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Gregory J. Norman, PhD; Marc A. Adams, MPH; Karen J. Calfas, PhD; Jennifer Covin, MPH; James F. Sallis, PhD; Joseph S. Rossi, PhD; Colleen A. Redding, PhD; John Cella, MD; Kevin Patrick, MD

Arch Pediatr Adolesc Med. 2007;161(2):146-152.

Objective  To evaluate a multicomponent primary care–based intervention to increase sun protection behaviors among adolescents. Excessive sun exposure in childhood increases the lifetime risk of melanomas and other forms of skin cancer. Interventions to improve sun protection behaviors in childhood have been based primarily in school and community settings, with little attention to the role of primary care physicians.

Design  A 2-year randomized controlled trial.

Setting  Primary care physician offices and participant homes.

Participants  Eight hundred nineteen adolescents aged 11 to 15 years.

Interventions  At the study onset and the 12-month follow-up, the adolescents engaged in an office-based expert system assessment of sun protection behaviors followed by brief stage-based counseling from the primary care provider. Participants also received up to 6 expert system–generated feedback reports, a brief printed manual, and periodic mailed tip sheets. Participants randomized to the comparison condition received a physical activity and nutrition intervention.

Main Outcome Measure  A self-reported composite measure of sun protection behavior.

Results  A random-effects repeated-measures model indicated a greater adoption of sun protection behaviors over time in the intervention group compared with the control group. The intervention effect corresponded to between-group differences at 24 months in avoiding the sun and limiting exposure during midday hours and using sunscreen with a sun protection factor of at least 15. Secondary analysis indicated that, by 24 months, more adolescents in the intervention group had moved to the action or the maintenance stage of change than those in the control group (25.1% vs 14.9%; odds ratio, 1.74; 95% confidence interval, 1.13-2.68). Sun protection behavior was also found to be positively associated with the completion of more intervention sessions (P = .002).

Conclusion  Primary care counseling coupled with a minimal-intensity expert system intervention can improve adolescents' sun protection behaviors.

Author Affiliations: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla (Drs Norman and Patrick, Mr Adams, and Ms Covin); Department of Psychology, San Diego State University (Drs Calfas and Sallis) and Kaiser Permanente Medical Group (Dr Cella), San Diego, Calif; and Cancer Prevention Research Center, University of Rhode Island, Kingston (Drs Rossi and Redding).

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