Abstract
Sun protection standards among teenagers are low while sun exposure peaks in this age group. Study 1 explores predictors of adolescent protection intentions and exposure behavior. Study 2 tests the effectiveness of an intervention based on these predictors. Study 1(cross-sectional, N = 207, ages 15–18) and Study 2 (RCT, N = 253, ages 13–19) were conducted in schools. Path models were used to analyze data. Self-efficacy (β = .26, p < .001) and time perspective (β = .17, p = .014) were the strongest predictors of intentions; appearance motivation (β = .54, p < .001) and intention (β = −.18, p = .015) predicted behavior. The intervention effected changes in all predictors except self-efficacy. Changes in outcome expectancies (β = .19, p < .001) and time perspective (β = .09, p = .039) predicted changes in intention, while changes in intention (β = −.17, p = .002) and appearance motivation (β = .29, p < .001) predicted behavior changes. Target group- and behavior-specific intervention components are as important for changes in intentions and behavior as components derived from common health behavior theories.
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Notes
All p-values refer to one-sided tests due to directed hypotheses.
References
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Action-control: From cognition to behavior (pp. 11–39). Heidelberg: Springer.
Armitage, C. J., & Conner, M. (2000). Social cognition models and health behaviour: A structured review. Psychology & Health, 15, 173. doi:10.1080/08870440008400299
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40, 471–499. doi:10.1348/014466601164939
Ashford, S., Edmunds, J., & French, D. P. (2010). What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis. British Journal of Health Psychology, 15, 265–288. doi:10.1348/135910709x461752
Becker, B. E., & Luthar, S. S. (2007). Peer-perceived admiration and social preference: Contextual correlates of positive peer regard among suburban and urban adolescents. Journal of Research on Adolescence, 17, 117–144. doi:10.1111/j.1532-7795.2007.00514.x
Broadstock, M., Borland, R., & Gason, R. (1992). Effects of suntan on judgments of healthiness and attractiveness by adolescents. Journal of Applied Social Psychology, 22, 157–172. doi:j.1559-1816.1992.tb01527.x
Brown, T. T., Quain, R. D., Troxel, A. B., & Gelfand, J. M. (2006). The epidemiology of sunburn in the US population in 2003. Journal of the American Academy of Dermatology, 55, 577–583. doi:10.1016/j.jaad.2006.05.029
Cafri, G., Thompson, J. K., Roehrig, M., van den Berg, P., Jacobsen, P. B., & Stark, S. (2006). An investigation of appearance motives for tanning: The development and evaluation of the physical appearance reasons for tanning scale (PARTS) and its relation to sunbathing and indoor tanning intentions. Body Image, 3, 199–209. doi:10.1016/j.bodyim.2006.05.002
Craciun, C., Schüz, N., Lippke, S., & Schwarzer, R. (2012). A mediator model of sunscreen use: A longitudinal analysis of social-cognitive predictors and mediators. International Journal of Behavioral Medicine, 1, 65–72. doi:10.1007/s12529-011-9153-x
Dobbinson, S. J., White, V., Wakefield, M. A., Jamsen, K. M., Livingston, P. M., English, D. R., et al. (2009). Adolescents’ use of purpose built shade in secondary schools: Cluster randomised controlled trial. British Medical Journal, 338, 6. doi:10.1136/bmj.b95
Eid, M. (1997). Sonnenschutzverhalten: Ein typologischer Ansatz (Sun protection behavior: A typological approach). Zeitschrift für Gesundheitspsychologie, 5, 73–91.
