Community-wide Interventions to Prevent Skin Cancer

ion and evaluation of studies. Each study that met the inclusion criteria was abstracted by two independent reviewers using the standard Community Guide abstraction process. Disagreements between reviewers were resolved by consensus. Community Guide methods were used to assess each study for internal and external validity (Appendix A, available Figure 2. Search yield for evidence included in MM and MCCW interventions. Note: Per update methods, the original 1966–2000 search for evidence was not repeated. MCCW, multicomponent community-wide; MM, mass media. Sandhu et al / Am J Prev Med 2016;51(4):531–539 534 online). Information about suitability of study design, quality of execution, sampling, comparison groups, effect modifiers, and outcomes was assessed according to the standard methodology of the Community Guide (www.thecommunityguide.org/methods/ abstractionform.pdf). Primary outcomes of interest. Several categories of outcome measures were abstracted and summarized for this review, including adoption of UVR protective behaviors; UVR exposure; and health outcomes (i.e., incidence of sunburn and skin cancer). Ultraviolet radiation protective behaviors. Typically measured by self-reported or observed use of sunscreen, hat, protective clothing, sunglasses, shade, and by limiting time spent in the sun during peak UVR hours (10AM to 4PM daylight savings or 9AM to 3PM standard time). Other UVR protective behaviors include decrease in use of indoor tanning devices, which is typically measured by proportion of individuals using tanning devices (e.g., tanning beds, lamps) or total number of tanning sessions. A combined sun protective score is commonly measured by combining effect estimates for multiple UVR protective behaviors. Ultraviolet radiation exposure. UVR exposure can be assessed by change in levels of skin coloration (e.g., measured with a colorimeter or spectrophotometer) associated with UVR from sun rays or tanning devices. Sunburn incidence. Sunburn is a marker for both sun sensitivity and intermittent sun exposure. The definition of sunburn varies across studies, ranging from the presence of any sunburn to sunburns that are painful or blistering. Incidence of sunburn is generally measured as number of sunburns in a specified time period. Incidence of skin cancer. Measured by the number of new skin cancer cases. In addition, the reviews examined which factors contributed to intervention effectiveness: type of setting (e.g., schools, recreation areas); population characteristics (e.g., gender, age, skin type); intervention characteristics, such as scope (e.g., national, state, or local) or intensity (e.g., reach, duration, number of components); or different combinations of these factors. Summarizing the Evidence To evaluate the effectiveness of these interventions, the effect estimates were expressed as absolute percentage point (pct pt) change and difference-in-differences of the mean change of combined evidence when possible (formulas used to calculate effect sizes are provided in Appendix B, available online).