Health Education Research, Vol. 15, No. 4, 405-414,
August 2000
© 2000 Oxford University Press
Orginal Articles |
Modeling tanning salon behavioral tendencies using appearance motivation, self-monitoring and the Theory of Planned Behavior
Department of Psychology, East Tennessee State University, Johnson City, TN 37614 and
1 Department of Psychology, Boise State University, Boise, ID, 83725, USA
Abstract
The constructs of appearance motivation and self-monitoring were added to the Theory of Planned Behavior in the prediction of tanning salon use in young people. The variables of the Theory of Planned Behavior proved effective at predicting tanning salon behavioral intentions and tendencies. Intentions and perceived behavioral control predicted tanning salon behavioral tendencies, while attitudes, subjective norms and perceived behavioral control predicted tanning salon behavioral intentions. Appearance motivation did not show any direct or interaction effects in the prediction of tanning salon behavioral intentions. It did, however, prove superior to health orientation in the prediction of tanning salon attitudes. Self-monitoring interacted with subjective norms in the prediction of tanning salon intentions, with high self-monitors showing stronger subjective norm–intention relationships than low self-monitors. These results imply that appearance-related interventions could prove efficacious in reducing young people's tanning salon behavioral tendencies. Furthermore, it may be important to consider individual's self-monitoring status when targeting skin cancer prevention information to young people.
Introduction
It is generally recognized by the medical community that excessive, unprotected exposure to ultraviolet (UV) radiation is harmful to one's skin (American Academy of Dermatology, 1988
). Despite the ample media attention to this effect, millions of Americans continue to deliberately engage in behaviors that increase their exposure to UV radiation. As a result there has been a near epidemic growth of skin cancers over the past decade [(Fears and Scotto, 1982; American Academy of Dermatology, 1988; Pathak, 1991); see also Oliphant et al. (Oliphant et al., 1991) for additional information on UV exposure and negative health-related effects]. Cutaneous melanoma, the most serious form of skin cancer, has increased faster than all other skin cancers combined. Given this trend, it is particularly disturbing to see an increase in intentional exposure to UV radiation due to frequent sunbathing and the use of indoor tanning beds in young people.
This increased UV exposure in young people can be partly attributed to the fact that artificial tanning has become a billion dollar per year business (Amonette, 1994). Reports indicate that there are now more than 20 000 commercial tanning establishments, 40 000 businesses which provide tanning beds to their customers and 200 000 personal home-based tanning units in the US (Baker et al., 1990; Fleisher and Fleisher, 1992). In addition, aggressive ad campaigns by the artificial tanning industry, which offer free tanning as prizes at school functions as well as student discounts, have resulted in an increased popularity among teenagers and young adults, especially among young women (Banks et al., 1992; Oliphant et al., 1994; Wichstrom, 1994; Boldeman et al., 1997; Hillhouse et al., 1997). These reports, in combination with studies conducted over the past decade which have repeatedly identified associations between cutaneous malignant melanoma and sunlamp use in humans (Walters et al., 1990; Autier et al., 1991; Westerdahl et al., 1995), underscore the need for efficacious interventions in this area.
There is some evidence that simply educating individuals about the health risks of intentional UV exposure may be of little utility. For example, interventions in other health areas, such as cigarette smoking, have shown that increasing individual's knowledge about the health risks of their behavior only leads to minor changes in behaviors (Blais and Rossi, 1991; Biener and Abrams, 1992). A recent report which examined the impact of health-focused education in the UV exposure area revealed tanning salon users indicated a desire to continue using salons even after they knew about the potential health risks (Beasley and Kittel, 1997). Further, Robinson (Robinson, 1990) reported that over one-third of her patients who were already in treatment for skin cancer did not respond to an intensive health-based educational campaign which focused on the reduction of intentional exposure to UV radiation. Finally, Beasley and Kittle (Beasley and Kittle, 1997) found that knowledge of governmental regulations and health warnings concerning tanning salon use had little effect on tanning salon users. These authors report that the perceived immediate benefit of using a sunbed appeared to outweigh any potential health risks. Thus, tanning salon behavior appears to be more strongly associated with interpersonal motives than perceived health risk.
In order to develop better strategies to reduce these health-risky behaviors, it may be beneficial to examine factors that influence the decision to use a tanning salon other than perceived health risk. Unfortunately, much of the previous work examining decision tendencies in this area has focused on distinguishing general attitudes, health orientation and personalities of high-risk individuals relative to lower-risk controls (Banks et al. 1992; Mermelstein and Riesenberg, 1992; Wichstrom, 1994; Hillhouse et al. 1996). While this approach is useful from the standpoint of identifying individuals in need of education, such variables are very difficult to change in short-term educational campaigns. Unfortunately, those studies focusing on more immediate cognitive variables tend to focus on a few, isolated cognitions in an atheoretical manner.
