CDC COMMUNITY GUIDE: Skin Cancer: Interventions in Outdoor Recreational and Tourism Settings

Interventions in recreational or tourism settings are designed to increase sun-protective knowledge, attitudes, and intentions, and affect behaviors among adults and children. Interventions may include one or more of the following:
• Educational brochures (e.g., culturally-relevant materials, photographs of skin cancer lesions)
• Sun-safety training for, and role-modeling by, lifeguards, aquatic instructors, and recreation staff
• Sun-safety lessons, interactive activities, and incentives for parents and children
• Increasing available shaded areas
• Provision of sunscreen
• Point-of-purchase prompts

The Community Preventive Services Task Force (CPSTF) recommends interventions in outdoor recreational and tourism settings that include skin cancer prevention messages or educational activities for visitors, and may also provide free sunscreen of SPF 15 or greater. This recommendation is based on strong evidence of effectiveness for increasing sunscreen use and avoidance of sun exposure, and decreasing incidence of sunburns.

Results from the Updated Systematic Reviews:
Eight studies qualified for the review.
-Sunscreen use increased 12 percentage points for children and 9.1 percentage points for adults (1 study)
-Amateur golfers used sunscreen an average of 1.13 more days per week when it was made readily available in locker rooms (1 study). During competitions, athletes increased reapplication of sunscreen by 22 percentage points (95% CI: 0.9, 43.1), though reapplication during practice did not change.
-Children enrolled in ski and snowboard classes at high altitude resorts and their parents increased sunscreen use an estimated 20.0 percentage points (95% CI:10.1, 29.9) and lip balm use a non-significant 4.0 percentage points (95% CI: ‑6.2, 14.2).
-Multiple studies used various measures of sunscreen use and showed similar increases in use, particularly during activities other than intentional sunbathing.
-Results were generally favorable for other sun protective behaviors, such as use of sunglasses or ski goggles (1 study), avoidance of sun exposure (4 studies, 8 study arms), and combined sun protective behaviors (3 studies, 5 study arms).
-Two months following an intervention focused on educating beach goers about the effects of excessive UV exposure on appearance, a small and non-significant decrease in skin darkening due to UV exposure was seen among participants (1 study with 3 study arms).
-The proportion of tourists presenting with at least one sunburn during their stay at a beach resort decreased among both an intervention group that received free sunscreen (‑16.9 percentage points; 95% CI: ‑28.9, ‑4.9), and one that received free sunscreen and information on sun protection (‑25.6 percentage points; 95% CI: ‑36.9, ‑14.2).