FLARE intervention improves child sun protection but not sunburns, study finds

A 4-week family-based telehealth intervention successfully improved sun-protective behaviors in children of melanoma survivors but failed to reduce actual sunburns over time, according to a study published on October 7 in JAMA Dermatology. Led by Yelena P. Wu, PhD, at the Huntsman Cancer Institute at the University of Utah in Salt Lake City, the research tested whether structured remote counseling could lower skin cancer risks in vulnerable pediatric populations.

Testing Family Telehealth on 364 Survivor-Child Pairs

Researchers randomly assigned 364 melanoma survivor-child pairs to either the family-based behavioral intervention, known as FLARE, or a control group that received standard skin cancer education. Participating children were aged 8 to 17 years, with a mean age of 12.9 years, and 51.9% were girls. Every participating child had experienced at least one sunburn in the previous year. The melanoma survivors had a mean age of 45.1 years, with 62.6% women and 97.3% non-Hispanic White.

Both groups completed a 4-week telehealth program. The FLARE intervention focused on familial risk education, structured problem-solving, and personalized family sun-protection plans. Meanwhile, the control group accessed reliable skin cancer information online. Investigators tracked sunburn occurrence at weeks 4 and 8 after the final session as the primary outcome, while monitoring sun-protection behaviors and tanning as secondary outcomes.

Behavioral Gains Without Sunburn Reductions

Children in the FLARE group reported 0.17 fewer sunburns at week 4, but the program did not reduce sunburns more than standard education across the entire study period. Overall sun-protective behaviors, however, improved more in the FLARE group than in standard education by week 8. These gains covered hat use, sunglasses use, shade seeking, avoidance of peak ultraviolet radiation, sunscreen use, and sunscreen reapplication. Among those actions, avoidance of peak ultraviolet radiation was the only significant change observed over time.

Neither intentional nor unintentional tanning was significantly affected by FLARE, though both forms of tanning were uncommon at baseline. In both study arms, the proportion of children reporting zero sunburns in the previous month increased, rising by 24.0% in the FLARE group and 17.6% in the control condition.

FLARE did not significantly reduce child sunburn over time beyond an active educational intervention, despite improving child sun-protective behaviors.

Study authors

The authors noted that these findings suggest family-based behavioral interventions can successfully alter preventive habits, but additional strategies are likely necessary for those behavioral improvements to translate into sustained sunburn reductions among children at elevated familial risk of melanoma. Study limitations included participant recruitment from a single geographic area and a population characterized by generally high socioeconomic status, alongside self-reported outcomes and a low overall number of sunburn events.