Professor John Lowe: finding his place out of the sun (Photograph: Chris Stacey).

Guest writer:

Rada Rouse is the national medical correspondent for AAP Information Services. Since graduating from The University of Queensland's Journalism Department in 1976, Rada has worked in regional and metropolitan media including a stint in the Canberra press gallery. In 1992 she was awarded a Foreign Affairs Department scholarship to report on HIV and malaria control in South-East Asia. Since 1996, she has specialised in medical writing at AAP, which provides services to media, corporate and government subscribers. Rada also contributes to the news pages of the journal Nature Medicine.

Research team:

Director: Associate Professor John Lowe Senior staff: Drs Zandy Clavarino, Warren Stanton and Kevin Balanda Research: Lynette Saeck, Liane McDermott, Sue-Ann Carmont and Jenny Moffatt PhD students: David O'Riordan and Dr Ignacio Correa Administration: Cathy Steven, Michele Dixon and Cathy Swart

Funding:

1997–2001 Queensland Cancer Fund ($57,422) 1998–2000 Queensland Health ($73,874) 1998–2000 NHMRC ($189,450) 1999–2000 Australian Rotary Health Research Fund ($18,000) 1999–2001 NHMRC ($175,809) 2000 Queensland Health ($527,350) 2001 Queensland Health ($300,000) 2001 Queensland Health and AMA ($19,000)

Email/Web link:

j.lowe@mailbox.uq.edu.au a.clavarino@spmed.uq.edu.au stanton@physio.therapies.uq.edu.au k.balanda@mailbox.uq.edu.au www.spmed.uq.edu.au/chpcpr/

Faculty of Health Science

Skin cancer prevention should be as easy as slip, slop, slap! Changing human behaviour, however, continues to be a challenge.

While skin cancer warning slogans may be instantly recognisable, it does not necessarily follow that people will apply the messages to themselves, according to public health expert Associate Professor John Lowe.

Understanding what motivates individuals to engage in risky behaviour is at the heart of effective public health promotion, and it requires a scientific approach.

The Centre for Health Promotion and Cancer Prevention Research (CHPCPR) was set up a decade ago in the hope it could answer riddles such as why, despite years of campaigns, people continue to take up cigarettes and let themselves get sunburnt.

The University of Queensland was successful in tendering for this Queensland Health initiative, and the Centre, based on the Herston health sciences campus and headed by Dr Lowe, has now survived several rigorous reviews.

"We wanted to do more than collect data about cancer," Queensland Health principal medical epidemiologist Dr Ian Ring said. "We wanted to control the direction of things described by the data.

"We wanted a Centre which would provide expertise in the human behavioural aspects of cancer prevention."

The CHPCPR is similar to centres in Newcastle and in Victoria which also work closely with state cancer councils.

According to Dr Lowe, its unique quality has been its ability to build a multi-disciplinary partnership incorporating the University, the State Government and a major benefactor, the Queensland Cancer Fund.

"We can meet the needs of all these players, but more importantly we can make health promotion scientific, adding credibility," he said.

Skin cancer prevention and tobacco control are major foci for the Centre, which has a brief to tease out the reasons behind non-compliance with cancer prevention messages.

Projects undertaken by the Centre include several targeting teenagers and skin cancer.

"The key to making a breakthrough in changing adolescent behaviour may be to understand the intricacies of how they perceive tanning — it may be all about beauty and self-confidence," Dr Lowe said.

Masters student Leanne McDermot is attempting to quantify the images bombarding 15– to 17-year-olds from television, cinema and magazines to define the subliminal messages being sent to teens by the popular media.

Are the geeky guys white and overweight? Are the nicer people more slender with deep tans, or a bit of a tan, and does a tan equate to looking nice and to being in shape?

Answers to these questions will provide an evidence-based platform for crafting new messages to the target audience, finding a happy medium where one can be considered healthy without calling for a ghostly white look.

Research projects undertaken by the CHPCPR range from this more academic exercise to trials of direct intervention.

In the mothers and babies sun protection project, the Centre is attempting to combine a biological outcome — the number of freckles on children's skin — with a behavioural program. "This is the first time anybody has looked at whether you can intervene with mothers to change their behaviour with regard to their babies, from birth to age three years," Dr Lowe said.

Principal research fellow Dr Warren Stanton has so far discovered that while most mothers protect their children from the sun extremely well up to the age of one, by the time children reach the age of three years, most have been sunburnt at least once.

Given the cumulative effect of sunburn as a carcinogen, the aim must be zero incidence of sunburn.

The project has been extended to employ the popularity of the children's band The Wiggles, by developing a story-book involving Dorothy the Dinosaur's sun-hat to see if this assists in getting toddlers to keep their own hats on.

"What this Centre is about is not only design and development, but evaluation, so before this book is released to the public we want to evaluate it with mothers taking part in a randomised controlled trial," Dr Lowe said.

Well-meaning organisations which distribute unproven health promotion materials — or those developed for another country — may cause even more harm than if there was no intervention, he said.

In other instances, opportunities — and money — may be wasted because campaigns are not based on the realities of behaviour.

The Queensland Cancer Fund (QCF) describes the kinds of analysis undertaken by the CHPCPR as "essential" to its adolescent smoking strategies.

"By analysing the three-yearly Education Queensland surveys of year seven to 12 students' attitudes to smoking, the Centre discovered that a large number of students were already smoking in patterns consistent with addiction," QCF spokesman Alan Inglis said.

"As a result of this, we changed our health promotion focus from one which had concentrated solely on prevention of uptake, to one which added in assistance for students to quit."

The success of another CHPCPR project — to provide smoking pregnant women with "quit" materials in selected public hospitals — may lead to Statewide provision of quit assistance at antenatal clinics.

A spokeswoman for State Health Minister Wendy Edmond said the proposal would form part of a submission to Cabinet for a Statewide Queensland Tobacco Action Plan.

Meanwhile Queensland Health is also looking to the Centre to help answer one of the major questions in cancer control: whether melanoma mortality can be lowered through population screening.

"We have something approaching 200 deaths a year in Queensland from melanoma, and if we're able to reduce that number we think the benefits will rate at least equally with the savings we're already starting to see coming through from the breast and cervical cancer screening programs," Dr Ring said.

While womens' cancers, skin cancer and tobacco-related cancers have been the core of the Centre's research, as other issues arise — such as toddler pool drownings — projects are funded.

Dr Ring foresees a future demand for data on the feasibility of bowel-cancer screening.

"There's now probably enough trial evidence to ask would it be cost-effective to look at a bowel-cancer screening program, and, while it was an issue in the last Commonwealth budget, it's likely to be an issue for the states soon," he said.

Dr Lowe also nominates bowel cancer and prostate cancer as likely new directions for the Centre.

"We're driven by the needs of Queenslanders, and this Centre, unlike many others, is really all about applied focus: ways to help people, not just study things," he said.

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