Skin Cancer: High School- and College-Based Interventions

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of high school- and college-based interventions to prevent skin cancer by reducing exposure to ultraviolet radiation. Evidence was considered insufficient based on inconsistent results for sun protective behavioral outcomes. Interpretation of included studies also was complicated by (1) variability in interventions and evaluated outcomes; (2) short follow-up times; and (3) limitations in the design and execution of important subsets of studies.

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

Intervention

High school- and college-based interventions to promote sun-protective behaviors among adolescents and young adults include at least one of the following:

  • Educational approaches (e.g., providing informational messages about ultraviolet [UV] protection to adolescents and young adults through instruction, small media, Internet, or social media). UV protection messages may be health-related, appearance-based, or both
  • Activities designed to influence behaviors of adolescents and young adults (e.g., modeling, demonstration, role playing)
  • Activities intended to change knowledge, attitudes, or behaviors of teachers and parents or caregivers
  • Environmental and policy approaches (e.g., providing sunscreen or shade, scheduling outdoor activities to avoid hours of peak sunlight)

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.

Study Characteristics

  • Some 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 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.

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 sunscreen use (6 studies, 13 study arms) and 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

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

  • 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.

Implementation Considerations and Resources

  • Older adolescents and young adults are an important group to target for interventions to reduce UV exposure as they are often resistant to using adequate sun protective measures in their outdoor activities and many are frequent users of tanning beds.
  • High school and college settings offer convenient places to reach these populations, and they offer different opportunities and challenges for implementing interventions.
  • Intervention approaches that are well-suited to one setting may not be the most appropriate in another.

Crosswalks

Find programs from the Evidence-Based Cancer Control Programs (EBCCP) website that align with this systematic review. (What is EBCCP?)