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Original Investigation |

Development and Validation of the Comprehensive Indoor Tanning Expectations Scale

Seth M. Noar, PhD1,2; Jessica Gall Myrick, PhD3; Brenda Morales-Pico, BS4; Nancy E. Thomas, MD, PhD2,4
[+] Author Affiliations
1School of Journalism and Mass Communication, The University of North Carolina at Chapel Hill
2Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill
3School of Journalism, Indiana University, Bloomington
4Department of Dermatology, School of Medicine, The University of North Carolina at Chapel Hill
JAMA Dermatol. 2014;150(5):512-521. doi:10.1001/jamadermatol.2013.9086.
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Importance  Strong links between indoor tanning behavior and skin cancer have been demonstrated across several studies. Understanding the complex belief systems that underlie indoor tanning in young women is a crucial first step in developing interventions to deter this behavior.

Objectives  To develop and validate a comprehensive, multidimensional, theory-based outcome expectations measure to advance an understanding of the sets of beliefs that underlie indoor tanning behavior among young women.

Design, Setting, and Participants  Cross-sectional study comprising a web-based survey of 11 sororities at a large university in the southeastern United States. Study participants (n = 706) were aged 18 to 25 years; 45.3% had tanned indoors in their lifetime and 30.3% in the past year.

Main Outcomes and Measures  Intention to tan indoors, frequency of indoor tanning behavior in the past year, and indoor tanner type (nontanner, former tanner, or current tanner).

Results  A comprehensive scale assessing indoor tanning outcome expectations was developed. In total, 6 positive outcome expectations factors and 5 negative outcome expectations factors were identified. These subscales were reliable (coefficient α range, 0.86-0.95) and were significantly (mostly at P < .001) correlated with a set of established measures, including appearance motivation, indoor tanning attitudes and norms, and intention to tan indoors. Examination of subscales across the 3 indoor tanning groups also revealed significant (P < .001) differences on all 11 subscales. Current tanners had the most positive and least negative perceptions about indoor tanning, while nontanners had the most negative and least positive perceptions. Former tanners tended to fall in between these 2 groups. The 2 subscales with the largest differences across the groups were mood enhancement (positive outcome expectation) and psychological/physical discomfort (negative outcome expectation). Multiple linear regression analyses demonstrated several outcome expectations subscales to be significantly associated with intention to tan indoors and frequency of indoor tanning behavior.

Conclusions and Relevance  Results suggest that the Comprehensive Indoor Tanning Expectations (CITE) Scale provides a reliable and valid assessment of the complex sets of beliefs that underlie indoor tanning, including positive (motivational) and negative (deterrent) beliefs. This new scale may further advance research on indoor tanning beliefs and can guide health communications to prevent and deter indoor tanning behavior.

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