In Utah, people are at increased risk of developing skin cancer because of a predominance of sunny days, a high altitude, and residents with fair skin. Utah has approximately 241 sunny days annually, and the U.S. has an estimated 213 sunny days each year. Utah ranks third among all U.S. states in average elevation (6100 ft). Approximately 89% of the state's population is white, compared with the national average of 75%, for the year 2000 (2). These factors may contribute to higher incidence of skin cancer that consistently exceeds the national average.

According to Surveillance, Epidemiology, and End Results (1996–2000), the age-adjusted incidence rate for melanoma in Utah was 19.93 per 100,000, and the national average was 17.52 per 100,000 (3). Looking forward, it is projected that 420 Utahns will be diagnosed with malignant melanoma in 2004 (4). Additionally, the 2000 Utah Behavioral Risk Factor Surveillance System indicated that nearly 48% of adults reported obtaining sunburn in the previous 12 months (5).

It was estimated that 700 new cases of colon cancer would be diagnosed and 300 Utahns would die from colon cancer Utah in 2003 (6). Colon cancer is most common in men and women aged 50 and older (6,7). The risk increases with age: 93% of cases were diagnosed in people aged 50 years and older (6,7). Colon cancer is the number two cancer killer in both the United States and Utah, and it is more than 90% preventable if properly screened (7).

To assess public knowledge, attitudes, and health behaviors regarding skin and colon cancers both prior to and after the launch of the UCAN advertising campaigns, UCAN contracted with a local (Salt Lake City) marketing research firm to conduct the 2003 Utah Department of Health Cancer Advertising Awareness Survey. The research firm was selected because of its experience in opinion polls, marketing, customer information, and social and public policy research. Two telephone surveys were administered by the research firm: one in January 2003 and another in May 2003. The sample for both surveys was an equal probability telephone sample of all Utah households. The January survey was designed to obtain a baseline measurement of the Utah population's knowledge, attitudes, and behaviors.

The January survey was developed by the Cancer Program staff in conjunction with the marketing research firm. Prior to administering the survey, a draft survey instrument was prepared and tested among 23 randomly selected Utah residents in a focus group setting. The focus group participants were asked to complete the survey as if they were respondents, and they were also asked to provide feedback on questions, especially if they were unclear about the intent of a question, if there were terms they did not understand, or if the survey format was not clear. Feedback from these pretest interviews helped to formulate the final questionnaire.

January survey data collection began on January 20, 2003, and concluded by January 31. All sampling during the course of the survey research relied on random-digit-dial protocols. When a household was contacted, an adult within the household was identified and asked to participate in the survey, which required an average of 10 minutes for participants to complete. The overall survey response rate for the January 2003 administration was 81%, and 816 individuals completed the survey.

The January survey was divided into two target audiences, one for skin cancer, which targeted an audience of adults aged 18–49 with children, and another for colon cancer, which targeted an audience of adults aged 50 and older; 407 individuals completed the skin cancer surveys and 409 individuals completed the colon cancer surveys.

In February 2003, UCAN contracted with a local advertising firm to develop two advertising campaigns. Incorporating feedback from the January survey, UCAN developed several test messages for both colon and skin cancer. For skin cancer, UCAN focused on the issues of personal risk assessment and protective clothing. For colon cancer, UCAN focused on the perception that colon cancer primarily affects males and that screening is necessary only when symptoms are present. To help test the messages within each target audience, UCAN conducted focus group research, twice for skin cancer and twice for colon cancer. Each focus group consisted of eight or nine participants. Focus group results determined the creative strategy that shaped the key messages.

In May, four to six weeks after both campaigns had been launched, another pair of surveys was administered to assess public knowledge, attitudes, and health behaviors regarding skin and colon cancers; 426 adults aged 18 to 49 completed the post-campaign skin cancer surveys and 403 adults aged 50 and older completed post-campaign colon cancer surveys. The May follow-up survey began on May 23, 2003, and concluded on June 9. The response rate for the May 2003 administration was 68%.

Key research findings are summarized in Table 1 and Table 2. In January 2003, 18% of survey respondents reported seeing or hearing skin cancer prevention or sun protection announcements. The May follow-up survey showed that in less than four weeks on air, recall of UCAN skin cancer ads reached 76%. Among those recalling ads, 78% could "play back" the main message or other specific ad content.

In January 2003, only 36% of survey respondents had heard or seen advertising about colon cancer. This percentage more than doubled to 79% in May. Of the 79% that had heard or seen an ad, 85% could recall of one of UCAN's main messages.

In addition to increasing awareness of UCAN's message through advertising, we also generated favorable publicity. The skin cancer public-relations effort generated more than 33 newspaper articles statewide, 14 television interviews and appearances, and more than a dozen radio interviews with physicians, cancer survivors, and health care professionals.