<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03834974</url>
  </required_header>
  <id_info>
    <org_study_id>H19-033</org_study_id>
    <secondary_id>R21CA226133-01</secondary_id>
    <nct_id>NCT03834974</nct_id>
  </id_info>
  <brief_title>Social Media Indoor Tanning Study</brief_title>
  <official_title>Using a Narrative-Based Approach to Reducing Indoor Tanning</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Connecticut</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Cancer Institute (NCI)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Connecticut</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The purpose of this research is to develop a social media delivered intervention to reduce&#xD;
      unprotected sun exposure in young adults with a history of tanning.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      We will use social marketing theory and a user-centered design approach to develop a social&#xD;
      media intervention that engages young adults with a history of tanning to practice sun safety&#xD;
      behaviors. We will incentivize young adults who have a history of tanning to create social&#xD;
      media posts that encourage their peers to engage in sun safety. Focus groups of tanners&#xD;
      guided the development of the intervention. Investigators will conduct a pilot feasibility&#xD;
      trial where participants will be randomized to a condition in which they are incentivized to&#xD;
      create sun safety social media messages to be posted on a sun safety social media account or&#xD;
      a condition in which they are incentivized to create social media messages about how to use&#xD;
      technology to support healthy lifestyle behaviors to be posted on a health technology social&#xD;
      media account. The intervention will last 4 weeks. Feasibility outcomes include recruitment,&#xD;
      retention, acceptability, participation, social media message engagement (likes, comments,&#xD;
      shares), persuasive impact of messages, unprotected sun exposure, sun protection, and tanning&#xD;
      behavior. This work will inform a fully powered randomized trial testing the efficacy of this&#xD;
      intervention.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">June 6, 2020</start_date>
  <completion_date type="Actual">October 28, 2020</completion_date>
  <primary_completion_date type="Actual">October 28, 2020</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Prevention</primary_purpose>
    <masking>Single (Participant)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Recruitment</measure>
    <time_frame>Baseline</time_frame>
    <description>The number of completed respondents to recruitment ads, number of respondents eligible at initial screening, and number of respondents who completed baseline.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Retention</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>The % of participants in each condition who complete the follow-up assessment.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Acceptability</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>Number of participants who selected agree or strongly agree on 5-point Likert scale rating of how likely participants would be to recommend the intervention to a friend, and how likely they would be to participate again.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Participation</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>The number of posts created by participants</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Post Engagement</measure>
    <time_frame>4 weeks</time_frame>
    <description>The median number of likes, shares and retweets, and unique commenters each participant post received.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Desirability of Tanning</measure>
    <time_frame>Baseline</time_frame>
    <description>Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Desirability of Tanning</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Desirability of Tanning Alternatives</measure>
    <time_frame>Baseline</time_frame>
    <description>Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Desirability of Tanning Alternatives</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Persuasive Impact of Participant Messages</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>The mean of participants ratings for how persuasive they found each post (other than those they created) on a scale of 0-100, with higher scores indicating more persuasive.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Contamination</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>The number of participants who report they saw the opposite conditions Facebook or Twitter feeds.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Outdoor Tanning Intentions</measure>
    <time_frame>Baseline</time_frame>
    <description>Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Outdoor Tanning Intentions</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sun Exposure</measure>
    <time_frame>Baseline</time_frame>
    <description>How many hours the participant spent outside per week between the hours of 10am and 4pm.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sun Exposure</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>How many hours the participant spent outside per week between 10am and 4pm</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Outdoor Tanning</measure>
    <time_frame>Baseline</time_frame>
    <description>How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Outdoor Tanning</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sun Protection</measure>
    <time_frame>Baseline</time_frame>
    <description>Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sun Protection</measure>
    <time_frame>4-week follow-up</time_frame>
    <description>Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Indoor Tanning Behavior</measure>
    <time_frame>Baseline</time_frame>
    <description>Number of indoor tanning visits in the previous month</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Indoor Tanning Behavior</measure>
    <time_frame>4 weeks</time_frame>
    <description>Number of indoor tanning visits in the previous month</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sunburn</measure>
    <time_frame>baseline</time_frame>
    <description>Number of participants with 1 or more sunburns in the past month</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Sunburn</measure>
    <time_frame>4 weeks</time_frame>
    <description>Number of participants with 1 or more sunburns in the past month</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Outdoor Tanning Duration</measure>
    <time_frame>4 weeks</time_frame>
