Abstract B56: Adapting SunSafe: A skin cancer prevention intervention for use with multiethnic high school students
Authors: Cassel Kevin , Tran Anh , Murakami-Akasuka Lynn , Tanabe-Hanzawa Jodi , Burnett Terrilea , Lum Christopher 
Published: May 2016

Abstract
Skin cancers are one of the most preventable types of cancer. However, since 2004, skin cancer incidence rates have increased 3% each year in the U.S. In 2015, more than 3 million Americans will develop skin cancer and 76,000 will need treatment for the most deadly form, melanoma. More than $2.4 billion is spent annually on therapies, which does not consider the morbidity from disfiguring treatments. Increased exposure to ultraviolet radiation (UVR) from the sun or artificial sources is a primary risk factor and half the lifetime skin damage from UVR overexposure occurs before age 20.
Recently, skin cancer prevention interventions delivered in U.S. primary and middle schools have demonstrated effectiveness. However, there is deficiency in interventions for high school students, whose health behaviors are transitioning from the purview of parents or caretakers. Changes in social norms, risk-taking and the desire for sexual appeal affect this group's UVR exposure patterns and their perceived skin cancer risk. Few studies have addressed sun protection in multiethnic high school students, who underestimate their skin cancer risk.
To address this gap we conducted a pilot study using both qualitative and quasi-experimental designs to investigate whether a school-based intervention entitled, SunSafe In the Middle School Years (SunSafe), could be adapted for use in a multiethnic high school in Honolulu, HI. We used qualitative research methods to incorporate information from discussions with students, parents, teachers and community members to adapt the program. Discussion themes provided strategies that were integrated into the existing SunSafe program.
The adapted SunSafe intervention was then delivered to 250, 10th grade students. The curriculum consisted of a 30-minute presentation, modeling of sun protection apparel, and a Q&A component. Branded resources were created and included a UVR-sensitive wristband that changed color to provide a visible cue of students' UVR exposure levels. A quasi-experimental pretest/posttest design was used to assess changes in students' knowledge, attitudes, and self-reported and observed sun protection behaviors, relative to the intervention's implementation. A 28-item standardized survey assessed students' self-reported sun protection knowledge and attitude changes. A field assessment instrument, the Systematic Observation of Sun Protection Factors, measured observed changes in students' collective use of headwear, sunglasses, protective clothing, and shade.
A total of 208 students provided parental consent and were assented to the study. The students' ethnic distribution was 51.6 % Asian, 30.4% Native Hawaiian/Pacific Islander, 8.4% White, 3.5 % Hispanic, 2.7 % Black, and 3.2% two or more ethnicities. Significant increases were found in students' knowledge, attitudes, and intended sun protection behaviors at posttest, compared to pretest (T-test p &lt; 0.05). One item measuring attitudes toward tanning did not show significant improvement. At baseline, 12.5% of students wore hats, 4% sunglasses, 10.1% had long sleeves, 33.4 % had full lower body coverage, and 67.8% used shade. At 12 months, 13.1% used hats, 1.9% sunglasses, 16.3% had long sleeves, 39.4% had full lower body coverage, and 81% used shade.
Our pilot study found it feasible to adapt SunSafe in Middle School Years for multiethnic high schools students at risk for UVR overexposures and skin cancer. Lack of improvement in attitudes towards tanning may have been biased by students' self-perceptions regarding their own skin tone, with 90-80% having medium or darker complexions. Further investigations are needed to assess the active components of the adapted SunSafe program, the possible geographic differences in the program's utility and the role of skin complexion in attitudes towards tanning and sun exposure in multiethnic students.
Citation Format: Kevin Cassel, Anh Tran, Lynn Murakami-Akasuka, Jodi Tanabe-Hanzawa, Terrilea Burnett, Christopher Lum. Adapting SunSafe: A skin cancer prevention intervention for use with multiethnic high school students. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B56.