Strengthening cancer prevention in european schools: a randomized controlled trial of digital interventions in adolescents: the SUNRISE program

BACKGROUND: Cancer remains a leading cause of mortality worldwide, with a substantial proportion of cases attributable to modifiable lifestyle-related risk factors that emerge during adolescence and often persist into adulthood. Despite the importance of this developmental period for habit formation, evidence on scalable, theory-driven, and sustainable school-based prevention interventions remains limited. The SUNRISE project addresses this gap by evaluating a co-created, digitally supported life-skills programme designed for routine school settings. METHODS: SUNRISE is a pragmatic, multinational, cluster randomised controlled trial conducted in approximately 80 primary and secondary schools across eight European countries (Greece, Switzerland, Slovenia, Spain, Cyprus, Italy, Belgium, and Romania), recruiting around 4,000 students. Classes are randomised at the class level (3:1) to either a six-month digitally enhanced life-skills intervention or standard education. The primary aim of the study is to evaluate the feasibility, implementation, and sustainability of the intervention in real-world school settings, with secondary exploratory assessment of behavioural outcomes. The intervention integrates multiple digital components, including a mobile-based life-skills coaching programme, a conversational assistant, educational and serious games, influencer-led media literacy content, moderated social interaction platforms, and teacher-led educational modules. Intervention design is guided by the Capability-Opportunity-Motivation Behaviour (COM-B) model and developed through systematic co-creation with students, educators, parents, public health experts, and policymakers within a School Living Lab framework. Feasibility, implementation, and sustainability are evaluated using the RE-AIM and PRISM frameworks. Secondary behavioural outcomes include substance use, dietary and physical activity behaviours, mental well-being, stress, social skills, critical thinking towards media and advertising, and critical coping with food-related information, assessed at baseline, 6 months, and 18 months. DISCUSSION: SUNRISE integrates behavioural science, participatory design, and digital innovation to address adolescent health behaviours in real-world educational contexts. By embedding implementation and sustainability evaluation alongside behavioural outcomes, the study aims to generate actionable evidence on how multi-component digital interventions can be adopted, adapted, and maintained across diverse school systems. Findings are expected to inform future large-scale, theory-driven, equitable, and sustainable cancer prevention strategies targeting adolescents across Europe. TRIAL REGISTRATION: NCT06931847 (registration date: 2025-04-09).

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Journal
BMC Public Health
Published
2026-06-25
DOI
https://doi.org/10.1186/s12889-026-28185-4
Primary Topic
Behavioral Health and Interventions
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article
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article

Strengthening cancer prevention in european schools: a randomized controlled trial of digital interventions in adolescents: the SUNRISE program

Janire Orcajo, Eunate Arana‐Arri, Susana Meijide, Ana Molina‐Barceló et al.
BMC Public Health
Behavioral Health and Interventions
article

Strengthening cancer prevention in european schools: a randomized controlled trial of digital interventions in adolescents: the SUNRISE program

Janire Orcajo, Eunate Arana‐Arri, Susana Meijide, Ana Molina‐Barceló, David Bogataj, Dieneke Van de Sompel, Polonca Serrano, Alvaro Sánchez Pérez, Elisabetta Iannelli, Marta Llarena, Gloria Cea, Ana Roca‐Umbert, Maria Krini, Severin Haug, Liselot Hudders, Irene Mallo, Giuseppe Fico, Itziar Astigarraga, Kleio Koutra, Sofia Segkouli, Alba Gallego, Emma Beuckels, Maitane Barasoain, Anastasios Alexiadis, Katerina Micheli, Pavlos Koulouris, Andreas Triantafyllidis, Nikolai Kiselev, Davide De Persis, Marco Manso, Ainara Vélez-del-Burgo, Evaggelia Maniadi, Bárbara Guerra, Vassilis Kilintzis, Haridimos Kondylakis, Chiara Pilotti, Nick Dietrich, Iraklis Tsoupouroglou, Charalabos Georgiadis, María Fernanda Cabrera, Sofoklis Sotiriou, Dimitrios Spachos, Paula Romeo, Stefanie Verduyn, Emmanouil Tsiknakis, Niculina Nicoara, Nikos Laloumis, Nicolas Philippou, Stavri Xydia, Rachele Valentinotti, Eline De Keyzer, Theophano Pampaka, Alice Summa, Pelekidou Lina, Marisa Ferentinou, Steffi DeJans, Justine Van der Feen, Belen Manyogil, Aggeliki Spirou, Chrysoula Katsapi, Anja Inkret, Sotirios Kafetzopoulos, Panagiotis Bamidis, Laura Campo, Lucas Javier Segal, Theocharis Konstantinidis, Yvette Albert, Tania Schreiner, Erika Marulanda, Giorgos Mavromanolakis, Francisco Lupianez Villanueva, Jose Pires, Macarena de Bareño, Eduardo Buhid, Maria Panagopoulou, Konstantinos Votis, Rafaela Samara, Loes Neven, Delia Nicoara, Haizea Martín-Rodríguez, Dimitrios Tzovaras, Verónica Gómez-Sánchez, Kostas Marias, the SUNRISE Study Group, Teresa de Pablo Pardo, Jon Eneko Idoyaga-Uribbarrena, Mireia Gandia, Óscar García, Evangelos Markakis, Francesco De Lorenzo, Enrique Peiro Callizo, Konstantina Pityanou, Charikleia Tziraki, Nandu Goswami, Sofia Reppou, Mercedes Vanaclocha, Vassilis Liakopoulos, Evdoxia-Eirini Lithoxoidou, Hayley Pearce, Maria Manteli
article en

