Journal of Cancer Survivorship

, Volume 5, Issue 3, pp 247–254

Improving short-term sun safety practices among adolescent survivors of childhood cancer: a randomized controlled efficacy trial

  • Darren Mays
  • Jessica Donze Black
  • Revonda B. Mosher
  • Aziza T. Shad
  • Kenneth P. Tercyak



Skin cancer is one of the most common secondary neoplasms among childhood cancer survivors. However, little evidence exists for effective interventions to promote sun safety behaviors within this population.


This small-scale randomized controlled trial examined the efficacy of the Survivor Health and Resilience Education (SHARE) Program intervention, a multiple health behavior change intervention designed to increase sun safety practices among adolescent survivors of childhood cancer. Adolescent survivors of childhood cancer (11–21 years) were randomly allocated to a group-based behavioral intervention (n = 38) or wait-list control (n = 37). Self-reported sun safety behaviors were assessed using a valid, 8-item scale at baseline and 1-month post-intervention.


Controlling for baseline sun safety, gender, and seasonal influences, intervention participants reported significantly more sun safety practices (e.g., using sunscreen, reapplying sunscreen regularly) at 1-month post-intervention than control participants (B = 2.64, 95% CI = 1.02, 4.27, p = 0.002).


The results suggest that SHARE was efficacious in producing improvements in short-term self-reported sun safety practices among adolescent survivors of childhood cancer. Future research is needed to build upon this work by incorporating objective measures of sun safety behaviors and examining intervention durability.

Implications for cancer survivors

Behavioral interventions addressing lifestyle factors, including sun safety behaviors, among adolescent survivors of childhood cancer should be integrated into long-term care to reduce the risk for secondary malignancies and diseases.