In a recent exception to this trend, Hillhouse et al. (Hillhouse et al., 1997, 2000) and Turrisi et al. (Turrisi et al., 1998) have successfully examined sunbathing, sunscreen use and tanning salon use utilizing strong theoretical decision-making models which are not restricted to the examination of the health orientations or general attitudes. These studies offer alternative conceptualizations to examine health-risk behaviors such as intentional UV exposure. For example, Hillhouse et al. (Hillhouse et al., 1997) successfully utilized the Theory of Planned Behavior to model these behaviors, while Turrisi et al. (Turrisi et al., 1998) found that sunbathing tendencies were not only influenced by how individuals construed the act of sunbathing, but also by how they perceived the alternatives to this behavior (e.g. doing something indoors on a hot, sunny day). To the extent that individuals found the alternatives to sunbathing moderately favorable, they were less likely to engage in sunbathing behaviors.
The present study is a continuation of this behavioral decision-making orientation in conceptualizing high-risk UV radiation behavioral tendencies. As such, it extends the findings of Hillhouse et al. (Hillhouse et al., 1997) by adding two theoretically relevant constructs to the conceptualization of the Theory of Planned Behavior, i.e. appearance motivation and self-monitoring, and contrasts their influence with individuals' health orientations in the prediction of tanning salon use.
Appearance motivation
The majority of tanners report tanning to improve their attractiveness (Hill et al., 1990; Miller et al., 1990; Broadstock et al., 1992). Tans are generally perceived as attractive, particularly by young people (Miller et al., 1990; Broadstock et al., 1992; Leary and Jones, 1993; Wichstrom, 1994). Leary and Jones (Leary and Jones, 1993) found that skin cancer-risky behaviors were best predicted by appearance-related concerns and the belief that one is more attractive with a tan. Jones and Leary (Jones and Leary, 1994) found that an intervention which focused on the long-term negative appearance effects of UV radiation exposure was more effective at reducing intentions to tan than an intervention which focused on skin cancer. A number of studies have demonstrated the importance of appearance concerns for sunbathing (Leary and Jones, 1993; Wichstrom, 1994; Hillhouse et al. 1996; Turrisi et al., 1998) and tanning salon use (Beasley and Kittle, 1997; Hillhouse et al., 1998). It is apparent that how we are perceived physically by others has important implication for our self-images and self-esteem, as well as for the social and material gains we can procure from our environment (Cash, 1990; Nell and Ashton, 1996; DeSantis and Kayson, 1997). In relation to the Theory of Planned Behavior, the influence of the motivation to improve one's appearance on the intention to use a tanning salon is likely to be mediated by the individual's attitude toward tanning salon use. Individuals with stronger appearance motivation should have more positive attitudes toward tanning salon use as a means to improve one's attractiveness, and subsequently more positive intentions and behavioral tendencies toward tanning salon use. It is also possible that appearance motivation might moderate the relationship between the attitude and intention, i.e. as appearance motivation increases the attitude toward tanning salon use has more influence on the subsequent intention to use a tanning salon.
Self-monitoring
Self-monitoring is the concept that people differ in how much their behavior is influenced by situational versus interpersonal variables (Snyder, 1979). High self-monitors are principally guided by situational cues, while low self-monitors are typically guided by interpersonal cues. As such, self-monitoring tendencies theoretically should moderate the relationships between core constructs in the Theory of Planned Behavior (e.g. attitudes, subjective norms and behavioral intentions). For example, as self-monitoring increases (e.g. increased guidance by external situational cues), the relationship between subjective norms and behavioral intentions should increase. Conversely, as self-monitoring decreases (e.g. increased guidance by internal interpersonal cues), the relationship between attitudes and behavioral intentions should increase. Thus, tanning behavioral decisions and their subsequent theoretical determinants should change depending on individual differences in regard to self-monitoring tendencies. Although in an earlier study Ajzen et al. (Ajzen et al., 1982) failed to support this hypothesis in a study examining voting and marijuana use, more recently Prislin and Kovrlija (Prislin and Kovrlija, 1992) observed in a study of classroom behaviors that high self-monitor's intentions were best predicted by subjective norms, where low self-monitor's intentions were better predicted by attitudes. The present study will examine the influence of self-monitoring in the analysis of tanning salon behavioral tendencies.
Health orientation
Our conceptualization thus far has downplayed the utility of examining tanning salon behavioral tendencies as being motivated by the individuals' health orientation. To examine this, we will contrast the importance of appearance motivation and self-monitoring with individuals' health orientation in the prediction of tanning salon attitudes, intentions and behaviors. Based on the literature cited earlier, it was anticipated that appearance motivation would be a better predictor of individuals' attitudes toward tanning salons than their health orientations.
