Effects of Gain vs. Loss Framed Sun Protection Messages on Rural Indiana Adolescents Abstract Skin cancer is the most common type of cancer, accounting for almost 50% of cancer incidences in the U.S. Pivotal to reducing the future rates of skin cancer is promoting sun protection among adolescents, because the number of sunburns during adolescence significantly increases the risk of developing melanoma and basal cell carcinoma later in life. The rate of sun protection reported by adolescents is poor. Only about 20% and 30% of adolescents use protective clothing and sunscreen, while over 75% of them experience at least one sunburn a year. Prior sun protection interventions have focused on adults and younger children and their parents, and little research has focused on adolescents, especially those who are at or over age 14. Their low sensitivity to risk and high sensitivity to peer attitudes concerning appearance presents a unique challenge to efforts to promote sun protection behaviors. Research needs to identify effective strategies for promoting sun protective behaviors among adolescents. Prior health promotion interventions indicate that message framing, a strategy based on prospect theory, significantly influences behavioral decisions. Prior sun protection interventions for college students, the most proximal age group to adolescents, evidenced that messages highlighting what the individual will gain by adopting sun protection behavior (i.e., gain frame) promoted the behavior of sunscreen request, while message emphasizing what the individual will lose by not adopting sun protection behavior (i.e., loss frame) promoted the behavior of using sunscreen. Apparently, both types of framing can promote some sun protection behaviors, but it is unknown which frame will be most effective for adolescents. Furthermore, it is unknown which frame will be most effective for promoting the behavior of protective clothing use, which is now determined as a primary means of protection against melanoma, among adolescents. This study proposes to examine the relative effectiveness of gain vs. loss framed messages advocating the sun protection behaviors of protective clothing use and sunscreen use on rural Indiana high school students (ages 14-18, N = 400). Students will be randomly assigned to receive either an intervention that is framed in terms of what they will gain by adopting sun protection behaviors, or an intervention that is framed in terms of what they will lose by not adopting sun protection behaviors. The two interventions will be compared in terms of students' attitudes towards sun protection, intentions to use sun protection, and sun protection behavior during the summer following the intervention. The results will inform which frame message is most appropriate for which sun protection behavior of adolescents, and this knowledge will inform future development of effective interventions for this population. /Relevance Preventing the increase in the incidence of skin cancer is a significant public health agenda. Skin cancer is the most common type of cancer, accounting for almost 50% of cancer incidences in the U.S (American Cancer Society, 2006). Pivotal to reducing future rates of skin cancer is promoting sun protection among adolescents because the number of sunburns during adolescence significantly increases the risk of developing melanoma and basal cell carcinoma later in life (Elwood & Jobson, 1997; Kricker et al., 1995; Gallagher et al., 1995; Weinstock et al., 1989; Westerdahl et al., 1994; Whiteman & Green, 1994). The rate of sun protection reported by adolescents is poor. The latest nationwide representative survey of adolescents' sun protection practices (Cokkinides et al., 2001; Davis et al., 2002) indicates that less than one third of U.S. adolescents use sun protection consistently, while the majority (75%) experience at least one sunburn a year. Research is needed to identify effective strategies for promoting sun protection practices among adolescents. ? ? ?
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