To find the most effective ways to prevent skin cancer as a result of excessive sun exposure, behavioral scientist Sherry Pagoto, PhD, followed sun lovers longing for a golden tan to their favorite place—the beach. What she discovered was that the right question to ask may be “To sun or not to sun?” rather than “To tan or not to tan?” Despite growing public awareness that sun exposure causes skin cancer—and the dramatic rise in skin cancer rates—for many, the instant gratification of basking in the sun to obtain a “healthy-looking” tan trumps the potential long-term devastating effects. So Dr. Pagoto and her research team headed to the beach to try to persuade sunbathers to use sunless tanning sprays instead of soaking up the sun’s dangerous ultraviolet rays. “Many people find a tanned appearance to be physically attractive and combating that with a health message is difficult,” said Pagoto, assistant professor of medicine, in Reuters Health—one of numerous national media outlets, including CNN Health and Time magazine, who reported on her paper “The Sunless Study—A Beach Randomized Trial of a Skin Cancer Prevention Intervention Promoting Sunless Tanning” after its publication in the September issue of Archives of Dermatology. “Instead of trying to talk people out of wanting to be tan, we decided to encourage them to use sunless tanning as a healthier alternative.” Pagoto’s team members conducted the study at Revere and Nantasket beaches in Massachusetts, where they set up tents and recruited 250 women to participate. Half were assigned to the test group and heard motivational messages about sunless tanning as an alternative to sunbathing and tanning booths. They also had pictures of their facial skin taken with a UV-sensing camera that graphically showed even the youngest participants that they had already experienced some degree of sun damage. They then viewed images of attractive women sporting sunless tans, received a free trial of a sunless tanning product and were given instructions on how to use product correctly. The other 125 women served as the control group, only completing surveys about their sunning and tanning behavior. Results were encouraging, indicating that for many participants, the intervention led them to take at least some of the recommended actions to protect themselves. After two months, the women given sunless tanners reduced their sunbathing significantly more than those in the control group (a 33 percent decline versus 10 percent), and reported significantly fewer sunburns and greater use of protective clothing. The sunless tanning intervention proved more effective than prior approaches that emphasized sun protection and sun avoidance alone. Understanding that a change in behavior is preceded by a change in attitude for most people, Pagoto combined psychology with medicine in this study, as in others she conducts related to helping individuals make healthy lifestyle choices. “Every unhealthy decision makes perfect sense in its immediate context, so we need to identify underlying motivations and find healthy alternatives to meet those needs,” she explained. For example, many people sunbathe as a way to fight stress, so for them, alternative relaxation techniques such as yoga might reduce their urge to hit the beach. Education is also key, as misperceptions abound, such as sunbathing with sunscreen affords complete protection (it doesn’t), that prolonged sunbathing is necessary for adequate vitamin D levels (it isn’t), and even that sunless tanners, long approved by the Food and Drug Administration, are themselves dangerous (they are not). Pagoto hopes to further link behavior to prevention and is designing more studies to determine how to better convince tanners to switch to sunless tanning. She noted that melanoma, the deadliest form of skin cancer, is the number two cancer diagnosed in young women, and is highly associated with UV exposure via the sun or tanning booths. “People who really want to be tan should strongly consider using sunless tanning instead of tanning booths or sunbathing," she said.