Effectiveness of Sun Protection Interventions Delivered to Adolescents in a Secondary School Setting: A Systematic Review

Sun exposure and protection habits: Self-reported attitudes, knowledge and behaviours

BACKGROUND

As exposure to UV radiation is the primary modifiable environmental risk factor associated with skin cancer, it remains the principal focus of most prevention strategies. Numerous sun protection campaigns have been implemented worldwide; however, their impact on the actual incidence and mortality rates of skin cancer seems to be limited. To create successful skin cancer prevention campaigns, it is important to have a comprehensive understanding of individuals' attitudes and behaviours regarding sun protection. The aim of the current study was to determine and report on the prevalence of self-reported attitudes, knowledge and behaviours regarding two of the major sun protection recommendations-avoidance of sun exposure and use of sunscreens-in an international representative sample across five continents.

METHODS

This cross-sectional study was conducted in 20 countries using a web-based online survey.

FINDINGS

A total of 50,552 individuals, comprising 25,388 men (50.22%) and 25,164 women (49.78%), participated in the survey. Among them, 83.2% reported having been voluntarily exposed to the sun (for sun-basking reasons) at least once in the last 12 months, and 47.96% acknowledged being exposed to the sun between the hours of 10 AM and 4 PM. The primary reason for non-adherence was that these hours were the most convenient times (32.28%). Only 24.05% reported applying sunscreen every 2 h when outdoors. Forgetfulness was the primary reason as provided by 27.79% of participants. Males and older age groups were less likely to adopt sun-protective behaviours around the world. Forgetfulness and the challenges posed by time constraints seem to be the biggest barriers to proper adherence.

INTERPRETATION

These findings should prompt the collaboration with health authorities and the manufacturers to enhance adherence by setting reasonable sunscreen prices and creating formulations that make their application less burdensome.

A Photoaging Intervention Delivered to Adolescents in Secondary Schools: A Feasibility Study

Excessive exposure to ultraviolet radiation during adolescence can have a lasting effect on long-term skin cancer risk. Skin cancer prevention interventions for adolescents have been less commonly investigated than those for children and adults. The study objectives were to develop and evaluate the feasibility of a secondary school-based appearance focused intervention, including the development and testing of protocols and instruments, as a resource module that could be efficiently integrated into the secondary school science curriculum. This longitudinal study was conducted with a convenience sample of 38 13–14 year-old students attending one New Zealand (NZ) urban secondary school. The recruitment rate was excellent with only one student not participating because of parental concern. In terms of the implementation practicality, the intervention, as it stands, was extremely resource intensive, involving four research staff to deliver. This will not work if delivered in a classroom setting by a single teacher. However, the intervention was well received by students, so it shows promise if a less resource intensive version could be produced. The acceptability of the intervention with the students was good with the majority (61%) having no suggestions for improvements. Suggested improvements were minor and could be easily addressed.

LinkNet-B7: Noise Removal and Lesion Segmentation in Images of Skin Cancer

Skin cancer is common nowadays. Early diagnosis of skin cancer is essential to increase patients’ survival rate. In addition to traditional methods, computer-aided diagnosis is used in diagnosis of skin cancer. One of the benefits of this method is that it eliminates human error in cancer diagnosis. Skin images may contain noise such as like hair, ink spots, rulers, etc., in addition to the lesion. For this reason, noise removal is required. The noise reduction in lesion images can be referred to as noise removal. This phase is very important for the correct segmentation of the lesions. One of the most critical problems in using such automated methods is the inaccuracy in cancer diagnosis because noise removal and segmentation cannot be performed effectively. We have created a noise dataset (hair, rulers, ink spots, etc.) that includes 2500 images and masks. There is no such noise dataset in the literature. We used this dataset for noise removal in skin cancer images. Two datasets from the International Skin Imaging Collaboration (ISIC) and the PH2 were used in this study. In this study, a new approach called LinkNet-B7 for noise removal and segmentation of skin cancer images is presented. LinkNet-B7 is a LinkNet-based approach that uses EfficientNetB7 as the encoder. We used images with 16 slices. This way, we lose fewer pixel values. LinkNet-B7 has a 6% higher success rate than LinkNet with the same dataset and parameters. Training accuracy for noise removal and lesion segmentation was calculated to be 95.72% and 97.80%, respectively.