Are Environmental Interventions Targeting Skin Cancer Prevention among Children and Adolescents Effective? A Systematic Review.

K Thoonen,F Schneider,S Jongen,H De Vries,L Van Osch

doi:10.3390/ijerph17020529

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.

Highlights

Melanoma and non-melanoma skin cancers (NMSC) are two of the most rapidly increasing cancer types among white populations [1]
The first author of this article mentioned that the data would be submitted on a short notice and that follow-up results were presented at two conferences
From the 45 articles, eight studies that described the stand-alone effects of environmental interventions were qualified for data-abstraction

Summary

Introduction

Melanoma and non-melanoma skin cancers (NMSC) are two of the most rapidly increasing cancer types among white populations [1]. Since the early 1980s, melanoma incidence rates have risen twofold in the United States to even threefold in Europe [2,3,4,5]. More than 55,000 people died from melanoma in 2012, with the greatest burden in Europe, the United States, Australia, and New. Zealand [6,7]. Continuation of the rising incidence rates of melanoma is predicted until 2022 at least in the United States and among European countries [3], implying increased health care costs and need for a new skin cancer disease management strategy [8,9]. Objective data about the overall time children are exposed to UVR are inconsistent and vary per age group, latitude, and country of origin [18,19,20,21]. Even though insight in specific settings where children spend their outside time nowadays is scarce, children seem

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