BACKGROUND. Solid-organ transplant recipients (OTRs) with sun-sensitive skin, a history of sun exposure, and clinical signs of photoaging have an increased risk of developing squamous cell carcinoma. OBJECTIVE. The objective of this study was to compare the sun protection attitudes and behaviors of OTRs with those of the general public. METHODS. In spring 2003, a telephone survey of 200 OTRs and a random sample of 1091 U.S. residents were performed with standardized questions previously used in population surveys. RESULTS. Seventy-nine percent of OTRs and 69% of the U.S. public believe that the appearance of a tan is attractive. The attitude was expressed more often by men than by women and is not related to the education of the person. A greater proportion of OTRs believed that people looked "healthier" with a tan and 88% of OTRs were not aware of their increased risk of developing skin cancer. Thirty-five percent of OTRs reported regularly using sunscreen, which is the principal form of sun protection used. Women report more regular use of sunscreen than men. OTRs wear less protective clothing and seek less shade when outdoors than the public. Sunburning was reported by 35% of OTRs, which is similar to the rate reported by the public. CONCLUSION. OTRs' attitude that people look "better, healthier" with a tan inhibits effective sun protection. Although physicians who care for OTRs provide patient education in the hope that it increases their awareness of their risk of developing skin cancer and will promote change in their sun protection behaviors, the OTRs' perception of risk is influenced by many concerns. Interpersonal motives, particularly for OTRs, the self-presentational ones related to appearance and the social image or prototype of a tanned person being healthy, mitigate risk perception of the health problem. Risk perception does not always inhibit risk behavior; therefore, unprotected sun exposure occurs in OTRs.
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