Purpose of the present research
The purpose of the present research was two-fold: (1) to extend previous studies examining the behavioral determinants of tanning salon use by integrating constructs based on appearance motivation and interpersonal versus situational influence into a well-developed theoretical model of decision making, and (2) to contrast the influence of health-oriented versus non-health-oriented motivational constructs in the prediction of tanning salon behavioral tendencies.
Method
Sample
Respondents were 197 students recruited from randomly selected lower division (freshman and sophomore) classes from a mid-sized university located in a southeastern US city. All participants were volunteers. Of the students approached, 88.3% agreed to participate. We do not have data to compare participants versus non-participants. However, the mean age of our sample (22.44) closely approximates the institutional average for all lower division classes (22.24), as does the gender distribution (our sample = 39.6% male, 60.4% female; institutional lower division = 40.8% male, 59.2% female). Thus, we have confidence that this sample is representative of the institutional population. Skin type was assessed using the methods described by Fitzpatrick (Fitzpatrick, 1975), which has been shown to be a valid and reliable indicator of burn tendency as well as being related to skin cancer risk. Only students with skin types I–IV were used for statistical analyses in this study as those with darker skin types (e.g. V and VI) are at a much reduced risk for the development of skin cancer (Goldsmith, 1987) and are very unlikely to be users of tanning salons (Hillhouse et al., 1997). Skin type distribution was consistent with previous results reported in this population (I = 6%; II = 28%; III = 49%; IV = 17%) (Hillhouse et al., 1997).
Procedures and materials
Participants completed questionnaires assessing attitudes, subjective norms, perceived behavioral control, intentions and reported behavior related to tanning salon use. In addition, participants completed measures assessing appearance motivation, self-monitoring and health orientation. The general method for measuring attitudinal and behavioral constructs was derived from those suggested by Ajzen and Madden (Ajzen and Madden, 1986). For extensive information regarding the reliability and validity of the measurement approaches, see also Ajzen (Ajzen, 1985, 1988). All responses were made anonymously by the participants. The study and its methods were approved by the Institutional Review Board of the university.
Behavioral tendencies and intention
Artificial tanning salon behavioral tendencies were assessed with an item drawn from the literature (Hillhouse et al., 1997). The item asked for an estimate of frequency of tanning salon use in general during the past year (test–retest r = 0.95). In previous research, this measure has been found to be strongly correlated (r = 0.78) with diary measures of tanning salon behavior collected daily (Nappier et al., 1995) and uncorrelated with measures of social desirability.
For the behavioral intention, participants were asked to indicate how likely they were to go to a tanning salon in the next year. Individuals responded on a seven-point scale anchored by `yes, definitely do intend'–`no, definitely do not intend' response format.
Attitude and subjective norm
To assess the attitude toward tanning salon use participants were asked to indicate how agreeable/disagreeable, interesting/dull, stimulating/boring, pleasant/unpleasant, useful/useless, advantageous/disadvantageous, relaxing/not relaxing, attractive/unattractive, sexy/not sexy and not vain/vain tanning salon use is. Individual responses for each of the constructs were made on seven-point semantic differential scales ranging from –3 to +3. Attitude items were summed across the response dimensions to form the attitudinal measure. This scale demonstrated excellent internal reliability (coefficient 
= 0.94).
To assess normative perceptions, participants indicated whether people who were important to them (friends, family, partner) thought they should (or should not) `use a tanning salon'. Seven-point scales anchored by `strongly think I should' and `strongly think I should not' at their endpoints were used to obtain these measures. Participants were also asked to indicate how motivated they were in complying with each of the listed referent's opinions concerning tanning salon use on seven-point `completely motivated' to `not at all motivated' semantic differential scales. Subjective norm total scores for tanning salon use was calculated by multiplying the normative perceptions and motivations to comply for each referent and summing across the referents. This scale evidenced good internal reliability (coefficient = 0.85).
Perceived behavioral control
To measure perceived behavioral control, individuals were asked the following question: `In the next year, how easy/difficult would it be for you to use a tanning salon?'. Individuals responded to this item using a seven-point easy–difficult semantic differential type scale.
Appearance motivation
Appearance motivation was assessed with 12 items drawn from the literature (Cash, 1990; Wichstrom, 1994; Hillhouse et al., 2000). Individuals were asked to indicate on five-point Likert-type response format whether they agreed or disagreed with statements pertaining to their motivation to develop and maintain an attractive appearance (e.g. `It is important that others view me as physically attractive', `How I look is important to me', I spend what others consider a large amount of time on my appearance daily'). This scale evidenced good internal reliability (coefficient = 0.87) and is uncorrelated with measures of social desirability.
