“I know I’ll probably get skin cancer from tanning, but that will be when I’m old, like in my forties.”
by Joel Hillhouse, PhD
Those words, from a student of mine, changed how I looked at skin cancer prevention in young people. Both my personal focus and professional training had always emphasized the value and importance of health. If you know something is unnecessarily harming your health, and you know ways to prevent it, you’d change what you were doing, right? That student taught me that not everyone values health the same way I do. She also gave me insight into why traditional educational efforts, with their focus on long-term health issues, were having little impact on young people’s risky sun habits and tanning behavior, especially indoor UVR (ultraviolet radiation) tanning.
Since that day more than 10 years ago, my colleagues and I have pursued a skin cancer prevention strategy focusing on appearance, which our empirical research demonstrates is a key factor in young people’s decision to tan indoors.
In our tanning interventions, we provide college-aged, female UVR tanners (71 percent of tanning salon patrons are girls and women aged 16-29) with a workbook that resembles a women’s fashion magazine. It depicts attractive, untanned models, as well as images of bronzed television stars who have publicly stated that they use non-UVR tanning products (“sunless tanning”) and wear sunscreens with an SPF of 30+. We theorized that if young people tan primarily to improve their appearance, then credible information on how tanning harms the appearance should dissuade many from the habit. So our workbooks also draw attention to tanning’s unattractive effects on the skin (fine lines, wrinkles, sagging, and brown spots, for instance), with images of people with weathered faces. Additionally, the workbook contains several humorous images to aid memory retention, including close-ups of tortoise skin, a baby’s bottom, and a burned chicken. However, our research shows that focusing on the benefits of avoiding UV tanning is more effective than heavy reliance on scare tactics.
Of course, young people still want to look good. If they feel they do not have better options, many will convince themselves, or be convinced by the tanning industry, to return to UV tanning. For this reason, our approach also teaches young people about alternative means to look good, such as exercise; healthy weight control; wearing stylish clothes that don’t require a tan (such as long-sleeved shirts and long pants); and, for those who still desire the tanned look, sunless tanning. This approach has proven consistently effective in several studies, reducing tanning behaviors and intentions by 33-50 percent in college-aged female indoor tanners.1,2 [See Figure 1.] This corresponds with a growing body of research on the effectiveness of appearance-based tanning interventions.3-6
Our experience persuading young people to reduce and even quit tanning has taught us a number of important lessons:
- Know your audience. What do they value and what is important in their daily lives?
- Respect your audience. If they don’t value health in the same way you do, they aren’t necessarily unintelligent or uneducated. You cannot reach an audience you talk down to.
- Persuade your audience. Provide credible information on the short-term, appearance-damaging effects of exposure, and discuss healthy, non-tanning alternatives to improve appearance. This may help young people rethink their tanning decisions.
After 15 years of research, we’ve found an approach that seems highly effective for young tanners. In the future, we hope to discover whether these methods can be widely disseminated through communication channels popular with youth, such as the internet, cell phones, and texting.
Dr. Hillhouse is Professor of Public Health, East Tennessee State University, Johnson City.
- Hillhouse J, Turrisi R. Examination of the efficacy of an appearance focused intervention to reduce UV exposure. Journal of Behavioral Medicine 2002; 25:395–409.
- Hillhouse J, Turrisi R, Stapleton J, Robinson J. A randomized controlled trial of an appearance-focused intervention to prevent skin cancer. Cancer 2008; 113(11):3257-3266.
- Gibbons FX, Gerrard M, Lane DJ, Mahler HI, Kulik JA. Using UV photography to reduce use of tanning booths: a test of cognitive mediation. Health Psychol Jul 2005; 24(4):358-363.
- Greene K, Brinn LS. Messages influencing college women’s tanning bed use: Statistical versus narrative evidence format and a self-assessment to increase perceived susceptibility. Journal of Health Communication Sep-Oct 2003; 8(5):443-461.
- Jackson KM, Aiken LS. Evaluation of a multicomponent appearance-based sun- protective intervention for young women: uncovering the mechanisms of program efficacy. Health Psychol Jan 2006; 25(1):34-46.
- Mahler H, Kulik J, Gibbons F, Gerrard M, Harrell J. Effects of appearance-based interventions on sun protection intentions and self-reported behaviors. Health Psychol Mar 2003; 22(2):199-209.