Skin Cancer Prevention Programs for Children

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Skin Cancer Prevention Programs for Children

• Lori Crane, Ph.D., M.P.H.
• University of Colorado Denver

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Melanoma Incidence Trends, Colorado and SEER,
1990-2000
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Lifetime expectancy for being diagnosed with
melanoma

• Born in 1935 1/1500
• Born in 1980 1/250
• Born in 2002 1/59

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Much of lifetime risk for melanoma is established
in childhood

• Modifiable risk factors
• Sunburns
• Tanning
• Trips to waterside locations
• Many moles (nevi)
• Non-modifiable risk factors
• Fair skin
• Skin type that burns and doesnt tan
• Red or light colored hair
• Blue or green eyes
• Freckling
• Genetics several specific genes have been
  identified that are low penetrance and are
  fairly common in white populations

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Estimates are that 60-80 of melanomas are caused
by UV exposure
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Recommendations

• Avoid sun between 10 am 4 pm
• Wear clothes that cover arms and legs
• Wear a hat
• Stay in the shade
• Wear sunscreen on exposed skin (SPF 15)

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Colorado Cancer Plan for Skin Cancer

• Reduce proportion of children that get a sunburn
  each year
• Increase proportion of children that use sun
  protection

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1993-2007 Three Skin Cancer Prevention
Intervention Studies for Children

• 1993-1995 Skin cancer prevention in preschools
  and child care centers
• 1997-2001 Skin cancer prevention through
  well-child care for infants to age 3
• 2003-2008 Skin cancer prevention for children
  age 6-9 through a semi-tailored mailed
  intervention

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Skin Cancer prevention in preschools and child
care centers (1993-1995)

• Workshops for center staff on sun protection for
  children
• Letter from Dept. of Social Services explaining
  requirements for using sunscreen
• Recommendations for policies at the center
• Informational packets for parents

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Skin Cancer prevention in preschools and child
care centers (1993-1995) Results

• 27 Preschools and child care centers
• Program resulted in
• Increased levels of knowledge and attitudes among
  center directors
• Increased use of sunscreen at centers
• Increased parent satisfaction with sun protection
  at centers
• Materials available at
• http//cancercontrolplanet.cancer.gov/sun_safety.h
  tml

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Skin cancer prevention through well-child care
for infants to age 3 (1997-2001)

• Anticipatory guidance (age appropriate) by health
  care providers at all well-child visits between 2
  months and 36 months
• Educational materials at each visit (age
  appropriate)
• Sunhat, sunscreen, sunglasses for child

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• KAISER KIDS SUN CARE PROGRAM
• Anticipatory Guidance Recommendations (sample)
• 2 months
• Sunburns during childhood dangerously increase
  the risk of developing skin cancer later in life.
  
• It is much easier for infants and young children
  to get sunburned than adults. Please contact me
  if your child becomes severely sunburned with
  blisters.
• Be sure to keep your child out of the sun. Cover
  his/her body in clothing or light blankets, and
  always keep a hat on your child when he/she is
  outside.
• Also, be sure to use a stroller or carriage with
  a hood, and avoid the sunniest part of the day -
  between 10 am and 3 pm.
• GIVE PARENT 2 MONTHS PACKET OF MATERIALS. REVIEW
  MATERIALS WITH PARENT IF TIME ALLOWS.
• 36 months
• EVALUATE AND COMMENT ON HOW CHILDS SKIN APPEARS.
• Parents should make sun protection a habit for
  their children. Make sunscreen use a daily habit
  like brushing teeth. Put sunscreen on your child
  every morning before he/she goes out to play or
  to daycare. Your child can start practicing
  putting sunscreen on him/herself, but you should
  watch to make sure they do a good job.
• Arm your child with a wide-brimmed hat,
  sunglasses, SPF 15 sunscreen and lipbalm in
  his/her backpack.
• Remind your child to use his/her sun safety gear
  everyday. Talk to your child about how important
  it is to protect his/her skin from tanning and
  sunburn.
• GIVE PARENT 36 MONTHS PACKET OF MATERIALS. REVIEW
  MATERIALS WITH PARENT IF TIME ALLOWS.

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Skin cancer prevention through well-child care
for infants to age 3 (1997-2001) Results

• 728 children and their parents enrolled
• Program resulted in a doubling of sun protection
  advice during pediatric visits
• Small but significant improvements in practice of
  sun protection by parents (especially use of hats
  and shade)

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Skin cancer prevention for children age 6-9
through a semi-tailored mailed intervention
(2003-2008)

• Theory-based educational materials (Precaution
  Adoption Process Model)
• Series of semi-tailored newsletters sent to
  parents (and children) each spring (2005-2007)
  emphasizing risk of skin cancer, reduction of
  barriers to sun protection
• Sun protection items hats, swim shirts,
  sunscreen, UV science activities, tree seeds

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Skin cancer prevention for children age 6-9
through a semi-tailored mailed intervention
(2003-2008) Results

• 1,145 children (and their parents) enrolled
• Small but statistically significantly differences
  in overall sun protection, mostly due to use of
  clothing, hats, and sunscreen
• Still analyzing data

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Dissemination

• Pediatric care program currently being
  disseminated under the CCPD Program (tobacco tax
  funding)

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Challenges

• Public perception that sunscreen is all they need
  for sun protection
• Difficulty implementing programs outside the
  research context
• Time intensive
• Need to enroll people so they can receive an
  ongoing intervention -- HIPAA restrictions on
  access to information
• Tendency to want to water down research tested
  programs