Self-monitoring
Self-monitoring was assessed using Snyder and Gangestad's (Snyder and Gangestad, 1986) 18-item self-monitoring scale. This scale had reasonable internal consistency as measured by Cronbach's (0.66).
Health orientation
We assessed individuals health orientation using a subscale from the MBSQ (Cash, 1990) in order to examine other potential moderator variables that have been previously focused on in the skin cancer prevention literature. This scale evidenced good internal reliability (coefficient = 0.77).
Demographic and background information
Finally, respondents completed a brief questionnaire that assessed standard demographic and background characteristics (e.g. gender, income, religion, age, education, skin type, etc.).
Results
Behavioral tendencies and intention
The first analysis was an examination of behavioral tendencies. Tanning salon use was regressed on the intention to go to a tanning salon, perceived behavioral control and a product term representing the interaction of these variables [see (Jaccard et al., 1990)], controlling for the effects of sex, age and skin type. The intention and perceived behavioral control variables were able to account for 41% of the tanning salon use variance beyond the 14% accounted for by gender, age and skin type. The overall R2 (0.55) was significant, F(5,190) = 46.52, P < 0.001. Examination of the unique effects revealed significant relationships for gender (b = 0.63, t = 3.91, part r2 = 0.07) and intention (b = 0.43, t = 11.17, part r2 = 0.40), with tanning salon behavioral tendencies. These data suggest that females were more frequent users of tanning salons than males and those who intended to go to a tanning salon reported more frequent tanning salon use. Further examination of the interaction effects revealed that perceived behavioral control moderated the relationship between intentions and reported tanning salon use behavior (b = 0.07, t = 3.56, P < 0.05, part r2 = 0.06). As perceived behavioral control increased, the relationship between the intention and tanning salon use became stronger (and more positive).
The second focus of the analysis regressed the intention to go to a tanning salon on the attitude toward tanning salon use, the subjective norm regarding tanning salon use and perceived behavioral control, product terms representing the interactions between these constructs, controlling for the effects of sex, age and skin type. The attitude, subjective norm and perceived behavioral control accounted for 49% of the tanning salon use variance beyond the 9% accounted for by gender, age and skin type. The overall R2 (0.58) was significant, F(6,178) = 40.29, P < 0.001. Examination of the unique effects revealed significant relationships for gender, attitude, subjective norms, perceived behavioral control and the intention to go to a tanning salon (see Table I). The data suggest that individuals with more positive attitudes, those with more positive subjective norms and those who believed they had more control over their tanning salon use were more likely to report intending to use a tanning salon. Further examination of the interaction effects revealed that perceived behavioral control moderated the relationships between attitudes and intentions (b = 0.02, t = 6.28, part r2 = 0.18). This suggests that as perceived control increased, the relationship between the attitude and the intention became stronger (and more positive).
|
Appearance motivation and health orientation
It was predicted that the influence of the motivation to improve one's appearance on the intention to use a tanning salon would be mediated by the individual's attitude toward tanning salon use (e.g. individuals with stronger appearance motivation should have more positive attitudes toward tanning salon use as a means to improve one's attractiveness, and subsequently more positive intentions and behavioral tendencies toward tanning salon use). Thus, the first focus of the analysis regressed the attitude toward tanning salon use on appearance motivation and health orientation, controlling for the effects of sex, age and skin type. Appearance motivation and health orientation were able to account for 16% of the tanning salon attitude variance beyond the 8% accounted for by gender, age and skin type. The overall R2 (0.24) was significant, F(5,182) = 11.11, P < 0.001. As predicted, those with higher appearance motivation were more likely to report positive tanning salon attitudes (b = 0.67, t = 6.06, part r2 = 0.17). No unique significant effect was observed for health orientation.
It was also predicted that appearance motivation might moderate the relationship between the attitude and intention (e.g. as appearance motivation increases, the attitude toward tanning salon use has more influence on the subsequent intention to use a tanning salon). Thus, the behavioral intention was regressed onto the attitude, appearance motivation, health orientation and product terms representing the interaction effects (controlling for the effects of background as above). The addition of the product terms did not result in a significant increase in the percent of variance accounted for in behavioral intentions (change in R2 = 0.01; t's all less than 1.65).
Self-monitoring and health orientation
It was predicted that the self-monitoring tendencies would moderate the relationships between core constructs in the Theory of Planned Behavior (e.g. attitudes, subjective norms and behavioral intentions). Thus, the behavioral intention was regressed onto the attitude, self-monitoring, health orientation and product terms representing the interaction effects (controlling for the effects of background as above). Examination of the significant effects revealed an interaction between self-monitoring and subjective norms in the prediction of tanning salon intentions (b = 0.004, t = 2.01, part r2 = 0.02). As predicted, as self-monitoring increased (e.g. increased guidance by external situational cues), the relationship between subjective norms and behavioral intentions increased. No other significant effects emerged between self-monitoring or health orientation.
