title: Effectiveness of a Multicomponent Sun Protection Program for Young Children: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Emphasizing sun protection behaviors among young children may minimize sun damage and foster lifelong sun protection behaviors that will reduce the likelihood of developing skin cancer, especially melanoma.
  
  
  OBJECTIVE
  To determine whether a multicomponent sun protection program delivered in pediatric clinics during the summer could increase summertime sun protection among young children.
  
  
  METHODS
  Randomized controlled clinical trial with 4-week follow-up that included 300 parents or relatives (hereafter simply referred to as caregivers [mean age, 36.0 years]) who brought the child (2-6 years of age) in their care to an Advocate Medical Group clinic during the period from May 15 to August 14, 2015. Of the 300 caregiver-child pairs, 153 (51.0%) were randomly assigned to receive a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors (intervention group) and 147 (49.0%) were randomly assigned to receive the information usually provided at a well-child visit (control group). Data analysis was performed from August 20 to 30, 2015.
  
  
  METHODS
  Multicomponent sun protection program composed of a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors.
  
  
  METHODS
  Outcomes were caregiver-reported use of sun protection by the child (seeking shade and wearing sun-protective clothing and sunscreen) using a 5-point Likert scale, duration of outdoor activities, and number of children who had sunburn or skin irritation. The biologic measurement of the skin pigment of a child's arm was performed with a spectrophotometer at baseline and 4 weeks later.
  
  
  RESULTS
  Of the 300 caregiver-child pairs, the 153 children in the intervention group had significantly higher scores related to sun protection behaviors on both sunny (mean [SE], 15.748 [0.267] for the intervention group; mean [SE], 14.780 [0.282] for the control group; mean difference, 0.968) and cloudy days (mean [SE], 14.286 [0.282] for the intervention group; mean [SE], 12.850 [0.297] for the control group; mean difference, 1.436). Examination of pigmentary changes by spectrophotometry revealed that the children in the control group significantly increased their melanin levels, whereas the children in the intervention group did not have a significant change in melanin level on their protected upper arms (P < .001 for skin type 1, P = .008 for skin type 2, and P < .001 for skin types 4-6).
  
  
  CONCLUSIONS
  A multicomponent intervention using text-message reminders and distribution of read-along books and swim shirts was associated with increased sun protection behaviors among young children. This was corroborated by a smaller change in skin pigment among children receiving the intervention. This implementable program can help augment anticipatory sun protection guidance in pediatric clinics and decrease children's future skin cancer risk.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT02376517.
authors: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Byron K
authors: BK
authors: Ho
authors: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Katie
authors: K
authors: Reidy
authors: Advocate Children's Hospital, Park Ridge and Oak Lawn, Illinois.
authors: Imelda
authors: I
authors: Huerta
authors: Advocate Children's Hospital, Park Ridge and Oak Lawn, Illinois.
authors: Kimberley
authors: K
authors: Dilley
authors: Advocate Children's Hospital, Park Ridge and Oak Lawn, Illinois.
authors: Susan
authors: S
authors: Crawford
authors: Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park.
authors: Brittney A
authors: BA
authors: Hultgren
authors: Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park.
authors: Kimberly A
authors: KA
authors: Mallett
authors: Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park.
authors: Rob
authors: R
authors: Turrisi
authors: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois4Editor, JAMA Dermatology.
authors: June K
authors: JK
authors: Robinson
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D015397:Program Evaluation; D011481:Protective Clothing; D013471:Sunburn / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000627:therapeutic use*
chemical_list: D013473:Sunscreening Agents