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Wu YP, Brady HL, Wankier AP, Tanguy WJ, Smith HJ, Brunsgaard EK, Chipman J, DeSantis S, Abildso C, Haaland B, Schlechter CR, Wetter DW, Tercyak KP. Preliminary effects of a rural skin cancer prevention intervention for youths. Health Psychol 2024; 43:339-351. [PMID: 38206847 PMCID: PMC11031317 DOI: 10.1037/hea0001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To pilot and assess the feasibility, acceptability, and preliminary effects of the Rural Adult and Youth Sun (RAYS) protection program, a multilevel skin cancer preventive intervention for young children living in rural U.S. communities, delivered through community-organized team sports. METHOD Three rural counties in Utah participated with two receiving the intervention and the third serving as a control. Youth sports leagues were recruited through recreation departments and the study took place from May through October 2021. Intervention leagues received sun protection supplies for players and coaches, educational materials for parents, and coaches were offered training on skin cancer and sun protection behaviors. RESULTS The RAYS program is both feasible to deliver and acceptable to coaches, parents, and players. The intervention also demonstrates beneficial preliminary effects on components of observed child sun-protective behaviors, coach sun protection behaviors, knowledge of skin cancer prevention recommendations, and self-efficacy in skin cancer prevention. CONCLUSIONS Multilevel interventions for skin cancer prevention among young children can be successfully delivered through community organizations and their settings. A priority moving forward is the identification of ways to optimize delivery of such programs to positively influence skin cancer preventive behaviors among children living in diverse rural areas. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Hannah L. Brady
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ali P. Wankier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | | | - Elise K. Brunsgaard
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jonathan Chipman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Sarah DeSantis
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Christiaan Abildso
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, West Virginia
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Chelsey R. Schlechter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - David W. Wetter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Kenneth P. Tercyak
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, D.C
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Okati-Aliabad H, Hosseini ES, Sharifabad MAM, Mohammadi M, Ardakani ME, Talebrouhi AH. Efficacy of a facial-aging web app on sun protection behaviors among primary school students in Iran: a randomized controlled trial. BMC Public Health 2024; 24:737. [PMID: 38454389 PMCID: PMC10921649 DOI: 10.1186/s12889-024-18241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Skin cancers resulting from excessive exposure to solar ultraviolet (UV) radiation are on the rise. This study aims to investigate the impact of facial-aging app intervention on promoting safe and healthy behaviors and its influence on reducing students' UV exposure. METHOD Utilizing a Pretest-Posttest repeated-measures design, we developed a theory-guided web app on the WhatsApp platform, named the Sunshine and Skin Health app. This app allows users to visualize their altered faces in three stages of adolescence, middle age, and old age based on sun protection behavior. The intervention continued within WhatsApp, incorporating 27 health messages grounded in the PMT theory, eight educational files, and a skin cancer video clip. The primary outcome is the change in sun protection behavior between the two groups (intervention and control) immediately after the intervention (T2) and the secondary outcome is the change in sun protection behavior between the two groups at 3 months follow-up (T3). The data are analyzed in SPSS 22 and a significance level of 0.05 is considered. RESULTS The results revealed no significant difference between the two groups before the intervention. However, in the intervention group, there were significant differences in the utilization of sunglasses, hats, and sunscreen in the last month, as well as sunscreen reapplication after washing their hands and face, both immediately after the intervention and at the 3-month follow-up, compared to the control group (P = 0.001). Furthermore, a significant intervention effect, time effect, and interaction effect between group and time were observed in behaviors related to using sunscreen in the last month and sunscreen reapplication after washing hands and face (P = 0.001). Specifically, the intervention group exhibited a significant difference from Time 1 to 2 and from Time 1 to 3 (p = 0.001), but no significant difference from Time 2 to 3. In contrast, the control group did not show any significant differences over time. CONCLUSIONS This study indicated that the Facial-Aging web app can effectively encourage safe behaviors in sunlight. To ensure the maintenance and sustainability of these behaviors over the long term, it is crucial to consider implementing booster sessions. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20200924048825N1. Registered prospectively on 8 February 2021.
