Associations between Perceived Costs and Rewards of Sun Protection and Sun Safety Practices among Rural and Urban High School Students

BACKGROUND: 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; and 33.4% rural) at baseline who enrolled in the Sun-safe Habits Intervention and Education cluster-randomized trial conducted in Utah high schools from 2021 to 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 <0 .001) and greater rewards of tanning (r = -0.28; P <0 .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 <0 .01), higher perceived protection cost (B = -0.32; P <0 .001), and greater tanning reward (B = -0.19; P <0 .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. IMPACT: Addressing both cognitive and motivational barriers to UVR protection during adolescence could strengthen early prevention efforts and reduce future skin cancer burden.