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.

The awareness of health risks associated with sun exposure, primarily ultra violet (UV) radiation, have played a large role in the introduction of sunless self-tanning products. These products, produced by cosmetic companies, are intended to provide the user with a sun-tanned appearance without exposing the skin to harmful UV radiation. While the manufacturers of these products claim that the products are transfer-free, several reports of the tanner depositing onto the wearers clothing have been documented1. As this is a highly undesirable characteristic for the consumer, the product's ability to transfer onto clothing makes sunless self-tanners a potentially valuable piece of forensic evidence in cases where an altercation between two individuals has occurred, specifically in sexual assaults, beatings, and homicides. The presence of self-tanner on an individual's clothing could help corroborate a story and provide an additional piece of evidence and/or leads to an investigation. The purpose of this study was to determine if sunless self-tanners transfer from skin to clothing. Given that a transfer occurs, this research was also intended to both identify and evaluate the differences seen between self-tanning products using instrumental techniques that would typically be used in forensic labs. Sixteen sunless self-tanning products were added to the skin as directed by the manufacturer. After an assigned time interval since application (15 minutes, 30 minutes, 1 hour, 3 hours, 6 hours, or 12 hours) was reached, a white cotton swatch was used to wipe a portion of the sunless self-tanner off of the skin in attempt to simulate a realistic scenario of an altercation between individuals who may be wearing the product. Observations of the cotton swatches were document. Transferred material on the cotton swatches was analyzed using Fourier Transform Infrared Spectroscopy (FTIR). Analysis of the products prepared directly from the packaging as well as two samples containing transferred material were analyzed using Gas Chromatography- Mass Spectrometry (GC-MS). All of the sixteen samples tested transferred from the skin onto the cotton swatch when forcibly wiped at each time interval. FTIR analysis was unable to discriminate between the commercial products but was able to separate the samples into six groups based on similarities seen between the spectra. Analysis using this instrumental technique was useful in identifying the samples as sunless self-tanning products, but was unable to differentiate further. Analysis of the sunless self-tanners prepared directly from their packaging/bottle using GC-MS was able to differentiate between the products, providing a combination of chemical ingredients that were unique to each product. Analysis of the transferred material on the cotton swatches did not identify all of the chemical components that were earlier considered unique to that sample, however, peaks were observed in the chromatogram that were also present in the samples when prepared directly from their packaging. These transferred samples were able to be identified when a known sample was available for comparison. The instrumental techniques used in this study are useful in analyzing and identifying suspected sunless self-tanner stains on clothing in a crime laboratory setting. The results obtained from this analysis can provide probative information in an investigation.

As skin cancer rates increase, it has become more important for at risk individuals to reduce ultraviolet radiation (UVR) exposure. Limited information is available on characteristics and behaviors of sunless tanning product users in populations with high sun-seeking behaviors. This information is important because use of sunless tanning products could reduce tanning through UVR exposure thereby leading to a reduction in skin cancer. Sorority and fraternity students (n=163) completed a self-administered questionnaire examining sun exposure and tanning attitudes, behaviors and beliefs. Characteristics of sunless tanning product users were compared to non-users using logistic regression accounting for potential clustering effects within sororities and fraternities. Among students surveyed, 34% reported ever using sunless tanning products. Ever users of sunless tanning products were significantly more likely to be female (OR=7.5), have fair skin (OR=1.4), have used tanning beds greater than 50 times (OR=2.5), and reapply sunscreen when outside on a sunny day (OR=1.3). Ever users of sunless tanning products and those with a preference for these products because they are safer than tanning beds or sunbathing were more likely to reapply sunscreen on a sunny day in the summer. However, other sun protection behaviors (i.e. sunscreen use, amount of sunscreen used, and avoidance of midday sun while on spring break) were not more likely to be adopted by these students. Prevention efforts could target these fair-skinned females to increase their use of sunless tanning products in combination with sunscreen use and reapplication along with avoidance of midday sun.

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Background Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens. Methods Teenage females (N = 778) aged 12–18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use. Results Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR = 1.82, 95% CI: 1.07–3.10). Age, geographic regions, and race increased the likelihood of IT and STP use. Conclusions Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.