Skin cancer is a major public health problem with a major avoidable causative factor (solar ultraviolet radiation) and substantial potential for minimization of morbidity and mortality by early detection. Individuals can minimize exposure to solar ultraviolet by simple behavior changes but many do not, and primary care physicians can play an effective role in counseling and screening patients for skin cancer, but also typically do not. This project will develop, implement, and evaluate in a randomize controlled trial an innovative multicomponent educational intervention initiated in a high exposure setting (among sun bathers at the beach) and followed by a personalized expert system intervention delivered by mail (the """"""""beach/expert"""""""" component). This project will also develop, implement, and evaluate, in a controlled trial, an educational intervention for primary care physicians to increase their awareness and knowledge about skin cancer and their skills in counseling about and screening for skin cancer (the """"""""physician"""""""" component). Both components are based on the transtheoretical (""""""""stage of change"""""""") model of behavior change. The intervention package delivered at the beach includes elements appropriate to each stage. The expert system is an individualized stage-specific intervention. The physician component will include training in stage-appropriate counseling of patients as well as in early detection skills. Ultimately, the beach/expert component seeks to demonstrate the potential effectiveness of beach-based intervention programs for future use in the high risk beach-going population, and in the broader context of community-based, public health interventions; and to better define the processes and determinants leading to behavior change for sun exposure, with consequent generalization of the transtheoretical model of behavior change for cancer prevention. We also seek to demonstrate how a stage-based approach may be integrated with comprehensive educational programs developed to enhanced the effectiveness of physician-based cancer prevention. The overall project is designed to be disseminable so that the results obtained may be used in public health efforts to decrease the incidence, morbidity, and mortality from skin cancer.
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