Are Interventions to Promote Sun-Protective Behaviors in Recreational and Tourist Settings Effective? A Systematic Review with Meta-analysis and Moderator Analysis
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Intermittent sun exposure and sunburn are risk factors for skin cancer that mostly occur in recreational/tourist settings. This review assesses the efficacy of skin cancer prevention interventions designed to promote sun-protective behaviors in recreational/tourist settings.
Systematic review with meta-analyses of controlled trials with outcome measures of sun-protective behaviors and/or sunburn published until January 2011.
Twenty-three studies were included. We found no evidence for the efficacy of current interventions in reducing tanning or promoting protective clothing and seeking shade. Meta-analyses show a small heterogeneous effect for interventions on sun-protective behavior indices. Larger but heterogeneous effects were observed for self-reported sun exposure and sunburns. Modest methodological quality suggests risk of bias. Effective interventions were more likely to stimulate social norms supporting sun-protective behaviors and provide appearance-based information about photoaging illustrated with ultraviolet photographs.
There is weak and inconclusive evidence for the efficacy of interventions in promoting sun-protective behaviors.
- Lens, MB, Dawes, M (2004) Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma. Br J Dermatol 150: pp. 179-185 CrossRef
- United States Cancer Statistics: 1999–2007 Incidence and mortality web-based report. [Internet]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. 2010. Available from: http://apps.nccd.cdc.gov/uscs/.
- American Cancer Society. Skin cancer—melanoma [Web page]. American Cancer Society; 2011 [updated 28 April 201130 April 2011]. Available from: http://www.cancer.org/cancer/skincancer-melanoma/index.
- Gandini, S, Sera, F, Cattaruzza, MS, Pasquini, P, Picconi, O, Boyle, P (2005) Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 41: pp. 45-60 CrossRef
- Kricker, A, Armstrong, BK, English, DR (1994) Sun exposure and non-melanocytic skin cancer. Cancer Causes Control 5: pp. 367-392 CrossRef
- Kricker, A, Armstrong, BK, English, DR, Heenan, PJ (1995) Does intermittent sun exposure cause basal cell carcinoma? A case–control study in Western Australia. Int J Cancer 60: pp. 489-494 CrossRef
- Armstrong, BK, Kricker, A (2001) The epidemiology of UV induced skin cancer. J Photochem Photobiol B Biol 63: pp. 8-18 CrossRef
- Diffey, BL, Norridge, Z (2009) Reported sun exposure, attitudes to sun protection and perceptions of skin cancer risk: A survey of visitors to Cancer Research UK’s SunSmart campaign website. Br J Dermatol 160: pp. 1292-1298 CrossRef
- Manning, DL, Quigley, P (2002) Sunbathing intentions in Irish people travelling to Mediterranean summer holiday destinations. Eur J Cancer Prev 11: pp. 159-163 CrossRef
- Agredano, YZ, Chan, JL, Kimball, RC, Kimball, AB (2006) Accessibility to air travel correlates strongly with increasing melanoma incidence. Melanoma Res 16: pp. 77-81 CrossRef
- Cancer Research UK. Advice for tour operators [web page]. Cancer Research UK; 2011 [updated 25 September 2009; cited 2011 28 April 2011]. Available from: http://www.sunsmart.org.uk/advice-and-prevention/touroperators/.
- World Health Organisation. Sun protection: An essential element of health-promoting schools. WHO INFORMATION SERIES ON SCHOOL HEALTH [Internet]. 2002 10 November 2009. Available from: http://www.who.int/hpr/gshi/.
- Godar, DE, Wengraitis, SP, Shreffler, J, Sliney, DH (2001) UV doses of Americans. Photochem Photobiol 73: pp. 621-629 CrossRef
- Saraiya, M, Glanz, K, Briss, PA, Nichols, P, White, C, Das, D (2004) Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: A systematic review. Am J Prev Med 27: pp. 422-466
- Avenell, A, Broom, J, Brown, TJ, Poobalan, A, Aucott, L, Stearns, SC (2004) Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 8: pp. 1-182
- Data Collection Checklist. Institute of Population Health, University of Ottawa, Canada
- Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, and French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology & Health. 2010.
- Davidson, K, Goldstein, M, Kaplan, R, Kaufmann, P, Knatterud, G, Orleans, C (2003) Evidence-based behavioral medicine: What is it and how do we achieve it?. Annals Behav Med 26: pp. 161-171 CrossRef
- Version 5.1 ed. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen
- Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0: The Cochrane Collaboration; 2011. Available from: www.cochrane-handbook.org.
- Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339. doi:10.1136/bmj.b2535.
