The role of skin cancer knowledge in sun-related behaviours: A systematic review

Skin cancer is the most commonly diagnosed cancer in many Western countries. This systematic review provides a comprehensive overview of the relationship between skin cancer knowledge and sun-protective, exposure and tanning behaviours in the general population. A total of 34 studies, published in peer-reviewed journals over three decades, were reviewed and synthesised. Sun-protective behaviour was positively associated with skin cancer knowledge in most cases. Findings were inconsistent regarding other sun-related behaviours. Heterogeneity in measurement compromised the capacity to definitively link knowledge and sun-related behaviours. There is a need for development and utilisation of a standardised skin cancer knowledge scale, and guidelines are suggested.

[1]  A. Armstrong,et al.  Effects of video-based, online education on behavioral and knowledge outcomes in sunscreen use: a randomized controlled trial. , 2011, Patient education and counseling.

[2]  V. Hearing,et al.  The deceptive nature of UVA tanning versus the modest protective effects of UVB tanning on human skin , 2011, Pigment cell & melanoma research.

[3]  D. Lazovich,et al.  Prevalence and characteristics of indoor tanning use among men and women in the United States. , 2010, Archives of dermatology.

[4]  H. Landrine,et al.  Perceived Skin Cancer Risk and Sunscreen Use among African American Adults , 2010, Journal of health psychology.

[5]  M. Bass,et al.  Skin Cancer: Knowledge, Behaviors, and Attitudes of College Students , 2010, Southern medical journal.

[6]  S. Burke,et al.  College Students' Knowledge, Attitudes and Perceptions of Risks Regarding Intentional Sun Exposure , 2010 .

[7]  M. Weinstock,et al.  Use of sunless tanning products among US adolescents aged 11 to 18 years. , 2010, Archives of dermatology.

[8]  M. Weinstock,et al.  Indoor ultraviolet tanning: what the data do and do not show regarding risk of melanoma and keratinocyte malignancies. , 2010, Journal of the National Comprehensive Cancer Network : JNCCN.

[9]  Yisrael Parmet,et al.  Skin cancer awareness, attitude, and sun protection behavior among medical students at the University of Miami Miller School of Medicine. , 2010, Archives of dermatology.

[10]  S. Schneider,et al.  Who uses sunbeds? A systematic literature review of risk groups in developed countries , 2009, Journal of the European Academy of Dermatology and Venereology : JEADV.

[11]  D. Moher,et al.  Reprint--preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2009, Physical therapy.

[12]  B. Meiser,et al.  Skin cancer-related prevention and screening behaviors: a review of the literature , 2009, Journal of Behavioral Medicine.

[13]  T. Gambichler,et al.  Indoor tanning in North Rhine‐Westphalia Germany: a self‐reported survey , 2009, Photodermatology, photoimmunology & photomedicine.

[14]  I. H. Clemmensen,et al.  Sunbed use in the Danish population in 2007: a cross-sectional study. , 2009, Preventive medicine.

[15]  J. Bodenlos,et al.  Design and methods for a cluster randomized trial of the Sunless Study: A skin cancer prevention intervention promoting sunless tanning among beach visitors , 2009, BMC public health.

[16]  S. Keeney,et al.  Attitudes, knowledge and behaviours with regard to skin cancer: a literature review. , 2009, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[17]  C. Wright,et al.  Child sun protection: Sun‐related attitudes mediate the association between children's knowledge and behaviours , 2008, Journal of paediatrics and child health.

[18]  R. Turrisi,et al.  Peer Crowd Identification and Indoor Artificial UV Tanning Behavioral Tendencies , 2008, Journal of health psychology.

[19]  B. Egleston,et al.  A preliminary investigation of the predictors of tanning dependence. , 2008, American journal of health behavior.

[20]  Ilima L. Kane,et al.  Randomized trial evaluating computer-based sun safety education for children in elementary school , 2008, Journal of Cancer Education.

[21]  Amanda Sandford.  Trends in smoking among adolescents and young adults in the United Kingdom , 2008 .

