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THE SUN LESS STUDY: A RANDOMIZED TRIAL OF A SKIN CANCER PREVENTION INTERVENTION FEATURING SUNLESS TANNING Sherry Pagoto, Kristin Schneider, Jessica Oleski, Jamie Bodenlos, and Yunsheng Ma University of Massachusetts Medical School www.vancls.info COLLABORATORS Kristin Schneider, PhD Jessica Oleski, MA Jamie Bodenlos, PhD Yunsheng Ma, PhD Alan Geller, MPH, RN Kate Curtis Karen Ronayne R21CA109670 National Cancer Institute www.vancls.info RATIONALE The desire to be a tan is a strong motivator to sunbathe People desiring a tan tend to be resistant to sun safety messages Difficult to reduce the desire to be tan! Sun tanning alternatives might be a different approach If you can’t beat, join em? www.vancls.info SUNLESS TANNING Sunless tanning are a non-UV tan alternative Products containing dihydroxyacetone (DHA), a colorless vegetable-derived sugar that interacts with dead surface cells in the epidermis to stain the skin a tan color Creams, foams, or sprays applied professionally Not a source of sun protection Relatively inexpensive alternative to indoor tanning ($5 for bottle, $30 for a spray) www.vncls.ifo EVERYBODY’S DOING IT… www.vancls.info HERE’S THE ALTERNATIVE! www.vancls.info SUNLESS TANNING HELPFUL OR HARMFUL? People attending a sunless tanning visit reported intentions to reduce their indoor tanning but not their outdoor tanning (Sheehan & Lesher, 2005) Sunless tanning users reported more use of indoor tanning and more burns than nonusers (Brooks et al 2006) Intervention promoting sunless tanning as part of a sun safety message found increases in sun protection but no effect on sunbathing (Mahler et al 2005) www.vancls.info AIMS To compare a multi-component beach-based intervention featuring sunless tanning as a substitute for sunbathing to a survey-only control condition on sunbathing 2-months following the intervention. Secondary outcomes include frequency of sunburns, use of sunless tanning products, and sun protection. www.vancls.info SETTING Massachusetts public beaches (Nantasket and Revere beaches) Beaches were 27 miles apart and randomly assigned as intervention or control on each of 11 days of data collection (average temp 78F) Randomization by beach allowed weather conditions and day to be held constant. www.vncls.info RECRUITMENT Study site was set up in a central location at each beach. Research assistants actively approached female beach visitors to participate in a study about sun habits. Interested intervention participants were asked to have a seat in the tent to complete informed consent, questionnaires, and a brief intervention. Interested control participants were asked to complete informed consent and questionnaires. www.vancls.info MEASURES Sunbathing In the last 2 months, how often did you spend time in the sun in order to get a tan? 0 = never, 1 = once, 2 = once a month, 3 = twice a month, 4 = once a week, 5 = twice a week, 6 = almost every day and 7 = everyday. Sunburns In the last 2 months, how many times did you have a red OR painful sunburn that lasted a day or more? 0 = not at all, 1 =once, 2 = twice, 3 = three times, 4 = four times and 5 = five times or more Sun protection Think about what you do when you are outside during the summer, how often do you: wear sunscreen or non-sunscreen protection (shirt with sleeves, hat, sunglasses, shade, umbrella). 0 = never, 1= rarely, 2=sometimes, 3= often, 4= always www.vancls.info MEASURES (CONT) Sunless tanning behavior Sunless tanning, also known as self-tanning or fake tanning, involves the application of creams, foams, sprays that dye skin a tanned color, or spray tans that you can get at a tanning business. These do NOT include bronzing powders and creams which can be washed off with soap and water. Have you used sunless tanning products or spray- on tans in the last 2 months?“ Yes or No www.vacls.ifo MEASURES (CONT) Indoor tanning Have you used an indoor UV tanning device in the last two months? Yes or Nowww.vancls.info INTERVENTION Completed questionnaires Took a UV instant photo Skin cancer pamphlet Skin cancer rates Skin cancer detection, types, and symptoms Skin cancer prevention Suntanning Myths Graphic photos of skin with heavy UV damage Graphic photos of skin cancer lesions and scars Attractive photos of women with protective clothing, using umbrellas and tents Free sunscreen sample with verbal and written instructions for use www.vancls.info www.vancls.info www.vancls.info INTERVENTION (CONT) Free sunless tanning cream sample with verbal instructions for use Application of sunless tanning cream to small area of skin to demonstrate the color. Sunless tanning pamphlet General information about sunless tanning Application instructions for sunless tanning creams including common application errors Attractive photos of women before and after sunless tans www.vancls.ifo www.vancls.info INTERVENTION (CONT) Show them their standard and UV photos and give them copies to take home. www.vancls.info CONTROL CONDITION Completed the same questionnaires Received a free gift pack Beauty product samples Candy, snacks www.vancls.info FOLLOW-UP Participants were contacted via the information they provided Email Phone Home address 1-month following the beach contact. They were re-contacted in 1 week if no response, then in 2 weeks if no response, then in 3 weeks, etc. 77% completed follow-up at the end of the summer www.vancls.info N=250 Age M=31.21 (sd = 12.36) Ethnicity Caucasian 85% Hispanic 5% (4% multiracial) African American 2% Education Less than college degree 63% College degree 22% Graduate degree 12% Skin Type I 8% II 26% III 45% IV 21% Family hx of skin cancer 30% Personal hx of skin cancer 3% www.vancls.info RESULTS Intention to treat analyses using mixed effects regression modeling with a random intercepts trend Age and skin type were covariates www.vancls.info SUNBATHING p =.03 www.vancls.info SUNBURNS p =.04 www.vancls.info SUNSCREEN USE p =NS www.vancls.info OTHER PROTECTION (CLOTHES, SHADE, HAT, GLASSES) p =.02 www.vancls.info SUNLESS TANNING p =.01 p =.13 www.vancls.info INDOOR TANNING p =.04 p =.44 www.vancls.info MORE ON SUNLESS TANNING… 55% of participants in the Intervention condition reported having tried the free sample of sunless tanner. Those who used the sample were no different from nonusers in their sunbathing at two-months (p = .29) www.vacls.inf LIMITATIONS Randomization by individual not feasible in the beach setting No effect on sunscreen use Multi-component intervention makes it difficult to tell which components are the active ingredients and we cannot isolate the impact of sunless tanning. www.vancls.info CONCLUSIONS A beach-based sun safety intervention that promotes sunless tanning appears to reduce sunbathing and indoor tanning and increase some forms of protection as well as use of sunless tanning No evidence of harm Sunless tanning is a desirable option for some but not all tanners, and might be a viable substitute for indoor tanners www.vancls.info