- Walkosz B, Voeks J, Andersen P, Scott M, Buller D, Cutter G, et al. Randomized trial on sun safety education at ski and snowboard schools in western North America. Pediatric dermatology [Internet]. 2007; (3):[222–9 pp.]. Available from: http://www.mrw.interscience.wiley.com/cochrane/clcentral/articles/080/CN-00705080/frame.html.
- Walkosz, BJ, Buller, DB, Andersen, PA, Scott, MD, Dignan, MB, Cutter, GR (2008) Increasing sun protection in winter outdoor recreation a theory-based health communication program. Am J Prev Med 34: pp. 502-509 CrossRef
- Buller, DB, Andersen, PA, Walkosz, BJ, Scott, MD, Cutter, GR, Dignan, MB (2005) Randomized trial testing a worksite sun protection program in an outdoor recreation industry. Health Educ Behav 32: pp. 514-535 CrossRef
- Nicol, I, Gaudy, C, Gouvernet, J, Richard, MA, Grob, JJ (2007) Skin protection by sunscreens is improved by explicit labeling and providing free sunscreen. J Investig Dermatol 127: pp. 41-48 CrossRef
- Olson, AL, Gaffney, C, Starr, P, Gibson, JJ, Cole, BF, Dietrich, AJ (2007) SunSafe in the middle school years: A community-wide intervention to change early-adolescent sun protection. Pediatrics 119: pp. e247-e256 CrossRef
- Dietrich, AJ, Olson, AL, Sox, CH, Stevens, M, Tosteson, TD, Ahles, T (1998) A community-based randomized trial encouraging sun protection for children. Pediatrics 102: pp. E64 CrossRef
- Glanz, K, Lew, RA, Song, V, Murakami-Akatsuka, L (2000) Skin cancer prevention in outdoor recreation settings: Effects of the Hawaii SunSmart Program. Eff Clin Pract 3: pp. 53-61
- Glanz, K, Maddock, JE, Lew, RA, Murakami-Akatsuka, L (2001) A randomized trial of the Hawaii SunSmart program’s impact on outdoor recreation staff. J Am Acad Dermatol 44: pp. 973-978 CrossRef
- Glanz, K, Geller, AC, Shigaki, D, Maddock, JE, Isnec, MR (2002) A randomized trial of skin cancer prevention in aquatics settings: The Pool Cool program. Heal Psychol 21: pp. 579-587 CrossRef
- Geller, AC, Glanz, K, Shigaki, D, Isnec, MR, Sun, T, Maddock, J (2001) Impact of skin cancer prevention on outdoor aquatics staff: The Pool Cool program in Hawaii and Massachusetts. Prev Med 33: pp. 155-161 CrossRef
- Pagoto, SL, Schneider, KL, Oleski, J, Bodenlos, JS, Ma, Y (2010) The sunless study: A beach randomized trial of a skin cancer prevention intervention promoting sunless tanning. Arch Dermatol 146: pp. 979-984 CrossRef
- Mayer, JA, Slymen, DJ, Eckhardt, L, Johnston, MR, Elder, JP, Sallis, JF (1997) Reducing ultraviolet radiation exposure in children. Prev Med 26: pp. 516-522 CrossRef
- Dey, P, Collins, S, Will, S, Woodman, CBJ (1995) Randomised controlled trial assessing effectiveness of health education leaflets in reducing incidence of sunburn. BMJ 311: pp. 1062-1063 CrossRef
- Segan, CJ, Borland, R, Hill, DJ (1999) Development and evaluation of a brochure on sun protection and sun exposure for tourists. Heal Educ J 58: pp. 177-191 CrossRef
- Winett, RA, Cleaveland, BL, Tate, DF, Lombard, DN, Lombard, TN, Russ, CR (1997) The effects of the Safe-Sun Program on patrons’ and lifeguards’ skin cancer risk-reduction behaviors at swimming pools. J Heal Psychol 2: pp. 85-95 CrossRef
- Dupuy, A, Dunant, A, Grob, J-J (2005) Randomized controlled trial testing the impact of high-protection sunscreens on sun-exposure behavior. Arch Dermatol 141: pp. 950-956 CrossRef
- Mahler, HIM, Kulik, JA, Gibbons, FX, Gerrard, M, Harrell, J (2003) Effects of appearance-based interventions on sun protection intentions and self-reported behaviors. Heal Psychol 22: pp. 199-209 CrossRef
- Weinstock, MA, Rossi, JS, Redding, CA, Maddock, JE (2002) Randomized controlled community trial of the efficacy of a multicomponent stage-matched intervention to increase sun protection among beachgoers. Prev Med 35: pp. 584-592 CrossRef
