Are interventions to promote sun-protective behaviors in recreational and tourist settings effective? A systematic review with meta-analysis and moderator analysis

Abstract

Background: Intermittent sun exposure and sunburn are risk factors for skin cancer that mostly occur in recreational/tourist settings. This review assesses the efficacy of skin cancer prevention interventions designed to promote sun-protective behaviors in recreational/tourist settings. Methods: Systematic review with meta-analyses of controlled trials with outcome measures of sun-protective behaviors and/or sunburn published until January 2011. Results: Twenty-three studies were included. We found no evidence for the efficacy of current interventions in reducing tanning or promoting protective clothing and seeking shade. Meta-analyses show a small heterogeneous effect for interventions on sun-protective behavior indices. Larger but heterogeneous effects were observed for self-reported sun exposure and sunburns. Modest methodological quality suggests risk of bias. Effective interventions were more likely to stimulate social norms supporting sun-protective behaviors and provide appearance-based information about photoaging illustrated with ultraviolet photographs. Conclusion: There is weak and inconclusive evidence for the efficacy of interventions in promoting sun-protective behaviors. © 2012 The Society of Behavioral Medicine.