An Appearance-Based Intervention to Reduce Teen Skin Cancer Risk

描述（由申请人提供）：国际癌症研究机构（IARC）最近将室内晒黑列为最高癌症风险类别，“对人类致癌”，加入石棉，烟草，砷和芥子气。一项综合荟萃分析得出结论，30岁之前开始室内晒黑时，黑色素瘤的风险增加了75%。黑色素瘤的发病率上升速度比任何其他癌症都快，在美国每年估计有60，000例诊断。尽管如此，室内晒黑越来越受欢迎，特别是在年轻人中。最近的审查报告显示，在过去的一年中，大约10%的15岁以下的美国青少年使用室内晒黑，年龄较大的青少年女性的患病率估计为25- 40%。有证据表明，女性室内晒黑使用显着增加，从大一到高中（HS）的高年级，使高中反晒黑干预措施实施的关键时期。该提案评估了皮肤癌预防计划的有效性，该计划将通过互联网在随机对照试验中向全国代表性的高中青少年样本提供。在过去的8年里，通过小册子提供的成人样本证明了抗晒黑干预在减少紫外线风险行为方面的成功。我们的研究将确定HS女性在未来的紫外线风险行为的风险（即，目前的用户加上女性表示强烈打算在未来6个月内开始室内晒黑），并通过一个有吸引力的，用户友好的网站向他们提供关于紫外线暴露的外观损害影响的有说服力的信息。干预是基于健康行为改变的成熟理论（即，行为替代模型、社会认知理论、理性行动理论和保护动机理论）以及高中样本的形成性研究。一个全国性的、屡获殊荣的网络开发团队将制作一个网站，该网站将与青少年群体进行beta测试，以确保与当前青少年文化、价值观和信仰的一致性。研究小组已成功地与网络开发小组和青少年测试人员合作，制作和修改了干预措施的原型，该原型已被证明与试点研究中的青少年相关并对其感兴趣。该提案采用确保干预保真度和干预剂量评估的做法。我们将跟踪这些妇女从HS到HS后，以检查干预是否能够减少长期紫外线暴露的总体频率。这种干预措施具有成本效益，易于传播，并可能吸引目标青少年受众。如果成功，这种干预的广泛传播可能会大大减少高中青少年的室内晒黑开始和使用，从而减少该人群中黑色素瘤和非黑色素瘤皮肤癌的未来发生率和死亡率。调查小组拥有成功完成研究各个方面所需的经验和技能，该方法已在以前资助的项目中成功使用。本研究具有创新性。这将是第一个针对高中生的反晒黑干预措施，第一个针对HS皮肤病的外观干预措施，第一个关注青少年皮肤癌风险行为的互联网干预措施，以及第一个使用全国代表性样本的干预措施。有一个强有力的理由使用外观为基础的，互联网提供的干预与长期随访针对高中生。 高中是黑色素瘤风险的关键发育阶段（即，风险似乎随着年轻人的室内晒黑而增加）以及通过晒黑而经常性地故意暴露于紫外线的发展。 测试我们的青少年晒黑的概念模型的实证结果提供的证据表明，改变干预措施中的关键认知变量将减少青少年晒黑的动机和行为。 通过互联网提供的干预措施传播起来既方便又便宜，而且会受到目标青少年的欢迎。 公共卫生相关性：这项研究将提高我们对青少年人群紫外线风险行为的理解和影响能力。如果成功的话，它的传播有可能大大降低未来青少年黑色素瘤和非黑色素瘤皮肤癌的发病率和死亡率。

DESCRIPTION (provided by applicant): The International Agency for Research in Cancer (IARC) has recently assigned indoor tanning to its highest cancer risk category, "carcinogenic to humans", joining asbestos, tobacco, arsenic and mustard gas. A comprehensive meta-analysis concluded that the risk of melanoma increased by 75% when indoor tanning is initiated before 30 years old. Melanoma incidence is rising faster than any other cancer with an estimated 60,000 diagnoses annually in the US. Despite this, indoor tanning is gaining tremendous popularity, especially among youth. Recent reviews report approximately 10% of US adolescents under the age of 15 have used indoor tanning in the past year, with prevalence among older adolescent females estimated at 25-40%. There is evidence that female indoor tanning use increases dramatically from freshman to senior years of high school (HS) making high school a critical time period for anti-tanning interventions to be implemented. This proposal assesses the efficacy of a skin cancer prevention program that will be delivered via the Internet to a nationally representative sample of high school teens in a randomized controlled trial. The anti-tanning intervention has proven success in reducing UV risk behaviors across multiple trials and multiple sites over the past 8 years with adult samples when delivered via a booklet. Our research will identify HS females at risk for future UV risk behavior (i.e., current users plus women indicating strong intentions to initiate indoor tanning in the next 6 months), and provide them with persuasive information on the appearance damaging effects of UV exposure, delivered via an attractive, user friendly website. The intervention is based on proven theories of health behavior change (i.e., behavioral alternatives model, social cognitive theory, theory of reasoned action and protection motivation theory), and formative research in high school samples. A national, award-winning web development team will produce the website which will be beta tested with groups of teen tanners to ensure congruence with current teen culture, values and beliefs. The research team has successfully worked with the web-development team and with teen testers to produce and modify a prototype of the intervention which has proven to be relevant and of interest to teen tanners in pilot studies. The proposal uses practices that ensure intervention fidelity and assessments of intervention dosage. We will follow these women from HS through post-HS to examine whether the intervention is able to reduce the overall frequency of long-term UV exposure. The intervention is cost-effective, can be easily disseminated and is likely to be engaging for the targeted teen audience. If successful, wide dissemination of this intervention is likely to substantially reduce indoor tanning initiation and use in high school teens and thus the future occurrence of and mortality from melanoma and non- melanoma skin cancers in this population. The investigative team has the experience and skills needed to successfully complete all aspects of the research, and the approach has been used successfully in previously funded projects. The study is innovative. It will be the first anti-tanning intervention directed at high school students, the first appearance-focused intervention targeting HS tanners, the first Internet-delivered intervention focusing on skin cancer risk behavior in teens, and the first using a nationally representative sample. There is a strong rationale for the use of an appearance-based, Internet delivered intervention with long-term follow-up targeting high school students. High school represents a critical developmental stage for both melanoma risk (i.e., risk appears to increase with indoor tanning in youth) and for the development of regular, frequent intentional UV exposure through tanning. Empirical results testing our conceptual model of teen tanning provides evidence that changing the key cognitive variables in the intervention will reduce tanning motivations and behaviors in teens. An Internet-delivered intervention can be easily and cheaply disseminated, and will be well received by the targeted teen population. PUBLIC HEALTH RELEVANCE: This research will improve our understanding of, and ability to affect UV risk behavior in teenage populations. If successful, its dissemination has the potential to substantially reduce future melanoma and non-melanoma skin cancer morbidity and mortality in adolescents.