Randomized Trial of a Sun Safety Intervention for Young Adults

In this trial, 278 adults will be randomized to one of two campaigns: the Healthy Skin Campaign or the Healthy Lifestyle campaign. Participants must be ages 18-30 years, and have tanned indoors and/or outdoors at least 5 times in the past year (either intentionally or unintentionally), have intentions of tanning indoors or outdoors in the next 6 months, be regular social media users (i.e., logged into a social media platform every day in the past 4 weeks), and be a resident of the 12 states with average UV Index ≥5 between April-October (CA, AZ, TX, AL, AR, FL, GA, LA, MS, SC, NM, HI).

Recruitment will target 12 states with average UV Index is ≥5 during the intervention and follow-up period of April-September. We will use social media advertisements, Research Match, and Qualtrics (internet panel company).

Recruitment advertisements will link to an online survey to evaluate initial eligibility. Those initially eligible will undergo a screening call where they will give verbal consent, learn about the two campaigns, and share their availability to attend an orientation webinar. Following the screening call, eligible candidates will be sent a baseline survey of study measures and upon completion be randomized.

After randomization, participants will attend an orientation webinar where they will learn about their social media campaign, how to create posts, guidelines for appropriate content (e.g., no nudity, explicit language, brand names, images or language that directly or indirectly promoted unhealthy behaviors, or pictures of people without consent), and campaign-related guidance on what to post about (as described below). In the webinar, staff will state that the researchers "are interested in learning how to develop effective health-related social media messages" and "want to examine how engaging young adults find health-related social media posts created by other young adults." Participants will be asked to create social media posts related to the topic of their condition to be posted to the campaign feeds on Facebook and Instagram. In each condition, participants will be instructed to create up to 12 social media posts during the 6-week social media campaign (maximum of 2 in any week). This number of posts would result in a maximum of 5-6 per day in each condition which is consistent with norms reported in social media marketing outlets.

Participants will receive a $10 gift card for each post they create and have a chance to win an additional $50 gift card each week if their post receives the most engagement points in their respective condition within the first 48 hours of posting. The 48-hour time limit allows all posts posted between Monday and Sunday to have the same time frame to garner engagement. Winners each week will be determined on the Tuesday that follows that week (to allow all posts to garner 48 hours of engagement. Social media posts typically get the vast majority of engagement in less than 48 hours.53 The incentive structure is as follows: reactions ("likes") earn 1 point, comments (from unique users because one user can make \>1 comments) earn 2 points, and shares/retweets earn 3 points. Shares/reposts earn the most points because this form of engagement has potential to reach a larger audience. This engagement data from the first 48 hours across both Facebook and Instagram will be tallied.

Participants will also earn 2 points for each post they put on one of their personal social media accounts. If they put up a post on more than one of their social media accounts, they will get 2 points for each account they put it on. Participants may use a personal account on any social media platform (e.g., Instagram, TikTok, Snapchat) as long as that account has ≥100 followers at the start of the study. Participants will also get a bonus incentive of $25 if they address all key areas of their assigned topic. On the following Tuesday of each week, research staff will tally the points for each participant and then notify the winner by email. Study staff will email all participants to inform them of the winner's point total each week to nudge them to increase the engagement they are driving to their posts and to post on their own accounts to grow their point totals faster in the next week.

Healthy Skin Campaign. In the orientation webinar, participants assigned to the Healthy Skin campaign will be instructed to create social media posts promoting healthy skin. First, we will discuss the tan ideal and its origins (e.g., media, companies, peer pressure) along with the negative consequences of the tan ideals including ideal internalization, body dissatisfaction, negative mood, premature aging, and skin cancer including the disfiguring ways it is treated and deadly melanoma. We will show a brief video message by a young melanoma survivor and former tanner who will reinforce these points. Second, participants will be encouraged to design posts that reflect the 10 key tenets of dissonance induction interventions, including 1) critique the tan ideal, 2) make arguments against the tan ideal, 3) are messages to younger people and/or their younger self about the costs of attempting to live up to the tan ideal, that promote skin color acceptance (body positivity), 4) speak out about experiences in which they felt pressured to live up to the tan ideal (e.g., being called pale or sick looking), 5) encourage the use of social media to speak out against the tan ideal, 6) share quick catchy verbal comebacks to statements that promote the tan ideal (e.g., "loving the skin I'm in!"), 7) promote sunscreen to protect skin from the harms of UVR, 8) discourage tanning, 9) promote ways to enhance the personal aesthetic via sun safety behaviors (e.g., fashionable protective clothing, hats, and parasols), and 10) promote shade use. They will be shown examples and encouraged to incorporate all 10 topics in their 12 posts. Posts for this campaign will be simultaneously posted to the Skin Smart Campus Initiative Facebook and Instagram pages.

Healthy Lifestyle Campaign. Participants assigned to the Healthy Lifestyle campaign will be asked to create social media posts promoting healthy lifestyle behaviors such as fruit and vegetable consumption, reducing sugary beverages, exercise, sleep, and stress reduction. First, they will be informed of the health benefits of these behaviors and ways to adopt each into a daily routine. Second, they will be asked to create posts that promote engagement in these behaviors, emphasizing the benefits, risks, and any tips and tricks. Posts created by participants in this condition will be posted to the UConn Center for mHealth and Social Media Facebook and Instagram pages.

At the end of 6 weeks and then again at 3- and 15-months, participants will receive a link to complete the survey battery.

• tanning [Time frame: post-intervention (6 weeks)]
• tanning [Time frame: 15 months post-intervention]
• sunburn [Time frame: 3 months post-intervention]
• sunburn [Time frame: post-intervention (6 weeks)]
• sunburn [Time frame: 15 months post-intervention]
• unprotected sun exposure [Time frame: 3 months post-intervention]
• unprotected sun exposure [Time frame: post-intervention (6 weeks)]
• unprotected sun exposure [Time frame: 15 months post-intervention]