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Affiliation(s)
- Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Esmat-Sadat Hosseini
- Health Education and Health Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Hagerman CJ, Stock ML, Jobe MC, Dwyer LA, Houlihan AE, Yeung EW. Ethnic and Gender Differences in Sun-Related Cognitions Among College Students: Implications for Intervention. Int J Behav Med 2024:10.1007/s12529-024-10257-7. [PMID: 38360939 DOI: 10.1007/s12529-024-10257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Skin cancer incidence and prognosis vary by ethnicity and gender, and previous studies demonstrate ethnic and gender differences in sun-related cognitions and behaviors that contribute to this disease. The current study sought to inform skin cancer interventions tailored to specific demographic groups of college students. The study applied the prototype willingness model (PWM) to examine how unique combinations of ethnic and gender identities influence sun-related cognitions. METHOD Using data from a survey of 262 college students, the study tested whether self-reported sun-related cognitions were different for White women, Hispanic women, White men, and Hispanic men. Path modeling was also used to identify which PWM cognitions (e.g., prototypes, norms) were the strongest predictors of risk and protection intentions and willingness in each demographic group. RESULTS Several differences in sun-related cognitions and PWM pathways emerged across groups, emphasizing the need for tailored skin cancer education and interventions. Results suggest that, for White women, interventions should primarily focus on creating less favorable attitudes toward being tan. CONCLUSION Interventions for Hispanic women may instead benefit from manipulating perceived similarity to sun-related prototypes, encouraging closer personal identification with images of women who protect their skin and encouraging less identification with images of women who tan. For White men, skin cancer interventions may focus on creating more favorable images of men who protect their skin from the sun. Lastly, interventions for Hispanic men should increase perceived vulnerability for skin cancer.
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Affiliation(s)
- Charlotte J Hagerman
- Weight, Eating, and Lifestyle Science (WELL) Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle L Stock
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
| | - Mary C Jobe
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA.
| | - Laura A Dwyer
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
| | | | - Ellen W Yeung
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
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Manne S, Wu Y, Buller D, Heckman C, Devine K, Frederick S, Solleder J, Schaefer A, Lu SE. The Effects of a Parent-Focused Social Media Intervention on Child Sun Safety: Pilot and Feasibility Study. JMIR Form Res 2023; 7:e48402. [PMID: 38064250 PMCID: PMC10746961 DOI: 10.2196/48402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Middle childhood (ages 8-12 years) is a critical period for forming behavioral habits and reducing the risk for the development of skin cancer later in life. During this time, children develop more autonomy and spend more unsupervised time away from their parents. Professional agencies recommend that all children engage in regular sun protection behaviors and avoid the sun during peak daytime hours. Unfortunately, in middle childhood, child sun protection often declines and UV radiation exposure increases. Effective parenting involves balancing ways to encourage the child's increasing independence while providing practical assistance to ensure sun protection is implemented. OBJECTIVE The goal was to evaluate the feasibility, acceptability, and preliminary effects of Sun Safe Families, a Facebook group intervention for parents of children between 8 and 12 years of age. METHODS The team developed Facebook messages targeting parent knowledge, normative influences, sun safety barriers, planning and goal setting, confidence in implementing sun safety, communication, forming habits, and managing sun safety in risky situations. A total of 92 parents were enrolled, and the groups ran for 6 weeks. Feasibility was measured by enrollment and retention rates. Acceptability was measured by engagement in the Facebook groups. Satisfaction was assessed by a treatment evaluation. At pre- and post-intervention, parents completed measures of child sun protection, UV radiation exposure, sunburn, sun safety knowledge, child risk, barriers, sun protection self-efficacy, planning, sun safe habits, norms for child sun safety, and communication about sun safety. RESULTS Enrollment (64.3%, 92/143) and retention (94.6%, 87/92) were good. On average, participants viewed 67.6% (56.8/84) of posts, "liked" 16.4% (13.77/84) of posts, commented on 14.8% (12.43/84) of posts, and voted on 46% (6.4/14) of polls. Satisfaction was excellent. From pre- to post-intervention, there were significant increases in child sun protection, sun exposure, and sunburn (P<.01; moderate effect sizes), as well as statistically significant increases in planning and self-efficacy (P<.05) and family norms and parent communication (P<.01). CONCLUSIONS This study demonstrated high survey retention, acceptability, and satisfaction with the intervention. There were promising preliminary effects on child sun protection behaviors and parent sun protection attitudes and communication with their child. Replication with a larger sample size and a comparison condition is warranted.
