Awareness of UV danger doesn’t always translate into safer choices, as attitudes toward tanning and sunscreen, rooted in social and appearance norms, continue to shape sun exposure behavior for teens.
Study: Associations between Perceived Costs and Rewards of Sun Protection and Sun Safety Practices among Rural and Urban High School Students. Image credit: verona studio/Shutterstock.com
Why do teens expose themselves to the sun despite knowing that it elevates their risk of cancer? A study published in the journal Cancer Epidemiology, Biomarkers and Prevention suggests that these choices are associated with negative perceptions of sun protection behavior compared to positive perceptions of tanning benefits.
Early sunburn and risky teen habits raise melanoma risk
Skin cancer is estimated to affect 20 % of Americans over their lifetime, with ultraviolet radiation (UVR) exposure as the leading cause. Although melanoma is less common than other skin cancers, it accounts for the majority of related deaths.
A history of sunburn during childhood significantly increases melanoma risk, with evidence showing that even a single severe burn can nearly double the likelihood of developing the disease later in life. Early sun protection is thus important in reducing this risk.
Yet adolescence is a period marked by greater risk-taking, often influenced by peer dynamics and a desire for independence. This is reflected in sun safety habits: only 17 % of teens and young adults in the United States consistently practice protective behaviors, while nearly 64 % of high school students report at least one sunburn in the past year
Sunscreen hassles clash with the appeal of tanning
For many adolescents, sun protection feels like a hassle rather than a habit. Applying sunscreen can seem inconvenient or time-consuming, some find it greasy or uncomfortable, and protective clothing is often seen as impractical. Cost, effort, and simple forgetfulness further reduce the likelihood of consistent use.
At the same time, tanning carries a strong social appeal. A tan is often viewed as more attractive, and many young people associate it with feeling relaxed, confident, and more comfortable in social settings, which can reinforce behaviors that increase sun exposure.
Social norms drive greater sun exposure
Young women are more likely to seek a tanned appearance, are more influenced by peer norms, and tend to place less emphasis on the risks of UVR exposure. Tanning behaviors are also more common among non-Hispanic White adolescents.
Study examines how beliefs shape teen sun habits
The current study assessed sun protection behavior among 2,105 high school students, mostly White, with representation from both rural and urban schools, who participated in the Sun-safe Habits Intervention and Education (SHINE) protocol. This was an analysis of baseline (cross-sectional) data from a cluster-randomized trial conducted in Utah high schools between 2021 and 2023.
SHINE is an adaptation of the Extended Parallel Process Model (EPPM), a framework that explains behavior in terms of perceived threat and efficacy beliefs.
The EPPM has been effectively used earlier to promote cancer prevention behavior among high school students. The current study sought to understand how students' perception of tanning rewards and sun protection costs affects their use of sun protection.
Students reported on their outdoor time, perceived costs of sun protection, and rewards of tanning, sun protection behavior, and knowledge of how to prevent skin cancer.
Costs and rewards predict behavior more than awareness
Most students spent over an hour outdoors on weekdays, and overall adherence to sun protective behaviors was moderate (about 50 % across multiple behaviors such as staying in the shade and wearing sunscreen). Younger high school students (Freshmen and Sophomores) were more likely to use sun protection than Juniors or Seniors. The same was true of Hispanic or Latine students compared to other ethnicities.
When adjusted for grade and ethnicity, lower sun protection behavior was independently associated with three factors: lower knowledge about the risks of sun exposure, higher perceived cost, and greater rewards of tanning. Students who knew less about skin cancer risks due to UVR were less likely to use sun protection. This association was statistically significant but weak.
Perceived barriers to sun protection showed the strongest link to lower use, followed by the perceived benefits of tanning, and both remained significant independent predictors after adjusting for other factors. There was no significant interaction between these two influences.
Overall, adolescents’ sun protection habits appear to be shaped more by how they weigh the drawbacks of protection against the appeal of tanning than by knowledge alone. This aligns with earlier research showing that education about cancer risks, on its own, often does not lead to sustained behavior change.
Implications for public health strategies
To address these drivers, the authors suggest focusing on appearance-based strategies relevant to adolescents’ motivations. This could include demonstrating the visible effects of sun damage, such as ultraviolet photography or simulations of premature skin aging.
They propose integrating these approaches into school-based programs like SHINE to strengthen their impact.
Strengths and limitations
The study was based on a large sample of adolescents considered representative of Utah’s youth population, from a state with a high prevalence of melanoma. However, it has several limitations. It used self-reported data and a cross-sectional design, preventing causal inferences, and may have introduced bias. Utah is a dry state with high UVR levels, restricting generalizability. In addition, the model explained a modest proportion of variation in behavior, suggesting other unmeasured factors also play a role.
Future longitudinal studies are required to assess how changes in such beliefs are linked to changes in behavior, the value of digital technology in effecting these changes, and differences in strategy across cultures and ethnicities.
Addressing both cognitive and motivational barriers to UVR protection during adolescence could strengthen early prevention efforts and reduce future skin cancer burden.
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