Target population: High school students—Yazd, Iran Sample size: Schools—4 Students—360 Demographic characteristics: Age (years): mean 16.04 (0.98) Sex: female—100% Ethnicity/skin colour: not provided
Theoretical framework: Protection motivation theory Intervention—individually directed Format: Lecture, group teaching and performance Content: Education (not further described) Duration: 3 × 1 hour sessions Delivery: Researchers Control Wait listed intervention
2 months
Behaviour score (self-report) Individual sun protection measures (self-report) Sunscreen, sunglasses, gloves, hat, clothes
Target population: High school students—Brazil Sample size: School—8 (52 classes) Students—1,573 Demographic characteristics: Age (years): mean 15.9 (1.3) Sex: female—51.6%, male—48.4% Skin type: 7.4% I or II, 34.9% III, 50.2% IV, 7.6% V
Theoretical framework: None mentioned Intervention “Sunface” — individually directed Format: Application (app) and education in classroom setting Content: Adolescents’ selfies were altered by an app to show UVR effects on their future faces (taking into account skin type) and were shown in front of their class, accompanied by information about UVR protection. The app encompasses the effects of UVR on photoaging of the skin in general and the development of skin cancer. Duration: 45 minutes Delivery: Medical students Control No intervention received
Target population: Secondary school students—Melbourne, Australia Sample size: Schools—51 Demographic characteristics: Not collected
Theoretical framework: None mentioned Intervention—Environmental directed Format: Environmental Content: Two full sun areas in each school (1 intervention (primary) and 1 alternate site) had building shade sail structures installed (at intervention site only) for students to use during passive activities such as eating lunch (mean cost A$11,500 of shade sail and installation costs varied, maximum $22,000) Duration: NA Delivery: Environmental Control No intervention received
Target population: High school students—Fasa city, Iran Sample size: Schools—4 Students—300 Demographic characteristics: Age (years): IG: 16.05 (1.76), CG: 16.20 (1.71) Sex: 100% male Ethnicity/skin colour: not provided
Theoretical framework: PRECEDE model Intervention Format: Educational session including group discussion, questions and answers, practical presentation, use of videos, PowerPoint presentation, instruction booklet. Content: Education—skin health, skin cancer and risks, sunlight, sun protection. n.b. Telephone group also organised for students parents Duration: 6 training sessions of 45–50 minutes duration held on weekly basis Delivery: Research team Control No intervention received
4 months
Behaviour score (self-report)
Rahmatiasl [17] Year not provided Pre/post (control group)
Moderate
Target population: 1st-grade high school students—Ahwaz, Iran Sample size: Schools—4 Students—215 Demographic characteristics: Age (years): 1st grade (13 years) Sex: 47.9%—females, 52.1%—male
Ethnicity/skin colour: not provided
Theoretical framework: Protection motivation theory Intervention Format: Lecture and question and answer session. Pamphlet also distributed. Content: UVR, UVR and health effects of exposure to UVR, the factors affecting the exposure to UV light, the importance of sun protection in childhood and adolescence, how to protect from the sunlight, benefits of using protective devices against the sunlight and correct ways to use sunscreen. Duration: Not specified Delivery: Not specified Control No intervention received
Theoretical framework: None mentioned Intervention—individually directed Format: E-magazine, short films, advertisements, campaign materials, paintings, social media, poetry, fiction & literature Content: Health risks associated with sunbed use as well as appearance damaging effects Duration: Mean 5.6 lessons per class Delivery: Classroom teacher—teachers guide provided Control No intervention received
Target population: Students 12–16 years—Andalusia, Spain Sample size: Schools—12 Students—1,290 Demographic characteristics: Age (years): 12–16, mean 13.75 Sex: 49.8% female, 50.2% male Skin type: 11.5% I or II, 76.8% III or IV, 11.8% V or VI
Theoretical framework: None mentioned Intervention “Healthy sun Habits”—individually directed Format: Online web page Content: Webpage structured The sun—sun & UVR characteristics, dangers of sunburn sun without danger—emphasised factors associated with sunburn and appropriate sun protection behaviours Key sun protection messages Games and website links Duration: Pupils used the website for at least 1 hour at school and then had it available for use through the summer. Delivery: Entirely on the Internet with teachers only providing technical support for using web page. Control No intervention received
3 months
Physiological measures (self-report) Sunburn, sunburn with blisters Individual behaviour (self-report) -sunbathing, sun protection measures, sun protection cloudy day Sun cream
Target population: High school students aged 12–18 years in Beijing, China Sample size: Schools—3 Students—638 Demographic characteristics: Age (years): mean 14.4 (2.5) Sex: 51%—female, 49%—male Ethnicity/skin colour: not provided
Theoretical framework: None specified Intervention IG1 Format: Presentations, photograph, and pamphlets Content: (i) Education—nature and dangers of UVR, sun protection methods, correct use of sunscreen (ii) A photograph was taken of students to assess skin type and students were taught how to protect themselves according to skin type and UV index (iii) Pamphlets contained highlights of presentation Duration: 2 × 45 minutes per year (over 3 years) Delivery: Received 2X during year 1 and year 2 IG2 Content: Educational pamphlet (as IG1) Format: Pamphlet Duration: Received 2X during year 1 Delivery: NA Control No intervention received