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Affiliation(s)
- Sharon Manne
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - Carolyn Heckman
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Katie Devine
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Sara Frederick
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Justin Solleder
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Alexis Schaefer
- Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Shou-En Lu
- Rutgers School of Public Health, New Brunswick, NJ, United States
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Alsaidan MS, Alsohaimi A, Alanazi ZG, Alnefea AZ, Alanazi RM, Algraene TS. Current practice and beliefs of parents toward sunscreen use for their children: A cross-sectional study. Prev Med Rep 2023; 34:102237. [PMID: 37214162 PMCID: PMC10199206 DOI: 10.1016/j.pmedr.2023.102237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Parents are generally influencing the sun protection behaviors of their children, including sunscreen use. In Saudi Arabia, sunscreen use was estimated in adults but not children. The objective was to estimate the prevalence and predictors of sunscreen use among parents and their children. An observational cross-sectional study was conducted in April 2022. Parents who were visiting outpatient clinics at a university hospital in Al-Kharj city, Saudi Arabia, were invited to complete an online questionnaire. A total of 266 participants were included in the final analysis. The mean age of parents was 39.0 ± 8.9 years, and the mean age of children was 8.2 ± 3.2 years. The prevalence of sunscreen use was 38.7% in parents and 24.1% in their children. Females had higher sunscreen use than males in both parents (49.7% versus 7.2%, p < 0.001) and in children (31.9% versus 18.3%, p = 0.011). The most frequent sunburn protection measures practiced by children were wearing long-sleeved clothes (77.0%), sitting in the shade (70.6%), and wearing hats (39.2%). In multivariable analysis, predictors of sunscreen use in parents included female sex, history of sunburn, and sunscreen use by children. Independent predictors of sunscreen use in children included a history of sunburn, wearing hats, and practicing other sunburn protection measures on risky occasions, and sunscreen use in parents. Sunscreen use in parents and children in Saudi Arabia is still inadequate or limited. This calls for community/school intervention programs using educational activities and multimedia promotion. Further studies are needed.
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Affiliation(s)
- Mohammed Saud Alsaidan
- Internal Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
| | - Aziz Alsohaimi
- Department of Medicine, Al-Baha University, Saudi Arabia
| | - Ziad Ghanem Alanazi
- College of Medicine, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
| | | | | | - Turky Saad Algraene
- College of Medicine, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
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Thoonen K, Woodhouse S, Minto C, Blane S, Talati Z. Patterns of Sun Protection Behaviours among Australian Adolescents and Adults over a Six-Year Period. Curr Oncol 2023; 30:7178-7188. [PMID: 37623001 PMCID: PMC10453427 DOI: 10.3390/curroncol30080520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The major cause for skin cancer is the excessive and unprotected exposure to ultraviolet radiation (UVR), which can be prevented by engaging in sun protection behaviours. As longitudinal studies on both adolescents' and adults' performances of sun protection behaviours are limited, the current study aimed to investigate changes in sun protection in these population segments in Western Australia, a region with high annual UVR. During six summer seasons (2015/16 to 2020/21), cross-sectional surveys were conducted among 1806 adolescents (14 to 17 years old) and 1808 adults (18-45 years old), investigating the frequency of five sun protection behaviours (wearing clothing, applying sunscreen, wearing a hat, wearing sunglasses, and seeking shade) and sun avoidance (staying indoors). Over the six-year period, staying indoors increased in both groups. Among adolescents, a decrease in wearing clothing and sunglasses and an increase in seeking shade was demonstrated, and hat and sunscreen use remained relatively stable. Among adults, an increase in sunscreen use was shown, whereas all other sun-related behaviours remained consistent over the six-year period. The results from this study can provide directions for health communications focusing on improving sun protection behaviours among both adolescent and adult populations.
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Affiliation(s)
- Karlijn Thoonen
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne 3010, Australia
| | - Sade Woodhouse
- School of Population Health, Curtin University, Perth 6845, Australia (Z.T.)
| | - Carolyn Minto
- Cancer Council Western Australia, Perth 6008, Australia;
| | - Sally Blane
- Cancer Council Western Australia, Perth 6008, Australia;
| | - Zenobia Talati
- School of Population Health, Curtin University, Perth 6845, Australia (Z.T.)