Emmons, K. M., Geller, A. C., Viswanath, V., Rutsch, L., Zwirn, J., Gorham, S., et al. (2008). The SunWise policy intervention for school-based sun protection: a pilot study. Journal of School Nursing, 24, 215–221. doi:10.1177/1059840508319627
Fabrizi, G., Pagliarello, C., & Massi, G. (2008). A simple and inexpensive method for performing ultraviolet photography in your dermatology practice. Dermatologic Surgery, 34, 1093–1095. doi:10.1111/j.1524-4725.2008.34217.x
Gerrard, M., Gibbons, F. X., Houlihan, A. E., Stock, M. L., & Pomery, E. A. (2008). A dual-process approach to health risk decision making: The prototype willingness model. Developmental Review, 28, 29–61. doi:10.1016/j.dr.2007.10.001
Gibbons, F. X., & Gerrard, M. (1995). Predicting young adults’ health risk behavior. Journal of Personality and Social Psychology, 69, 505–517. doi:10.1037/0022-3514.69.3.505
Gibbons, F. X., Gerrard, M., Lane, D. J., Mahler, H. I. M., & Kulik, J. A. (2005). Using UV photography to reduce use of tanning booths: a test of cognitive mediation. Health Psychology, 24, 358–363. doi:10.1037/0278-6133.24.4.358
Gibbons, F. X., Houlihan, A. E., & Gerrard, M. (2009). Reason and reaction: The utility of a dual-focus, dual-processing perspective on promotion and prevention of adolescent health risk behaviour. British Journal of Health Psychology, 14, 231–248. doi:10.1348/135910708x376640
Hall, P. A., & Fong, G. T. (2003). The effects of a brief time perspective intervention for increasing physical activity among young adults. Psychology & Health, 18, 685–706. doi:10.1080/0887044031000110447
Hall, P. A., Fong, G. T., & Cheng, A. (2012). Time perspective and weight management behaviors in newly diagnosed Type 2 diabetes: A mediational analysis. Journal of Behavioral Medicine. Advance online publication. doi:10.1007/s10865-011-9389-6
Hillhouse, J. J., & Turrisi, R. (2002). Examination of the efficacy of an appearance-focused intervention to reduce UV exposure. Journal of Behavioral Medicine, 25, 395–409. doi:10.1023/A:1015870516460
Hollands, G. J., Hankins, M., & Marteau, T. M. (2010). Visual feedback of individuals’ medical imaging results for changing health behaviour. Cochrane Database of Systematic Reviews, CD007434. doi:10.1002/14651858.CD007434.pub2
Jackson, K. M., & Aiken, L. S. (2000). A psychosocial model of sun protection and sunbathing in young women: The impact of health beliefs, attitudes, norms, and self-efficacy for sun protection. Health Psychology, 19, 469–478. doi:10.1037/0278-6133.19.5.469
Jackson, K. M., & Aiken, L. S. (2006). Evaluation of a multicomponent appearance-based sun-protective intervention for young women: Uncovering the mechanisms of program efficacy. Health Psychology, 25, 34–46. doi:10.1037/0278-6133.25.1.34
Jacobson, N. S., & Baucom, D. H. (1977). Design and assessment of nonspecific control groups in behavior-modification research. Behavior Therapy, 8, 709–719. doi:10.1016/S0005-7894(77)80203-7
Jobim, A. C., & de Moraes, V. (Writers). (1962). The girl from Ipanema (Recorded by A. Gilberto, J. Gilberto, & S. Getz), On Getz/Gilberto. United States: Verve Records.
Linos, E., Swetter, S. M., Cockburn, M. G., Colditz, G. A., & Clarke, C. A. (2009). Increasing burden of melanoma in the United States. Journal of Investigative Dermatology, 129, 1666–1674. doi:10.1038/jid.2008.423
Lohr, J. M., DeMaio, C., & McGlynn, F. D. (2003). Specific and nonspecific treatment factors in the experimental analysis of behavioral treatment efficacy. Behavior Modification, 27, 322–368. doi:10.1177/0145445503253831
Mahler, H. I. M., Kulik, J. A., Gerrard, M., & Gibbons, F. X. (2006). Effects of two appearance-based interventions on the sun protection behaviors of Southern California beach patrons. Basic and Applied Social Psychology, 28, 263–272. doi:10.1207/s15324834basp2803_5
Mahler, H. I. M., Kulik, J. A., Gerrard, M., & Gibbons, F. X. (2007). Long-term effects of appearance-based interventions on sun protection behaviors. Health Psychology, 26, 350–360. doi:10.1037/0278-6133.26.3.350
Mahler, H. I. M., Kulik, J. A., Gerrard, M., & Gibbons, F. X. (2010). Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: A randomized, controlled experiment. Journal of Behavioral Medicine, 33, 496–507. doi:10.1007/s10865-010-9279-3
Mahler, H. I. M., Kulik, J. A., Harrell, J., Correa, A., Gibbons, F. X., & Gerrard, M. (2005). Effects of UV photographs, photoaging information, and use of sunless tanning lotion on sun protection behaviors. Archives of Dermatology, 141, 373–380. doi:10.1001/archderm.141.3.373
Michie, S., & Abraham, C. (2004). Interventions to change health behaviours: Evidence-based or evidence-inspired? Psychology & Health, 19, 29–49. doi:10.1080/0887044031000141199
Muthén, L. K., & Muthén, B. O. (1998–2007). Mplus User’s Guide. Fifth Edition. Los Angeles, CA: Muthén & Muthén.
