Mailed Intervention to Promote Sun Protection of Children

Abstract

Background Sun exposure, especially during childhood, is the most important preventable risk factor for skin cancer, yet few effective interventions to reduce exposure exist. Purpose To test the effectiveness of a partially tailored mailed intervention based on the Precaution Adoption Process Model, delivered in the spring over 3 years to parents and children. Design RCT, with data collection through telephone interviews of parents and skin exams of children at baseline (Summer 2004) and annually (Summer 2005–2007). The control group received no intervention. Setting/participants Families recruited in the Denver CO area, through private pediatric clinics, a large MCO, and community settings. Children born in 1998 were aged approximately 6 years at baseline; 867 children met inclusion criteria; analysis is reported for 677 white, non-Hispanic participants at highest risk for skin cancer. Main outcome measures Primary outcomes were parent-reported child sun protection behaviors. Secondary outcomes included parents' risk perception, and perceived effectiveness of and barriers to prevention behaviors, stage of change, reported sunburns, and observed tanning and nevus development. The longitudinal mixed-model analysis was conducted between 2008 and 2011. Results The intervention group reported more use of protective clothing and hats, shadeseeking, sunscreen and midday sun avoidance; fewer sunburns; more knowledge of the risk of skin cancer; higher perceived effectiveness of sun protection and stage of change; and lower perception of barriers to sun protection (all p<0.05). The intervention group had fewer nevi ≥2 mm in 1 year of the study, 2006 (p=0.03). No differences were found in tanning or nevi <2 mm. Conclusions The level of behavior change associated with this single-modality intervention is not likely sufficient to reduce skin cancer risk. However, the intervention shows promise for inclusion in longer-term, multicomponent interventions that have sufficient intensity to affect skin cancer incidence. Trial registration This study is registered at www.clinicaltrials.gov NCT01464957.

The Parent–Child Dyad and Risk Perceptions Among Parents Who Quit Smoking

“…18 This approach has been used successfully in achieving significant cessation rates in parental smokers, 16,19 as well as in interventions promoting a variety of health behaviors including colorectal and mammography screening 20,21 and encouraging healthy eating and sun protective behaviors in adolescents. 22,23 The current study was conducted to advance the understanding of the potential influence of parent risk perceptions of their smoking on their smoking-cessation outcomes. A particular variable of interest was parents’ perception of the degree to which their smoking interferes or conflicts with their role as a parent in maintaining their child’s health and well-being.…”

Recall of indoor tanning salon warnings and safety guidelines among a national sample of tanners

“…Skin type was assessed by asking participants the color of their non-sun-exposed skin (very fair, fair, olive, light brown, medium brown, dark brown, or black) [29]. This item was developed as part of a comprehensive, reliable, and frequently utilized skin cancer risk assessment measure [29][30][31].…”

Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

“…Prentice-Dunn, McMath, & Cramer (2009) illustrated that the transition from the precontemplation to contemplation stage of sun protection was promoted by threat appraisal information (exposure graphic photos of cancer lesions, leathery skin and age spots), but transition from contemplation to the preparation stage occurred only when individuals were provided with both high threat and high coping information (threat appraisal photos and information about the benefits of sun avoidance and sunscreen use for skin cancer prevention). Crane et al (2012) evaluated the use of the Precaution Adoption Model (which includes seven stages of change based on awareness about a health issue, risk perception, personal significance, and perception of significance for others) for the assessment of intervention effectiveness to increase sun protection in children. Movement to advanced stages was associated with being more aware of skin cancer risk factors, perceiving fewer barriers to engaging in sun protection, and regarding sun protection as effective in reducing skin cancer risk (Crane et al, 2012).…”