\

PERGAMON
Personality and Individual Di}erences 14 "0887# 778784

Is health protective behaviour in adolescents related to personality< A study of sun protective behaviour and the Eysenck Personality Questionnaire "junior version# in Queensland
C[ Braynea\ \ K[!A[ Dob\ L[ Greenb\ A[ C[ Greenb
a

Department of Community Medicine\ University of Cambrid`e\ Institute of Public Health\ Robinson Way\ Cambrid`e CB1 1SR\ U[K[ b Queensland Institute of Medical Research\ Brisbane\ Australia Received 06 August 0886

Abstract In a study of moles in 100 adolescents\ information on sun protective behaviour was collected\ in addition to the Eysenck Personality Questionnaire[ The relationship between the neuroticism\ extraversion\ psychoticism and lie scale and several types of sun protective behaviour was examined[ Consistent with well! established fact that there is a gender di}erence\ girls exhibit more sun protective behaviour than boys\ as well as demonstrating di}erent personality pro_les[ Controlling for these factors we found that psychoticism scale decreases while the lie scale increases with sun protective behaviours[ The _ndings suggest that programmes aimed at reducing skin cancer in the future through the promotion of healthy practices in early life should take into account the di}erent behaviours found with di}erent personalities[ This is an approach which has not been exploited su.ciently and holds promise for the future[ 0887 Elsevier Science Ltd[ All rights reserved[
Key words] Adolescence^ Health promotion^ EPQ^ Epidemiology

0[ Introduction At a time when individual responsibility for health protective behaviour is increasingly encour! aged factors which may in~uence the uptake of such behaviour need to be better understood[ In particular\ the factors which in~uence health!seeking behaviours in early life may be the most

Corresponding author[
S90807758:87:,08[99 0887 Elsevier Science Ltd[ All rights reserved PII] S 9 0 8 0 7 7 5 8 " 8 7 # 9 9 9 6 0 2

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important[ Several studies have shown that potentially harmful exposures in early life may a}ect chronic disease in later life\ such as exercise and osteoporosis or fetal nutrition and cardiovascular disease and diabetes "Teegarden et al[\ 0885^ Barker et al[\ 0882#[ The link between sun exposure and premature ageing of the skin and skin cancers is well established\ and many countries have implemented programmes aimed at increasing sun avoidance and sun protection in all age groups[ Australians have the highest recorded incidence of skin cancer in the world\ and residents of Queensland are particularly a}ected "Green et al[\ 0885#[ Much sun damage to skin occurs before adulthood\ and thus programmes for sun protection are aimed towards parents[ Sun protection has been examined on beaches in a range of age groups and has shown that younger children tend to be better protected than adolescents "Foot et al[\ 0882#[ In adolescence individuals are beginning to take responsibility for their own risk behaviours and it is at this age that it is particularly important to establish healthy patterns which will stand the individual in good stead for the rest of their lives[ The consequences of earlier lack of awareness of sun damage is well documented in a study from Darwin where\ in a study of mainly adult individuals at market in the midday sun\ less than 19) were wearing sunscreen and under a third a hat "Whiteman et al[\ 0883#[ This is important for both sexes^ as only half boys and girls in another beach study had applied sunscreen "Pincus et al[\ 0880#[ Personal attributes are likely to in~uence the way an individual takes up messages generally available on healthy behaviours[ Barriers to the use of sunscreen in school children have been examined and found to be greater in boys and the older grades despite this age group being well informed about the risks for skin cancer "Lowe et al[\ 0882#[ No studies appear to have examined the relationship between personality and sun protection behaviour in adolescence^ even in adults little has been published beyond an increase in anxiety in those who exhibit sun protective behaviours "Keesling and Friedman\ 0876#[ Such information should help inform those involved in developing health promotion programmes for adolescent audiences and whether there are speci_c subgroups who need a targeted approach[ In the course of a longitudinal study of mole development in adolescents in Brisbane\ Queensland this association has been examined[