    <description>Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Outdoor Tanning Duration</measure>
    <time_frame>Baseline</time_frame>
    <description>Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">66</enrollment>
  <condition>Skin Cancer</condition>
  <arm_group>
    <arm_group_label>Sun Safety Social Media Challenge</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Digital Health Social Media Challenge</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Sun Safety Social Media Challenge</intervention_name>
    <description>Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
    <arm_group_label>Sun Safety Social Media Challenge</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Digital Health Social Media Challenge</intervention_name>
    <description>Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
    <arm_group_label>Digital Health Social Media Challenge</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Ages 18-30&#xD;
&#xD;
          -  Tanned indoors or outdoors at least once in the past year&#xD;
&#xD;
          -  Intends to tan indoors or outdoors this summer&#xD;
&#xD;
          -  Daily user of any social media platform&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  No smartphone&#xD;
&#xD;
          -  Does not use a social media platform daily&#xD;
&#xD;
          -  Lives in a state with an average temperature &lt;75 degrees in May&#xD;
&#xD;
          -  Inability to provide consent due to mental illness or a cognitive impairment&#xD;
&#xD;
          -  Non-English speaking&#xD;
&#xD;
          -  Prisoner&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>30 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Sherry L Pagoto, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Connecticut</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University of Connecticut</name>
      <address>
        <city>Storrs</city>
        <state>Connecticut</state>
        <zip>06269</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <verification_date>December 2021</verification_date>
  <study_first_submitted>February 7, 2019</study_first_submitted>
  <study_first_submitted_qc>February 7, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">February 8, 2019</study_first_posted>
  <results_first_submitted>October 27, 2021</results_first_submitted>
  <results_first_submitted_qc>December 2, 2021</results_first_submitted_qc>
  <results_first_posted type="Actual">January 3, 2022</results_first_posted>
  <last_update_submitted>December 2, 2021</last_update_submitted>
  <last_update_submitted_qc>December 2, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">January 3, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University of Connecticut</investigator_affiliation>
    <investigator_full_name>Sherry Pagoto</investigator_full_name>
    <investigator_title>Professor</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Skin Neoplasms</mesh_term>
  </condition_browse>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>July 21, 2020</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/74/NCT03834974/Prot_000.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Statistical Analysis Plan</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>October 25, 2021</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/74/NCT03834974/SAP_001.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Informed Consent Form</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>July 21, 2020</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/74/NCT03834974/ICF_002.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <group_list>
        <group group_id="P1">
          <title>Sun Safety Social Media Challenge</title>
          <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
        </group>
        <group group_id="P2">
          <title>Digital Health Social Media Challenge</title>
          <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="34"/>
                <participants group_id="P2" count="32"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="34"/>
                <participants group_id="P2" count="32"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Sun Safety Social Media Challenge</title>
          <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
        </group>
        <group group_id="B2">
          <title>Digital Health Social Media Challenge</title>
          <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
        </group>
        <group group_id="B3">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="34"/>
            <count group_id="B2" value="32"/>
            <count group_id="B3" value="66"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="24.0" lower_limit="20.0" upper_limit="28.0"/>
                    <measurement group_id="B2" value="23.5" lower_limit="20.5" upper_limit="27.5"/>
                    <measurement group_id="B3" value="24.0" lower_limit="20.0" upper_limit="28.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex/Gender, Customized</title>
          <description>Number of participants belonging to each gender</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <title>Gender</title>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="28"/>
                    <measurement group_id="B2" value="27"/>
                    <measurement group_id="B3" value="55"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                    <measurement group_id="B2" value="5"/>
                    <measurement group_id="B3" value="10"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Non-Binary/Third Gender</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race/Ethnicity, Customized</title>
          <description>Number of participants belonging to each race/ethnicity</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <title>Race/ethnicity</title>
              <category_list>
                <category>
                  <title>Non-Hispanic White</title>
                  <measurement_list>
                    <measurement group_id="B1" value="18"/>
                    <measurement group_id="B2" value="17"/>
                    <measurement group_id="B3" value="35"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Non-Hispanic Black/African American</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="1"/>
                    <measurement group_id="B3" value="2"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Hispanic/Latino of any race</title>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                    <measurement group_id="B2" value="7"/>
                    <measurement group_id="B3" value="12"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Non-Hispanic Asian</title>
                  <measurement_list>
                    <measurement group_id="B1" value="9"/>
                    <measurement group_id="B2" value="3"/>
