HLTH 5403 Module 1 Culture and Health Behavior Analysis Example

The Summer Glow: How Culture, Values and Family Tradition Shape Tanning Among Adolescent Girls in a Rural Midwestern Community

Student Name

American College of Education

HLTH5403: Behavioral Practices in Health Education

Module 1 Assignment

Instructor Name

October 5, 2026

Introduction

Every spring, the health educator at a composite rural high school in the Midwest watches the same pattern unfold. As prom approaches, several girls book sessions at the tanning salon in town. By June, the school's summer softball and swim teams are practicing outdoors for hours, and sunburned shoulders are common at the county fair. Students can repeat that the sun causes skin cancer, yet their behavior changes little. The gap between knowledge and practice suggests that tanning is shaped by forces that information alone does not reach.

This paper examines one behavior, intentional tanning and the related neglect of sun protection, in one group, adolescent girls in a rural Midwestern community. It asks how culture, social norms, values, beliefs and personal experience give tanning its meaning and make it persist. The analysis is intended to guide health education that works with, rather than against, the culture students live in.

The Behavior and Why It Matters

Ultraviolet radiation from the sun and from tanning beds is the main preventable cause of skin cancer, and sunburns during childhood and adolescence add to lifetime risk. Among U.S. high school students surveyed in 2023, 54.7% reported at least one sunburn in the past year, and nearly a quarter of those reported five or more (Holman et al., 2026). Intentional tanning, spending time in the sun or in a tanning bed in order to get a tan, is a separate behavior from incidental exposure, and it is concentrated in particular groups. Using a national survey from 2014, Niu et al. (2018) found that 15.6% of adolescents frequently tanned outdoors on purpose, with girls more than twice as likely as boys to do so after adjustment for other factors.

In the composite school, a student health survey found that about four in ten girls said they had tried to get a tan in the past year, and fewer than one in five said they used sunscreen most of the time when outside for more than an hour. These numbers describe the behavior; the rest of this paper seeks to explain it.

The Meaning of a Tan

Culture gives objects and appearances meaning, and in this community a tan carries several. For many girls, tanned skin signals health, energy and attractiveness. A pale complexion in late spring is described as looking sick or washed out, while a tan is said to look healthy, a belief that reverses the medical reality. A tan also signals leisure and belonging. It shows that a girl has spent time at the lake, at the pool or at tournaments, the settings where teenage social life happens in summer.

Holman and Watson (2013), reviewing 13 studies of U.S. adolescents, found that preferring tanned skin was among the individual attitudes most consistently associated with intentional tanning, along with female sex, older age and participation in other appearance-focused behaviors such as dieting. In other words, tanning is often one part of a wider set of practices through which girls manage how they look. Health education that treats tanning as an isolated mistake misses this meaning.

Family Tradition and Rural Life

Family culture adds a second layer. In farm families, long days outdoors are a normal part of work, and a farmer's tan, dark forearms and neck, is a familiar mark of labor rather than a warning sign. Parents and grandparents who worked in fields without sunscreen may treat sunburn as an ordinary summer event. Several students have told the school nurse that their mothers tanned when they were young, and a few mothers still use the salon themselves. The review by Holman and Watson (2013) identified parental influence, having a parent who tans or permits tanning, as one of the social factors correlated with adolescent tanning, and it noted that living in the Midwest or South and attending a rural high school were also associated with the behavior.

Rural life also shapes access and routine. The town's tanning salon is one of few businesses open late, and unlimited monthly packages are inexpensive. Summer jobs such as detasseling corn, lifeguarding and working at the fairgrounds keep teenagers outdoors at midday. Shade is scarce at ballfields and in the bleachers at county events. None of these conditions is chosen by the girls, but each makes sun exposure the default.

Values and Beliefs

The behavior also reflects what girls value. In interviews conducted by the health educator with a small group of juniors, appearance ranked high, particularly for events that will be photographed and shared: prom, graduation, homecoming and summer outings. Belonging mattered too; girls described tanning together before events as a social activity with friends. Health was valued, but it was understood as feeling well and looking fit now, not as avoiding a disease decades away.

Beliefs complete the picture. Several students believed that a base tan protects against sunburn, that sunscreen is only needed at the beach, that tanning beds are safer than the sun because they are controlled, or that skin cancer happens only to older people or to those with very fair skin. Some of these beliefs are passed from parents and some circulate on social media, where tanning tips and before-and-after photos are common. Each belief makes tanning seem reasonable within the girls' own understanding.

Personal Experience

Personal experience can reinforce or disrupt these patterns. Most girls have had sunburns that healed without apparent harm, which teaches that sun exposure is safe enough. Few have known a young person with melanoma. The exceptions are revealing: one student whose aunt was treated for melanoma in her thirties described changing her habits, using sunscreen and skipping the salon, and her friends had noticed. Experience with a real case made the risk personal in a way that classroom facts had not. For health educators, this suggests that stories and personal connection may carry more weight than statistics.

Implications for Health Education

Understanding tanning as a cultural practice changes how a health educator might respond. Because tanned skin means health and beauty to these students, messages that only warn about cancer compete with a strongly held value and are likely to be dismissed. Messages that engage appearance directly, such as how sun exposure causes wrinkles and spots, may work better, and later modules will examine the evidence for that approach. Because families shape the behavior, parents should be included, not bypassed. Because rural routines create exposure, environmental supports such as shade at ballfields, sunscreen at the pool and team policies may matter as much as lessons. Because tanning is social, peer leaders and team captains could help shift what is considered normal. Finally, because culture deserves respect, education should avoid shaming girls or their families and should build on values they already hold, such as caring for their appearance, their friends and their future.

Conclusion

Intentional tanning among girls in this rural Midwestern community is not a simple failure of knowledge. It is sustained by the meaning of a tan as a sign of health, beauty and belonging, by family traditions rooted in outdoor work, by rural routines that make sun exposure the default, by values that place appearance and friendship ahead of distant risks and by beliefs and experiences that make the behavior seem safe. The next modules will examine the role of peers and social norms more closely and apply a behavior theory to explain how these influences combine into a decision to tan.

References

Holman, D. M., & Watson, M. (2013). Correlates of intentional tanning among adolescents in the United States: A systematic review of the literature. Journal of Adolescent Health, 52(5), S52-S59. https://doi.org/10.1016/j.jadohealth.2012.09.021

Holman, D. M., Saelee, R., Kiplagat, S. J., & Julian, A. K. (2026). Sunburn prevalence among US high school students, Youth Risk Behavior Survey, United States, 2023. Preventing Chronic Disease, 23, 260069. https://doi.org/10.5888/pcd23.260069

Niu, Z., Parmar, V., Xu, B., Coups, E. J., & Stapleton, J. L. (2018). Prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States: Findings from the FLASHE survey. Preventive Medicine Reports, 11, 187-190. https://doi.org/10.1016/j.pmedr.2018.06.014