Multicomponent intervention linked to better sun protection for kids

A multicomponent intervention including reminder text messages, a swim shirt for children and a read-along book was associated with increased sun-protection behaviors among young children and a smaller change in children's skin pigment, according to an article published online by JAMA Pediatrics.

Melanoma is the second most common form of cancer among adolescents and young adults and sun exposure increases the risk of skin cancer whether it occurs during childhood or adolescence.

June K. Robinson, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and editor of JAMA Dermatology, and coauthors conducted a summertime randomized clinical trial including 300 caregivers (parents or relatives) who brought a child (ages 2 to 6 years) to a well-child visit at two urban pediatric clinics with 15 participating pediatricians from the Advocate Children's Hospital system.

Of the 300 caregiver-child pairs, 153 (51 percent) were assigned to the sun-protection intervention and the remaining 147 (49 percent) were assigned to receive the information usually provided during a well-child visit. The sun protection intervention included a 13-page, read-along book that emphasized sun-protection behaviors using child characters, a sun-protective swim shirt and four sun-protection reminders sent weekly by text message. The study had a four-week follow-up.

Participants in the sun-protection intervention had higher scores related to sun-protection behaviors on both sunny and cloudy days, on scores related to sunscreen use and on scores related to wearing a shirt with sleeves on sunny days, according to the results.

The authors corroborated their findings by measuring skin pigment changes in the children using spectrophotometry. The results showed children in the sun-protection group did not have a significant change in melanin level on their protected upper arms.

The authors note a few study limitations, including that a relatively small number of children in minority groups prevented an ethnically stratified analysis of the data. Most of the children in the study were white.

"This implementable program can help augment anticipatory sun protection guidance in pediatric clinics and decrease children's future skin cancer risk," the article concludes.

"As clinicians, we tend to believe that 'less is more' and that simplifying recommendations benefits our patients. Ultimately, sun protection programs are behavioral interventions designed to change patterns long term, and it would not surprise us to find that more complex multimodal approaches, such as those advocated by Ho et al, may prove more effective at reinforcing healthier sun-protection habits and that, in this instance, 'more is more,'" the editorial concludes.