2 years
Physiological outcomes (self-reported) Sunburn, suntan Individual behaviour (self-report) -sunscreen, protective clothes, hats, sun umbrella, sunglasses, avoiding sun exposure, seeking shade
Target population: Grade 8 high school students Queensland, Australia Sample population: Schools—26 Students—3400 Demographic characteristics: Age (years): grade 8 (13 years) Sex: not provided Ethnicity/skin colour: not provided
3 years
Behaviour score (self-report)∗
Sumen [21] 2013 Nonrandomised trial (with control group)
Weak
Target population: maritime high school students—Antalya, Turkey Sample population: Schools—2 Students—567 Demographic characteristics: Age (years): 14–2.6%, 15–25.7%, 16–31.7%, 17–25.4%, 18–14.6% Sex: 10.1% female, 89.9% male Ethnicity/skin colour: not provided
Theoretical framework: None specified Intervention Format: Didactic (classroom), brochures (take-home), and posters (environment) Content: Training regarding skin cancer, sun protection steps, and harmful effects of the sun followed by “Dear 16-year old me” video which emphasises the importance of sun protection in the adolescent period. Educational material also provided to students at the end of training session. Four weeks following training posters were hung within the school and classrooms as a reminder. Duration: 35–45 minutes Delivery: Not specified Control Wait listed intervention
3 months
Individual behaviour (self-report) Sun protection cream∗, sun protection cream – beach∗, sun protection cream – long time outdoors∗, sun protection factor above 20∗, remain in shade∗, stay indoors∗, sunglasses∗, clothing – shoulders, sun protective hats
Target population: 11 grade students—California, USA Sample population: School—1 Students—50 Demographic characteristics: Age (years): ∗IG: mean age 17.1 (0.88) CG: mean age 17.2 (0.44) Sex: IG: 76% female, 24% male CG: 84% female, 16% male Skin type: IG: 12% White, 88% non-White CG: 4% White, 96% non-White
Theoretical framework: Health Belief Model Intervention Format: Integrated into the classroom health education, viewed video assigned as a group Content: Appearance-based video on UV induced premature ageing Duration: video 5-minute duration Delivery: Assume classroom teacher Control Health-based video emphasising UV exposure and skin cancer risk
6 weeks
Individual behaviour (self-report) Sunscreen∗, shade, hat, long sleeved shirt,
Sampling frame: High school students—Queensland, Australia Sample population: Schools —9 Students—382 students (analysed 213) Demographic characteristics: Age (years): mean 13.73 Sex: 61.1% female, 38.9% male Skin type: 59% very fair or fair
Theoretical framework: Theory of Planned Behaviour Intervention Format: group-based discussions, role playing, and goal setting. Content: Session 1: sun protection related attitudes and beliefs, long/short-term effects of sun exposure and advantages and disadvantages of sun protection Session 2: Foster perceptions of normative beliefs on sun protection. Session 3: Aimed to increased perceptions of self-efficacy over using sun protection measures Duration: 1 hour per week for 3 weeks Delivery: Facilitated by Cancer Council Queensland staff Control Wait-listed intervention
Wu [24] 2017 Cluster (school) non randomised trial (with control group)
Weak
Target population: High school students grades 9-12—Utah, USA Sample population: Schools—11 Students—1,573 students Demographic characteristics: Age (years): 9th grade—26.2%, 10th grade 52.3%, 11th grade—12.1%, 12th grade—9.3% Sex: 49.5% female, 50% male, 0.5% other Race: 62.5% non-Hispanic White, 25.8% Hispanic, 2.8% African American, 2.0% American Indian, 3.2% Asian American, 3.7% other
Theoretical framework: Extended parallel process model—communicate health risk and prevention information by targeted individual’s perceived threat and perceived efficacy. Intervention IG1 Format: Health or science class, PowerPoint and interactive activity (3-4 students per group), classroom discussion Content: Education (see CG) plus a sunscreen activity which illustrates the UVR blocking properties of sunscreen of differing SPF levels Duration: 1 classroom period Delivery: Research assistants IG2 Format: Health/science class Content: Education (see CG) and receipt of a printed personalised photograph showing current skin damage cause of UVR exposure. Class discussion on how these photos related to UVR dam GE and skin cancer risk. Duration: 1 classroom period Delivery: Research assistants IG3 Format: Health/science class, PowerPoint and interactive activity (individual) Content: Education (see CG) and behavioural change worksheet aimed to improve self-efficacy using sun protection goal setting and planning. Students first selected a behaviour they were willing to commit to implementing in the next month Duration: 1 classroom period Delivery: Research assistants Control Format: Health/science class— PowerPoint and interactive activity (individual), classroom discussion Content: Skin cancer education—incidence, risk factors, causes, strategies to prevent and screen, common misconceptions, and prevention strategies Duration: 1 classroom period Delivery: Research Assistants
1 month
Individual behaviour (self-report) Sunscreen∗, long-sleeved shirt∗, long pants or skirt∗, wide brimmed hat∗, shade or umbrella∗, avoid peak hours∗, sunglasses, indoor tanning∗, outdoor tanning∗ Physiological behaviour (self-report) Sunburn∗
+More detailed information and full results are provided in the Supplementary File 2.