[22]  P. Jacobsen,et al.  Appearance Motives to Tan and Not Tan: Evidence for Validity and Reliability of a New Scale , 2008, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[23]  Kristen M. Hart,et al.  Primary Prevention of Skin Cancer in Children and Adolescents: A Review of the Literature , 2008, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[24]  K. Glanz,et al.  Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. , 2008, Archives of dermatology.

[25]  L. Dennis,et al.  Measuring nonsolar tanning behavior: indoor and sunless tanning. , 2008, Archives of dermatology.

[26]  Diane Reynolds.  Literature review of theory-based empirical studies examining adolescent tanning practices. , 2007, Dermatology nursing.

[27]  David B Buller,et al.  Reducing ultraviolet radiation exposure among outdoor workers: State of the evidence and recommendations , 2007, Environmental health : a global access science source.

[28]  Jennifer J. Gibson,et al.  SunSafe in the Middle School Years: A Community-wide Intervention to Change Early-Adolescent Sun Protection , 2006, Pediatrics.

[29]  D. Buller,et al.  Mediation of a middle school skin cancer prevention program. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[30]  S. Swetter,et al.  Use of artificial tanning products among young adults. , 2006, Journal of the American Academy of Dermatology.

[31]  C. Bakoula,et al.  Improvement of sun-related knowledge and protection practice. , 2006, European journal of dermatology : EJD.

[32]  Suchitra Krishnan-Sarin,et al.  Knowledge and perceived risk of smoking-related conditions: a survey of cigarette smokers. , 2005, Preventive medicine.

[33]  R. Mermelstein,et al.  Psychosocial Characteristics Associated with Sun Protection Practices Among Parents of Young Children , 2005, Journal of Behavioral Medicine.

[34]  H. Vries,et al.  Skin cancer prevention: behaviour and motives of Dutch adolescents , 2005, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[35]  R. Hiatt,et al.  Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. , 2004, American journal of preventive medicine.

[36]  S. Nicholson,et al.  Does knowledge influence melanoma-prone behavior? Awareness, exposure, and sun protection among five social groups. , 2004, Oncology nursing forum.

[37]  L. Sjöberg,et al.  Tanning and risk perception in adolescents , 2004 .

[38]  J. Bouwes Bavinck,et al.  The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. , 2003, The Journal of investigative dermatology.

[39]  R. Sayre,et al.  Sunbathing vs. indoor tanning: a realistic perspective , 2003, Photodermatology, photoimmunology & photomedicine.

[40]  R. Parrott,et al.  When the Worlds of Work and Wellness Collide: The Role of Familial Support on Skin Cancer Control , 2003 .

[41]  J. Verne,et al.  Preventing skin cancer , 2003, BMJ : British Medical Journal.

[42]  A. Alberg,et al.  Knowledge, attitudes, and behaviors toward skin cancer in Maryland youths. , 2002, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[43]  R. Loo.  A caveat on using single‐item versus multiple‐item scales , 2002 .

[44]  R. Bränström,et al.  Tanning habits and sunburn in a Swedish population age 13-50 years. , 2001, European journal of cancer.

[45]  S. Arif,et al.  The skin we are in--knowledge and practices regarding skin cancer in pre-clinical medical students. , 2001, JPMA. The Journal of the Pakistan Medical Association.

[46]  K. McCaul,et al.  Use of fake tanning lotions in the South Australian population , 2001, The Medical journal of Australia.

[47]  M. Quarterman,et al.  The relationship between skin cancer knowledge and preventive behaviors used by parents. , 1999, Dermatology nursing.

[48]  K. Glanz,et al.  Factors Associated with Skin Cancer Prevention Practices in a Multiethnic Population , 1999, Health education & behavior : the official publication of the Society for Public Health Education.

[49]  T. Skinner,et al.  Young women and suntanning: An evaluation of a heath education leaflet , 1999 .

[50]  Y. Brandberg,et al.  Sun-related behaviour and melanoma awareness among Swedish university students. , 1999, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[51]  J. Mark Elwood,et al.  Melanoma and sun exposure: An overview of published studies , 1997, International journal of cancer.

