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Celebrate 10 Years with Cancer Control P.L.A.N.E.T.

Preventing Skin Cancer: Education and Policy Approaches in Outdoor Recreational Settings

Interventions in recreational or tourism settings are designed to increase sun-protective knowledge, attitudes, and intentions, and affect behaviors among adults and children. Interventions may include one or more of the following:

  • Educational brochures (e.g., culturally-relevant materials, photographs of skin cancer lesions)
  • Sun-safety training for, and role-modeling by, lifeguards, aquatic instructors, and recreation staff
  • Sun-safety lessons, interactive activities, and incentives for parents and children
  • Increasing available shaded areas
  • Provision of sunscreen
  • Point-of-purchase prompts

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force  recommends educational and policy approaches for adults in recreational settings, based on sufficient evidence of effectiveness in improving the sun-protective behavior of covering up. There was insufficient evidence of effectiveness in reducing sunburn due to inconsistent results.

The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of this intervention for children, because too few studies reported its effects on children’s sunburn. Although there is evidence of improvements in children’s sun-protective behaviors—including sunscreen use and composite sun-protective behaviors—these are not recommendation outcomes.

Task Force Finding

Results from the Systematic Review

Eleven studies qualified for the review.

  • Adult sun-protective behavior of wearing protective clothing (hat or shirt): median relative difference of 11.2% (interquartile range 5.1% to 12.9%; 5 study arms)
  • Children’s sun protective behavior of wearing a hat, wearing a shirt, and seeking shade: inconsistent effects
  • Incidence of children’s sunburn: 41.2% decrease (2 study arms)
  • Incidence of adults’ sunburn: inconsistent effects (2 studies)
  • Children’s sunscreen use: median relative increase of 9.8% (5 study arms)
  • Composite sun protective behaviors: median relative increase of 15.4% (5 study arms)
  • Available reports found inconsistent effects on the adult outcomes including:
    • Information-seeking behavior or follow-up study participation (1 study)
    • Knowledge (3 studies)
    • Attitudes or beliefs (2 studies)
    • Intentions (4 studies)
    • Sun-protection measures and environmental supports at outdoor recreational centers or swimming pools (3 studies)
  • Most of the interventions contributing to this review:
    • Took place in diverse outdoor recreational, tourism and geographical settings
    • Included participants with ages ranging from 6.5 years to 79 years
    • Were based on studies conducted with a predominantly white population
    • Were conducted among predominantly female populations

These results are based on a systematic review of all available studies led by scientists from CDC’s Division of Cancer Prevention and Control with input from a team of specialists in systematic review methods and experts in research, practice and policy related to preventing skin cancer.

image of planetFind a Research-tested Intervention Program (RTIP) External Web Site Icon about the use of education and policy approaches in outdoor recreation settings (What is an RTIP?).

Supporting Materials


CDC. Preventing skin cancer. Findings of the Task Force on Community Preventive Services on reducing exposure to ultraviolet light. MMWR 2003;52(RR-15):1–12. External Web Site Icon

Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Adobe PDF File [PDF - 788 kB] Am J Prev Med 2004;27(5):422-66.

Task Force on Community Preventive Services. Recommendations to prevent skin cancer by reducing exposure to ultraviolet radiation. Adobe PDF File [PDF - 70 kB] Am J Prev Med 2004;27(5):467-70.

Task Force on Community Preventive Services. Cancer. Adobe PDF File [PDF - 402 kB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:143-87.

Read other Community Guide publications about Cancer Prevention and Control in our library.


The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing skin cancer: education and policy approaches in outdoor recreational settings. www.thecommunityguide.org/cancer/skin/education-policy/outdoorrecreation.html. Last updated: MM/DD/YYYY.

Review completed: July 2002