Preventing Skin Cancer: Education and Policy Approaches in Outdoor Recreation 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 & 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 Reviews

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

Find a Research-tested Intervention Program (RTIP) about the use of education and policy approaches in outdoor recreation settings (What is an RTIP?).

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.

Supporting Materials

• Analytic framework [PDF - 68KB]
• Research gaps
• Included studies

Publications

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.

Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. [PDF - 788KB] 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. [PDF - 70KB] Am J Prev Med 2004;27(5):467-70.

Task Force on Community Preventive Services. Cancer. [PDF - 402KB] 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.

More Community Guide publications about Cancer Prevention and Control

---



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 recreation settings. www.thecommunityguide.org/cancer/skin/education-policy/outdoorrecreation.html. Last updated: MM/DD/YYYY.

Review completed: July 2002