International Journal of Behavioral Medicine

, Volume 22, Issue 4, pp 435–442 | Cite as

Skin Tone Dissatisfaction, Sun Exposure, and Sun Protection in Australian Adolescents

  • Amanda D. HutchinsonEmail author
  • Ivanka Prichard
  • Kerry Ettridge
  • Carlene Wilson



This study aimed to assess the adoption of sun protection and sun exposure behaviors, the extent to which these behaviors group together, and the relationship between skin tone dissatisfaction and sun-related behaviors in South Australian adolescents (aged 12–17).


A total of 2,875 secondary school students (1,461 male and 1,414 female) completed a questionnaire including questions about sun protection and sun exposure behaviors and skin tone dissatisfaction.


Regular adoption of sun protection behaviors was low and ranged from 20 % (wearing protective clothing) to 44 % (sunscreen use). A principal components analysis identified four subgroups of sun-related behaviors: sun protection, appearance enhancement, sun avoidance, and sun exposure. Females had significantly higher skin tone dissatisfaction than males. Skin tone dissatisfaction was associated with decreased sun protection and avoidance and increased appearance enhancement and sun exposure in both males and females.


Skin tone dissatisfaction plays an important role in Australian adolescents’ sun-related behavior. Appearance-based interventions may be effective in reducing skin cancer risk through reduced sun exposure.


Tanning Adolescent Appearance Skin cancer Behavior 



We would like to acknowledge Dr Jacqueline Bowden for her assistance with statistical analyses.

Conflict of Interest

Authors Hutchinson, Prichard, Ettridge, and Wilson declare that they have no conflict of interest.

Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants for being included in the study.