[52]  W. Velicer,et al.  The Transtheoretical Model of Health Behavior Change , 1997, American journal of health promotion : AJHP.

[53]  Valerie A. Clarke,et al.  Skin Type and Optimistic Bias in Relation to the Sun Protection and Suntanning Behaviors of Young Adults , 1997, Journal of Behavioral Medicine.

[54]  D. Piacquadio,et al.  Promoting sun awareness: evaluation of an educational children's book. , 1996, Pediatrics.

[55]  S. Woodruff,et al.  A survey of recreational sun exposure of residents of San Diego, California. , 1996, American journal of preventive medicine.

[56]  D B Buller,et al.  Skin cancer prevention by parents of young children: health information sources, skin cancer knowledge, and sun-protection practices. , 1995, Oncology nursing forum.

[57]  C. Bakoula,et al.  Mothers' Knowledge and Practices Related to Sun Protection in Greece , 1995, Pediatric dermatology.

[58]  A. Banerjee,et al.  Relationship between risk factors, knowledge and preventive behaviour relevant to skin cancer in general practice patients in south Australia. , 1995, The British journal of general practice : the journal of the Royal College of General Practitioners.

[59]  A. Fleischer,et al.  A survey of attitudes, beliefs, and behavior regarding tanning bed use, sunbathing, and sunscreen use. , 1993, Journal of the American Academy of Dermatology.

[60]  M. Leary,et al.  The Social Psychology of Tanning and Sunscreen Use: Self‐Presentational Motives as a Predictor of Health Risk1 , 1993 .

[61]  W. M. Felts,et al.  Sunbathing: college students' knowledge, attitudes, and perceptions of risks. , 1993, Journal of American college health : J of ACH.

[62]  D. Altman,et al.  Melanoma and skin cancer: evaluation of a health education programme for secondary schools , 1993, The British journal of dermatology.

[63]  A. R. Gilpin.  Table for Conversion of Kendall'S Tau to Spearman'S Rho Within the Context of Measures of Magnitude of Effect for Meta-Analysis , 1993 .

[64]  P. J. Solomon,et al.  Sun exposure in Australian adolescents. , 1992, Journal of the American Academy of Dermatology.

[65]  M. Berwick,et al.  Sun exposure and sunscreen use following a community skin cancer screening. , 1992, Preventive medicine.

[66]  R. Silverman,et al.  Attitudes of teenagers toward sun exposure and sunscreen use. , 1992, Pediatrics.

[67]  P. Easterbrook,et al.  Publication bias in clinical research , 1991, The Lancet.

[68]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[69]  R. Marks,et al.  Behavioural change in adolescence: a major challenge for skin‐cancer control in Australia , 1988, The Medical journal of Australia.

[70]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[71]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration , 2013 .

[72]  J. Higgins.  Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration , 2011 .

[73]  E. Coups.  Rural-urban differences in sunscreen use: clarification of results from the 2005 Health Information National Trends Survey. , 2011, Journal of the American Academy of Dermatology.

[74]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[75]  D. Whiteman,et al.  Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies , 2004, Cancer Causes & Control.

[76]  Donald R. Miller,et al.  Sunburn reduction through parental role modeling and sunscreen vigilance. , 2003, The Journal of pediatrics.

[77]  G. Colditz,et al.  How to review the evidence: systematic identification and review of the scientific literature , 2000 .

[78]  H. Friedman,et al.  Psychosocial factors in sunbathing and sunscreen use. , 1987, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[79]  D. Wagstaff,et al.  Skin cancer/melanoma knowledge and behavior in Hawaii: changes during a community-based cancer control program. , 1983, Progress in clinical and biological research.

[80]  K. Ph,et al.  Skin cancer/melanoma knowledge and behavior in Hawaii: changes during a community-based cancer control program. , 1983 .

[81]  B. Brannon,et al.  Multimedia public/professional skin cancer education in a multiethnic setting. , 1982, Progress in clinical and biological research.