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Skin Cancer: High School- and College-Based Interventions


What the CPSTF Found

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 with behavioral outcomes; search period January 1966 – June 2000) combined with more recent evidence (17 studies with 27 arms, 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 2002 CPSTF finding on Education and Policy Approaches in Secondary Schools and Colleges pdf icon [PDF - 290 KB].

Summary of Results

Updated Evidence (search period June 2000 – May 2011)

Included studies found generally mixed intervention effects across the entire body of evidence including:

  • Sun protective behaviors
    • Use of sunscreen (9 studies, 17 study arms), hats (1 study), or sunglasses (1 study)
    • Combined sun-protective behaviors (5 studies, 9 study arms)
    • Avoidance of excessive sun exposure (7 studies, 11 study arms) and tanning bed use (8 studies, 10 study arms)
  • Physiological outcomes
    • Direct measures of UV exposure or changes in skin pigmentation (2 studies, 4 arms)
    • Incidence of sunburn (3 studies)

A subset of the included studies were identified as message testing studies because they assessed efficacy of different ways of delivering UV protection messages to small, selected samples of students (12 studies, 21 study arms). Results from these studies showed generally favorable short-term effects on the following:

  • Sunscreen use (6 studies, 13 study arms)
  • Avoidance of tanning bed use (6 studies, 8 study arms; each with different outcome measures)

Previous Review (search period January 1966- June 2000)

Results from 4 studies of behavioral outcomes found no significant change in sunscreen use or incidence of sun exposure.

Summary of Economic Evidence

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.


Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help fill remaining gaps in the evidence base. (What are evidence gaps?)

  • More, higher quality evidence is needed on the effectiveness of interventions implemented to improve the health of large groups of students.
  • Limited evidence is available on the following:
    • Interventions with environmental and policy components
    • High school based interventions
    • Interventions delivering health-based educational messages
  • Studies with longer follow-up times would provide useful information about the sustainability of intervention effects and also account for seasonal variations.

Study Characteristics

  • Some of the included studies assessed the effectiveness of programs delivered to broad groups of students in natural settings (5 studies). Other studies tested specific skin cancer prevention messages, or ways of delivering them, often using participants who volunteered in exchange for required course credits (12 studies).
  • The majority of studies were conducted in the United States (13 studies), with the remainder coming from Australia (2 studies), Canada (1 study), and Italy (1 study).
  • Most of the evidence was derived from university or college settings (14 studies); 5 of these studies targeted young women.
  • All but one of the interventions involved educational and behavioral approaches, with the majority delivering primarily appearance-based messages (12 studies). The remaining study assessed the effects of installing shade structures outside of high schools and found they increased use of shade during lunch breaks.
  • Most outcome measures were based on self-report.