Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults

Abstract

Introduction Skin cancer is the most common cancer, and its incidence is increasing. Young adults expose themselves to large amounts of ultraviolet radiation (UV) and engage in minimal skin protection, which increases their risk. Internet interventions are effective in modifying health behaviors and are highly disseminable. The current study's purpose was to test an Internet intervention to decrease UV exposure and increase skin protection behavior among young adults. Study design RCT conducted in 2014, with data analyzed in 2015. Setting/participants A national sample of adults aged 18–25 years at moderate to high risk of developing skin cancer by a self-report measure was recruited online. Intervention Participants were randomized to one of three intervention conditions: assessment only, the website of a skin cancer organization, or a tailored interactive multimedia internet intervention program (UV4.me) based on the Integrative Model of Behavioral Prediction. Main outcome measures Self-reported overall UV exposure and skin protection assessed at 3 and 12 weeks after baseline. Secondary outcomes were self-reported intentional and incidental UV exposure, sunburns, sunscreen use, and skin cancer screening. Results For the intervention arm, there were significant decreases in UV exposure and increases in skin protection at both follow-up time points compared with the assessment-only condition (p<0.001). The effect sizes (Cohen's d) comparing the experimental and assessment-only arm for exposure behaviors were 0.41 at 3-week follow-up and 0.43 at 12-week follow-up. The effect sizes for protection behaviors were 0.41 at 3-week follow-up and 0.53 at 12-week follow-up. The control condition was not significantly different from the assessment only condition. All three conditions exhibited decreased exposure and increased protection at both follow-ups (p<0.01), but the effect was much stronger in the intervention group. Secondary outcomes were generally also significantly improved in the intervention condition compared with the other conditions. Conclusions This is the first published report describing the results of an RCT of an Internet intervention to modify skin cancer risk behaviors among young adults. The UV4.me intervention significantly improved self-reported skin cancer prevention behaviors. Future research will investigate mechanisms of change and approaches for dissemination.

Indoor Tanning Dependence in Young Adult Women

“…Interventions have targeted young adults generally and those with any history of indoor tanning using used web- and print-based education to address perceived risks and benefits of tanning and appearance-based motives (38, 59–62). Although interventions aimed at affecting perceived risks and benefits of health behaviors have promising effects generally (26, 63) and in some studies of indoor tanning (61, 64), our findings suggest this approach alone may be insufficient to promote behavior change among young adults endorsing indoor tanning dependence.…”

Behavioral Counseling for Skin Cancer Prevention

“…One young adult trial involving a tailored interactive web program 46 ing, or standard mailings) found significant increases in selfreported skin self-examination compared with control conditions. Odds ratios for skin self-examination in intervention groups compared with control groups ranged from 1.16 to 2.64, with absolute differences in rates of skin self-examination ranging from 3.2% to 24.0% in favor of the intervention groups ( Figure 5).…”

“…In that trial of online education for young adults (n = 965; 86% with fair skin), the proportion of participants reporting red or painful sunburn in the past month decreased more markedly from baseline to 3 months in the tailored interactive web program group compared with 2 other groups (54.5% to 26.3% in the tailored interactive web program group; 51.5% to 38.2% in the public website group; 56.3% to 41.2% in the assessment-only control group; P = .01 for comparison of intervention vs assessment only, between-group difference not reported). 46 One trial (n = 1356) of counseling and promotional materials to encourage skin self-examination assessed skin cancer outcomes at 12 months and found no difference in numbers of cancers and atypical nevi detected in intervention and control groups.…”

“…All studies for KQ1 (sunburn, precursor lesions, or skin cancer) represent new evidence since the previous review. Across 9 fair-to good-quality pediatric and adult trials, 23,25,26,29,30,32,39,42,46 the body of evidence suggests no consistent association between interventions and sunburn frequency in adults or children. Baseline rates of sunburn were low in some but not all populations (for example, in 4-to 10-year-olds and their parents), so a floor effect may be possible.…”

A Mobile Technology Intervention With Ultraviolet Radiation Dosimeters and Smartphone Apps for Skin Cancer Prevention in Young Adults: Randomized Controlled Trial (Preprint)

“…At 12 months post randomisation, the sun protection group had significantly greater improvement in their SPH index compared to control [16] and building behavioural capacity (e.g., obtaining information and receiving reminders) was the most valued aspect of the messages [28]. Heckman et al 2016 recently reported significant decreases in UV exposure and increases in SPH index 3 and 12 weeks after baseline for participants who received a tailored interactive multimedia internet intervention program (UV4.me) [29]. These studies are illustrating that further improvements to the technology platforms are needed to reduce the sunburn prevalence in young adult populations.…”