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Table. Item Endorsement Labels and Scale Reliabilities
Table. Item Endorsement Labels and Scale Reliabilities
1.
Demierre MF. Time for the national legislation of indoor tanning to protect minors.  Arch Dermatol. 2003;139(4):520-524PubMedArticle
2.
Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population.  Cancer Epidemiol Biomarkers Prev. 2010;19(6):1557-1568PubMedArticle
3.
Stapleton J, Turrisi R, Hillhouse J, Robinson JK, Abar B. A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis.  J Behav Med. 2010;33(3):181-190PubMedArticle
4.
Festinger L. A Theory of Cognitive Dissonance. Evanston, IL: Row; 1957
5.
Oakes W, Chapman S, Borland R, Balmford J, Trotter L. “Bulletproof skeptics in life's jungle”: which self-exempting beliefs about smoking most predict lack of progression towards quitting?  Prev Med. 2004;39(4):776-782PubMedArticle
6.
Cafri G, Thompson JK, Roehrig M,  et al.  Appearance motives to tan and not tan: evidence for validity and reliability of a new scale.  Ann Behav Med. 2008;35(2):209-220PubMedArticle
Research Letter
June 2012

College Students' Cognitive Rationalizations for Tanning Bed Use: An Exploratory Study

Author Affiliations

Author Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York (Drs Banerjee and Hay); Department of Communication, Rutgers University, New Brunswick, New Jersey (Dr Greene).

Arch Dermatol. 2012;148(6):761-762. doi:10.1001/archdermatol.2012.398

Tanning bed use is a popular behavior among American youth1 despite evidence of increased risk of melanoma.2 Current interventions to reduce tanning bed use3 have not been very successful with resistant tanners, characterized by engagement in tanning bed use for appearance enhancement despite being knowledgeable about harmful effects of their behavior.

This dichotomy between unfavorable attitudinal beliefs (tanning bed use is harmful) and continued tanning bed use can possibly be explained by cognitive dissonance theory.4 According to cognitive dissonance theory, individuals seek consistency among their cognitions. Inconsistent cognitions create psychological discomfort that motivates people to alter their cognitions to restore consistency.4

Prior research demonstrates that individuals often rationalize their existing inconsistent beliefs to decrease dissonance. Therefore, in the case of tanning bed use, people's continued use may be supported by cognitive rationalizations justifying tanning bed use despite awareness of risks.

To identify these rationalizations, we adapted an available measure of cognitive rationalization5 to tanning bed use (original measure explored cognitive rationalizations related to smoking) and conducted a survey with a sample of college students. The aim of this article is to examine the distribution of the item responses to examine how relevant these rationalizations are to our population of interest, ie, current tanning bed users.

Methods

After receiving human subjects' approval from the university institutional review board, we surveyed 587 undergraduate students in introductory communication courses at a large university in the northeastern United States. Of the original 587 participants, students older than 25 years were excluded (n = 36) to retain sample homogeneity.

Of the 551 participants included, 218 participants had ever used tanning beds (39.6%). Given that we wanted to examine cognitive rationalizations used by former and current tanners, we utilized the data from these 218 participants to examine the cognitive rationalization scale. Among this group of ever tanners, 87.6% were women (n = 191). The mean (SD) age of participants was 19.98 (1.13) years (age range, 18-24 years), and about 78.4% of participants identified themselves as white, 9.6% Asian, and 7.8% Hispanic/Latino (other groups, <2% each).

We adapted the cognitive rationalization scale developed by Oakes and colleagues5 to tanning bed use. The scale consisted of a common stem for all items, “Tanning bed use can make me ill, but . . . ,” and was measured with 16 Likert-type items, with responses ranging from 1 (strongly disagree) to 5 (strongly agree). We used 16 of the 18 items supporting the following 3 a priori factors (we altered the factor names for relevance to tanning bed use) (Table): factor 1, skeptical rationalizations (ie, beliefs indicating tanning bed users do not believe medical evidence about tanning bed use and disease); factor 2, worth-it rationalizations (ie, beliefs indicating tanning bed users consider tanning bed use a worthwhile activity despite potential hazards); and factor 3, danger ubiquity rationalizations (ie, beliefs normalizing the dangers of tanning bed use because of the ubiquity of risks).

Results

We examined the endorsement (percentage of current tanners who chose “agree” or “strongly agree” responses) of each item included in our cognitive rationalization scale (Table). We used a cutoff point of 10% and deleted the items that were not endorsed by at least 10% of the participants. Item endorsement clearly reflects the high endorsement of danger ubiquity rationalizations that normalize the dangers of tanning bed use because of the ubiquity of risks.

Comment

This exploratory study aimed to examine item response distribution of an adapted cognitive rationalization scale by tanning bed users. The results indicated that current tanners endorse danger ubiquity rationalizations most strongly, but other rationalizations are endorsed moderately, suggesting the need for more qualitative work to uncover other rationalizations.

Strong motivations for tanning bed use also include peer norms, parental norms, and other sociocultural influences to use tanning beds,6 but these motivations were not reflected in the adapted cognitive rationalization scale. More in-depth qualitative work may uncover other rationalizations that tanning bed users may offer when they are made aware that they continue to use tanning beds despite awareness of risks associated with usage.

The results presented here should be interpreted with caution given the small sample size, cross-sectional data, and the lack of demographic background data. We adapted a preexisting cognitive rationalization scale (on smoking behavior) to tanning bed use. Given that these 2 behaviors are very different in context, and endorsement is moderate, a more complete measure would need to include more strongly endorsed rationalizations, possibly through rich focus group data.

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Article Information

Correspondence: Dr Banerjee, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, Seventh Floor, New York, NY 10022 (banerjes@mskcc.org).

Accepted for Publication: January 30, 2012.

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Banerjee, Hay, and Greene. Acquisition of data: Banerjee and Greene. Analysis and interpretation of data: Banerjee and Hay. Drafting of the manuscript: Banerjee. Critical revision of the manuscript for important intellectual content: Banerjee, Hay, and Greene. Statistical analysis: Banerjee. Administrative, technical, and material support: Banerjee and Greene. Study supervision: Banerjee, Hay, and Greene.

Financial Disclosure: None reported.

References
1.
Demierre MF. Time for the national legislation of indoor tanning to protect minors.  Arch Dermatol. 2003;139(4):520-524PubMedArticle
2.
Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population.  Cancer Epidemiol Biomarkers Prev. 2010;19(6):1557-1568PubMedArticle
3.
Stapleton J, Turrisi R, Hillhouse J, Robinson JK, Abar B. A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis.  J Behav Med. 2010;33(3):181-190PubMedArticle
4.
Festinger L. A Theory of Cognitive Dissonance. Evanston, IL: Row; 1957
5.
Oakes W, Chapman S, Borland R, Balmford J, Trotter L. “Bulletproof skeptics in life's jungle”: which self-exempting beliefs about smoking most predict lack of progression towards quitting?  Prev Med. 2004;39(4):776-782PubMedArticle
6.
Cafri G, Thompson JK, Roehrig M,  et al.  Appearance motives to tan and not tan: evidence for validity and reliability of a new scale.  Ann Behav Med. 2008;35(2):209-220PubMedArticle
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