- Mahler, HIM, Kulik, JA, Gerrard, M, Gibbons, FX (2006) Effects of two appearance-based interventions on the sun protection behaviors of Southern California beach patrons. Basic Appl Soc Psychol 28: pp. 263-272 CrossRef
- Roberts, DC, Black, D (2009) Comparison of interventions to reduce sun exposure. Behav Med 35: pp. 67-76 CrossRef
- Pagoto, S, McChargue, D, Fuqua, RW (2003) Effects of a multicomponent intervention on motivation and sun protection behaviors among midwestern beachgoers. Heal Psychol 22: pp. 429-433 CrossRef
- Mayer, JA, Lewis, EC, Eckhardt, L, Slymen, D, Belch, G, Elder, J (2001) Promoting sun safety among zoo visitors. Prev Med 33: pp. 162-169 CrossRef
- Creech, L, Mayer, J (1997) Ultraviolet radiation exposure in children: A review of measurement strategies. Annals Behav Med 19: pp. 399-407 CrossRef
- Dombrowski, S, Sniehotta, F, Avenell, A (2007) Current issues and future directions in psychology and health: Towards a cumulative science of behaviour change: Do current conduct and reporting of behavioural interventions fall short of best practice?. Psychol Heal 22: pp. 869-874 CrossRef
- Michie, S, Abraham, C, Whittington, C, McAteer, J, Gupta, S (2009) Effective techniques in healthy eating and physical activity interventions: A meta-regression. Heal Psychol 28: pp. 690-701 CrossRef
- World Health Organisation. INTERSUN Programme [Web page]. WHO; 2011 [updated 201129 April 2011]. Available from: http://www.who.int/uv/intersunprogramme/en/.
- Armstrong, AW, Watson, AJ, Makredes, M, Frangos, JE, Kimball, AB, Kvedar, JC (2009) Text-message reminders to improve sunscreen use: A randomized, controlled trial using electronic monitoring. Arch Dermatol 145: pp. 1230-1236 CrossRef
- Harbottle, A, Maki, J, Reguly, B, Wittock, R, Robinson, K, Parr, R (2010) Real-time polymerase chain reaction analysis of a 3895-bp mitochondrial DNA deletion in epithelial swabs and its use as a quantitative marker for sunlight exposure in human skin. Br J Dermatol 163: pp. 1291-1295 CrossRef
- Harbottle, A, Birch-Machin, MA (2006) Real-time PCR analysis of a 3895[thinsp]bp mitochondrial DNA deletion in nonmelanoma skin cancer and its use as a quantitative marker for sunlight exposure in human skin. Br J Cancer 94: pp. 1887-1893 CrossRef
- WIDER. WIDER recommendations to improve reporting of the content of behaviour change interventions 2007 [18 October 2009]. Available from: http://interventiondesign.co.uk/wp-content/uploads/2009/02/wider-recommendations.pdf.
- Schulz, KF, Altman, DG, Moher, D (2011) CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Ann Intern Med 154: pp. 291-292
- Dodd, LJ, Forshaw, MJ (2010) Assessing the efficacy of appearance-focused interventions to prevent skin cancer: A systematic review of the literature. Health Psychol Rev 4: pp. 93-111 CrossRef
- Hollands GJ, Matthew H, Marteau, Theresa M. Visual feedback of individuals’ medical imaging results for changing health behaviour. Cochrane Database of Systematic Reviews. 2010; Issue 1:Art. No: CD007434.
- Gibbons, FX, Gerrard, M, Lane, DJ, Mahler, HI, Kulik, JA (2005) Using UV photography to reduce use of tanning booths: A test of cognitive mediation. Health Psychol Off J Div Health Psychol, Am Psychol Assoc 24: pp. 358-363
- Mahler, HIMK, James, A, Gerrard, M, Gibbons, FX (2007) Long-term effects of appearance-based interventions on sun protection behaviors. Heal Psychol 26: pp. 350-360 CrossRef
- Are Interventions to Promote Sun-Protective Behaviors in Recreational and Tourist Settings Effective? A Systematic Review with Meta-analysis and Moderator Analysis
Annals of Behavioral Medicine
Volume 45, Issue 2 , pp 224-238
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Skin cancer
- Sun safety
- Industry Sectors
- Author Affiliations
- 1. Health Psychology Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- 2. Medical Faculty, Institute of Health and Society, Newcastle University, Baddiley-Clarke Building, Richardson Road, NE2 4AX, Newcastle upon Tyne, UK