title: Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults.
abstract: 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.
  
  
  
  RCT conducted in 2014, with data analyzed in 2015.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  This study is registered at www.clinicaltrials.gov NCT02147080.
authors.affiliation: Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania. Electronic address: carolyn.heckman@fccc.edu.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Heckman
authors.affiliation: Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Darlow
authors.affiliation: BeHealth Solutions, LLC, Charlottesville, Virginia; University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ritterband
authors.affiliation: Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania;
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Handorf
authors.affiliation: Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Manne
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D012309:Risk-Taking; D057566:Self Report; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control; D013473:Sunscreening Agents / Q000008:administration & dosage; D014466:Ultraviolet Rays / Q000009:adverse effects; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents
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