication

What have we achieved in 5 years?

Awareness & attitudes - Summer

•  75% of the population(15-64 yrs) know our slogan •  1 in 2 Danes (15-64 yrs) know at least 3 of the 4

pieces of sun safety advice •  98% of parents aged 25-49 know the UV-index •  4 out of 10 parents aged 25-49 use the UV-index

to plan sun protection

Awareness

•  95% of parents aged 25-49 believe it is important to protect their children in the sun to prevent redness and sunburn.

•  87% of those aged 15-24 think it is important to protect themselves in the sun in Denmark to prevent redness and sunburn.

Attitudes

References: • Sun Survey 2011 - A survey of the sun habits of the Danish population in Denmark during the summer of 2011. The Danish Cancer Society and TrygFonden, June 2012. •  Special calculation based on the evaluation of the Summerprogram of the SunSafety Campaign 2011 (In Danish)

Behaviour - summer

1 in 6 parents aged 25-49 has changed behaviour thanks to the campaign (2011) Fewer are sunburnt (2011)

References: • Sun Survey 2011 - A survey of the sun habits of the Danish population in Denmark during the summer of 2011. The Danish Cancer Society and TrygFonden, June 2012. • Special calculation based on the evaluation of the Summerprogram of the SunSafety Campaign 2011 (In Danish)

0 1

32

67

0 0

23

77

0

20

40

60

80

100

More than 5 times

3-5 times 1-2 times I haven´t been

sunburnt

Perc

ent

How many times have you been sunburnt this summer?

June 2010

June 2011

89

31

55

71

85

33

60

74

86

35

64

77

0 10 20 30 40 50 60 70 80 90

100

Shade Sunhat Clothes that cover body, overarms and thighs

Sunscreen

Perc

ent

2008

2009

2010

More people follow sun safety advice – often or sometimes

Knowledge & attitudes – Turn off the sunbed

•  96% of young people (15-25 yrs) know that sunbeds increase the risk of melanoma. They know that sunbeds are dangerous but have a low perception of their own risk

Knowledge

• 24% of young sunbed users (15-25 yrs) do not realise the health risk associated with their own use of sunbeds.

• 21% of those aged 15-25 continue to use sunbeds Risk perception

• 52% of mothers aged 40-50 who have children using sun- beds are against their children’s use of sunbeds.

• Danes increasingly support a sunbed ban for young people under 18 years.

Attitudes

Reference: • Sunbed habits of children and young people in Denmark 2010. The Danish Cancer Society and TrygFonden, November 2011. • Sunbed habits of the Danes 2010. The Danish Cancer Society and TrygFonden, November 2011.

Behaviour - Sunbeds*

47 45

31

22

16

2 4

14

44

38

28

23

15

1

4

14

33 32

22 23

14

2 2

11

18

22

14

17

12

0

5

10

15

20

25

30

35

40

45

50

8-9 10-12 13-14 15-19 20-29 30-39 40-49 50-59

Perc

ent

Age (years)

Sunbed use within the past year by age

2007

2008

2009

2010

Reference: • Sunbed habits of children and young people in Denmark 2010. The Danish Cancer Society and TrygFonden, November 2011 (in Danish) • Sunbed habits of the Danes 2010. The Danish Cancer Society and TrygFonden, November 2011 (in Danish).

Behaviour - Sun holidays

Slightly more people follow sun safety advice on sun holidays

Fewer young people sunbathe on a sun holiday

References: • Sun Survey 2009. The Danish Cancer Society and TrygFonden, Feb. 2010 (in Danish). • The sun habits of the Danish population on holidays in sunny destinations in 2010. The Danish Cancer Soecity and TrygFonden,, Feb. 2011 (in Danish). • The sun habits of the Danish population on holidays in sunny destinations in 20101 The Danish Cancer Soecity and TrygFonden,, Feb. 2012 (in Danish).

92

36

59

90 94

36

63

91

0

20

40

60

80

100

Shade Sunhat Clothes that cover

body, overarms and thighs

Sunscreen

Perc

ent

Use of sun safety advice among the Danish population (15-64 yrs)

2009

2010

61 54 55 53

84 75 79

66

0

20

40

60

80

100

2008 2009 2010 2011

Perc

ent

Proportion of those aged 15-19 who go on holiday to a sunny destination Proportion of those aged 15-19 who sunbathe on this kind of holiday

Structural changes

• Sun safety policies at municipalities, day care, schools and workplaces

•  Information on sun protection provided in health visitors’ manuals, lifeguard training, physiotherapists, drugstores

General initiatives

• UV-index in weather forecasts on TV and in newspapers • Documented sun protection products • Education in primary and secondary schools

Summer

• Legislation proposal regarding sunbed ban for under18s • New EU standards for sunbeds • Removal of sunbeds from 51 municipal buildings • Proposed sunbed ban for under 18s in 5 municipalities

Turn off the sunbed

• Education at guide schools Sun holiday

Reference: http://www.cancer.dk/NR/rdonlyres/90B6F08B-CF18-4E0A-B505-C201E25B80D9/0/Danmarkskortsolarier200812.pdf (in Danish)

There’s still a long way to go 2017 GOAL! 2007 level! 2010 level! Has the goal been achieved? !

75% awareness of ”Reduce your sun between 12 and 3 pm”*

(20%)* 74%* Yes*

25% unprompted awareness of ”Reduce your sun between 12 and 3 pm”*

(<2%)* 10% of the target group * No*

25% unprompted awareness of 3 ways of sun protection*60% often use the shade for protection *

43%* 41%* No*

30% wear a sunhat as protection* 20%* 15%* No *

80% wear light clothing for protection *

-* 24% * No *

70% use sunscreen as protection * 50%* 47%* No*

30% fewer sunburn incidences * 39% were sunburnt* 41%* No *

60% of those aged 15-17 have not used a sunbed during the past 12 months *

49%* 76% (aged13 -15) 62% (aged16-18)*

Yes*

85% of those aged 18-65 have not used a sunbed during the past 12 months *

74%* 85% * Yes*

80% of all children in daycare institutions are protected against the sun between 12 and 3 pm *

-* -* (probably achieved for kindergartens)*

Project foundation – key learnings

•  Anchor the campaign in one organisation that is the primary driver.

•  Make sure that the campaign is based on evidence and best practice from other relevant campaigns

•  Secure long-term financing Strategy •  Early formulated vision,

mission and strategy •  Strategic partnerships

•  Result-based steering with clearly measurable goals

•  Continuous evaluation and monitoring for adjustments to the strategy and action plan

Daily work - key learnings •  Commercial partnerships can

also be a challenge •  Relevant info packs and

materials for volunteers and ambassadors with allocated resources

•  On-curriculum, innovative educational materials

•  E-learning as a knowledge tool for volunteers

•  Hands-on policies for implementation of sun safety at daycare centres and schools

•  Implement sun safety at existing events instead of creating your own.

Questions

? Line Rasmussen

Head of the Danish ”Reduce Your Sun” Campaign The Danish Cancer Society

Direct phone: +45 3525 7577 E-mail: lras@cancer.dk