An Appearance-Based Intervention to Reduce Teen Skin Cancer Risk

描述(由申请者提供)：国际癌症研究机构(IARC)最近将室内晒黑列为其癌症风险最高的类别，与石棉、烟草、砷和芥子气一起被归入对人类具有致癌作用的类别。一项全面的荟萃分析得出结论，30岁之前开始室内日光浴时，患黑色素瘤的风险增加了75%。黑色素瘤发病率的上升速度比其他任何癌症都快，据估计，美国每年有6万例黑色素瘤确诊病例。尽管如此，室内日光浴越来越受欢迎，特别是在年轻人中。最近的评论报告说，在过去的一年里，大约10%的15岁以下的美国青少年使用过室内日光浴，而在青春期较大的女性中，这一比例估计为25%-40%。有证据表明，从一年级到高年级，女性室内晒黑的使用量急剧增加，这使得高中阶段成为实施防晒黑干预措施的关键时期。这项建议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提供给具有全国代表性的高中青少年样本。在过去的8年里，反晒黑干预已被证明成功地减少了多个试验和多个地点的紫外线危险行为，通过小册子提供成人样本。我们的研究将确定HS女性在未来紫外线风险行为中的风险(即，目前的用户加上表示在未来6个月内强烈意图开始室内晒黑的女性)，并通过一个有吸引力的、用户友好的网站为他们提供关于紫外线暴露对外表有害影响的有说服力的信息。干预基于健康行为改变的成熟理论(即行为选择模型、社会认知理论、理性行为理论和保护动机理论)和高中样本的形成性研究。一个屡获殊荣的国家网络开发团队将制作该网站，并将与青少年皮肤晒黑团体进行Beta测试，以确保与当前青少年文化、价值观和信仰保持一致。研究团队已经成功地与网络开发团队和青少年测试员合作，制作和修改了干预的原型，并在试点研究中证明了这一干预与青少年皮肤晒黑相关和感兴趣。该提案使用了确保干预保真度和干预剂量评估的做法。我们将跟踪这些女性，从HS到HS后，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，可以很容易地传播，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室内晒黑在高中青少年中的启动和使用，从而减少这一人群未来黑色素瘤和非黑色素瘤皮肤癌的发生和死亡。调查小组拥有成功完成所有方面研究所需的经验和技能，该方法已成功地用于以前资助的项目。这项研究具有创新性。这将是第一次针对高中生的防晒黑干预，第一次针对HS晒黑的外观干预，第一次通过互联网传递的关注青少年皮肤癌风险行为的干预，以及第一次使用具有全国代表性的样本。有一个强有力的理由使用基于外表的、互联网传递的干预措施，并以高中生为目标进行长期跟踪。高中是黑色素瘤风险的关键发展阶段(即青少年在室内晒黑的风险似乎会增加)，也是通过晒黑形成定期、频繁的故意紫外线暴露的关键发展阶段。检验我们的青少年晒黑概念模型的实证结果提供了证据，证明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。互联网提供的干预措施可以轻松且廉价地传播，并将受到目标青少年人口的欢迎。 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危险行为的理解和影响的能力。如果成功，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.