Journal of Behavioral Medicine

, Volume 42, Issue 3, pp 401–422 | Cite as

Do ultraviolet photos increase sun safe behavior expectations via fear? A randomized controlled trial in a sample of U.S. adults

  • Manusheela PokharelEmail author
  • Katheryn R. Christy
  • Jakob D. Jensen
  • Elizabeth A. Giorgi
  • Kevin K. John
  • Yelena P. Wu


Ultraviolet (UV) photos reveal the world in a different light spectrum, including damage that is caused by UV light. In the context of skin cancer control, UV photos have the potential to communicate fear because they reveal underlying skin damage. U.S. adults (N = 2219) were assigned to a 5 (visual: UV skin damage, sun exposure, sunburn, photoaging, and mole removal) × 3 (replication: three examples of each visual condition) × 4 (efficacy: no efficacy, text only, visual, visual + text) randomized controlled trial. Compared to all other visual conditions combined, UV skin damage visuals generated greater fear which triggered increased sun safe behavior expectations. Compared with other visual conditions separately, only mole removal visuals produced equivalent fear as UV skin damage visuals. Visual efficacy conditions appeared to nullify rather than magnify the indirect path through fear. The results suggest one way UV images impact sun safe behavioral expectations is via fear and that researchers should continue to examine the position of fear in fear appeal theories.


Skin cancer Sun-safe behaviors Fear appeal UV photo Visuals EPPM 



This research was funded by a New Innovator grant (#DP2EB022360) from the National Institutes of Health (NIH) (PI: JDJ; Co-I: KKJ) and in part by the National Cancer Institute of the National Institutes of Health (K07CA196985 to YPW). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

Manusheela Pokharel, Katheryn R. Christy, Jakob D. Jensen, Elizabeth A. Giorgi, Kevin K. John, Yelena P. Wu have no conflicts of interest to declare.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Manusheela Pokharel
    • 1
    Email author
  • Katheryn R. Christy
    • 2
  • Jakob D. Jensen
    • 1
    • 3
  • Elizabeth A. Giorgi
    • 1
  • Kevin K. John
    • 4
  • Yelena P. Wu
    • 3
    • 5
  1. 1.Department of CommunicationUniversity of UtahSalt Lake CityUSA
  2. 2.School of Journalism and Mass CommunicationUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA
  4. 4.School of CommunicationsBrigham Young UniversityProvoUSA
  5. 5.Department of DermatologyUniversity of UtahSalt Lake CityUSA

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