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”，与石棉、烟草、砷和芥子气并列。一项综合荟萃分析得出结论，如果在30岁之前开始室内晒黑，患黑色素瘤的风险会增加75%。在美国，黑色素瘤发病率的上升速度比其他任何癌症都要快，估计每年有6万例确诊病例。尽管如此，室内晒黑越来越受欢迎，尤其是在年轻人中。最近的评论报告称，在过去一年中，约有10%的15岁以下美国青少年使用室内美黑，而在年龄较大的青少年女性中，患病率估计为25-40%。有证据表明，从高一到高三，女性室内美黑的使用急剧增加，这使得高中成为实施反美黑干预措施的关键时期。该提案评估了一项皮肤癌预防计划的效果，该计划将通过互联网在一项随机对照试验中向全国具有代表性的高中青少年提供样本。在过去的8年里，通过多次试验和多个地点，通过一本小册子提供成人样本，证明了抗晒黑干预措施在减少紫外线风险行为方面取得了成功。我们的研究将确定未来有紫外线风险行为的HS女性（即当前用户加上在未来6个月内有强烈意愿开始室内晒黑的女性），并通过一个有吸引力、用户友好的网站向她们提供有关紫外线暴露对外观损害影响的有说服力的信息。干预是基于已证实的健康行为改变理论（即行为替代模型、社会认知理论、理性行为理论和保护动机理论）和对高中样本的形成性研究。一个屡获殊荣的国家级网络开发团队将制作这个网站，并将在青少年晒黑者群体中进行beta测试，以确保与当前青少年的文化、价值观和信仰相一致。研究小组成功地与网络开发团队和青少年测试人员合作，制作并修改了干预的原型，该原型在试点研究中已被证明与青少年晒黑者相关且感兴趣。该建议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照射的总体频率。这种干预具有成本效益，易于传播，并可能吸引目标青少年受众。如果成功，这种干预措施的广泛传播可能会大大减少高中青少年室内晒黑的开始和使用，从而减少这一人群中黑色素瘤和非黑色素瘤皮肤癌的发病率和死亡率。调查团队拥有成功完成研究各个方面所需的经验和技能，并且该方法已在先前资助的项目中成功使用。这项研究具有创新性。这将是第一个针对高中学生的反美黑干预，第一个针对HS晒黑者的外表干预，第一个关注青少年皮肤癌风险行为的互联网干预，以及第一个使用全国代表性样本的干预。有一个强有力的理由使用基于外表的，互联网提供干预与长期跟踪针对高中学生。高中是黑色素瘤风险（即，青少年室内晒黑似乎会增加风险）和通过晒黑形成定期、频繁的故意紫外线暴露的关键发育阶段。实证结果验证了我们的青少年晒黑概念模型，提供了证据，改变干预中的关键认知变量将减少青少年晒黑的动机和行为。互联网提供的干预可以很容易和廉价地传播，并且会受到目标青少年人群的欢迎。

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.