An online skin cancer risk-reduction intervention for young adults: mechanisms of effects

Carolyn J. Heckman, Elizabeth A. Handorf, Susan D. Darlow, Lee M. Ritterband, Sharon L. Manne

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: The study's purpose was to investigate moderator, implementation, and mediator variables related to the efficacy of, an Internet intervention that decreased ultraviolet radiation (UV) exposure and increased skin protection behaviors among young adults. Method: A total of 965 18-25 year olds at risk for skin cancer were recruited nationally online. Participants were randomized to an experimental website (, a control website, or assessment only. Participant characteristics (moderators), engagement with and perceptions of interventions (implementation measures), and exposure and protection attitudinal variables (mediators) were assessed. Linear regression and mediation analyses were conducted. Results: Intervention effects on skin protection were greater for participants with a family history of skin cancer (p = .01). Intervention effects on UV exposure were greater among recent indoor tanners (p = .04). Improvements in skin protection (but not UV exposure) were associated with perceiving the interventions as satisfying or helpful (ps < .01). The experimental group had better outcomes if they completed more modules (ps < .01) or set more behavioral goals (ps < .01). Knowledge and exposure decisional balance mediated intervention effects for UV exposure (ps < .05), and protection decisional balance, self-efficacy, and intentions mediated intervention effects for protection (ps < .05). Conclusions: The experimental intervention was more efficacious for certain high risk groups. The more individuals liked and engaged with the interventions (e.g., by setting goals), the better their outcomes. Mediation results inform theory about change mechanisms and differed by behavioral outcome.

Original languageEnglish (US)
Pages (from-to)215-225
Number of pages11
JournalHealth Psychology
Issue number3
StatePublished - Mar 1 2017

All Science Journal Classification (ASJC) codes

  • Applied Psychology
  • Psychiatry and Mental health


  • Intervention mechanisms
  • Online intervention
  • Skin cancer prevention
  • Young adults


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