Cancer Causes & Control

, Volume 30, Issue 11, pp 1251–1258 | Cite as

Differences in reported sun protection practices, skin cancer knowledge, and perceived risk for skin cancer between rural and urban high school students

  • Elizabeth S. Nagelhout
  • Bridget G. Parsons
  • Benjamin Haaland
  • Kenneth P. Tercyak
  • Kelsey Zaugg
  • Angela Zhu
  • Garrett Harding
  • Jeffrey Yancey
  • Jakob D. Jensen
  • Douglas Grossman
  • David W. Wetter
  • Yelena P. WuEmail author
Original Paper



The purpose of the current study was to evaluate differences in reported use of sun protection, tanning behaviors, skin cancer-related knowledge, and perceived risk between rural and urban high school students in a geographic area with high rates of melanoma.


A total of 1,570 high school students (56.8% female) from urban (6 schools) and rural (7 schools) geographic areas in Utah completed questionnaires assessing sun protection and tanning behaviors, skin cancer-related knowledge, and perceived risk for skin cancer. Analyses examined potential differences in these outcomes between rural and urban students and by gender.


Compared to students in urban areas, those in rural areas had lower odds of wearing sunscreen (OR 0.71; 95% CI 0.53, 0.95; p = 0.022), re-applying sunscreen (OR 0.61; 95% CI 0.74, 1.02; p = 0.002), wearing long-sleeved shirts (OR 0.63 95% CI 0.46, 0.86; p = 0.004), and seeking shade (OR 0.67; 95% CI 0.50, 0.88; p = 0.005).


Rural students reported less adequate use of sun protection than urban students. Rural male students reported lower knowledge scores compared to urban males. Future skin cancer prevention efforts targeting rural high schoolers are warranted.


Skin cancer Rural health Health education Cancer prevention 



We greatly appreciate the efforts of the following individuals for their assistance with data collection: Ayesha Patil, Patsaporn Kanokvimankul, Judy Ou, Rachel Forrest, Jane Ostler, Jennyffer Morales, Chelsea Ratcliff Bush, Katheryn Christy, Samuel Whittier, and Alexa Wright. This work was supported by the Utah Department of Health (Centers for Disease Control Grant Number 1NU58DP006321) and a pilot grant from Cancer Control and Population Sciences at Huntsman Cancer Institute (both to Y.P.W.). Yelena Wu, David Wetter, and Douglas Grossman were supported by the Huntsman Cancer Foundation. Yelena Wu and Douglas Grossman were also supported by the Department of Dermatology at the University of Utah. This work was also supported by the National Cancer Institute of the National Institutes of Health (K07CA196985; Y.P.W., P30CA042014; D.W; P30CA051008; K.P.T.). Dr. Jensen was supported by the National Institute of Health 1DP2EB022360-01 (PI: J. Jensen) and 3P30CA042014-29S7 (PI: J. Jensen). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Data entry for this project was completed using REDCap, which is supported by the National Cancer Institute of the National Institutes of Health (8UL1TR000105, formerly UL1RR025764). We acknowledge the support of the Office of Communications supported by funds in conjunction with grant P30 CA042014 awarded to Huntsman Cancer Institute. This work was supported by funding from the Undergraduate Research Opportunities Program at the University of Utah awarded to Angela Zhu.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Research involving human participants and/or animals

All study procedures were approved by the University of Utah Institutional Review Board and the appropriate school district authorities.

Informed consent

Prior to data collection, consent cover letters were sent by schools to all parents, allowing them to opt their child out of participation.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Elizabeth S. Nagelhout
    • 1
  • Bridget G. Parsons
    • 2
  • Benjamin Haaland
    • 2
    • 3
  • Kenneth P. Tercyak
    • 4
  • Kelsey Zaugg
    • 2
  • Angela Zhu
    • 2
  • Garrett Harding
    • 2
  • Jeffrey Yancey
    • 2
  • Jakob D. Jensen
    • 5
  • Douglas Grossman
    • 2
    • 6
    • 7
  • David W. Wetter
    • 2
  • Yelena P. Wu
    • 2
    • 7
    Email author
  1. 1.Division of Public Health, Department of Family & Preventive MedicineUniversity of UtahSalt Lake CityUSA
  2. 2.Huntsman Cancer InstituteSalt Lake CityUSA
  3. 3.Division of Biostatistics, Department of Population Health SciencesUniversity of UtahSalt Lake CityUSA
  4. 4.Cancer Prevention & Control Program, Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashington, DCUSA
  5. 5.Department of CommunicationUniversity of UtahSalt Lake CityUSA
  6. 6.Department of Oncological SciencesUniversity of UtahSalt Lake CityUSA
  7. 7.Department of DermatologyUniversity of UtahSalt Lake CityUSA

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