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Okati-Aliabad H, Hosseini ES, Sharifabad MAM, Mohammadi M, Ardakani ME, Talebrouhi AH. Photoaging and theory-based intervention to improve sun protection behaviors in students in Zahedan: study protocol for a randomized controlled trial. Trials 2023; 24:430. [PMID: 37365669 DOI: 10.1186/s13063-023-07270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Excessive exposure to solar ultraviolet (UV) radiation can cause skin cancer. Implementing new technologies and computational algorithms can potentially change the outlook for cancer prevention and facilitate early detection of melanoma, thereby reducing mortality. Mobile technology as a potential provider of health services in delivering health information and conducting interventions, especially in skin fields, where a significant part of diagnosis is based on visual examination, can be important. Evidence showed that constructs of protection motivation theory (PMT) were good predictors of practicing sun protection behaviors in students. This study will investigate whether mobile applications improve safe and healthy behaviors and affect students' reduced UV exposure. METHOD/DESIGN This randomized controlled trial will be conducted on 320 students on 06/04/2022 in Zahedan. We created mobile applications (Sunshine and Skin Health and WhatsApp apps). Sunshine and Skin Health app allows users to see their changed faces in three stages of adolescence, middle age, and old age based on sun protection behavior. The WhatsApp app has 27 health messages based on PMT theory, eight educational files, and a skin cancer clip that will be sent through WhatsApp during a week. Randomization will be performed using a 1:1 (control: intervention) ratio. The primary endpoint is the group difference in sun-protective behaviors and PMT constructs immediately after the intervention. The secondary endpoint is the group difference in sun-protective behaviors and PMT constructs at a 3-month follow-up. The data will be analyzed in SPSS.22, and the significance level will be considered at 0.05. DISCUSSION The present study examines the effectiveness of mobile applications in improving sun-protective behaviors. If this intervention enhances sun protection behaviors, it can prevent students' skin damage. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20200924048825N1. Prospectively registered on 8 February 2021.
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Affiliation(s)
- Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Esmat Sadat Hosseini
- PhD candidate of Health Education and Health Promotion,, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Kulasinghe K, Mitchell AE, Morawska A. Parent-Reported Barriers and Enablers to Establishing Sun Safety Practices with Young Children in Australia. Compr Child Adolesc Nurs 2022; 45:403-413. [DOI: 10.1080/24694193.2022.2079765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Kavindri Kulasinghe
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children’s Health Research, The University of Queensland, South Brisbane, Australia
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, Australia
| | - Amy E. Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, St Lucia, Australia
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Diehl K, Thoonen K, Breitbart EW, Pfahlberg AB, Görig T. Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116876. [PMID: 35682459 PMCID: PMC9180203 DOI: 10.3390/ijerph19116876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022]
Abstract
The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children’s behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1−10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers’ sun protection behaviors were positively associated with children’s behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers’ risk behavior was associated with children’s reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today’s children from developing skin cancer in later life.
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Affiliation(s)
- Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
- Correspondence:
| | - Karlijn Thoonen
- Centre for Environmental Safety and Security, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands;
| | | | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
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Gefeller O, Mathes S, Uter W, Pfahlberg AB. The Role of the Global Solar UV Index for Sun Protection of Children in German Kindergartens. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020198. [PMID: 35204917 PMCID: PMC8870228 DOI: 10.3390/children9020198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
Abstract
More than twenty-five years ago, the Global Solar UV index (UVI) was introduced as a simple means of visualizing the intensity of ultraviolet radiation and to alert people to the need for sun protection. In our survey, among directors of 436 kindergartens in southern Germany we investigated the level of awareness and knowledge about the UVI as well as the practical consequences for sun protection in kindergartens. Less than half of the directors (n = 208, 47.7%) had ever heard of the UVI, and only a small minority of them (n = 34, 8.7%) used the daily UVI information to adapt sun protective measures in their kindergartens. Detailed knowledge about the UVI was a rarity among the respondents. The proportion of respondents with self-perceived detailed UVI knowledge was five times higher than the actual knowledge assessed by an in-depth structured interview using open-ended questions about the UVI (14.2% vs. 2.8%). No clear relationship between UVI awareness, knowledge, and use and directors' age and gender was found. The UVI-related variables also showed no association with directors' knowledge of risk factors for skin cancer and their attitudes towards tanned skin. Overall, the results paint a sobering picture regarding the penetration of the UVI into sun protection policies of German kindergartens. Future public health campaigns should aim to increase the awareness and understanding of the UVI as well as its relevance for sun protection of children.
