Digital Skin Cancer Risk Reduction Interventions for Young Adults: Findings from a Hybrid Type-II Effectiveness-Implementation Trial.

Background: Engagement in sun protection behaviors is low among young adults (YA, ages 18-25 years). Efficacious sun safety interventions for this at-risk population and information on intervention engagement and costs are needed. The purpose was to conduct secondary analyses examining intervention implementation strategies and outcomes (e.g., engagement), intervention moderators, and costs of three digital interventions to increase sun protection behaviors previously evaluated for effectiveness in a randomized controlled trial (RCT).

Methods: The RCT compared three conditions: a Basic efficacious intervention, an Enhanced version of the intervention, and an educational e-Pamphlet. Sun protection measures, intervention engagement and implementation, putative moderators, and intervention costs were assessed through one year.

Results: Engagement (4.6 of 12 modules completed) was similar for Basic and Enhanced. Engagement was significantly associated with sun protection. Men and individuals with lower tanning ability completed more modules than women and those with higher tanning ability. Enhanced was more effective than Basic for men (but not women) through one year. After initial development, both active interventions were similar in cost per person at larger sample sizes.

Conclusions: Despite attempts at enhancement, engagement in Basic and Enhanced was similar. Although all interventions were costly to create, they were less costly to maintain and could be scaled up for dissemination. Based on both engagement and effects on sun protection, the Enhanced intervention would be recommended for men, women, or both.

Impact: This digital intervention offers the potential to reduce skin cancer risk in a large population of US YAs.