Norman Gregory J, Adams Marc A, Calfas Karen J, Covin Jennifer, Sallis James F, Rossi Joseph S, Redding Colleen A, Cella John, Patrick Kevin
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093, USA.
Arch Pediatr Adolesc Med. 2007 Feb;161(2):146-52. doi: 10.1001/archpedi.161.2.146.
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.
A 2-year randomized controlled trial.
Primary care physician offices and participant homes.
Eight hundred nineteen adolescents aged 11 to 15 years.
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.
A self-reported composite measure of sun protection behavior.
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).
Primary care counseling coupled with a minimal-intensity expert system intervention can improve adolescents' sun protection behaviors.
评估一项基于初级保健的多组分干预措施，以增加青少年的防晒行为。儿童期过度暴露于阳光下会增加患黑色素瘤和其他形式皮肤癌的终生风险。改善儿童期防晒行为的干预措施主要基于学校和社区环境，很少关注初级保健医生的作用。
一项为期2年的随机对照试验。
初级保健医生办公室和参与者家中。
819名11至15岁的青少年。
在研究开始时和12个月随访时，青少年接受基于办公室的防晒行为专家系统评估，随后由初级保健提供者进行简短的基于阶段的咨询。参与者还收到多达6份专家系统生成的反馈报告、一本简短的印刷手册和定期邮寄的小贴士。随机分配到对照条件的参与者接受体育活动和营养干预。
自我报告的防晒行为综合指标。
随机效应重复测量模型表明，与对照组相比，干预组随着时间的推移更广泛地采用了防晒行为。干预效果对应于24个月时两组在避免阳光照射、限制中午时段暴露以及使用防晒系数至少为15的防晒霜方面的组间差异。二次分析表明，到24个月时，干预组中进入行动或维持改变阶段的青少年比对照组更多（25.1%对14.9%；优势比，1.74；95%置信区间，1.13 - 2.68）。还发现防晒行为与完成更多干预课程呈正相关（P = .002）。
初级保健咨询与最低强度的专家系统干预相结合可以改善青少年的防晒行为。