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Affiliation(s)
- Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (W.U.); (A.B.P.)
- Correspondence: ; Tel.: +49-9131-85-22750
| | - Sonja Mathes
- Department of Dermatology and Allergy, Technical University of Munich, 80802 Munich, Germany;
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (W.U.); (A.B.P.)
| | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (W.U.); (A.B.P.)
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Application of protection motivation theory (PMT) on skin cancer preventive behaviors amongst primary school students in rural areas of Fasa city-Iran. BMC Cancer 2022; 22:21. [PMID: 34980035 PMCID: PMC8722042 DOI: 10.1186/s12885-021-09142-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Considering that exposure to sunlight in childhood and adolescence has an important role in skin cancer, so it seems that training protective behaviors in this period is more effective. Objectives To survey the application of protection motivation theory (PMT) on skin cancer preventive behaviors among students in rural areas of Fasa city, Iran. Methods This study was done in two stages: Phase I of this study, the descriptive-analytic and cross-sectional study was conducted in 2018 to investigate the predictive value of the protection motivation theory on skin cancer preventive behaviors. In the second stage, a quasi-experimental interventional study was conducted on 400 primary school students in 2019. The educational intervention was performed in the experimental group for 8 sessions. Data were collected using a demographic information questionnaire and protection motivation theory before and six months after the intervention. Results The constructs of protection motivation theory predicted 58.6% of skin cancer preventive behaviors. The results indicated that there was no significant difference between the two groups in terms of knowledge, perceived sensitivity, perceived severity, reward, fear, protection motivation, response efficacy, self-efficacy, response costs, and the skin cancer preventive behaviors in before the intervention (p > 0.05). However, six months after the intervention, the experimental group showed a significant increase in each of the mentioned constructs and skin cancer protective behaviors (p < 0.05). Conclusion This study showed the effectiveness of the intervention based on the PMT constructs in adoption of skin cancer preventive behaviors in 6 months’ post intervention in primary school students.
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Sun Exposure in Pediatric Age: Perspective of Caregivers. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111019. [PMID: 34828732 PMCID: PMC8625385 DOI: 10.3390/children8111019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/22/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022]
Abstract
Excessive sun exposure during childhood increases the risk of skin cancer. This study characterized the knowledge and attitudes of caregivers regarding exposure and sun protection of children and adolescents. One hundred and ninety-eight caregivers (38.5 ± 8.0 years) who resorted to the consultations of a Pediatrics Service or a Family Health Unit answered a questionnaire. The age of children/adolescents was 6.5 ± 5.1 years. On average, caregivers presented a high level of knowledge regarding exposure and sun protection. One hundred and twenty-six caregivers indicated that they obtained more information about sun protection on social communication, and 66% considered the information provided by healthcare professionals to be enough. One-hundred and fifteen caregivers reported that the child/adolescent was more exposed to the sun after 4 a.m., and 88% reported applying sunscreen on the beach/pool and outdoor activities. Fifty-seven percent of caregivers renewed sunscreen application on the child/adolescent every 2 h, and 94% applied a sun protection factor ≥ 50 in the child/adolescent. There was a significant association (p < 0.001) between education level and caregivers’ self-knowledge about sun protection (the higher the education, the higher the knowledge), and between the knowledge of the hour of sun exposure avoidance and the time when the child/adolescent was more exposed to the sun. This study shows that caregivers are highly knowledgeable about exposure and sun protection in children/adolescents, and their attitudes follow the general recommendations.
