Associations between perceived costs and rewards of sun protection and sun safety practices among high school students

Objectives: Adolescents frequently engage in behaviors that increase ultraviolet radiation (UVR) exposure, elevating their lifetime risk for skin cancer. This study 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 targets for intervention. Methods: Data were drawn from N=2,105 students (46% male; 77% white; 33.4% rural) at baseline who enrolled in the Sun-safe Habits Intervention and Education (SHINE) cluster-randomized trial conducted in Utah high schools from 2021-2023. 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. Results: Students who perceived higher costs of UVR protection (r=-0.34, p<.001) and greater rewards of tanning (r=-0.28, p<.001) engaged in fewer UVR-protective behaviors. In an adjusted model, lower sun-safe behavior was independently predicted by lower knowledge of UVR safety (B=0.21, p<.01), higher perceived protection cost (B=-0.32, p<.001), and greater tanning reward (B=-0.19, p<.001). Conclusions: Perceived costs of UVR protection and appearance-based rewards of tanning are key attributes of adolescent UVR exposure. 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.