Attitudes toward sunburn and sunscreen, rooted in social and appearance norms, continue to shape teens’ sun exposure behaviors, so awareness of the dangers of UV rays does not always lead to safer choices.
Study: Associations between perceived costs and rewards of sun protection and sun protection practices among rural and urban high school students. Image credit: verona studio/Shutterstock.com
Why do teens expose themselves to sunlight, even though we know it increases their risk of cancer? Study published in the journal Cancer epidemiology, biomarkers, and prevention We suggest that these choices are associated with negative perceptions of sun protection behaviors compared to positive perceptions of the benefits of tanning.
Early tanning and risky teenage habits increase melanoma risk
Skin cancer is estimated to affect 20% of Americans during their lifetime, and the primary cause is exposure to ultraviolet radiation (UVR). Although melanoma is less common than other skin cancers, it accounts for the majority of related deaths.
There is evidence that a history of sunburn in childhood significantly increases the risk of melanoma, and that even one severe burn can almost double the chance of developing the disease later in life. Therefore, early sun protection is important to reduce this risk.
However, adolescence is a time of greater risk-taking and is often influenced by peer dynamics and the desire for independence. This is reflected in sun safety practices. While only 17 percent of U.S. teens and young adults consistently practice sun protection behaviors, nearly 64 percent of high school students report at least one sunburn in the past year.
The hassle of sunscreen and the appeal of tanning are contradictory.
For many adolescents, sunscreen is more of a chore than a habit. Applying sunscreen can seem inconvenient and time-consuming, some people find it greasy or uncomfortable, and protective clothing often seems impractical. Cost, effort, and simple forgetfulness make continued use even less likely.
At the same time, tanning has a strong social appeal. Tanning is often seen as more attractive, and many young people associate tanning with feeling relaxed, confident, and more comfortable in social situations, which can reinforce behaviors that increase sun exposure.
Social norms increase sun exposure
Young women are more likely to desire a tanned appearance, are more influenced by peer norms, and tend to place less importance on the risks of UVR exposure. Tanning is also more common among non-Hispanic white youth.
Study investigates how beliefs shape teen sun habits
The current study assessed the sun protection behaviors of 2,105 high school students (mostly Caucasian), including representatives from 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.
EPPM has previously been used effectively to promote cancer prevention behaviors in high school students. In the current study, we sought to understand how students’ perceptions of the rewards of tanning and the costs of sunscreen influence sunscreen use.
Students reported knowledge about time spent outdoors, cost of sunscreen, benefits of tanning, sun protection behaviors, and ways to prevent skin cancer.
Costs and rewards predict behavior more than awareness
Most students spent at least 1 hour outdoors on weekdays, and overall compliance with sun protection behaviors was moderate (approximately 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 sunscreen than juniors and seniors. The same was true for Hispanic and Latino students when compared to other ethnicities.
After adjusting for grade and ethnicity, lower sun protection behaviors were independently associated with three factors: lower knowledge about the risks of sun exposure, higher perceived costs, and higher benefits of tanning. Students with less knowledge about the risk of skin cancer from UVR were less likely to use sunscreen. Although this association was statistically significant, it was weak.
Perceived barriers to sunscreen showed the strongest association with reduced use, followed by perceived benefits of tanning, and both remained significant independent predictors even after controlling for other factors. There was no significant interaction between these two effects.
Overall, adolescents’ sunscreen habits appear to be shaped less by knowledge alone and more by how they weigh the benefits of tanning against the drawbacks of sunscreen. This is consistent with previous research showing that education alone about cancer risk often does not lead to lasting behavioral change.
Implications for public health strategies
To address these factors, the authors suggest focusing on appearance-based strategies related to youth motivation. This may include demonstrating the visible effects of sun damage, such as ultraviolet photography or simulations of premature skin aging.
They suggest integrating these approaches into school-based programs like SHINE to strengthen their impact.
strengths and limitations
This study is based on a large sample of youth believed to be representative of the youth population in Utah, a state with a high prevalence of melanoma. However, there are some limitations. We used self-reported data and a cross-sectional design, which may have introduced bias, preventing causal inferences. Utah is an arid state with high UVR levels, limiting generalizability. Furthermore, this model explains a modest proportion of the variation in behavior, suggesting that other unmeasured factors are also involved.
Future longitudinal research is needed to assess how changes in these beliefs are related to changes in behavior, the value of digital technologies that influence these changes, and differences in strategies across cultures and ethnic groups.
Addressing both cognitive and motivational barriers to UVR protection in adolescence may enhance early prevention efforts and reduce the future burden of skin cancer.
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