                    <measurement group_id="B3" value="12"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Native Hawaiian or Other Pacific Islander, Native, Other, and Multiracial (Non-Hispanic)</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="4"/>
                    <measurement group_id="B3" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Recruitment</title>
        <description>The number of completed respondents to recruitment ads, number of respondents eligible at initial screening, and number of respondents who completed baseline.</description>
        <time_frame>Baseline</time_frame>
        <population>All prospective participants</population>
        <group_list>
          <group group_id="O1">
            <title>Prospective Participants</title>
            <description>All prospective participants</description>
          </group>
        </group_list>
        <measure>
          <title>Recruitment</title>
          <description>The number of completed respondents to recruitment ads, number of respondents eligible at initial screening, and number of respondents who completed baseline.</description>
          <population>All prospective participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="549"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Number of completed respondents to recruitment ads</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="549"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Number of respondents eligible at initial screening</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="79"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Number of respondents who completed baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="66"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Retention</title>
        <description>The % of participants in each condition who complete the follow-up assessment.</description>
        <time_frame>4-week follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Retention</title>
          <description>The % of participants in each condition who complete the follow-up assessment.</description>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="34"/>
                    <measurement group_id="O2" value="32"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Acceptability</title>
        <description>Number of participants who selected agree or strongly agree on 5-point Likert scale rating of how likely participants would be to recommend the intervention to a friend, and how likely they would be to participate again.</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Acceptability</title>
          <description>Number of participants who selected agree or strongly agree on 5-point Likert scale rating of how likely participants would be to recommend the intervention to a friend, and how likely they would be to participate again.</description>
          <population>Randomized participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>I would participate in this study competition on this health topic again.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="31"/>
                    <measurement group_id="O2" value="29"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>I would recommend this study competition to a friend.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="32"/>
                    <measurement group_id="O2" value="31"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Participation</title>
        <description>The number of posts created by participants</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Participation</title>
          <description>The number of posts created by participants</description>
          <population>Randomized participants</population>
          <units>number of posts</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="148"/>
                    <measurement group_id="O2" value="129"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Post Engagement</title>
        <description>The median number of likes, shares and retweets, and unique commenters each participant post received.</description>
        <time_frame>4 weeks</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Post Engagement</title>
          <description>The median number of likes, shares and retweets, and unique commenters each participant post received.</description>
          <population>Randomized participants</population>
          <units>Engagement</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <units_analyzed>Posts</units_analyzed>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
            <analyzed>
              <units>Posts</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="148"/>
                <count group_id="O2" value="129"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Twitter Likes and Facebook Reactions</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4" lower_limit="2" upper_limit="8"/>
                    <measurement group_id="O2" value="2" lower_limit="1" upper_limit="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Twitter Retweets and Facebook Shares</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2" lower_limit="1" upper_limit="5"/>
                    <measurement group_id="O2" value="0" lower_limit="0" upper_limit="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Unique Commenters on Facebook and Twitter</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" lower_limit="0" upper_limit="2"/>
                    <measurement group_id="O2" value="0" lower_limit="0" upper_limit="2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Desirability of Tanning</title>
        <description>Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Desirability of Tanning</title>
          <description>Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.</description>
          <population>Randomized participants</population>
          <units>score on a scale</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="11" lower_limit="9" upper_limit="12"/>
                    <measurement group_id="O2" value="11" lower_limit="9" upper_limit="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Desirability of Tanning</title>
        <description>Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Desirability of Tanning</title>
          <description>Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.</description>
          <population>Randomized participants</population>
          <units>score on a scale</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="10" lower_limit="9" upper_limit="12"/>
                    <measurement group_id="O2" value="10.5" lower_limit="9" upper_limit="12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Desirability of Tanning Alternatives</title>