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Sim WMB, Zeng MX, Rojas-Garcia A. The effectiveness of educational programmes in promoting sun protection among children under the age of 18: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2021; 35:2154-2165. [PMID: 34379846 DOI: 10.1111/jdv.17599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
Childhood ultraviolet radiation exposure has a strong connection to the development of skin cancer in later life. Therefore, there have been numerous sun protection educational programmes targeted to this age group. However, the association between these have not been well established. This systematic review aims to summarize the evidence on, and assess, the effectiveness of educational programmes in improving sun protection among children under age-18. The protocol was prospectively registered in the PROSPERO database (CRD42020178264). Per PRISMA guidelines, bibliographic databases CENTRAL, OVID (EMBASE, MEDLINE, PsycINFO), LILACS, trial registries, grey literature and other sources were systematically searched for randomized controlled and clinical controlled trials published between database inception to 9 June 2020. Dual independent review of abstracts and full texts was performed. Eligible studies were assessed for methodological quality using the Cochrane risk-of-bias tool. The primary outcome was postintervention scores [standardized mean difference (SMD)] for sun protection (i) knowledge (ii) attitudes and beliefs (iii) behavioural intentions and behaviours. Sidik-Jonkman random effects meta-analysis, sensitivity and subgroup analyses were performed for specific outcomes (sunscreen and sun-safe hat use) which were sufficiently reported. 1350 publications were identified and 24 eligible trials, conducted across 8 different countries, with sufficient aggregate data were included. Small-to-moderate effects of educational programmes were observed across all sun protection outcomes of interest, but negligible effect sizes were demonstrated when specific outcomes were meta-analysed - sunscreen use, SMD 0.18 (95% CI 0.07-0.29; n = 8) and sun-safe hat use, SMD 0.08 (95% CI, 0.00-0.16; n = 6). A promising approach in the future may be to consider targeting children in secondary education with a digitally delivered interactive intervention. Current evidence, however, is insufficient to assess the effects of potential moderators and change in sun protection outcomes is likely not one-size-fits-all. Further research is warranted to direct intervention design and public policy.
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Affiliation(s)
- W M B Sim
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK
| | - M X Zeng
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK
| | - A Rojas-Garcia
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
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Görig T, Södel C, Pfahlberg AB, Gefeller O, Breitbart EW, Diehl K. Sun Protection and Sunburn in Children Aged 1-10 Years in Germany: Prevalence and Determinants. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8080668. [PMID: 34438559 PMCID: PMC8394729 DOI: 10.3390/children8080668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022]
Abstract
Seeking shade, the use of textile sun protection and sunscreen, and protecting one’s eyes by wearing sunglasses are recommended sun protection measures in children. We aimed to quantify the use of these measures as well as the prevalence of sunburn in children aged 1 to 10 years in Germany and to identify their determinants. Data collected via telephone interviews in a nationwide sample of 554 parents or caregivers in family were analyzed. Use of sunscreen was the most common measure applied (77.8%), while sunglasses were least frequently used (12.5%). The prevalence of sunburn during the past year was 21.8%, and it was positively associated with children’s age. The use of sun protection measures was significantly associated with the age and skin color of the child, while characteristics and tanning behaviors of the caregivers only played a minor role. The use of sun protection measures was higher when caregivers perceived themselves as a role model (Odds Ratio (OR) = 4.33, p < 0.001). Our nationwide data show that there remains a need for the improved use of sun protection measures, especially in children aged 7 to 10 years. In educational material, parents should be encouraged to become positive role models for their children regarding sun protection.
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Affiliation(s)
- Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, 68167 Mannheim, Germany; (T.G.); (C.S.)
| | - Corinna Södel
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, 68167 Mannheim, Germany; (T.G.); (C.S.)
| | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.B.P.); (O.G.)
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.B.P.); (O.G.)
| | | | - Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, 68167 Mannheim, Germany; (T.G.); (C.S.)
- Correspondence: ; Tel.: +49-621-383-71811
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Thoonen K, van Osch L, Crutzen R, de Vries H, Schneider F. Identification of Relevant Sociocognitive Determinants Explaining Multiple Parental Sun Protection Behaviors. HEALTH EDUCATION & BEHAVIOR 2021; 49:392-404. [PMID: 34053307 PMCID: PMC9150145 DOI: 10.1177/10901981211010434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Adequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their children, insight into the determinants associated with their sun protection behaviors is limited. Aims This study aims to identify the most relevant determinants in predicting multiple parental sun protection intentions and behaviors in different sun exposure situations. Method A longitudinal survey study with two measurements was conducted among Dutch parents (N = 670) of children (4–12 years old). Twenty-seven sociocognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The Confidence Interval-Based Estimation of Relevance approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors. Results Behavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all sociocognitive determinants was highest for shade-seeking behavior (R2 = .41 and .43) and lowest for supportive behavior (R2 = .19 and .29) in both planned and incidental sun exposure situations, respectively. Discussion This study provides detailed insight into relevant sociocognitive determinants of parental sun protection behaviors in various sun exposure situations and directions for composing parental skin cancer prevention interventions. Conclusions Future composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.