Abstract

BACKGROUND: Cancer remains a leading cause of mortality worldwide, with a substantial proportion of cases attributable to modifiable lifestyle-related risk factors that emerge during adolescence and often persist into adulthood. Despite the importance of this developmental period for habit formation, evidence on scalable, theory-driven, and sustainable school-based prevention interventions remains limited. The SUNRISE project addresses this gap by evaluating a co-created, digitally supported life-skills programme designed for routine school settings. METHODS: SUNRISE is a pragmatic, multinational, cluster randomised controlled trial conducted in approximately 80 primary and secondary schools across eight European countries (Greece, Switzerland, Slovenia, Spain, Cyprus, Italy, Belgium, and Romania), recruiting around 4,000 students. Classes are randomised at the class level (3:1) to either a six-month digitally enhanced life-skills intervention or standard education. The primary aim of the study is to evaluate the feasibility, implementation, and sustainability of the intervention in real-world school settings, with secondary exploratory assessment of behavioural outcomes. The intervention integrates multiple digital components, including a mobile-based life-skills coaching programme, a conversational assistant, educational and serious games, influencer-led media literacy content, moderated social interaction platforms, and teacher-led educational modules. Intervention design is guided by the Capability-Opportunity-Motivation Behaviour (COM-B) model and developed through systematic co-creation with students, educators, parents, public health experts, and policymakers within a School Living Lab framework. Feasibility, implementation, and sustainability are evaluated using the RE-AIM and PRISM frameworks. Secondary behavioural outcomes include substance use, dietary and physical activity behaviours, mental well-being, stress, social skills, critical thinking towards media and advertising, and critical coping with food-related information, assessed at baseline, 6 months, and 18 months. DISCUSSION: SUNRISE integrates behavioural science, participatory design, and digital innovation to address adolescent health behaviours in real-world educational contexts. By embedding implementation and sustainability evaluation alongside behavioural outcomes, the study aims to generate actionable evidence on how multi-component digital interventions can be adopted, adapted, and maintained across diverse school systems. Findings are expected to inform future large-scale, theory-driven, equitable, and sustainable cancer prevention strategies targeting adolescents across Europe. TRIAL REGISTRATION: NCT06931847 (registration date: 2025-04-09).

BMC Public Health
HOGENT University of Applied Sciences and Arts (BE), Tallinn University (EE), University of Zurich (CH), Aristotle University of Thessaloniki (GR), Mediterranean University (ME), Alma Mater Europaea (SI), Flemish Government (BE), Ghent University Hospital (BE), University of Mediterranean Karpasia (CY), Ghent University (BE), BioCruces Health research Institute (ES), Information Technologies Institute (GR), Addiction Switzerland (CH), Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (ES), Institute of Oncology Prof. Dr. Ion Chiricuta (RO), Fondazione FADOI (IT), Predict (France) (FR), FORTH Institute of Computer Science (GR), Osakidetza (ES), Swiss Re (Switzerland) (CH), Centre for Research and Technology Hellas (GR), Hospital de Cruces (ES)
Quality Education
Openalex Percentile: Top 6%
Behavioral Health and Interventions
DOIOpen Access PDFOpenAlex
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