FLARE Intervention Improves Sun Protection in Children

Key Takeaways

• Among children of melanoma survivors with a prior-year sunburn, telehealth-delivered FLARE did not significantly change the primary sunburn trajectory relative to active education.
• Child-reported sunburn was significantly lower with FLARE at the first postintervention assessment.
• Child sun-protective behavior improved significantly more with FLARE through the second postintervention assessment.
• Intentional and unintentional tanning did not differ significantly between the educational groups.

Preventable sunburn is a concern for children whose parents have survived melanoma, particularly when sun protection is inconsistent. A recent study explored whether remote education tailored to familial melanoma risk offers an advantage over general skin cancer education delivered by telehealth.

Investigators randomized 364 melanoma survivor–child dyads in this parallel-group trial. Eligible parents had a confirmed melanoma diagnosis, and their children were aged 8 to 17 years and had experienced a sunburn during the preceding year. Recruitment drew on a cancer registry and statewide and clinical databases.

Both groups received four weeks of telehealth education: family, lifestyles, actions, and risk education (FLARE) covered familial melanoma risk and child sun-protection skills, while the active control covered general skin cancer education and identifying reputable health information. The intention-to-treat analysis included all randomized dyads. The primary outcome was change in child sunburn occurrence from baseline through two postintervention assessments; secondary outcomes included child sun-protective behaviors and tanning.

The primary intention-to-treat analysis found no significant between-group difference in the rate of child sunburn change from baseline across the postintervention assessments. At the first postintervention assessment, however, child-reported sunburn was lower with FLARE than with active education (B = −0.17; 95% confidence interval [CI], −0.30 to −0.04; P = .01).

Child sun-protective behaviors increased more with FLARE than with active education from baseline through the second postintervention assessment (B = 0.26; 95% CI, 0.14 to 0.38; P < .001). Intentional and unintentional tanning did not differ significantly between groups; both were infrequently reported at baseline.

The first-assessment difference in child-reported sunburn does not establish a significant FLARE effect on the primary change-over-time outcome. The reported postintervention assessments do not establish whether any reduction persisted over a longer period. Sunburn, protective behavior, and tanning are prevention-related outcomes, not measures of melanoma incidence.

Investigators concluded that FLARE improved child sun-protective behavior and was associated with lower child-reported sunburn at the first assessment, but did not reduce sunburn over time relative to active education. They suggested that additional approaches may be needed for sustained sunburn reduction.

Clinician Questions

How much higher is lifetime melanoma risk in children of melanoma survivors?

Children of melanoma survivors have a twofold increased lifetime melanoma risk.

Does the FLARE sunburn regression coefficient represent a percentage-point reduction in children’s sunburns?

No. The FLARE-versus-active-education coefficient for child-reported sunburn at the first postintervention assessment among children of melanoma survivors is a regression estimate. Without the outcome coding, it cannot be interpreted as a percentage-point or absolute-risk difference.