Covering up reduces exposure to cancer-causing ultraviolet radiation, according to a systematic review of evidence

Educating children in primary school and adults at the beach about the benefits of wearing sun-protective hats and clothing can effectively motivate them to cover up and reduce their exposure to cancer-causing ultraviolet radiation, according to a systematic review of evidence.

The review appears in the American Journal of Preventive Medicine.

Skin cancer is the most common type of cancer in the United States. The incidence of one type - melanoma - is rising, due in part to increased exposure to ultraviolet radiation from the sun.

Staying in the shade, keeping out of the midday sun and wearing protective clothing can reduce ultraviolet exposure and reduce risk of skin cancers, according to the Task Force on Community Preventive Services. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical studies on a topic.

The Task Force, an independent, nonfederal group, found there was good evidence for the effectiveness of teaching children how to protect themselves from the sun.

"Virtually any primary school can be an appropriate environment in which to carry out sun-protection programs," says lead study author Mona Saraiya, M.D., M.P.H., of the Centers for Disease Control and Prevention in Atlanta.

Task Force members combed through 33 studies and found approaches that attempted to change the behavior of children in kindergarten through eighth grade (or their caregivers and teachers). These included some combination of lectures, videos, interactive CD-ROMs, skits, brochures, posters and material incorporated into science classes that moved the children to wear hats, shirts or long pants.

"Skin cancer education programs can be integrated into existing learning situations and support policy and environmental interventions," Saraiya says.

Younger children did better than adolescents.

Children in primary school, the Task Force says, "are more receptive than adolescents to practicing self-protective behaviors and are more amenable to instruction from adults, including teachers and parents."

Other studies offered useful evidence for persuading adults to cover up at recreational and tourist settings like beaches, zoos or resorts. Interventions tested ranged from lifeguard training and printed materials to warning signage.

The utility of recreation-area programs might be limited by available staff time or by tightly scheduled swimming classes, speculates Saraiya. The tourist industry might also be skittish at first about warning vacationers away from their prime reason for visiting beaches or ski resorts, says the task force, but that could be offset by an appreciation that the industry was showing concern for the health of its patrons. Promoting sun safety might even encourage visitors by allaying fears of overexposure.

The Task Force found insufficient evidence to recommend approaches for ultraviolet exposure reduction in child care centers, secondary schools and colleges, workplaces or healthcare settings.