使用郵寄資料改善防曬行為


  【24drs.com】根據發表於10月美國預防醫學期刊的一篇文獻,多年試驗發現,與對照組相比,郵寄防曬組與防曬電子報給科羅拉多州的家庭,改善了這些家庭的防曬行為。
  
  根據科羅拉多公衛學院社區與行為健康系主任Lori Crane博士等人表示,這些結果顯示此類型的長期介入方式有助於減少過度日曬引起的皮膚癌盛行率。
  
  該研究團隊進行了一項隨機控制試驗,對象是丹佛地區的867個家庭,藉由每年對家長進行電話訪談與孩童的皮膚檢查而獲取相關資料。
  
  介入組方面,透過郵寄提供有關皮膚癌與防曬資訊的教育電子報(2005年4次、2006年5次、2007年3次),還有防曬衣物、防曬品與背包等工具包。每年的第一份電子報會提及皮膚癌與其原因,第二份則是根據在2004年搜集的家族與孩童特定風險因素,例如眼睛、頭髮與皮膚顏色;雀斑;發生曬傷的趨勢等資訊,提出個別對孩童風險認知的資訊。後續的電子報則是報導保護措施,包括避免中午日曬、穿長袖衣物、找遮陰處、使用防曬霜等。
  
  由該研究的皮膚科醫師訓練、對介入狀態不知情的4-7名健康照護提供者,在每年夏天為這些孩童進行皮膚檢查。
  
  至於對照組,只是在每年春天寄給他們一封邀請他們參與資料蒐集與皮膚檢查的信件。
  
  從2008至2011年,研究者進行了677名白人、非西班牙裔孩童之資料的分析。(其他經隨機分組、非白人或西班牙裔的家庭則未被納入此次分析。)家長訪談完成率介於90%-97%,皮膚檢查完成率介於77%-82%。
  
  對於介入組,78%-85%的家長表示每年收到電子報,70%-82%表示每年會詳讀收到的電子報,39%-60%表示他們每年獲得一些或許多新資訊。
  
  與對照組相比,介入組的家長更多表示他們的孩童使用長袖衣物、帽子、遮陰、防曬霜以及避免中午日曬;雖然各組的一般差異不大且每年不一致,在該年的電子報特別強調的特定行為,則會有比較明顯的差異。
  
  Crane博士在大學記者會中表示,在2005年春天強調長袖衣物之後,我們在2005和2006年的衣物穿著行為發現有差異,2007年則無。在2006年強調戴帽子之後,在該年發現這方面的差異。在2007年強調遮陰之後,我們發現家長對使用遮陰作為防曬行為的警覺增加。
  
  在這幾年之間,介入組的不嚴重曬傷比較少,而嚴重曬傷只有在2007年的介入組有降低。2006年時,介入組比較少大於等於2mm的痣(可能會導致癌症的黑痣)(P = 0.03),但是在曬黑或小於2 mm的痣方面則無差異。
  
  介入組也有比較高的有效防曬認知、防曬觀念的障礙度也較低(兩項都是P < .05)。
  
  研究限制包括,自我報告之資料、家長的教育程度和收入相對較高,因而減少了一般化的程度。研究強度包括,研究對象夠多、約80%的介入組可回憶收到的電子報。
  
  Crane博士在發表時結論表示,這是低成本而有效的介入方式,對於在這些年來皮膚癌風險更高的情況下,這是致力於減少孩童曝曬於陽光的重要方法。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6945&x_classno=0&x_chkdelpoint=Y
  

Sun-Protection Behaviors Improve With Mailed Materials

By Larry Hand
Medscape Medical News

September 27, 2012 — A multiyear trial of mailed sun-protection kits and newsletters about sun protection to families in Colorado improved the sun-protection behaviors of those families compared with those of a control group, according to an article published in the October issue of the American Journal of Preventive Medicine.

The results indicate that longer-term interventions of this type could help to curb the rising prevalence of skin cancer largely caused by overexposure to the sun, according to Lori Crane, PhD, MPH, chair of the Department of Community and Behavioral Health at the Colorado School of Public Health, Denver, and colleagues.

The team conducted a randomized controlled trial involving 867 families in the Denver area. Data collection consisted of annual telephone interviews of parents and skin examinations of children.

For the intervention group, educational newsletters containing information about skin cancer and sun protection were mailed (4 in 2005, 5 in 2006, and 3 in 2007), in addition to resource kits including protective clothing, sunscreen, and backpacks. The first newsletter each year addressed skin cancer and its causes. The second tailored information to personalized risk perception for children based on baseline data collected in 2004, including family histories and child-specific risk factors such as eye, hair, and skin color; freckling; and tendency to get sunburn. Subsequent newsletters described protective measures, including avoiding midday sun, wearing long clothes, seeking shade, and using sunscreen.

From 4 to 7 healthcare providers trained by the study's lead dermatologist, but blind to intervention status, administered skin exams to children each summer.

A single letter was mailed to the control group each spring inviting them to participate in data collection and skin examinations.

During 2008 through 2011, the researchers conducted an analysis of the records of 677 white, non-Hispanic children. (The remaining families that had been randomly assignment were nonwhite or Hispanic and were not included in the current analysis.) The parent interview completion rate was between 90% and 97%, and the skin exam completion rate was between 77% and 82%.

For the intervention group, between 78% and 85% of parents reported receiving newsletters each year, between 70% and 82% reported reading all newsletters each year, and between 39% and 60% said they learned some or a lot of new information each year.

Parents in the intervention group reported their children using long clothing, hats, shade, and sunscreen and avoiding midday sun more frequently than those in the control group. Although general group differences were of small magnitude and inconsistent across the year, differences were more evident for the specific behaviors that were emphasized in a given year’s newsletters.

"After we emphasized long clothing in the spring of 2005, we saw a difference in clothing behavior in the summers of 2005 and 2006 not in 2007," Dr. Crane said in a university press release. "Then after emphasizing hats in 2006, we saw a difference in hat use that year. And then after highlighting shade in 2007, we saw a corresponding increase in parents' awareness and use of shade as a sun-protective behavior."

Fewer nonsevere sunburns were reported for the intervention group across all years, but severe sunburns were reduced in the intervention group in 2007 only. The intervention group also had fewer nevi (moles that may lead to cancer) that were greater than or equal to 2 mm in size in 2006 (P = 0.03), but no differences resulted in tanning or nevi smaller than 2 mm.

The intervention group also had greater perceptions of sun-protection effectiveness and lower perceptions of barriers to sun protection (both, P < .05).

Limitations of the study include self-reported data and the factor of relatively high levels of education and income of the parents, possibly reducing generalizability. Strengths include the large study population and the fact that about 80% of the intervention group recalled getting the newsletters.

"This is a low-cost, effective intervention that could be an important component in efforts to reduce sun exposure in children during the years that they acquire much of their risk for skin cancer," Dr. Crane concludes in the release.

This study was supported by a National Cancer Institute Grant. The authors have disclosed no relevant financial relationships.

Am J Prev Med. 2012;43:399-410.

    
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