Discussion
Artificial tanning is growing in popularity in young people. Despite the claims made by the tanning industry, the scientific community has demonstrated that regular sunlamp use represents a significant health risk for this population. Finding effective methods to reduce tanning salon behavioral tendencies in young people could have important long-term health benefits in terms of reduced skin cancer incidence. Unfortunately, attempts to modify UV-risky behaviors which have focused on the health risks of UV radiation exposure have had minimal success (Banks et al., 1992; Mermelstein and Riesenberg, 1992; Johnson and Lookingbill, 1984). In contrast, a growing body of literature suggests that it may be more beneficial to examine factors other than perceived health risk alone, which influence the decisions relevant to UV related behavioral tendencies (e.g. Turrisi et al., 1998; Hillhouse et al., 2000).
This study affirmed the usefulness of examining tanning salon behavioral tendencies using a well-developed decision theoretic model. For example, our findings revealed that the best predictor of tanning salon behavioral tendencies was the intention to go to a tanning salon, which in turn was influenced by the attitude toward tanning, subject norms and perceived behavioral control, respectively. These results suggest that perhaps the best strategy to change intentions and subsequent behavior is to focus on variables that are relevant to tanning salon attitudes. Interestingly, the motivation to maintain an attractive appearance was superior to health orientation as a predictor of the attitude toward going to a tanning salon. These results further suggest that focusing on appearance-related concerns should be more effective than health-related concerns in an effort to modify young people's tanning salon behavioral intentions. This position is consistent with a number of authors who have been calling for such appearance-related interventions to deal with the growing skin cancer problem (Jones and Leary, 1994; Beasley and Kittel, 1997; Hillhouse et al., 2000).
Although it is relatively easy to identify the need to alter appearance orientation, it is another issue as to what the best strategy might be to change this important construct. Unfortunately, the motive to create favorable impressions for others is often so powerful that people will engage in deliberate and thoughtful health-risky behaviors, such as going to a tanning salon to improve their appearance. This is particularly a concern with young people, where the motivation to manage their images, most importantly their attractiveness, is a very important driving social force (Berzonsky, 1995). A previous study (Hillhouse et al., 2000) offers some perspective in this regard. Hillhouse and his colleagues suggest that it is not enough to try and alter an individual's perception of the importance of using tanning to enhance appearance in order to induce change in appearance-related health-risky behaviors. Rather, it is equally important to provide individuals with alternative methods of addressing their appearance, which include healthy options. According to these authors, individuals are likely to choose appearance improvement strategies (alternatively referred to in the literature as impression management strategies) on the basis of the perceived advantages and disadvantages for each viable strategy. Thus, an effective examination of appearance motivation involves a psychological cost–benefit analysis of what individuals perceive to be practicable alternatives of improving their appearance. Hillhouse et al. (Hillhouse et al., 2000) have identified the five most frequent methods that young individuals commonly use to improve their attractiveness to others: (1) clothing, (2) exercise, (3) dieting, (4) personality and (5) tanning. Only when individual's attitudes toward clothing, exercise, dieting, etc., exceed their attitudes toward tanning will individuals be likely to alter their tanning intentions and subsequent behavior. Taken together, these studies underscore the importance of appearance concerns and alternative methods of improving appearance, as opposed to a singular focus on the health orientations of these behaviors (Broadstock et al., 1992; Leary and Jones, 1993; Hillhouse et al., 1996).
With regard to self-monitoring, we observed the predicted interaction between self-monitoring and subjective norms in the prediction of tanning salon behavioral intentions. This result is consistent with the work of Prislin and Kovrlija (Prislin and Kovrlija, 1992). Thus, individuals high in self-monitoring appeared to be more guided by situational cues relative to low self-monitors. As would be expected by self-monitoring theory, these high self-monitors seem to be more likely to listen to the opinions of significant others in their lives, at least when it comes to the use of tanning salons. The traditional view of high self-monitors as individuals who `follow the crowd' is thus supported by these results. This result has potential practical import in the future implementation of skin cancer prevention interventions. It could be important to consider self-monitoring status when deciding on how to target information toward young people engaging in skin cancer risky behaviors. Information targeted at low self-monitors might need to be more focused on personal attitudes and beliefs about tanning salons and tanning in order to be most effective. On the other hand, high self-monitors might be more easily influenced by information that focuses on other's beliefs and opinions about tanning and tanning salon use. For example, an intervention targeted at high self-monitoring individuals might discuss the waning popularity of tanning as a means of improving attractiveness or alternatively discuss the perceptions by their peers that individuals who purposely tan are vain.
