Skin Cancer: Multicomponent Community-Wide Interventions

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends multicomponent community-wide interventions to prevent skin cancer by increasing UV-protective behaviors, based on sufficient evidence of effectiveness in increasing sunscreen use. Some evidence also indicates benefits in reducing sunburn. Results for effects on other protective behaviors are mixed.

The full CPSTF Finding and Rationale Statement and supporting documents for Preventing Skin Cancer: Multicomponent Community-Wide Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Multicomponent community-wide interventions to prevent skin cancer use combinations of individual-directed strategies, mass media campaigns, and environmental and policy changes across multiple settings within a defined geographic area (city, state, province, or country), in an integrated effort to influence UV-protective behaviors. They are usually delivered with a defined theme, name, logo, and set of messages. Programs vary substantially in duration and breadth of included components.

Studies were eligible for this review if they were delivered in a defined geographic area and included at least two distinct components that were either implemented in different types of settings (e.g., schools, recreation areas) or directed at an entire community (e.g., mass media campaigns).

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review published in 2004 (Saraiya et al., 4 studies; search period January 1966–June 2000) combined with more recent evidence (3 studies, search period June 2000–May 2011). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing skin cancer. This finding updates and replaces the 2003 Task Force finding on Community-Wide Multicomponent Interventions.

Study Characteristics

  • Studies were conducted in the United States (3 studies), Australia (3 studies), and the United Kingdom (1 study)
  • Most of the evidence came from interventions conducted from 1980-2000 (6 studies)
  • Most of the interventions reached a high proportion of the targeted community and included children, youth, and adults
  • All of the interventions had individually-directed educational and persuasive components, such as didactic programs or small media (7 studies), and five of them also had considerable mass media components (5 studies)
  • Several studies also included environmental strategies to make it easier to engage in protective behaviors such as distribution of sunscreen or provision of shade structures (4 studies) and policy changes, often related to sun exposure during peak hours or tanning bed use (4 studies)

Summary of Results

  • Sunscreen use (7 studies)
    • Sunscreen use increased by a median of 10.8 percentage points (interquartile interval [IQI]: 7.3 to 23.2; 6 studies)
    • One additional study showed a substantial and sustained increase in sunscreen use over a period of two decades after the implementation of the SunSmart campaign in Australia
  • Sunburns (2 studies)
    • One study found significant decreases in painful sunburns among children: −15.4 percentage points among those under 6 years of age (95% confidence interval [CI]: −21.2, −9.6); −6.8 percentage points among children 6 to 13 years (95%CI: −14.8, −1.2)
    • Another study showed substantial reductions in sunburn among children and adults over the course of several years
  • Risk behaviors in children and adults (3 studies): Small decreases were seen in intentional sunbathing, use of tanning beds, and time spent in the sun during peak hours

Results from included studies were mixed for other sun protective behaviors, such as use of shade, hats, and other protective clothing (6 studies).

Summary of Economic Evidence

An economic review of this intervention was not conducted.

Applicability

Based on the location, settings, and populations from included studies, results are applicable to:

  • Multiple settings including entire communities, schools, recreation centers, child care centers, and healthcare and workplace settings
  • All age groups including children, youth, and adults

Although most evidence for this review comes from outside of the United States, the finding is likely to be applicable to the U.S. context because results were similar across countries, and the strongest evidence of intervention effectiveness comes from a U.S. study.

Evidence Gaps

  • High-quality studies are needed to better understand the long-term effectiveness of multicomponent community-wide interventions (e.g., interrupted time series studies)
  • More evidence is needed to determine variability in the effectiveness of interventions by type of setting and population characteristics (e.g., general population, children and their caregivers, race/ethnicity, type of skin)
    • More information is needed about how intervention effectiveness varies depending on the key characteristics such as scope of intervention (national vs. local), intensity, and the combination of components or presence/absence of specific components
  • It would be helpful to have more studies that measure skin cancer incidence as an outcome

Implementation Considerations and Resources

  • To maximize the effects, interventions should be implemented for an extensive time period
  • Programs implemented at the community level are most successful when there is a substantial commitment of resources and infrastructure (e.g., implementation of sun protection policies at the national level)
  • Reinforcing skin cancer prevention messages delivered through mass media with setting-specific messages, policy changes, and environmental changes can produce a solid basis for initiating and maintaining behavior changes

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