        <description>Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Desirability of Tanning Alternatives</title>
          <description>Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.</description>
          <population>Randomized participants</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.0" spread="1.2"/>
                    <measurement group_id="O2" value="3.5" spread="1.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Desirability of Tanning Alternatives</title>
        <description>Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Desirability of Tanning Alternatives</title>
          <description>Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.</description>
          <population>Randomized participants</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.8" spread="1.1"/>
                    <measurement group_id="O2" value="3.5" spread="1.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Persuasive Impact of Participant Messages</title>
        <description>The mean of participants ratings for how persuasive they found each post (other than those they created) on a scale of 0-100, with higher scores indicating more persuasive.</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Persuasive Impact of Participant Messages</title>
          <description>The mean of participants ratings for how persuasive they found each post (other than those they created) on a scale of 0-100, with higher scores indicating more persuasive.</description>
          <population>Randomized participants</population>
          <units>score on a sliding scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <units_analyzed>Posts</units_analyzed>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
            <analyzed>
              <units>Posts</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="148"/>
                <count group_id="O2" value="129"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="62.2" spread="13.3"/>
                    <measurement group_id="O2" value="62.5" spread="14.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Contamination</title>
        <description>The number of participants who report they saw the opposite conditions Facebook or Twitter feeds.</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Contamination</title>
          <description>The number of participants who report they saw the opposite conditions Facebook or Twitter feeds.</description>
          <population>Randomized participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7"/>
                    <measurement group_id="O2" value="10"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Outdoor Tanning Intentions</title>
        <description>Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Outdoor Tanning Intentions</title>
          <description>Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).</description>
          <population>Randomized participants</population>
          <units>score on a scale</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Tan outside in the sun sometime later in my life.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.0" lower_limit="4.0" upper_limit="6.0"/>
                    <measurement group_id="O2" value="6.0" lower_limit="5.0" upper_limit="6.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Tan outside in the sun more than 10 times in the next year.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.0" lower_limit="3.0" upper_limit="6.0"/>
                    <measurement group_id="O2" value="6.0" lower_limit="3.0" upper_limit="6.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Quit tanning outside in the next year.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.0" lower_limit="0.0" upper_limit="2.0"/>
                    <measurement group_id="O2" value="0.0" lower_limit="0.0" upper_limit="1.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Outdoor Tanning Intentions</title>
        <description>Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Outdoor Tanning Intentions</title>
          <description>Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).</description>
          <population>Randomized participants</population>
          <units>score on a scale</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Tan outside in the sun sometime later in my life.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.0" lower_limit="3.0" upper_limit="6.0"/>
                    <measurement group_id="O2" value="6.0" lower_limit="5.0" upper_limit="6.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Tan outside in the sun more than 10 times in the next year.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.0" lower_limit="1.0" upper_limit="4.0"/>
                    <measurement group_id="O2" value="5.0" lower_limit="3.0" upper_limit="6.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Quite tanning outside in the next year.</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.0" lower_limit="0.0" upper_limit="2.0"/>
                    <measurement group_id="O2" value="0.0" lower_limit="0.0" upper_limit="2.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Null hypothesis: There would be no difference in change in intent to tan outdoors 10 or more times in the next year.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>&lt;0.0286</p_value>
            <method>Wilcoxon (Mann-Whitney)</method>
          </analysis>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Null hypothesis: There would be no difference in change in in intent to tan later in life.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>0.0937</p_value>
            <method>Wilcoxon (Mann-Whitney)</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sun Exposure</title>
        <description>How many hours the participant spent outside per week between the hours of 10am and 4pm.</description>
        <time_frame>Baseline</time_frame>
        <population>all randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Sun Exposure</title>
          <description>How many hours the participant spent outside per week between the hours of 10am and 4pm.</description>
          <population>all randomized participants</population>
          <units>hours per week</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="16.1" spread="10.4"/>
                    <measurement group_id="O2" value="15.6" spread="7.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sun Exposure</title>
        <description>How many hours the participant spent outside per week between 10am and 4pm</description>
        <time_frame>4-week follow-up</time_frame>
        <population>all randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Sun Exposure</title>
          <description>How many hours the participant spent outside per week between 10am and 4pm</description>
          <population>all randomized participants</population>