Although the present study has extended previous work in this area, it is not without several limitations. First, even though our sampling method produced a sample that closely matched institutional averages on several demographic variables, we have no data comparing participants versus non-participants. Furthermore, we used a regional, college sample that may not be representative of the general population. Thus, the generalizability of this study is potentially limited. However, given that we used a well-developed theory as our guiding model, which has shown generalizability in the general population, we have more confidence in these results. It would be useful to conduct a large-scale, randomized study across a number of college campuses in different geographical regions to confirm whether these results are truly representative of college students in general. Of course, such a study would require significant resources and expense. It would also be interesting to replicate these findings in younger populations as well as in non-college-educated young people. Although an argument can be made that other groups may differ in the strength of the relationships, it is unlikely that other heterogeneous groups are likely to devalue the importance of their appearance in their everyday lives. Second, we examined a limited number of non-health-related motivational constructs. The present study identified the importance of non-health-related constructs, but the ones studied here are by no means exhaustive. For example, the recent work of Turrisi et al. (Turrisi et al., 1998) has suggested that individuals' behaviors are as much a function of how they feel about the behavior in question as how they feel about the alternatives to that behavior. In the context of tanning salon use, future research needs to examine how individuals construe the alternative of tanning salon use to other viable means of altering their skin color/appearance (e.g. tanning creams, etc.). Third, the present research studied individuals' attitudes and behaviors using correlational methods and a cross-sectional design. Future research needs to examine the relationships between these constructs in the context of experimental designs with behavioral outcomes in order to improve our ability to make predictions. For example, interventions which focus on changing appearance and health orientations in order to effect change in attitudes are likely to definitively answer the question of which construct has the most impact on tanning salon behavioral tendencies. Lastly, another potential limitation is the use of single-item indicators for some of our measures. However, Jaccard (Jaccard, 1975) found that single-item measures of attitude yield approximately the same results as multi-item assessment devices. Furthermore, the assessment strategies used in this study to measure the Theory of Planned Behavior's constructs have a relatively long history in the literature, giving us more confidence in their reliability and validity (Ajzen, 1985, 1988).
In conclusion, we have reaffirmed the utility of the Theory of Planned Behavior in modeling tanning behavior. We have also extended this model with the addition of the contrasting non-health oriented motivations, appearance motivation and self-monitoring, with health orientations. The motivation to improve one's appearance appears to have indirect effects on tanning salon behavioral intentions through its effect on tanning salon attitudes. These appearance-related attitudes are clearly superior to more traditional conceptualizations examining health-related attitudes in the prediction of tanning salon behavioral tendencies. Self-monitoring appears to interact with subjective norms in the prediction of tanning intentions. Thus, high self-monitors appear to be more likely to heed the attitudes and opinions of significant others in their lives when it comes to making behavioral decisions regarding tanning salon use than do low self-monitors.
References
Ajzen, I. (1985) From intentions to actions: a theory of planned behavior. In Kuhl, J. and Beckman, J. (eds), Action-control: From Cognition to Behavior. Springer, Heidelberg, pp. 11–39.
Ajzen, I. (1988) Attitudes, Personality and Behavior. Dorsey, Chicago, IL.
Ajzen, I. and Madden, T. J. (1986) Prediction of goal-directed behavior: attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22, 453–474.[Web of Science]
Ajzen, I., Timko, C. and White, J. B. (1982) Self-monitoring and the attitude–behavior relationship. Journal of Personality and Social Psychology, 42, 426–435.[Web of Science]
American Academy of Dermatology (1988) Americans Know Risks, Sun Themselves Anyway. American Academy of Dermatology, Evanston, IL.
Amonette, R. A. (1994) New campaigns needed to remind the public of the dangers of tanning salons. Cosmetic Dermatology, 7, 25–28.
Autier, P., Joarlette, M., Lejeune, F., Lienard, D., Andre, J. and Achten, G. (1991) Cutaneous malignant melanoma and exposure to sunlamps and sunbeds: a descriptive study in Belgium. Melanoma Research, 1, 69–74.[Medline]
Baker, D. R., Weary, P. E. and O'Neill, W. J. (1990) Tanning parlor regulation: a paradigm for physician involvement in public health issues. State Health Legislation Report, 18.
Banks, B. A., Silverman, R. A., Schwartz, R. H. and Tunnessen, W. W. (1992) Attitudes of teenagers toward sun exposure and sunscreen use. Pediatrics, 89, 40–42.
Beasley, T. M. and Kittel, B. S. (1997) Factors that influence health risk behaviors among tanning salon patrons. Evaluation and the Health Professions, 20, 371–388.