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Affiliation(s)
- Karlijn Thoonen
- Maastricht University, Maastricht, the Netherlands
- Karlijn Thoonen, Department of Health Promotion, School CAPHRI, Maastricht University, P. Debyeplein 1, Maastricht, 6229 HA, the Netherlands.
| | | | - Rik Crutzen
- Maastricht University, Maastricht, the Netherlands
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Thoonen K, van Osch L, Drittij R, de Vries H, Schneider F. A Qualitative Exploration of Parental Perceptions Regarding Children's Sun Exposure, Sun Protection, and Sunburn. Front Public Health 2021; 9:596253. [PMID: 33681123 PMCID: PMC7930008 DOI: 10.3389/fpubh.2021.596253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Abstract
Sun protection among children is of utmost importance since sunburn in early life is a major risk factor for skin cancer development. Because parents play a vital role in enhancing sun safety among children, this study explored parental perceptions concerning sun exposure, sun protection behaviors, and sunburn in children. Additionally, the context in which children experience sunburn in order to assist the development, optimization, and targeting of sun safety interventions for parents is revealed. A qualitative study design, using a semi-structured interview guide addressing several themes (e.g., sun exposure, sun protection, and sunburn experiences), was used. Data were collected in the Netherlands in the fall of 2019. Parents were recruited via purposive sampling at schools, youth services centers, and social media. Execution, transcription, and coding of the interviews was done by two researchers, using the qualitative analyzing program Nvivo (interrater reliability of d = 0.84). In total, 26 interviews were performed (n = 17 mothers, n = 17 daughters, aged between 4 and 11 years). Parental perceptions and recall of their child's lifetime sunburn were frequent, even though all parents reported using at least one sun protection measure during sun exposure situations and parents seemed often unaware of their child's sunburn. Moreover, parents reported an overreliance on sunscreen, often failing to adequately protect their children's skin. Water-related activities, a lack of shade, and misconceptions regarding UV-index were often related to sunburn. In addition, unexpected sun exposure or longer exposure duration than initially planned were reported as challenging situations. The majority of parents had positive perceptions regarding tanned skin for both themselves as for children. This study provides directions for skin cancer prevention efforts targeted at both parents and their children. Since a lack of knowledge regarding sufficient sun protection measures and sunburn occurrence in various situations was reported, educational efforts are warranted. Additionally, focusing on clothing, shade-seeking, and adequate sunscreen use is recommended to increase children's sun safety. By intervening in the physical environment as well (e.g., providing shady areas), sun protection barriers can be reduced. Lastly, the general positive attitude toward tanned skin evident in this study is certainly worthy of attention in future interventions.
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Affiliation(s)
- Karlijn Thoonen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Liesbeth van Osch
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Rowan Drittij
- Faculty of Health, Medicine and Life Sciences, Health Sciences Master, Health Education and Promotion, Maastricht University, Maastricht, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Francine Schneider
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Zehra Altunkurek S, Kaya E. Parents' knowledge and understanding of skin cancer and skin self-examination and behaviors to protect their children from the sun. Eur J Oncol Nurs 2021; 50:101884. [PMID: 33429351 DOI: 10.1016/j.ejon.2020.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/01/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to determine parents' knowledge of skin cancer and skin self-examination (SSE) and their efforts to protect their school aged children from the sun. METHODS This cross-sectional study was conducted between November 2018 and November 2019 in Turkey with 1004 parents of middle school students. RESULTS Of the parents, 53.7% did not have knowledge about skin cancer or SSE, and 76% did not conduct SSEs with their 9-14 years old children. A total of 61.3% of the participants prevented their children from standing in the sun, but 56.1% did not apply sunscreen to their children. The total mean score on the Skin Cancer and Sun Knowledge Scale (SCSKS) was 13.16 ± 3.03. There were significant differences in the total SCSKS scores by parental gender, number of children, education level, economic status, use of sunscreen, frequency of application of sunscreen, use of light-colored clothing, prevention of exposure to sunlight, use of sunglasses outside, knowledge about skin cancer and SSE and knowledge about early diagnosis of skin cancer (p < 0.05). CONCLUSION This study showed that parents' behaviors related to sun protection and their skin cancer and SSE knowledge levels were not sufficient. In schools, both students and parents should receive health education regarding skin cancer and prevention methods.