Cancer Adolescents Survivors Sun safety Health promotion Behavioral intervention 


  1. 1.
    National Cancer Institute. SEER Cancer Statistics Review 1975–2007. Retrieved August 31, 2010 from
  2. 2.
    Centers for Disease Control and Prevention (CDC). Cancer survivorship—United States, 1971–2001. MMWR Morb Mortal Wkly Rep. 2004;53:526–9.Google Scholar
  3. 3.
    Nathan PC, Ford JS, Henderson TO, Hudson MM, Emmons KM, Casillas JN, et al. Health behaviors, medical care, and interventions to promote healthy living in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:2363–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Dickerman JD. The late effects of childhood cancer therapy. Pediatrics. 2007;119:554–68.PubMedCrossRefGoogle Scholar
  6. 6.
    Perkins JL, Liu Y, Mitby PA, Neglia JP, Hammond S, Stovall M, et al. Nonmelanoma skin cancer in survivors of childhood and adolescent cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2005;23:3733–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Meadows AT, Friedman DL, Neglia JP, Mertens AC, Donaldson SS, Stovall M, et al. Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27:2356–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med. 2005;40:702–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Hudson MM, Tyc VL, Srivastava DK, Gattuso J, Quargnenti A, Crom DB, et al. Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study. Med Pediatr Oncol. 2002;39:2–11.PubMedCrossRefGoogle Scholar
  10. 10.
    American Cancer Society. What you should know about melanoma. American Cancer Society, Inc. 2005, No. 261900-Rev.07/08. Retrieved August 31, 2010 from
  11. 11.
    Armstrong BK, Kricker A. The epidemiology of UV induced skin cancer. J Photochem Photobiol B. 2001;63:8–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Stolley MR, Restrepo J, Sharp LK. Diet and physical activity in childhood cancer survivors: a review of the literature. Ann Behav Med. 2010;39:232–49.PubMedCrossRefGoogle Scholar
  13. 13.
    Donze JR, Tercyak KP. The Survivor Health and Resilience Education (SHARE) program: development and evaluation of a health behavior intervention for adolescent survivors of childhood cancer. J Clin Psychol Med Settings. 2006;13:169–76.CrossRefGoogle Scholar
  14. 14.
    Tercyak KP, Donze JR, Prahlad S, Mosher RB, Shad AT. Multiple behavioral risk factors among adolescent survivors of childhood cancer in the Survivor Health and Resilience Education (SHARE) program. Pediatr Blood Cancer. 2006;47:825–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Tercyak KP, Donze JR, Prahlad S, Mosher RB, Shad AT. Identifying, recruiting, and enrolling adolescent survivors of childhood cancer into a randomized controlled trial of health promotion: preliminary experiences in the Survivor Health and Resilience Education (SHARE) Program. J Pediatr Psychol. 2006;31:252–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Gritz ER, Tripp MK, de Moor CA, Eicher SA, Mueller NH, Spedale JH. Skin cancer prevention counseling and clinical practices of pediatricians. Pediatr Dermatol. 2003;20:16–24.PubMedCrossRefGoogle Scholar
  17. 17.
    Gritz ER, Tripp MK, James AS, Carvajal SC, Harrist RB, Mueller NH, et al. An intervention for parents to promote preschool children’s sun protection: effects of Sun Protection is Fun! Prev Med. 2005;41:357–66.PubMedCrossRefGoogle Scholar
  18. 18.
    Gritz ER, Tripp MK, James AS, Harrist RB, Mueller NH, Chamberlain RM, et al. Effects of a preschool staff intervention on children’s sun protection: outcomes of sun protection is fun! Health Educ Behav. 2007;34:562–77.PubMedGoogle Scholar
  19. 19.
    Glanz K, Mayer JA. Reducing ultraviolet radiation exposure to prevent skin cancer methodology and measurement. Am J Prev Med. 2005;29:131–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Green LW, Kreuter MW. Health promotion planning: an educational and ecological approach. New York: McGraw-Hill; 2004.Google Scholar
  21. 21.
    Glanz K, Rimer BK, Marcus F. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass; 2002.Google Scholar
  22. 22.
    Tabachnick BG, Fidell LS. Using multivariate statistics. Boston: Allyn & Bacon; 2007.Google Scholar
  23. 23.
    Cox CL, McLaughlin RA, Rai SN, Steen BD, Hudson MM. Adolescent survivors: a secondary analysis of a clinical trial targeting behavior change. Pediatr Blood Cancer. 2005;45:144–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Saraiya M, Glanz K, Briss PA, Nichols P, White C, Das D, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med. 2004;27:422–66.PubMedGoogle Scholar
  25. 25.
    Glanz K, Gies P, O’Riordan DL, Elliott T, Nehl E, McCarty F, et al. Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure. Cancer Epidemiol Biomark Prev. 2010;19:3005–12.CrossRefGoogle Scholar
  26. 26.
    Yaroch AL, Reynolds KD, Buller DB, Maloy JA, Geno CR. Validity of a sun safety diary using UV monitors in middle school children. Health Educ Behav. 2006;33:340–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Glanz K, McCarty F, Nehl EJ, O’Riordan DL, Gies P, Bundy L, et al. Validity of self-reported sunscreen use by parents, children, and lifeguards. Am J Prev Med. 2009;36:63–9.PubMedCrossRefGoogle Scholar
  28. 28.
    O’Riordan DL, Nehl E, Gies P, Bundy L, Burgess K, Davis E, et al. Validity of covering-up sun-protection habits: association of observations and self-report. J Am Acad Dermatol. 2009;60:739–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Creech LL, Mayer JA. Ultraviolet radiation exposure in children: a review of measurement strategies. Ann Behav Med. 1997;19:399–407.PubMedCrossRefGoogle Scholar
  30. 30.
    Green A, Battistutta D, Hart V, Leslie D, Marks G, Williams G, et al. The Nambour Skin Cancer and Actinic Eye Disease Prevention Trial: design and baseline characteristics of participants. Control Clin Trials. 1994;15:512–22.PubMedCrossRefGoogle Scholar
  31. 31.
    van der Pols JC, Williams GM, Pandeya N, Logan V, Green AC. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomark Prev. 2006;15:2546–8.CrossRefGoogle Scholar
  32. 32.
    Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2010;Dec 6. [Epub ahead of print].Google Scholar
  33. 33.
    Mickler TJ, Rodrigue JR, Lescano CM. A comparison of three methods of teaching skin self-examinations. J Clin Psychol Med Settings. 1999;6:273–86.CrossRefGoogle Scholar
  34. 34.
    Stull VB, Snyder DC, Demark-Wahnefried W. Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. J Nutr. 2007;137:243S–8S.PubMedGoogle Scholar
  35. 35.
    Rabin C. Review of health behaviors and their correlates among young adult cancer survivors. J Behav Med. 2010;Aug 4. [Epub ahead of print].Google Scholar
  36. 36.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23:5814–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Darren Mays
    • 1
    • 4
  • Jessica Donze Black
    • 2
  • Revonda B. Mosher
    • 3
  • Aziza T. Shad
    • 1
  • Kenneth P. Tercyak
    • 1
  1. 1.Georgetown University Medical Center, Lombardi Comprehensive Cancer CenterWashingtonUSA
  2. 2.The George Washington UniversityWashingtonUSA
  3. 3.Sinai Hospital of BaltimoreBaltimoreUSA
  4. 4.Department of Oncology, Division of Health Outcomes & Health BehaviorsGeorgetown University Medical CenterWashingtonUSA

Personalised recommendations