          <units>hours per week</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="11.4" spread="5.9"/>
                    <measurement group_id="O2" value="13.2" spread="8.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Outdoor Tanning</title>
        <description>How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Outdoor Tanning</title>
          <description>How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.</description>
          <population>Randomized participants</population>
          <units>outdoor tanning sessions</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.0" lower_limit="0.0" upper_limit="8.0"/>
                    <measurement group_id="O2" value="5.0" lower_limit="2.0" upper_limit="10.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Outdoor Tanning</title>
        <description>How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Outdoor Tanning</title>
          <description>How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.</description>
          <population>Randomized participants</population>
          <units>outdoor tanning sessions</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.0" lower_limit="0.0" upper_limit="1.0"/>
                    <measurement group_id="O2" value="2.0" lower_limit="0.5" upper_limit="5.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Null hypothesis: There would be no difference in tanning outside at follow-up</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>&lt;0.0002</p_value>
            <method>Wilcoxon (Mann-Whitney)</method>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sun Protection</title>
        <description>Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Sun Protection</title>
          <description>Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month</description>
          <population>Randomized participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>How often did you wear sunscreen?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="18"/>
                    <measurement group_id="O2" value="16"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you wear a shirt with sleeves that covered your shoulders?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15"/>
                    <measurement group_id="O2" value="9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you wear a hat?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8"/>
                    <measurement group_id="O2" value="2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you stay in the shade or under an umbrella?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3"/>
                    <measurement group_id="O2" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you wear sunglasses?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="19"/>
                    <measurement group_id="O2" value="21"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sun Protection</title>
        <description>Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month</description>
        <time_frame>4-week follow-up</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Sun Protection</title>
          <description>Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month</description>
          <population>Randomized participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>How often did you wear sunscreen?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="19"/>
                    <measurement group_id="O2" value="16"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you wear a shirt with sleeves that covered your shoulders?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="20"/>
                    <measurement group_id="O2" value="14"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you wear a hat?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6"/>
                    <measurement group_id="O2" value="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you stay in the shade or under an umbrella?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12"/>
                    <measurement group_id="O2" value="5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>How often did you wear sunglasses?</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="18"/>
                    <measurement group_id="O2" value="22"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Indoor Tanning Behavior</title>
        <description>Number of indoor tanning visits in the previous month</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Indoor Tanning Behavior</title>
          <description>Number of indoor tanning visits in the previous month</description>
          <population>Randomized participants</population>
          <units>indoor tanning sessions</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.0" lower_limit="0.0" upper_limit="0.0"/>
                    <measurement group_id="O2" value="0.0" lower_limit="0.0" upper_limit="1.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Indoor Tanning Behavior</title>
        <description>Number of indoor tanning visits in the previous month</description>
        <time_frame>4 weeks</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Indoor Tanning Behavior</title>
          <description>Number of indoor tanning visits in the previous month</description>
          <population>Randomized participants</population>
          <units>indoor tanning sessions</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.0" lower_limit="0.0" upper_limit="0.0"/>
                    <measurement group_id="O2" value="0.0" lower_limit="0.0" upper_limit="0.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sunburn</title>
        <description>Number of participants with 1 or more sunburns in the past month</description>
        <time_frame>baseline</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Sunburn</title>
          <description>Number of participants with 1 or more sunburns in the past month</description>
          <population>Randomized participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15"/>
                    <measurement group_id="O2" value="13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Sunburn</title>
        <description>Number of participants with 1 or more sunburns in the past month</description>
        <time_frame>4 weeks</time_frame>
        <population>Randomized participants</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Sunburn</title>
          <description>Number of participants with 1 or more sunburns in the past month</description>
          <population>Randomized participants</population>
          <units>Participants</units>
          <param>Count of Participants</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="34"/>
                <count group_id="O2" value="32"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5"/>