Berzonsky, M. D. (1995) Public self-presentations and self-conceptions: the moderating role of identity status. Journal of Social Psychology, 135, 737–745.
Cash, T. F. (1990) The psychology of physical appearance: aesthetics, attributes, and images. In Cash, T. F. and Pruzinsky, T. (eds), Body Images: Development, Deviance, and Changes. Guilford Press, New York.
Biener, L. and Abrams, D. B. (1992) The contemplation ladder: validation of a measure of readiness to consider smoking cessation. Health Psychology, 10, 360–365.
Blais, M. and Rossi, J. S. (1991) Development of a stages of change model for sun exposure. Paper presented at the Society of Behavioral Medicine, Washington, DC.
Boldeman, C., Jansson, B., Nilsson, B. and Ullen, H. (1997) Sunbed use in Swedish urban adolescents related to behavioral characteristics. Preventative Medicine, 26, 114–119.[Web of Science][Medline]
Broadstock, M., Borland, R. and Gason, R. (1992) Effects of suntan on judgments of healthiness and attractiveness by adolescents. Journal of Applied Social Psychology, 22, 157–172.[Web of Science]
DeSantis, A. and Kayson, W. A. (1997) Defendants' characteristics of attractiveness, race, and sex and sentencing decisions. Psychological Reports, 81, 670–683.
Fears, T. and Scotto, J. (1982) Changes in skin cancer morbidity between 1971–1972 and 1977–1978. Journal of the National Cancer Institute, 69, 365–370.
Fitzpatrick, T. B. (1975) Soleil et pau. Journal of Medical Esthetics, 2, 33–34.
Fleischer, A. B., Jr and Fleischer, A. B. (1992) North Carolina tanning operators: hazard on the horizon? Journal of the American Academy of Dermatology, 27, 199–203.[Web of Science][Medline]
Goldsmith, M. F. (1987) Paler is better, says skin cancer fighters. Journal of the American Medical Association, 257, 893–894.
Hill, D., Theobald, T., Borland, R., White, V. and Marks, R. (1990) Summer Activities, Sunburn, Sun-related Attitudes and Precautions against Skin Cancer—A Survey of Melbourne Residents in the Summer of 1987–1988. Center for Behavioural Research in Cancer, Melbourne.
Hillhouse, J. J., Stair, A. and Adler, C. M. (1996) Predictors of sunbathing and sunscreen use in college undergraduates. Journal of Behavioral Medicine, 19, 543–561.[Web of Science][Medline]
Hillhouse, J. J., Adler, C. M., Drinnon, J. and Turrisi, R. (1997) Application of Ajzen's Theory of Planned Behavior to predict sunbathing, tanning salon use, and sunscreen intentions and behaviors. Journal of Behavioral Medicine, 20, 363–376.
Hillhouse, J. J., Turrisi, R., Holwiski, F. and McVeigh, S. (2000) An examination of psychological variables relevant to artificial tanning tendencies. Journal of Health Psychology, in press.
Jaccard, J., Weber, J. and Lundmark, J. (1975) A multitrait–multimethod analysis of four attitude assessment procedures. Journal of Experimental Social Psychology, 11, 149–154.
Jaccard, J., Turrisi, R. and Wan, C. (1990) Interaction Effects in Multiple Regression. Sage, Beverly Hills, CA.
Johnson, E. Y. and Lookingbill, D. P. (1984) Sunscreen use and sun exposure: trends in a white population. Archives of Dermatology, 120, 727–731.
Jones, J. L. and Leary, M. R. (1994) Effects of appearance-based admonitions against sun exposure on tanning intentions in young adults. Health Psychology, 13, 86–90.[Web of Science][Medline]
Leary, M. R. and Jones, J. L. (1993) The social psychology of tanning and sunscreen use: self-presentational motives as a predictor of health risk. Journal of Applied Social Psychology, 23, 1390–1406.[Web of Science]
Mermelstein, R. J. and Riesenberg, L. A. (1992) Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychology, 11, 371–376.[Web of Science][Medline]
Miller, A. G., Ashton, W. A., McHoskey, J. W. and Gimbel, J. (1990) What price attractiveness? Stereotype and risk factors in suntanning behavior. Journal of Applied Social Psychology, 20, 1272–1300.[Web of Science]
Nappier C., Tompkins J. and Hillhouse J. J. (1995) Sun exposure diary use in sunbathing assessment. Presented at the Southeastern Psychological Association Annual Meeting. Savannah, GA.
Nell, K. and Ashton, N. L. (1996) Gender, self-esteem, and perception of own attractiveness. Perceptual and Motor Skills, 83, 1105–1106.
Oliphant, J. A., Forster, J. L. and McBride, C. M. (1994) The use of commercial tanning facilities by suburban Minnesota adolescents. American Journal of Public Health, 84, 476–478.
