Sun protection education for adolescents: a feasibility study of a wait-list controlled trial of an intervention involving a presentation, action planning, and SMS messages and using objective measurement of sun exposure

Abstract

Background: People increase their risk of melanoma unless they are protected from the harmful effects of sun exposure during childhood and adolescence. We aimed to assess the feasibility of a three-component sun protection intervention-presentation, action planning, and SMS messages -and trial parameters.Methods: This feasibility wait-list trial was conducted in the United Kingdom in 2018. Students aged 13-15 years were eligible. Feasibility outcomes were collected for recruitment rates; data availability rates for objective measurements of melanin and erythema using a Mexameter and self-reported sunburn occurrences, severity and body location, tanning, sun protection behaviours and Skin Self-Examination (SSE) collected before (baseline) and after the school summer holidays (follow-up); intervention reach, adherence, perceived impact and acceptability. Quantitative data were analysed using descriptive statistics; qualitative data were analysed thematically.Results: Five out of eight schools expressing an interest in participating with four allocated to act as intervention and one control. Four parents/carers opted their child out of the study. Four hundred and eighty-seven out of 724 students on the school register consented to the study at baseline (67%). Three hundred and eighty-five were in intervention group schools. Objective skin measurements were available for 255 (66%) of the intervention group at baseline and 237 (61%) of the group at follow up. Melanin increased; erythema decreased. Complete self-report data were available for 247 (64%) students in the intervention group. The number of students on the school register who attended the presentation and given the booklet was 379 (98%) and gave their mobile phone number was 155 (40%). No intervention component was perceived as more impactful on sun protection behaviours. Adolescents did not see the relevance of sun protection in the UK or for their age group.Conclusions: This is the first study to use a Mexameter to measure skin colour in adolescents. Erythema (visible redness) lasts no more than three days and its measurement before and after a six week summer holiday may not yield relevant or meaningful data. A major challenge is that adolescents do not see the relevance of sun protection and SSE.

Review of the Impact of Sun Safety Interventions in Children

“…A common theme among several of the unsuccessful studies was the utilization of interventions that involved brief (30–60 minute), one-time lessons or presentations with or without periodic follow-up. As an example, Hubbard et al involved a 50-minute presentation that addressed risk factors for skin cancer, personal anecdotes from individuals with skin cancer, etc., after which the children were given an informational booklet [ 60 ]. In the seven weeks following the presentation, motivational and informational text messages were sent twice weekly in an effort to influence summer behaviors.…”

Exposure to solar UV radiation of Polish teenagers after the first COVID-19 lockdown in March–April 2020

“…Teenagers aged 12 to 18 years old are a group, in which the deficiency of vitamin D is most often observed (Gonzalez-Gross et al 2011Al-Othman et al 2012 ; Vierucci et al 2013 ; Płudowski et al 2016 ; Farrar et al 2016 Kunz et al 2018). Nevertheless, while they usually do not spend enough time outside, they exhibit inadequate sun exposure patterns (Fernández-Morano et al 2017 ; Hubbard et al 2020 ; Liew and Cust 2021 ). Fernández-Morano et al ( 2017 ) found that even though teenagers have sufficient knowledge of sun risk and the importance of sunscreen use, they do not care about solar overexposures and still suffer from sunburns.…”

“…Therefore, social campaigns should be specifically targeted at young people. Patterns of risky behaviour among teenagers are common around the world and also existed before the first COVID-19 lockdown in 2020 (Fernández-Morano et al 2017 ; Hubbard et al 2020 ; Liew and Cust 2021 ).…”

“…While vitamin D deficiency among teenagers is well documented, patterns of behaviour in the sun may pose another problem (Fernández-Morano et al 2017 ; Hubbard et al 2020 ; Liew and Cust 2021 ). The occurrence of melanoma is associated not with chronic outdoor exposure, but with episodes of high-intensity UV radiation (Gandini et al 2005 ; Dennis et al 2008 ).…”

Life Interrupted: Experiences of adolescents, young adults and their family living with malignant melanoma

“…This study reinforces the need for greater public awareness, knowledge and understanding about skin cancer, especially for AYAs. Education must continue in schools, colleges and the media to increase awareness of skin cancer and prevention (Hubbard et al, 2020; Lea et al, 2018; Teenage Cancer Trust (TCT), 2020). Given the findings of our study, any changes to the delivery of education must not dilute the importance of sharing the experiences of young people (Lea et al, 2018).…”