Abstract
BackgroundSkin cancer rates are increasing. Interventions to increase adolescent sunscreen use and skin self-examination (SSE) are required.MethodsQuasi-experimental design; 1 control and 4 intervention group schools in Scotland, UK. Participants were 15–16 year old students on the school register. The intervention was a theoretically-informed (Common-Sense Model and Health Action Process Approach) 50-min presentation, delivered by a skin cancer specialist nurse and young adult skin cancer survivor, to students in a classroom, supplemented by a home-based assignment. Outcome variables were sunscreen use intention, SSE intention/behaviour, planning, illness perceptions and skin cancer communication behaviour, measured 2 weeks pre- and 4 weeks post- intervention using self-completed pen and paper survey. School attendance records were used to record intervention up-take; students self-reported completion of the home-based assignment. Pearson’s chi-square test, analysis of variance, and non-parametric Wilcoxon Signed Ranks Test were used to measure outcomes and associations between variables. Focus groups elicited students’ (n = 29) views on the intervention. Qualitative data were analysed thematically.ResultsFive of 37 invited schools participated. 639 (81%) students in intervention schools received the intervention; 33.8% completed the home-based assignment. 627 (69.6%) of students on the school register in intervention and control schools completed a questionnaire at baseline; data for 455 (72.6%) students were available at baseline and follow-up. Focus groups identified four themes – personal experiences of skin cancer, distaste for sunscreen, relevance of SSE in adolescence, and skin cancer conversations. Statistically significant (p < 0.05) changes were observed for sunscreen use, SSE, planning, and talk about skin cancer in intervention schools but not the control. Significant associations were found between sunscreen use, planning and 2 illness perceptions (identity and consequence) and between SSE, planning and 3 illness perceptions (timeline, causes, control).ConclusionsIt is feasible to promote sunscreen use and SSE in the context of an adolescent school-based psychoeducation intention. Further research is required to improve study uptake, intervention adherence and effectiveness.Trial registrationISRCTN11141528
Highlights
Skin cancer incidence has increased in the United Kingdom (UK) by 360% since the 1970s [2], with an estimated 86% of these cases attributable to excessive sunlight exposure [3]
Sunburn is implicated in the pathogenesis of different skin cancers including squamous cell carcinoma [4], basal cell carcinoma [5], and melanoma [6]
The recent rapid increase in skin cancer incidence in adolescence is attributed to environmental and genetic factors [7,8,9,10]
Summary
Interventions to increase adolescent sunscreen use and skin self-examination (SSE) are required. Skin cancer incidence has increased in the United Kingdom (UK) by 360% since the 1970s [2], with an estimated 86% of these cases attributable to excessive sunlight exposure [3]. The recent rapid increase in skin cancer incidence in adolescence is attributed to environmental (e.g., excessive sun exposure leading to sunburn) and genetic factors [7,8,9,10]. Sunburn in childhood and adolescence heightens the risk of skin cancer in adulthood [6, 11,12,13,14]. Multiple risk behaviours – smoking, hazardous alcohol consumption, low levels of physical activity, poor diet and excessive sun exposure – cluster in adolescence [23]. Adolescence provides a critical window of opportunity for the primary prevention of skin cancer caused by sunburn across the life-course
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