                    <measurement group_id="O2" value="2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Outdoor Tanning Duration</title>
        <description>Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.</description>
        <time_frame>4 weeks</time_frame>
        <population>Randomized participants who reported tanning one or more times in the past 4 weeks</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Outdoor Tanning Duration</title>
          <description>Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.</description>
          <population>Randomized participants who reported tanning one or more times in the past 4 weeks</population>
          <units>minutes</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="10"/>
                <count group_id="O2" value="24"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="45.0" lower_limit="25.0" upper_limit="120.0"/>
                    <measurement group_id="O2" value="60.0" lower_limit="30.0" upper_limit="72.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Outdoor Tanning Duration</title>
        <description>Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.</description>
        <time_frame>Baseline</time_frame>
        <population>Randomized participants who reported tanning one or more times in the past 4 weeks</population>
        <group_list>
          <group group_id="O1">
            <title>Sun Safety Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
          <group group_id="O2">
            <title>Digital Health Social Media Challenge</title>
            <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
          </group>
        </group_list>
        <measure>
          <title>Outdoor Tanning Duration</title>
          <description>Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.</description>
          <population>Randomized participants who reported tanning one or more times in the past 4 weeks</population>
          <units>minutes</units>
          <param>Median</param>
          <dispersion>Inter-Quartile Range</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="24"/>
                <count group_id="O2" value="25"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="60.0" lower_limit="42.5" upper_limit="105.0"/>
                    <measurement group_id="O2" value="60.0" lower_limit="45.0" upper_limit="120.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>4 weeks</time_frame>
      <group_list>
        <group group_id="E1">
          <title>Sun Safety Social Media Challenge</title>
          <description>During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.&#xD;
Sun Safety Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
        </group>
        <group group_id="E2">
          <title>Digital Health Social Media Challenge</title>
          <description>During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.&#xD;
Digital Health Social Media Challenge: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="34"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="32"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="34"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="32"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="34"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="32"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>Principal Investigators are NOT employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <point_of_contact>
      <name_or_title>Dr. Sherry Pagoto</name_or_title>
      <organization>University of Connecticut</organization>
      <phone>860-486-8979</phone>
      <email>sherry.pagoto@uconn.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03834974
org study id: H19-033
secondary id: R21CA226133-01
nct id: NCT03834974
lead sponsor: 
collaborator: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
The purpose of this research is to develop a social media delivered intervention to reduce
      unprotected sun exposure in young adults with a history of tanning.
We will use social marketing theory and a user-centered design approach to develop a social
      media intervention that engages young adults with a history of tanning to practice sun safety
      behaviors. We will incentivize young adults who have a history of tanning to create social
      media posts that encourage their peers to engage in sun safety. Focus groups of tanners
      guided the development of the intervention. Investigators will conduct a pilot feasibility
      trial where participants will be randomized to a condition in which they are incentivized to
      create sun safety social media messages to be posted on a sun safety social media account or
      a condition in which they are incentivized to create social media messages about how to use
      technology to support healthy lifestyle behaviors to be posted on a health technology social
      media account. The intervention will last 4 weeks. Feasibility outcomes include recruitment,
      retention, acceptability, participation, social media message engagement (likes, comments,
      shares), persuasive impact of messages, unprotected sun exposure, sun protection, and tanning
      behavior. This work will inform a fully powered randomized trial testing the efficacy of this
      intervention.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Prevention
masking: Single (Participant)
measure: Recruitment
time frame: Baseline
description: The number of completed respondents to recruitment ads, number of respondents eligible at initial screening, and number of respondents who completed baseline.
measure: Retention
time frame: 4-week follow-up
description: The % of participants in each condition who complete the follow-up assessment.
measure: Acceptability
time frame: 4-week follow-up
description: Number of participants who selected agree or strongly agree on 5-point Likert scale rating of how likely participants would be to recommend the intervention to a friend, and how likely they would be to participate again.
measure: Participation
time frame: 4-week follow-up
description: The number of posts created by participants
measure: Post Engagement
time frame: 4 weeks
description: The median number of likes, shares and retweets, and unique commenters each participant post received.
measure: Desirability of Tanning
time frame: Baseline
description: Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.
measure: Desirability of Tanning
time frame: 4-week follow-up
description: Scale measuring participants' belief that a tan is attractive. Scale ranges from 0-12 with higher scores indicating higher levels of belief that a tan is attractive.
measure: Desirability of Tanning Alternatives
time frame: Baseline
description: Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.