Myers, L. B., & Horswill, M. S. (2006). Social cognitive predictors of sun protection intention and behavior. Behavioral Medicine, 32, 57–63. doi:10.3200/BMED.32.2.57-63
Olson, A. L., Gaffney, C. A., Starr, P., & Dietrich, A. J. (2008). The impact of an appearance-based educational intervention on adolescent intention to use sunscreen. Health Education Research, 23, 763–769. doi:10.1093/Her/Cym005
Olson, A. L., Gaffney, C., Starr, P., Gibson, J. J., Cole, B. F., & Dietrich, A. J. (2007). SunSafe in the middle school years: A community-wide intervention to change early-adolescent sun protection. Pediatrics, 119, E247–E256. doi:10.1542/peds.2006-1579
Paul, C., Tzelepis, F., Parfitt, N., & Girgis, A. (2008). How to improve andolescents’ sun protection behavior? Age and gender issues. American Journal of Health Behavior, 32, 387–398. doi:10.5993/AJHB.32.4.6
Reynolds, K. D., Buller, D. B., Yaroch, A. L., Maloy, J. A., & Cutter, G. R. (2006). Mediation of a middle school skin cancer prevention program. Health Psychology, 25, 616–625. doi:10.1037/0278-6133.25.5.616
Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology, 91, 93–114. doi:10.1080/00223980.1975.9915803
Romer, D. (2010). Adolescent risk taking, impulsivity, and brain development: implications for prevention. Developmental Psychobiology, 52, 263–276. doi:10.1002/dev.20442
Saraiya, M., Glanz, K., Briss, P. A., Nichols, P., White, C., Das, D., et al. (2004). Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation—A systematic review. American Journal of Preventive Medicine, 27, 422–466.
Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology—An International Review, 57, 1–29.
Stanton, W. R., Janda, M., Baade, P. D., & Anderson, P. (2004). Primary prevention of skin cancer: A review of sun protection in Australia and internationally. Health Promotion International, 19, 369–378. doi:10.1093/heapro/dah310
Statistisches Bundesamt (Federal Statistical Office). (2010). Bruttoinlandsprodukt, regionale Tiefe: Kreise (Gross Domestic Product in Districts). Retrieved April 12th, 2012 https://http://www.regionalstatistik.de/genesis/online
Strathman, A., Gleicher, F., Boninger, D. S., & Edwards, C. S. (1994). The consideration of future consequences: Weighing immediate and distant outcomes of behavior. Journal of Personality and Social Psychology, 66, 742–752. doi:10.1037/0022-3514.66.4.742
Van Osch, L., Reubsaet, A., Lechner, L., Candel, M., Mercken, L., & De Vries, H. (2008). Predicting parental sunscreen use: Disentangling the role of action planning in the intention-behavior relationship. Psychology & Health, 23, 829–847. doi:10.1080/08870440701596577
Weinstein, N. D. (2003). Testing four competing theories of health-protective behavior. In P. Salovey & A. J. Rothman (Eds.), Social psychology of health (pp. 33–46). New York, NY, USA: Psychology Press.
White, K. M., Hyde, M. K., O’Connor, E. L., Naumann, L., & Hawkes, A. L. (2010). Testing a belief-based intervention encouraging sun-safety among adolescents in a high risk area. Preventive Medicine, 51, 325–328. doi:10.1016/j.ypmed.2010.07.003
Whiteman, D., Whiteman, C., & Green, A. (2001). Childhood sun exposure as a risk factor for melanoma: A systematic review of epidemiologic studies. Cancer Causes and Control, 12, 69–82. doi:10.1023/A:1008980919928
Wichstrøm, L. (1994). Predictors of Norwegian adolescents’ sunbathing and use of sunscreen. Health Psychology, 13, 412–420. doi:10.1037/0278-6133.13.5.412
Acknowledgments
During the work on her dissertation, the first author was a pre-doctoral fellow of the International Max Planck Research School "The Life Course: Evolutionary and Ontogenetic Dynamics" (LIFE, www.imprs-life.mpg.de). We would like to thank Benjamin Schüz for valuable comments on an earlier version of this article. Study 2 was funded by a research grant from La Roche-Posay Cosmétique Active Germany.
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Schüz, N., Eid, M. Beyond the usual suspects: target group- and behavior-specific factors add to a theory-based sun protection intervention for teenagers. J Behav Med 36, 508–519 (2013). https://doi.org/10.1007/s10865-012-9445-x
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DOI: https://doi.org/10.1007/s10865-012-9445-x