New program helps high-risk children improve sun protection behaviors

Children of parents who have melanoma, a serious type of skin cancer that starts in the cells that make pigment, have twice the lifetime risk of developing the disease themselves. A researcher from Huntsman Cancer Institute at the University of Utah (the U) has developed a successful program to teach melanoma patients and their children behaviors that will help prevent the onset of melanoma later in life.

Yelena Wu, PhD, investigator at Huntsman Cancer Institute and professor of dermatology at the U, has found that her FLARE program-short for Family, Lifestyles, Actions, and Risk Education-improved sun-protective behaviors among these at-risk children.

Prevention that happens in childhood is so important for avoiding skin cancer later in life. Children's skin is very vulnerable, and early sunburn patterns are predictive of later skin cancer risk. We're developing different programs to make it easier for families and others to adopt health behavior changes that will improve skin cancer prevention."

Yelena Wu, PhD, investigator, Huntsman Cancer Institute and professor of dermatology, University of Utah

Wu says that the children of melanoma patients have a higher risk of developing the disease because of biological factors, such as skin tone and genetics that increase their sun sensitivity. These children are also impacted by environmental factors, including sun exposure patterns, some of which are established by their parents. Despite being higher risk, these young people often engage in behaviors like tanning and avoiding using sun safety precautions to prevent sunburns. According to the National Cancer Institute, sunburns at a younger age are a strong predictor of skin cancer and particularly melanoma.

The main way to minimize risk of melanoma is to decrease exposure to ultraviolet radiation from the sun and artificial sources and to prevent sunburn, especially during childhood. This can include wearing sun-protective clothing like long-sleeved shirts, sunglasses, and wide-brimmed hats, avoiding outdoor activity during peak exposure hours, and applying and re-applying sunscreen.

"We need to find a way to counsel families and their kids on how important this is to manage their risk through sun-protective behaviors. This is particularly important in the Mountain West and the area we serve, where we have higher-than-average melanoma rates," says Wu. "Skin cancers like melanoma can be highly preventable, but in a way that I think is very challenging because it requires a daily, consistent set of health behaviors. We want to support families and others in our community in making those changes and sustaining them."

Wu adds that Utah has the highest melanoma incidence rate in the country.

To evaluate the FLARE program, Wu enrolled 364 pairs of patients and their children in a study to improve sun safety behaviors. One group of these participated in FLARE, a three-session telehealth program that focused on melanoma risk awareness, learning about how to implement sun protection strategies with children and within families, and collaborative parent-child problem-solving about sun safety barriers with a health educator. This included visual aids and videos to make the lesson more accessible. Another group met with a health educator to receive more general information about melanoma.

Wu found that the FLARE program improved sun-protective behaviors, decreasing overall sun exposure and damage, but did not decrease sunburn rates. 

"Reducing sunburn is the holy grail for outcomes for skin cancer prevention because it's such a strong indicator of skin cancer risk later in life. We still have work to do to make FLARE have the strongest possible outcome," says Wu. "But I'm really excited that we were able to improve their skin cancer prevention behaviors, and I still consider the study a success as it shows that family-based programs can change how kids and parents think about and implement sun safety."

The results of her research were published in JAMA Dermatology.

The critical research happening every day at Huntsman Cancer Institute is supported by the National Institutes of Health/National Cancer Institute, including cancer center support grant P30 CA042014, as well as Huntsman Cancer Foundation.