Pathak, M. A. (1991) Ultraviolet radiation and the development of non-melanoma and melanoma skin cancer: clinical and experimental evidence. Skin Pharmacology, 4 (Suppl. 1), 85–94.
Prislin, R. and Kovrlija, N. (1992) Predicting behavior of high and low self-monitors: an application of the theory of planned behavior. Psychological Reports, 70, 1131–1138.[Web of Science][Medline]
Robinson, J. (1990) Behavior modification obtained by skin protection education coupled with removal of a skin cancer. Archives of Dermatology, 126, 447–481.
Snyder, M. (1979) Self-monitoring processes. In Berkowitz, L. (ed.), Advances in Experimental Social Psychology. Academic Press, New York, vol. 12, pp. 85–128.
Snyder, M. and Gangestad, S. (1986) On the nature of self-monitoring: matters of assessment, matters of validity. Journal of Personality and Social Psychology, 51, 125–139.[Web of Science][Medline]
Turrisi, R., Hillhouse, J. J. and Gebert, C. (1998) Examination of cognitive variables relevant to sunbathing. Journal of Behavioral Medicine, 21, 79–93.
Walters, S. D., Marrett, L. D., From, L., Hertzman, C., Shannon, H. S. and Roy, P. (1990) The association of cutaneous malignant melanoma with the use of sunbeds and sunlamps. American Journal of Epidemiology, 131, 232–243.
Westerdahl, J., Olsson, H., Masback, A., Ingvar, C., Jonsson, N., Brandt, L., Jonsson, P. and Moller, T. (1994) Use of sunbeds or sunlamps and malignant melanoma in southern Sweden. American Journal of Epidemiology, 140, 691–699.
Wichstrom, L. (1994) Predictors of Norwegian adolescents' sunbathing and the use of sunscreen. Health Psychology, 13, 412–420.[Web of Science][Medline]
Received on June 22, 1999; accepted on January 1, 2000
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. C. Banerjee, K. Greene, Z. Bagdasarov, and S. Campo 'My friends love to tan': examining sensation seeking and the mediating role of association with friends who use tanning beds on tanning bed use intentions Health Educ. Res., July 2, 2009; (2009) cyp035v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Reilly and N. A. Rudd Social Anxiety as Predictor of Personal Aesthetic Among Women Clothing and Textiles Research Journal, July 1, 2009; 27(3): 227 - 239. [Abstract] [PDF]
|
|
|
|
 |
|
 S. L. Pagoto and J. Hillhouse Not All Tanners Are Created Equal: Implications of Tanning Subtypes for Skin Cancer Prevention Arch Dermatol, November 1, 2008; 144(11): 1505 - 1508. [Full Text] [PDF]
|
|
|
|
|
|
D. Lazovich, J. E. Stryker, J. A. Mayer, J. Hillhouse, L. K. Dennis, L. Pichon, S. Pagoto, C. Heckman, A. Olson, V. Cokkinides, et al. Measuring Nonsolar Tanning Behavior: Indoor and Sunless Tanning Arch Dermatol, February 1, 2008; 144(2): 225 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hillhouse, R. Turrisi, and A. L. Shields Patterns of Indoor Tanning Use: Implications for Clinical Interventions Arch Dermatol, December 1, 2007; 143(12): 1530 - 1535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Danoff-Burg and C. E. Mosher Predictors of Tanning Salon Use: Behavioral Alternatives for Enhancing Appearance, Relaxing and Socializing J Health Psychol, May 1, 2006; 11(3): 511 - 518. [Abstract] [PDF]
|
|
|
|
|
|
J. Hillhouse, J. Stapleton, and R. Turrisi Association of Frequent Indoor UV Tanning With Seasonal Affective Disorder Arch Dermatol, November 1, 2005; 141(11): 1465 - 1465. [Full Text] [PDF]
|
|
|
|
|
|
S. Rasmussen and R. C. O'Connor Factors Influencing Anticipated Decisions about Sunscreen Use J Health Psychol, July 1, 2005; 10(4): 585 - 595. [Abstract] [PDF]
|
|
|
|
 |
|
 D. Lazovich, J. Forster, G. Sorensen, K. Emmons, J. Stryker, M.-F. Demierre, A. Hickle, and N. Remba Characteristics Associated With Use or Intention to Use Indoor Tanning Among Adolescents Arch Pediatr Adolesc Med, September 1, 2004; 158(9): 918 - 924. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Jo, S. Lee, M. O. Ahn, and S. H. Jung Structural relationship of factors affecting health promotion behaviors of Korean urban residents Health Promot. Int., September 1, 2003; 18(3): 229 - 236. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||