National collaboration for skin cancer control in Australia: Outcomes of The Cancer Council Australia’s National Skin Cancer Steering Committee

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On behalf of the National Skin Cancer Steering Committee


The National Skin Cancer Steering Committee (NSCSC) is a sub-committee of The Cancer Council Australia’s (TCCA) Public Health Committee and has existed since 1985. The committee was initially established to coordinate national activities for National Skin Cancer Awareness Week (NSCAW). NSCAW arose from a proposal for a national campaign by the then Anti-Cancer Council of Victoria and the Australasian College of Dermatologists (ACD) in 19851.

Membership of the committee includes a representative from each state cancer council, the ACD and scientific and behavioural research disciplines.

The role of the NSCSC has developed over the 17 years from one of campaign coordination to a broader one with the key functions being to:

  • Draft position statements relating to issues associated with skin cancer and sun protection;
  • Develop skin cancer control program guidelines consistent with TCCA cancer control policies; and 
  • Facilitate national collaboration of TCCA member organisations on skin cancer control issues.

The committee meets face-to-face once a year and teleconferences bi-monthly.

This paper reports the key activities and achievements of the NSCSC during the period 1998-2001.

SunSmart Primary Schools Program
The SunSmart Schools Program is an accreditation program which recognises primary schools that have adopted comprehensive sun protection policies covering curriculum, behaviour and the environment that meet prescribed standards. The program was initially developed and implemented in Victoria in 1994. A modified version of the Victorian program was subsequently introduced in South Australia and Tasmania in 19962.

Through the NSCSC, state cancer councils collaborated on fine-tuning the program and all other states and territories, with the exception of New South Wales, began offering the program to primary schools in 1998. Table 1 shows the percentage of accredited SunSmart schools in each participating state and territory at the time of printing. Many of the remaining schools are participating in the program but have not yet reached the standard to achieve SunSmart status.

CF02Mar_39_Table1

Cost-efficiencies were achieved in the development and printing of resources through this collaboration which also included the development of a specially designed computer software package to meet the recording and documentation needs of the program. State/territory-based staff responsible for implementing the program were provided with training in the use of the software.

Collaboration between the cancer councils through the NSCSC enabled a base-line survey to be conducted in all states/territories (except NSW) prior to the implementation of the program in 1998. A follow-up survey is currently being conducted.

The degree to which cancer councils have been able to implement the program differs and reflects the variation in fiscal and personnel resources available to each council.

Best practice guidelines
Following a NSCSC strategic planning workshop in 1999, two working groups were established to develop best practice guidelines for the implementation of sun protection programs for early childhood centres and secondary schools.

These working groups comprised state-based cancer council staff with appropriate expertise led by a member of the NSCSC. State/territory cancer councils were regularly consulted during the production phase to take account of the specific needs states/territories might have.

UV Risk Reduction: A Planning Guide for Secondary School Communities was launched in November 2001. In some states/territories cancer council staff responsible for working with secondary schools do not have experience in the workings of the secondary school system. Consequently, guidelines for working with this sector have also been developed to assist these staff.

Guidelines For Working With Australian Early Childhood Services To Improve Skin Cancer Prevention Practices were released in December 2001. Again these were complemented by guidelines for cancer council staff responsible for implementing the program.

Publicity
National Skin Cancer Action Week (formerly National Skin Cancer Awareness Week) is held in the third week in November each year and is a focus for media activity to publicise issues associated with skin cancer and sun protection.

Apart from the national and regional print and electronic media, the media strategy has included targeting popular magazines, particularly those with a fashion focus. The success of this strategy has been largely due to a coordinated approach to the media led by the teamwork of the public relations experts available through TCCA and its member organisations.

In 1999 a television advertisement was produced by the NSCSC funded by TCCA, ACD and state/territory cancer councils. The advertisement, aimed at 17-25 year olds, underwent extensive formative research. Advertising concepts were focus tested in three states, Victoria, New South Wales and South Australia, coordinated by members of the NSCSC. This resulted in the production of a highly successful advertisement known as Timebomb that has been broadcast in Victoria, Western Australia and South Australia, these being the only states able to fund a media campaign.