1[ Method The respondents were students at either of two large state primary schools in Brisbane\ Queens! land\ Australia[ They were in third\ fourth or _fth grades in 0875[ Each school provided a sample of around 099 children aged 7 to 09 years from a variety of socioeconomic backgrounds[ The overall aim of the study was to examine the development of moles on the skin in schoolchildren "Green et al[\ 0884#[ A total of 100 children were successfully examined[ In 0880 and 0881 these children were examined again to document the incidence and development of their moles "Green et al[\ 0884#[ During the 0880 interview when the children were aged mainly 02 to 04 years\ they were asked about their sun protective behaviour[ In order to examine the relationship of sun protective behaviour to incidence of moles the items which related to an individual|s use of sunscreen\ wearing a top and hat were examined[ In the analysis presented here the activities which were within the individual|s control were selected and those activities which were outside their control were not examined\ such as location of holidays[ Each adolescent was asked to report\ for

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Table 0 Age by sex breakdown of 012 Australian adolescents and respective mean scores for personality scales and sun protection behaviour scores Sex Male "n Age N 02 2 58# 03 18 04 29 05 6 Female "n 02 4 43# 03 15 04 19 05 2

Psychoticism Extraversion Neuroticism Lie Sunscreen Wear hat Wear top

Mean scores "standard error# 3[12 "1[83# 07[44 "1[66# 8[69 "3[75# 5[95 "1[88# 09[14 "1[35# 5[32 "0[29# 6[67 "1[27#

0[85 "1[15# 06[73 "3[97# 01[16 "3[89# 6[52 "2[32# 01[30 "1[15# 4[65 "0[29# 6[56 "0[72#

their holidays and after school\ the frequency of sunscreen use\ wearing a hat or shirt:top while they were at an outdoor pool\ at the beach\ while doing water activities or other activities in the sun[ The responses were ordered as 0 never\ 1 sometimes\ 2 most times\ 3 always[ Those who reported {don|t remember| or {not applicable| were coded as missing[ The ordered responses were summed over all categories of activities to obtain continuous measurements of sun protection behaviour scores represented by the variables sunscreen\ wear hat and wear top[ In addition the Junior Eysenck Personality Questionnaire "EPQ\ Eysenck and Eysenck\ 0870^ Eaves et al[\ 0878#[ 1[0[ Statistical analysis Means of the Junior EPQ personality scales "psychoticism\ extraversion\ neuroticism and lie: social desirability# and sun protection behaviour scores between sexes were compared using t!tests and Wilcoxon non!parametric tests[ Assumptions of normality were checked by normality plots[ Since none of the continuous variables exhibited non!normality characteristics\ no logarithmic transformation of variables was required prior to statistical analyses[ Unless otherwise noted\ a nominal P 9[94 level of signi_cance was used and all tests were two!tailed[ Multiple regression analysis was employed to model personality scales as a function of sex and various sun protective behaviour scores for usage of sunscreen\ hat wearing and top wearing[ All analyses were performed using the statistical package SAS[ 2[ Results The age and sex distributions of the sample are given in Table 0\ with most students aged 03 or 04[ Individual items with missing responses accounted for a maximum of 04) of the sample[

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The combined continuous scores for sunscreen\ hat wearing and top wearing were based on 61 individuals[ Scores on the psychoticism\ neuroticism and lie scale were signi_cantly di}erent between boys and girls\ but there was no di}erence in the mean score on the extraversion score "P 9[53#[ Likewise signi_cant di}erences were noted between boys and girls in the continuous measures representing sunscreen use and hat wearing\ but not top wearing "P 9[76#[ Therefore multiple regression included the covariate sex and each of the sun protection behaviour scores _tted separately "Table 1#[ Psychoticism and lie scales were signi_cantly associated with all sun protection behaviours while extraversion was not associated with any[ Neuroticism was associated with sunscreen and hat wearing behaviours but not with top wearing behaviour[ A _nal multiple regression model based on 31 individuals with complete data was _tted using sex and all sun protection behaviour scores simultaneously as covariates[ This showed that after adjustment for sex and the other covariates only sunscreen remained marginally associated with psychoticism "P 9[0#\ but the lie scale more so "P 9[90#[ Hat wearing was associated marginally with neuroticism "P 9[0#[

