Association of Skin Cancer Risk and Protective Behaviors with Health Literacy Among Young Adults in the USA

Carolyn J. Heckman, Melissa V. Auerbach, Susan Darlow, Elizabeth A. Handorf, Stephanie Raivitch, Sharon L. Manne

Research output: Contribution to journalArticle


Background: The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. Method: A US national sample of 958 adults, 18–25 years old, at moderate to high risk of developing skin cancer, completed a survey online. Behavioral outcomes were ultraviolet (UV) radiation exposure (e.g., indoor and outdoor tanning, sunburn) and protective (e.g., sunscreen use, sunless tanning) behaviors. Multivariable regression analyses were conducted to determine whether health literacy (a four-item self-report measure assessing health-related reading, understanding, and writing) was associated with behavioral outcomes while controlling for demographic factors. Results: Higher health literacy was independently associated with less sunbathing, odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60–0.98; less indoor tanning, OR = 0.38, CI = 0.31–0.48; and less use of tanning oils, OR = 0.54, CI = 0.43–0.69. However, health literacy was also associated with a lower likelihood of wearing long pants, OR = 0.76, CI = 0.58–0.99, or a hat, OR = 0.68, CI = 0.53–0.87, when outdoors. On the other hand, higher health literacy was associated with higher incidental UV exposure, OR = 1.69, CI = 1.34–2.14, and a greater likelihood of ever having engaged in sunless tanning, OR = 1.50, CI = 1.17–1.92. Conclusion: Interestingly, higher health literacy was associated with lower levels of intentional tanning yet also higher incidental UV exposure and lower skin protection among US young adults. These findings suggest that interventions may be needed for young adults at varying levels of health literacy as well as populations (e.g., outdoor workers, outdoor athletes/exercisers) who may be receiving large amounts of unprotected incidental UV.

Original languageEnglish (US)
Pages (from-to)372-379
Number of pages8
JournalInternational Journal of Behavioral Medicine
Issue number4
StatePublished - Aug 15 2019

All Science Journal Classification (ASJC) codes

  • Applied Psychology


  • Health literacy
  • Prevention
  • Risk behaviors
  • Skin cancer
  • Young adults

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