AN ABSTRACT OF THE DISSERTATION OF DIANE M. LAND, for the Doctor of Philosophy degree in Health Education, presented on December 3, 2014, at Southern Illinois University Carbondale. TITLE: PSYCHOSOCIAL PREDICTORS OF HIGH SCHOOL ADOLESCENTS' SUN-TANNING AND SUN-PROTECTIVE BEHAVIORS MAJOR PROFESSOR: Dr. Roberta Ogletree Background: The incidence of skin cancer among adolescents and young adults is increasing in the United States (American Cancer Society, 2014). Ultraviolet radiation (UVR) exposure via sun-tanning is considered an important risk factor for development of melanoma. Sun-induced skin damage and sun-tanning habits are initiated in early life and promoted through later sun exposure patterns. Social norms, appearance attitudes, and perceptions of fitness and health attributed to sun-tanned skin and tanning bed usage have been established. The primary aim of this study was to investigate high school adolescents' sun-related attitudes and behaviors through a theoretical framework of psychosocial constructs grounded primarily in Bandura's (1986) Social Cognitive Theory. Assessing the differences in predictors of adolescents' UVR sun-tanning and sun-protective behaviors (including sunless tanning) has the potential to aid in developing age-appropriate strategies to prevent the adoption of sun-tanning habits and reinforce more health enhancing behaviors. Methods: This research study utilized a quantitative, cross-sectional, descriptive research design to assess the attitudes, motivations, and behaviors regarding sun-tanning and sun-protective practices of high school adolescents in rural Southern Illinois. A purposeful sample of 9 - 12th grade students (n = 900) enrolled in physical education class during the fall 2014 semester were invited to complete a self-report paper and pencil survey consisting of 56 Likert-type items and five demographic variables. Results: A total of 156 adolescents received parental permission and completed the survey, providing a 17.3% response rate. Intentional sun-tanning (UVR exposure) continues to be prevalent. Study participants reported sun-tanning more often and had a higher number of sunburns within the past twelve months that in previous national studies. Participants from low socio-economic status (SES) were more likely to outdoor suntan and use sunless tanning lotions, gels or creams than their not low SES counterparts. For sun-tanning behaviors, a significant amount of the variance in mean sun-risk behavior score was explained by the constructs situation, outcome expectations, and value expectancies. Situation, outcome expectations, value expectancies, and self-efficacy were all predictive of outdoor sun-tanning; whereas only outcome expectations were predictive of indoor sun-tanning. Self-efficacy explained a significant proportion of variance in sun-protective behavior mean score. Outcome expectations were predictive of both sunless tanning with lotions, creams or gels and spray tanning product use. Sunless tanning appears to be used as both an additive behavior for those reporting the highest frequency of indoor tanning and a substitution behavior for adolescents who reported never indoor tanning.

Using the Theory of Alternative Behavior (Jaccard, 1981), we examined the relationship of warmth sensuousness, physical sensuousness, and sensation seeking to individuals' tanning salon behaviors, intentions, and attitudes among undergraduates at a Southeastern university. Females, high sensation seekers, those high in warmth sensuousness, and those with darker skin types were more likely to tan. Females were more likely to intend to tan in the next year. Those higher in warmth sensuousness were more likely to intend to tan more than 10 times in the next year. Females and subjects higher in warmth sensuousness had more positive attitudes toward tanning. Significant interactions were found between warmth sensuousness and sensation seeking in the predictions of intention of tanning within the next year, and intentions of tanning more than 10 times within the next year. For both interactions, as sensation seeking increased, the relationship between warmth sensuousness and intentions strengthened.

This study explored the attitudes and behaviors of adolescents toward sunbathing and sunscreen use by employing the Theory of Alternative Behaviors (Jaccard, 1981) with adolescent participants and a respective parent co-participant. Females were found to be more likely to engage in intentional suntanning efforts, to stay in the sun for a longer duration, and to be more likely to use sunscreen yet to report higher incidence of sunburns. Those with a healthy lifestyle attitude are as likely to engage in intentional tanning, although they are more likely to wear sunscreen. Self-report of tanning behavior was positively correlated to parent's observation of adolescent's behavior. Results of this study support the position that sunscreen partially allows for longer sunlight exposure resulting in higher amounts of UV radiation exposure. Participants who were more likely to wear sunscreen were likewise more likely to spend more time in the sun and to sunburn more frequently.