Randomized Trial of a Dissonance-Based Sun Safety Intervention for Young Adult Tanners

Melanoma, the deadliest form of skin cancer, is the second most prevalent cancer in young adults ages 20-39. Three-quarters of melanomas diagnosed at this age are attributable to tanning. About 32-65% of college students have tanned outdoors in the past year and 72% got a tan unintentionally. Most young adults tan because they have internalized the notion that tanned skin improves their physical appearance. Appearance- focused skin cancer prevention interventions are more efficacious than health-focused interventions but unfortunately, they are not very scalable. Dissonance induction is an effective appearance-based intervention for eating disorder prevention that has been scaled up and implemented across the globe. Because physical appearance motivations drive both eating pathology and tanning, dissonance induction may be a promising intervention approach to reduce tanning. In dissonance induction interventions, participants are asked to craft arguments against body ideals and disordered eating behaviors and to present these arguments to their peers. This activity generates cognitive dissonance, a state of psychological discomfort that is produced when one’s behavior contradicts their attitudes. To resolve the discomfort, the individual aligns their attitudes and behavior. Dissonance induction interventions are effective, have high reproducibility, and have been implemented widely, reaching over 3.5 million girls and young women in 125 countries. A meta-analysis of dissonance induction interventions for eating disorders found that the most effective versions leverage social media and incentives. We designed a dissonance induction intervention to reduce tanning by incentivizing tanners to develop anti- tanning messaging for a social media campaign and to recruit their social ties to engage with those messages. In a pilot feasibility trial, we found high rates of participation, retention, and acceptability, and significant reductions in tanning motivation and intentions. We now propose a randomized controlled trial to test the efficacy of this intervention on short- and long-term tanning outcomes. We will randomize 278 young adult tanners to a 6-week dissonance induction intervention or a control group. The primary outcome will be tanning at 3-months. Secondary outcomes include tanning at 15-months and sunburn and sun protection use 3- and 15-months post-intervention. We will also test our conceptual model by examining proposed intervention mediators (tan ideal internalization, tan surveillance, and skin color dissatisfaction). Finally, in the intervention condition only, we will distill the independent and combined contributions of the dissonance-inducing intervention activities by examining the independent associations between the total number of posts made by participants, engagement they attracted to their posts, and the interaction between the two on tanning behavior at 3-months. This work will be overseen by a Stakeholder Advisory Board of leaders in skin cancer prevention, dissonance induction interventions, and implementation science as well as a young adult melanoma survivor/social media influencer, and two young adults from the target population. Project Number: 1R01CA309495-01 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: SHERRY PAGOTO | Institution: UNIVERSITY OF CONNECTICUT STORRS, STORRS-MANSFIELD, CT | Award Amount: $444,991 | Activity Code: R01 | Study Section: Lifestyle Change and Behavioral Health Study Section[LCBH] View on NIH RePORTER: https://reporter.nih.gov/project-details/11278616