Effectiveness of a Multicomponent Sun Protection Program for Young Children
Authors: Byron K. Ho, Katie Reidy, Imelda Huerta, Kimberley Dilley, Susan Crawford, Brittney A. Hultgren, Kimberly A. Mallett, Rob Turrisi, June K. Robinson
Journal: JAMA Pediatrics (2016)

<h3>Importance</h3> 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. <h3>Objective</h3> To determine whether a multicomponent sun protection program delivered in pediatric clinics during the summer could increase summertime sun protection among young children. <h3>Design, Setting, and Participants</h3> 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. <h3>Intervention</h3> Multicomponent sun protection program composed of a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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 (<i>P</i> &lt; .001 for skin type 1,<i>P</i> = .008 for skin type 2, and<i>P</i> &lt; .001 for skin types 4-6). <h3>Conclusions and Relevance</h3> 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. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT02376517