title: Mailed intervention to promote sun protection of children: a randomized controlled trial.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Families recruited in the Denver CO area, through private pediatric clinics, a large MCO, and community settings. Children born in 1998 were approximately 6 years of age at baseline; 867 children met inclusion criteria; analysis is reported for 677 white, non-Hispanic participants at highest risk for skin cancer.
  
  
  METHODS
  Primary outcomes were parent-reported child sun protection behaviors. Secondary outcomes included parents' risk perception, 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 sunscreen, protective clothing, hats, shade-seeking, and midday sun avoidance; fewer sunburns; more awareness of the risk of skin cancer; higher perceived effectiveness of sun protection; higher 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.
authors.affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. lori.crane@ucdenver.edu
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Asdigian
authors.forename: Anna E
authors.initials: AE
authors.lastname: Barón
authors.forename: Jenny
authors.initials: J
authors.lastname: Aalborg
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Marcus
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Mokrohisky
authors.forename: Tim E
authors.initials: TE
authors.lastname: Byers
authors.forename: Robert P
authors.initials: RP
authors.lastname: Dellavalle
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Morelli
mesh_terms: D002648:Child; D003120:Colorado; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009506:Nevus / Q000453:epidemiology; D011481:Protective Clothing; D012307:Risk Factors; D016037:Single-Blind Method; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000008:administration & dosage*
chemical_list: D013473:Sunscreening Agents