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Original Investigation |

Effectiveness of a Multicomponent Sun Protection Program for Young Children A Randomized Clinical Trial

Byron K. Ho, BA1; Katie Reidy, MS1; Imelda Huerta, MD2; Kimberley Dilley, MD, MPH2; Susan Crawford, MD2; Brittney A. Hultgren, MS3; Kimberly A. Mallett, PhD3; Rob Turrisi, PhD3; June K. Robinson, MD1,4
[+] Author Affiliations
1Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Advocate Children’s Hospital, Park Ridge and Oak Lawn, Illinois
3Biobehavioral Health and Prevention Research Center, Pennsylvania State University, University Park
4Editor, JAMA Dermatology
JAMA Pediatr. 2016;170(4):334-342. doi:10.1001/jamapediatrics.2015.4373.
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Importance  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.

Design, Setting, and Participants  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.

Intervention  Multicomponent sun protection program composed of a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors.

Main Outcomes and Measures  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 and Relevance  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.

Trial Registration  clinicaltrials.gov Identifier: NCT02376517

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Figure 1.
Representative Page From a Read-Along Book Demonstrating Sun Protection Behaviors

Reprinted with permission from June K. Robinson, MD.

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Figure 2.
CONSORT Diagram
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Figure 3.
Sun Protection Behaviors

Change in composite Likert scale scores from baseline to follow-up in control and intervention groups for (A) sunny-day behaviors (range, 5-25); (B) cloudy-day behaviors (range, 5-25); and (C) sunscreen behavior (range, 2-10).

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