Reducing exposure to ultraviolet radiation from the sun and indoor tanning: A meta-analysis.

Abstract

Objective: Skin cancer is the most frequently diagnosed cancer and rates are increasing because of global warming. This article reports a meta-analysis of randomized controlled trials of behavioral interventions to reduce exposure to ultraviolet radiation (UVR). The review aimed to (a) quantify the magnitude of intervention effects on indoor tanning, sun exposure, and sunscreen use, and (b) determine which intervention strategies maximize behavior change. Method: Out of 17,437 records identified via literature searches, 190 independent tests (N ϭ 89,365) met the inclusion criteria. Sample, intervention, and methodological characteristics, and change techniques were coded, and random effects meta-analyses and metaregressions were conducted. Results: The sample-weighted average effect size across all studies was d ϩ ϭ .193 (95% confidence interval, CI [.161, .226]), and there were significant effects on indoor tanning, sun exposure, and sunscreen use (d ϩ ϭ .080, . 149, and .196, respectively). However, there was evidence of publication bias, and trim and fill analyses indicated that the corrected effects for sun exposure and sunscreen use were of very small magnitude (d ϩ ~.06) and were not significantly different from zero for indoor tanning (d ϩ ϭ Ϫ.011, 95% CI [Ϫ.096, .074]). Metaregression analyses identified several intervention strategies that predicted effect sizes. For instance, interventions delivered individually that promoted alternatives to tanning were associated with larger effect sizes for indoor tanning. Conclusion: Interventions to date have had only a modest impact on behavioral exposure to UVR. The present findings offer new insights into how the effectiveness of future interventions can be improved.

Stratum corneum biomarkers after in vivo repeated exposure to sub‐erythemal dosages of ultraviolet radiation in unprotected and sunscreen (SPF 50+) protected skin

“…8,9 It is challenging to assess the protective effect of each method of UVR protection separately in complex interventions consisting of several methods, and quantitative and objective approaches are scarce. 13 The minimal erythema dose (MED) is often used as a biological measure of UVR exposure and indicator of individual sensitivity to UVR. 14,15 However, the use of visual assessment of erythemal status (ie MED) as a way to estimate UVR exposure has several disadvantages: firstly, it is a subjective and simply phenomenological end point, reflecting acute inflammation with poor sensitivity.…”

Visualising health risks with medical imaging for changing recipients’ health behaviours and risk factors: Systematic review with meta-analysis

“…Six studies [ 31 , 35 – 37 , 41 , 42 ] assessed use of cardiovascular medications, predominantly statins, with follow-up of up to 48 months, 12 months being the mode. All six studies used either ultrasound or CT to visualise cardiovascular health.…”

“…For example, these have assessed the impact of coronary artery calcium screening, but not specifically the role of visualised feedback, and have comprised solely or predominantly observational data, with little randomised evidence [ 28 , 29 ]. Systematic reviews of interventions to increase sun protection behaviours have also been conducted but have typically assessed a wide array of interventions, as opposed to those centred on medical imaging [ 30 , 31 ]. Most pertinently, a Cochrane review of visual feedback of medical images published in 2010 [ 32 ] was unable to reduce uncertainty on this topic due to the limited evidence available at that time, but this has increased greatly since.…”

Protection Against Solar Ultraviolet Radiation in Outdoor Construction Workers: Study Protocol for a Non-randomized Controlled Intervention Study

“…Our study is focused on reducing internal UVexposure by using sunscreen. To remove possible barriers such as availability, accessibility, and the costs of sunscreen (10,21,22), we provide sunscreen dispensers placed at easily accessible places. Furthermore, we will electronically monitor the amount of sunscreen used, and provide regular feedback on sunscreen use by means of posters.…”

“…However, in another study the majority of outdoor workers did use sunscreen during the summer but they used it incorrectly regarding time, frequency and amount applied (21). Additionally, a recently published meta-analysis showed that the most effective intervention for promoting sunscreen use is providing free sunscreen (22).…”