3[ Discussion In this population sample\ signi_cant di}erences in both sun protection behaviour and pro_les were found between the sexes[ The _nding that girls were more likely to use sun protection is di}erent from a study in New South Wales which found the opposite "Cockburn et al[\ 0878#[ When these were examined together\ the personality traits of increased psychoticism and increased lie scale "also named the social desirability scale# were noted to be associated with less likelihood of exhibiting sun protective behaviour\ even after correction for sex[ However\ the multiple regression taking all behaviours into account\ led to only the lie scale being signi_cantly associated with sunscreen application[ The major di.culties with this study are the nature of the sample*a small longitudinal study\ the limited age group\ and missing data[ These limit the generalisability of the _ndings[ The _nding that psychoticism and lie scales are associated with less sun protective behaviour seems logical in behavioural terms\ although it may have been expected that the more neurotic individuals would exhibit more sun protective behaviour[ This does have implications for the type of health promotion messages directed towards children as they become responsible for their own health risk behaviour[ The type of message which will be successful with individuals high on the neuroticism scale is not the same as that for the more psychopathic and those scoring high on the lie scale[ These individuals will have a di}erent perception of the consequences of risk[ This is well recognised\ but there has been little work to date on health promotions which capitalise on these _ndings[ An approach based on this knowledge was successfully developed for targeting and designing e}ective health promotion in the prevention of drug abuse "Donohew et al[\ 0880#[ It has been recognised that health messages laid down in adolescence are important in later life\ and several programmes have been developed by the Centre for Disease Control "0885 and 0886#\ as well as receiving more general attention "Millstein et al[\ 0882#\ but usually other diseases and behaviours are the focus of interest "e[g[ Boekeloo et al[\ 0885#[ More studies should include speci_c

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Table 1 Partial correlation\ regression coe.cients\ b\ standard error "se#\ and nominal P value "P# for the relationships of personality scales with sun protective behaviour scores Dependent variable Psychoticism Partial correlation * 9[28 9[31 * 9[33 9[13 * 9[44 9[09 * 9[90 9[09 * 9[90 9[90 * 9[91 9[90 * 9[15 9[19 * 9[13 9[19 * 9[04 9[95 * 9[11 9[06 * 9[13 9[09 * 9[22 9[06

Covariate Intercept Sex Sunscreen Intercept Sex Wear hat Intercept Sex Wear top Intercept Sex Sunscreen Intercept Sex Wear hat Intercept Sex Wear top Intercept Sex Sunscreen Intercept Sex Wear hat Intercept Sex Wear top Intercept Sex Sunscreen Intercept Sex Wear hat Intercept Sex Wear top

b 00[52 1[99 9[34 8[82 1[26 9[49 7[83 2[04 9[02 06[01 9[92 9[02 06[38 9[07 9[993 07[2 9[02 9[992 00[93 1[54 9[23 01[61 1[54 9[62 6[42 0[31 9[04 1[91 0[36 9[10 5[01 0[44 9[17 0[64 0[80 9[15

se"b# 0[22 9[52 9[01 0[77 9[51 9[13 0[40 9[48 9[04 0[67 9[73 9[05 1[74 9[80 9[24 0[73 9[61 9[07 1[63 0[18 9[14 2[46 0[18 9[33 1[81 0[03 9[17 0[62 9[71 9[05 1[21 9[63 9[18 0[63 9[57 9[06

P 9[990 9[990 9[990 9[990 9[990 9[94 9[990 9[990 9[27 9[990 9[86 9[33 9[990 9[74 9[88 9[990 9[74 9[88 9[990 9[94 9[07 9[990 9[94 9[00 9[94 9[11 9[50 9[14 9[97 9[08 9[94 9[94 9[22 9[21 9[94 9[02

Extraversion

Neuroticism

Lie

The partial correlation coe.cient represents the strength of the relationship between the dependent variable and a covariate while adjusting or controlling for other covariates in the model[ The linear regression model assumes that the expected value of the dependent variable is some function of the covariates with random error having mean value 9[ For example\ the regression model for Psychoticism score vs covariates Sex and Sunscreen score simultaneously is Psychoticism 00[521 Sex9[34 SunscreenRandom error[ The above equation may be interpreted as follows] , Holding Sunscreen _xed\ boys on average score 1 points fewer than girls on the Psychoticism scale[ , Within a particular Sex\ one unit increase in Sunscreen score induces 9[34 unit decrease on Psychoticism score[

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investigation of personality and behaviour in order to help those designing health promotion messages to target their audience more e.ciently\ and in particular to understand what charac! terises those who are least compliant[

Acknowledgements We are grateful to Professor Patton and Dr Toumbourou for their information on targeted health promotion in adolescents[

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