Target Audience Rating Points (TARPs) are the standard advertising industry measure of the weekly volume of television advertising weight. One TARP represents 1% of the target audience who have had the opportunity to see an advertisement on television3. Evaluation of the South Australian advertising campaign showed a peak recall rate of 85.6% with average weekly TARPs of 2904. This compares very favourably with other television advertising campaigns of health issues. How to Remove a Skin Cancer, a graphic advertisement that showed a skin cancer being removed and aimed at the 16-24 year old age group was screened in Victoria in 1997 and again in 1998. Recall of this advertisement was 72% in 1997 and 75% in 1998. The TARPs were 485 and 267 respectively5.

By comparison, the 1999 Evaluation Report of the National Tobacco Campaign6 shows that recall of the most prominent of three advertisements peaked at approximately 90% in week four of the campaign. This campaign was held mid year, when television viewing rates are generally higher than the summer months, and the TARPS for that week were a little over 400.

Almost all respondents in the South Australian evaluation survey (98.1%) thought the advertisement was believable and 88.5% said it was thought-provoking. Also, a high proportion (85.1%) thought it was relevant to them. These results indicate that the creative execution met the criteria identified in the focus testing conducted during the development of the advertisement.

Fifty-one percent of the target age group reported having increased their level of sun protection as a result of seeing the advertisement.

A well-executed advertising campaign is an important strategy in a multi-faceted program aimed at bringing about behaviour change, however, it is expensive in terms of production and advertising costs. The production of the advertisement through the NSCSC provided cancer councils with an excellent resource to complement their state-based programs. Where a paid advertising campaign was not possible, there was some free community service advertising using the Timebomb advertisement.

Development of position statements
There are many issues associated with skin cancer and sun protection that require an opinion from The Cancer Council Australia and its members. The NSCSC has been responsible for identifying the issues and over the past four years has developed the drafts of the position statements for consideration by the Public Health Committee and final endorsement by the Board of TCCA.

The various position statements, which are available on TCCA’s website atwww.cancer.org.au/skin have resulted in consistent, evidence-based information being provided across the nation. They are an important aspect of the public information role of TCCA as they form the basis of policies of and advice given by other non-government and government agencies.

Conclusion
The NSCSC links the state and territory cancer councils at the health promotion practitioner level providing peer support, in-service training and resource support to the smaller state cancer councils. This network is important in ensuring that educational messages and responses to skin cancer and sun protection issues that arise in the media are consistent across the nation.

It is through this state and territory collaboration that SunSmart has now become a highly respected trademark in Australia. SunSmart has also become part of the Australian language with the term used to describe behaviour, clothes, organisations and activities.

References

1 S Noy, J Houston. “National Skin Cancer Awareness Week 1985 – A new initiative in public education about skin cancer” Cancer Forum, 1, 3 (1986): 88-91.

2 A Peipers. National SunSmart Schools Program – A Project of the National Skin Cancer Steering Committee. Report for the Australian Cancer Society (1999).

3 P Williams, T Bleasdale. “The Relationship between Television Activity and Quitline Call Data” In: K Hassard (ed) Australia’s National Tobacco Campaign Evaluation Report, Appendix 3A. Commonwealth of Australia, 1 (1999): 107-26.

4 B Kirke, M Crawford, K Beckmann. “Time Bomb Television Advertising Campaign 2001” In: SunSmart Evaluation Report. Anti-Cancer Foundation of South Australia, 1 (2001): 34-41.

5 S Dobbinson, R Borland. “Reactions to the 1996/1997 SunSmart campaign: Results from a Household Survey of Victorians” In: SunSmart Evaluation Studies: The Anti-Cancer Council of Victoria’s Skin Cancer Control program 1996/97 and 1997/98 and Related Research and Evaluation. Anti-Cancer Council of Victoria, 6 (1999): 69 -92.

6 R Donovan, J Freeman, R Borland, J Boulter. “Tracking the National Tobacco Campaign” In K Hassard (ed). Australia’s National Tobacco Campaign Evaluation Report. Commonwealth of Australia, 1 (1999): 128-65.

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