measure: Desirability of Tanning Alternatives
time frame: 4-week follow-up
description: Average score on items relating to tanning alternative desirability. Scale ranges from 1 to 5, with higher scores indicating more positive attitudes towards tanning alternatives.
measure: Persuasive Impact of Participant Messages
time frame: 4-week follow-up
description: The mean of participants ratings for how persuasive they found each post (other than those they created) on a scale of 0-100, with higher scores indicating more persuasive.
measure: Contamination
time frame: 4-week follow-up
description: The number of participants who report they saw the opposite conditions Facebook or Twitter feeds.
measure: Outdoor Tanning Intentions
time frame: Baseline
description: Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).
measure: Outdoor Tanning Intentions
time frame: 4-week follow-up
description: Three items assessed intentions to tan even once, intentions to tan regularly in the next year, and intentions to quit on a 7-point scale (0=definitely will not, 6=definitely will).
measure: Sun Exposure
time frame: Baseline
description: How many hours the participant spent outside per week between the hours of 10am and 4pm.
measure: Sun Exposure
time frame: 4-week follow-up
description: How many hours the participant spent outside per week between 10am and 4pm
measure: Outdoor Tanning
time frame: Baseline
description: How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.
measure: Outdoor Tanning
time frame: 4-week follow-up
description: How many times in the last 4 weeks the participant went outside for the purpose of tanning in the sun.
measure: Sun Protection
time frame: Baseline
description: Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month
measure: Sun Protection
time frame: 4-week follow-up
description: Number of participants who reported using sun protection (sunscreen, protective clothing) often or always in the past month
measure: Indoor Tanning Behavior
time frame: Baseline
description: Number of indoor tanning visits in the previous month
measure: Indoor Tanning Behavior
time frame: 4 weeks
description: Number of indoor tanning visits in the previous month
measure: Sunburn
time frame: baseline
description: Number of participants with 1 or more sunburns in the past month
measure: Sunburn
time frame: 4 weeks
description: Number of participants with 1 or more sunburns in the past month
measure: Outdoor Tanning Duration
time frame: 4 weeks
description: Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.
measure: Outdoor Tanning Duration
time frame: Baseline
description: Median reported average number of minutes tanned per episode in the past 4 weeks, among participants who tanned in the past 4 weeks.
arm group label: Sun Safety Social Media Challenge
arm group type: Experimental
description: During this 4-week intervention, participants will be incentivized to create sun safety social media messages that will be distributed on our sun safety Twitter and Facebook feeds.
arm group label: Digital Health Social Media Challenge
arm group type: Active Comparator
description: During this 4-week intervention, participants will be incentivized to create posts that promote the use of technology to engage in healthy lifestyle behaviors (diet, exercise) on our digital health Twitter and Facebook feeds.
intervention type: Behavioral
intervention name: Sun Safety Social Media Challenge
description: Participants will attend a webinar to learn how to create effective social media posts about sun safety and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should include a sun safety message (e.g., promoting sunscreen use and protective clothing/hats or discouraging risk behaviors like tanning and burning). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.
arm group label: Sun Safety Social Media Challenge
intervention type: Behavioral
intervention name: Digital Health Social Media Challenge
description: Participants will attend a webinar to learn how to create effective social media posts about using technology to get healthy and be oriented to the social media accounts on which the messages will be posted. They will be informed that posts should mention some way that technology (e.g., mobile apps, wearables) can be used to promote a healthy habit (e.g., diet, exercise). They will be encouraged to be creative so that the message gets likes and shares. Participants will be encouraged to follow the feeds to see the engagement on their posts, to share the posts in their feed, and to see other participants' posts. Participants will receive a $10 Amazon gift card per post for a maximum of 6 posts ($60). The participant who created the post that receives the most likes, comments, and shares each week will win a $50 Amazon gift card.
arm group label: Digital Health Social Media Challenge
criteria: 
gender: All
minimum age: 18 Years
maximum age: 30 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Sherry L Pagoto, PhD
role: Principal Investigator
affiliation: University of Connecticut
facility: 
country: United States
responsible party type: Principal Investigator
investigator affiliation: University of Connecticut
investigator full name: Sherry Pagoto
investigator title: Professor
mesh term: Skin Neoplasms
provided document: 
provided document: 
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
point of contact: 