  1. 1.
    National Cancer Institute at the National Institutes of Health. Skin Cancer. Accessed May 23 2013.
  2. 2.
    Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010;146(3):283–7. doi: 10.1001/archdermatol.2010.19.CrossRefPubMedGoogle Scholar
  3. 3.
    Cancer Council Australia. Skin cancer. Accessed May 21 2014.
  4. 4.
    Cancer Research UK. Skin cancer key facts. Accessed May 21 2014.
  5. 5.
    Australian Institute of Health and Welfare & Australasian Association of Cancer Registries. Cancer in Australia: an overview 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW2012.Google Scholar
  6. 6.
    Australian Institute of Health and Welfare and Cancer Australia. Non-melanoma skin cancer: general practice consultations, hospitalisation and mortality.September 2008. Report No.: Cat no. CAN 39.Google Scholar
  7. 7.
    Australian Institute of Health and Welfare. Cancer in adolescents and young adults in Australia. Canberra: AIHW2011.Google Scholar
  8. 8.
    Elwood JM, Jopson J. Melanoma and sun exposure: an overview of published studies. Int J Cancer. 1997;73(2):198–203. doi: 10.1002/(SICI)1097-0215(19971009)73:2<198::AID-IJC6>3.0.CO;2-R.CrossRefPubMedGoogle Scholar
  9. 9.
    Whiteman DC, Whiteman CA, Green AC. Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control. 2001;12:69–82.CrossRefPubMedGoogle Scholar
  10. 10.
    Gallagher RP, Hill GB, Bajdik CD, Fincham S, Coldman AJ, McLean DI, et al. Sunlight exposure, pigmentary factors, and risk of nonmelanocytic skin cancer. I. Basal cell carcinoma. Arch Dermatol. 1995;131(2):157–63. doi: 10.1001/archderm.1995.01690140041006.CrossRefPubMedGoogle Scholar
  11. 11.
    Corona R, Dogliotti E, D’Errico M, Sera F, Iavarone I, Baliva G, et al. Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life. Arch Dermatol. 2001;137(9):1162–8. doi: 10.1001/archderm.137.9.1162.CrossRefPubMedGoogle Scholar
  12. 12.
    Autier P, Dore JF. Influence of sun exposures during childhood and during adulthood on melanoma risk. EPIMEL and EORTC Melanoma Cooperative Group. European Organisation for Research and Treatment of Cancer. Int J Cancer. 1998;77(4):533–7. doi: 10.1002/(SICI)1097-0215(19980812)77:4<533::AID-IJC10>3.0.CO;2-7.CrossRefPubMedGoogle Scholar
  13. 13.
    Ettridge K. Diet, physical activity and sun protection among South Australian adolescents: results of the 2008 survey. Adelaide: Cancer Council SA; 2009.Google Scholar
  14. 14.
    Day A, Wilson C, Hutchinson A, Roberts RM. The role of skin cancer knowledge in sun-related behaviours: a systematic review. J Health Psychol. 2013. doi: 10.1177/1359105313485483.PubMedGoogle Scholar
  15. 15.
    Jackson KM, Aiken LS. 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 Psychol. 2000;19(5):469–78.CrossRefPubMedGoogle Scholar
  16. 16.
    Williams M, Jones SC, Caputi P, Iverson D. Australian adolescent’s compliance with sun protection behaviours during summer: the importance of the school context. Health Promot Int. 2012;27(1):15–22. doi: 10.1093/heapro/dar028.CrossRefPubMedGoogle Scholar
  17. 17.
    Geller AC, Colditz G, Oliveria S, Emmons K, Jorgensen C, Aweh GN, et al. Use of sunscreen, sunburning rates, and tanning bed use among more than 10 000 US children and adolescents. Pediatrics. 2002;109(6):1009–14. doi: 10.1542/peds.109.6.1009.CrossRefPubMedGoogle Scholar
  18. 18.
    Prichard I, Kneebone A, Hutchinson AD, Wilson C. The relationship between skin tone dissatisfaction and tanning behaviour. Aust J Psychol. 2014;66:168–74. doi: 10.1111/ajpy.12039.CrossRefGoogle Scholar
  19. 19.
    Cafri G, Thompson JK, Roehrig M, van den Berg P, Jacobsen PB, Stark S. 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. 2006;3(3):199–209. doi: 10.1016/j.bodyim.2006.05.002.CrossRefPubMedGoogle Scholar
  20. 20.
    Australian Institute of Health and Welfare. Melanoma of the skin for Australia—Australian Cancer Incidence & Mortality Book. 2011. Accessed May 16 2013.
  21. 21.
    Stunkard AJ, Sorenson T, Schlusinger F. Use of the Danish adoption registers for the study of obesity and thinness. In: Kety SS, Rowland LP, Sidman RL, Matthysse SW, editors. The genetics of neurological and psychological disorders. New York: Raven; 1983. p. 115–20.Google Scholar
  22. 22.
    Flaherty KT. Targeting metastatic melanoma. Annu Rev Med. 2012;63:171–83. doi: 10.1146/annurev-med-050410-105655.CrossRefPubMedGoogle Scholar
  23. 23.
    Cafri G, Thompson JK, Jacobsen PB, Hillhouse J. Investigating the role of appearance-based factors in predicting sunbathing and tanning salon use. J Behav Med. 2009;32:532–44. doi: 10.1007/s10865-009-9224-5.CrossRefGoogle Scholar
  24. 24.
    Williams AL, Grogan S, Clark-Carter D, Buckley E. Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: a systematic review and meta-analyses. Br J Health Psychol. 2013;18(1):182–217. doi: 10.1111/j.2044-8287.2012.02089.x.CrossRefPubMedGoogle Scholar
  25. 25.
    Mahler HI, Kulik JA, Gerrard M, Gibbons FX. Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: a randomized, controlled experiment. J Behav Med. 2010;33(6):496–507. doi: 10.1007/s10865-010-9279-3.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Hillhouse J, Turrisi R, Stapleton J, Robinson J. A randomized controlled trial of an appearance-focused intervention to prevent skin cancer. Cancer. 2008;113(11):3257–66. doi: 10.1002/cncr.23922.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Hillhouse JJ, Turrisi R. Examination of the efficacy of an appearance-focused intervention to reduce UV exposure. J Behav Med. 2002;25(4):395–409.CrossRefPubMedGoogle Scholar
  28. 28.
    Kulik JA, Butler H, Gerrard M, Gibbons FX, Mahler H. Social norms information enhances the efficacy of an appearance-based sun protection intervention. Soc Sci Med. 2008;67(2):321–9.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2014

Authors and Affiliations

  • Amanda D. Hutchinson
    • 1
    • 5
    Email author
  • Ivanka Prichard
    • 2
    • 3
    • 5
  • Kerry Ettridge
    • 4
    • 5
  • Carlene Wilson
    • 2
    • 5
  1. 1.School of Psychology, Social Work & Social PolicyUniversity of South AustraliaAdelaideAustralia
  2. 2.Flinders Centre for Innovation in CancerFlinders UniversityAdelaideAustralia
  3. 3.School of Health SciencesFlinders UniversityAdelaideAustralia
  4. 4.Population Health Research, South Australian Health and Medical Research Institute (SAHMRI)AdelaideAustralia
  5. 5.Cancer Council SAAdelaideAustralia

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