A Randomized Trial of Tailored Skin Cancer Prevention Messages for Adults: Project SCAPE

Objectives. We evaluated the impact of a mailed, tailored intervention on skin cancer prevention and skin self-examination behaviors of adults at moderate and high risk for skin cancer.Methods. Adults at moderate and high risk for skin cancer were recruited in primary health care settings in Honolulu, HI, and Long Island, NY. After completing a baseline survey, participants were randomized to 2 groups. The treatment group received tailored materials, including personalized risk feedback, and the control group received general educational materials. Multivariate analyses compared sun protection and skin self-examination between groups, controlling for location, risk level, gender, and age.Results. A total of 596 adults completed the trial. The tailored materials had a significant effect on overall sun-protection habits, the use of hats, the use of sunglasses, and the recency of skin self-examination. Some effects were moderated by location and risk level.Conclusions. Tailored communications including personalized risk feedback can improve sun-protection behaviors and skin self-examination among adults at increased risk for skin cancer. These convenient, low-cost interventions can be implemented in a variety of settings and should be tested further to assess their long-term effectiveness.Skin cancer is the most commonly diagnosed cancer in the United States,¹ with more than 1 million Americans diagnosed with skin cancer each year.² The incidence of skin cancer has increased dramatically worldwide in the last decade.³ Both main types of skin cancer—malignant melanoma and nonmelanoma skin cancer—are now significant and costly public health concerns.^2,4 Although skin cancer rates are increasing, it is considered one of the most preventable types of cancer. Prevention guidelines include reducing exposure to ultraviolet radiation (UVR); adopting sun-protection habits including the use of sunscreen, hats, shirts, and sunglasses^5,6; performing regular skin self-examination; and seeking professional evaluation of suspicious skin changes. Nevertheless, levels of knowledge, concern, and the practice of prevention and early detection remain relatively low.^7,8Risk factors for skin cancer include age, sun-sensitive phenotypes, excess sun exposure, family history, personal history of skin cancer or precancerous lesions, and other medical conditions.⁹ Most skin cancer prevention interventions reported to date are directed at the general population through school-based curricula and media campaigns,¹⁰ and some recent trials have targeted people who experience high sun exposure at work or during outdoor recreation.^11–15 Only 2 reported studies have targeted groups at high risk: patients who have been treated for nonmelanoma skin cancer,¹⁶ and siblings of melanoma patients.¹⁷ There is a need for low-cost, effective interventions to improve skin cancer prevention and early detection behaviors among a broader population of persons at moderate and high risk.Tailored, mailed communications hold great promise for skin cancer prevention and detection among individuals at increased risk, but these interventions have not been widely tested. Interventions that are tailored to individuals'' characteristics, behaviors, needs, and beliefs are more likely to be seen as personally relevant and thus may be more motivating.¹⁸ Tailored interventions have been shown to be effective in the past for other health behaviors, particularly for prevention and screening behaviors.¹⁹ The aim of Project SCAPE (Skin Cancer Awareness, Prevention and Education) was to evaluate the impact of tailored interventions on skin cancer prevention and skin self-examination among adults at high and moderate risk for skin cancer in a randomized trial.