Associations between Perceived Costs and Rewards of Sun Protection and Sun Safety Practices among Rural and Urban High School Students.

BACKGROUND

Adolescents frequently engage in behaviors that increase ultraviolet radiation (UVR) exposure, elevating their lifetime risk for skin cancer. This study examined cross-sectional associations between high school students' perceptions of the costs of UVR protection, the rewards of tanning, and their engagement in UVR-protective behaviors to identify targets for intervention.

METHODS

Data were drawn from N = 2,105 students (46% male; 77% White; and 33.4% rural) at baseline who enrolled in the Sun-safe Habits Intervention and Education cluster-randomized trial conducted in Utah high schools from 2021 to 2023. Students completed self-reports of skin cancer prevention knowledge, time spent outdoors, perceived costs of UVR protection, perceived rewards of tanning, and UVR-protective behaviors. Analyses included bivariate tests and multivariable regression, adjusted for demographics and knowledge.

RESULTS

Students who perceived higher costs of UVR protection (r = -0.34; P <0 .001) and greater rewards of tanning (r = -0.28; P <0 .001) engaged in fewer UVR-protective behaviors. In an adjusted model, lower sun-safe behavior was independently predicted by lower knowledge of UVR safety (B = 0.21; P <0 .01), higher perceived protection cost (B = -0.32; P <0 .001), and greater tanning reward (B = -0.19; P <0 .001).

CONCLUSIONS

Perceived costs of UVR protection and appearance-based rewards of tanning are key attributes of adolescent UVR exposure. School-based skin cancer prevention should incorporate appearance-focused and tailored strategies (such as UV photography or photoaging feedback) to promote sustainable sun safety behaviors.

IMPACT: Addressing both cognitive and motivational barriers to UVR protection during adolescence could strengthen early prevention efforts and reduce future skin cancer burden.