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Perceived Costs and Rewards of Sun Protection among High School Students

Perceived Costs and Rewards of Sun Protection among High School Students

Adolescents frequently engage in behaviors that increase ultraviolet radiation (UVR) exposure, elevating their lifetime risk for skin cancer. Project Shine 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 opportunities for intervention.

New findings from this study have been published in Cancer Epidemiology. Biomarkers, and Prevention, a journal of the American Association for Cancer Research. The project was led by Dr. Yelena Wu from the Huntsman Cancer Institute at the University of Utah. Dr. David Buller from Klein Buendel was a member of the multi-institutional team.

Data were analyzed from 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.

Methods, analyses, and findings are described in detail in the Cancer Epidemiology, Biomarkers, and Prevention publication. In summary, students who perceived higher costs of UVR protection and greater rewards of tanning engaged in fewer UVR-protective behaviors. In an adjusted model, lower sun-safe behavior was independently predicted by lower knowledge of UVR safety, higher perceived protection cost, and greater tanning reward. Perceived costs of UVR protection and appearance-based rewards of tanning are key attributes of adolescent UVR exposure.

The authors suggest that 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. Addressing both cognitive and motivational barriers to UVR protection during adolescence could strengthen early prevention efforts and reduce future skin cancer burden.

This research was supported by a grant from the National Cancer Institute (CA244674; Dr. Yelena Wu, Principal Investigator). Co-authors include Omar Anwar, Marcelo Sleiman, Jr., Muriel Statman, and Dr. Kenneth Tercyak from the Lombardi Comprehensive Cancer Center at Georgetown University; Dr. Tammy Stump, Dr. Jakob Jensen, Dr. Douglas Grossman, Dr. Jincheng Shen, and Dr. Benjamin Haaland from the Huntsman Cancer Institute at the University of Utah; Dr. Jennifer Hay from Memorial Sloan Kettering Cancer Center in New York; and Dr. David Buller from Klein Buendel. Support was also provided by Georgetown University, the University of Utah, and Memorial Sloan Kettering Cancer Center.

Project SHINE Protocol

Project SHINE Protocol

A research team led by Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, and including Dr. David Buller from Klein Buendel, has published a detailed protocol for the project entitled, “Sun-safe Habits Intervention and Education” in Contemporary Clinical Trials. Project SHINE examines the efficacy of a personalized intervention targeting sun protection and tanning of high school students.

Adolescents infrequently use sun protection and engage in intentional tanning more frequently compared to other age groups, leading to increased ultraviolet radiation (UVR) exposure that heightens skin cancer risk across the lifespan. High schools are therefore an ideal setting for offering skin cancer prevention interventions. Yet, there are limited UVR protection interventions for high school students, especially those that are personalized, tested using randomized designs, and include long-term outcome assessment to determine the durability of intervention effects.

The SHINE cluster-randomized trial will test a novel, personalized intervention that targets high school adolescents’ sun protection and tanning behaviors, and tracks their outcomes for up to one year following intervention. Enrolled high schools will be randomized to receive either the personalized SHINE intervention, which includes facial UVR photographs and sun protection action planning, or standard education using publicly available materials. Students in both conditions will receive information about skin cancer, sun protection, and skin self-examination. Outcome variables will include students’ sun protection and tanning behaviors and sunburn occurrence. Potential moderators (such as race/ethnicity) and mediators (such as self-efficacy) will also be assessed and tested.

The investigators believe Project SHINE will lead to new scientific understanding of the theoretical mechanisms underlying outcomes and moderators of the intervention effects, which will inform future intervention tailoring to meet the needs of vulnerable subgroups.

This research is sponsored by the National Cancer Institute (Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, Principal Investigator). Dr. David Buller, Director of Research at Klein Buendel, is a Co-Investigator.