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Affiliation(s)
- Serife Zehra Altunkurek
- Public Health Nursing Department, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey.
| | - Eylül Kaya
- Public Health Nursing Department, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey.
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Li M, Gill N, Mathura P, Dytoc M. Sun-Safety Interventions for Elementary Schools. J Cutan Med Surg 2020; 25:334-335. [PMID: 33179518 DOI: 10.1177/1203475420974651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Miriam Li
- 3158 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Navjeet Gill
- 3158 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Pamela Mathura
- 3158 Department of Medicine, Alberta Health Services, University of Alberta, Edmonton, Canada
| | - Marlene Dytoc
- 3158 Division of Dermatology, University of Alberta, Edmonton, Canada
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Affiliation(s)
- Sherry L. Pagoto
- Department of Allied Health Sciences, Institute for Collaborations on Health, Interventions, and Policy, University of Connecticut, Storrs
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Hunkin H, Morris JN. A decade of sun protection in Australian early-childhood services: analysis of cross-sectional and repeated-measures data. HEALTH EDUCATION RESEARCH 2020; 35:99-109. [PMID: 32101611 DOI: 10.1093/her/cyaa005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
Limiting ultraviolet radiation exposure during early childhood can significantly reduce the risk of developing skin cancer, making early childhood a critical time for sun protection strategies. This study aimed to measure sun protection practices utilized in Australian early-childhood services over the past decade and evaluate the impact of Cancer Council Australia's SunSmart Early-Childhood Program. Results are presented from cross-sectional and repeated-measures survey data, completed by directors or other staff at randomly sampled early-childhood services in 2008, 2013 and 2018 (N�=�3243). Most sun protection practices were used by a significantly greater proportion of services in 2018 relative to earlier years, such as requiring the use of sunscreen (98.4%), and sun-protective hats (99.7%) and clothing (88.8%). However, only a small and declining proportion of services (16.3%-22.4%) required the use of specific items of sun-protective clothing. SunSmart program members reported enacting significantly more sun protection practices compared to non-members, while new members showed an increase in the use of those practices relative to services whose status did not change (d�=�0.48). The results demonstrate improvements in sun protection in Australian early-childhood settings, and highlight the benefits and limitations of the SunSmart program.
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Affiliation(s)
- Hugh Hunkin
- Behavioural Research and Evaluation Unit, Cancer Council SA, 202 Greenhill Road, Eastwood, SA 5063, Australia
| | - Juliaï N Morris
- Behavioural Research and Evaluation Unit, Cancer Council SA, 202 Greenhill Road, Eastwood, SA 5063, Australia
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Are Environmental Interventions Targeting Skin Cancer Prevention among Children and Adolescents Effective? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020529. [PMID: 31947667 PMCID: PMC7013813 DOI: 10.3390/ijerph17020529] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022]
Abstract
Skin cancer, which is increasing exceedingly worldwide, is substantially preventable by reducing unprotected exposure to ultraviolet radiation (UVR). Several comprehensive interventions targeting sun protection behaviors among children and adolescents in various outdoor settings have been developed; however, there is a lack of insight on stand-alone effectiveness of environmental elements. To compose future skin cancer prevention interventions optimally, identification of effective environmental components is necessary. Hence, an extensive systematic literature search was conducted, using four scientific databases and one academic search engine. Seven relevant studies were evaluated based on stand-alone effects of various types of environmental sun safety interventions on socio-cognitive determinants, sun protection behaviors, UVR exposure, and incidence of sunburns and nevi. Free provision of sunscreen was most often the environmental component of interest, however showing inconsistent results in terms of effectiveness. Evidence regarding shade provision on shade-seeking behavior was most apparent. Even though more research is necessary to consolidate the findings, this review accentuates the promising role of environmental components in skin cancer prevention interventions and provides directions for future multi-component sun safety interventions targeted at children and adolescents in various outdoor settings.
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