Review and Assessment of Global and Domestic Ultraviolet Light Protection Programs

September 2014 | Volume 13 | Issue 9 | Original Article | 1099 | Copyright © September 2014

Laura Jordan OMS4 MS MA MLS,a Sarah Malerich DO,b Summer Moon DO,c James Spencer MDd

aLake Erie College of Osteopathic Medicine, Bradenton Campus, St. Petersburg, FL
bLewisGale-Montgomery Hospital, Blacksburg, VA
cMcLaren Oakland Hospital, Pontiac, MI
dSpencer Dermatology & Skin Surgery Center, St. Petersburg, FL

Skin cancer is the most commonly diagnosed cancer in the United States. A number of UV protection programs have been developed and initiated both globally and domestically, and this article will review and assess the effectiveness of each of these programs. The programs reviewed in this article target grade school aged children, as this is a time when adult health behaviors are being formed. Among these programs, multiunit programs were more effective at changing behavior as they were given over a longer period of time with more frequent interventions and included various learning techniques.

J Drugs Dermatol. 2014;13(9):1099-1103.


The number one diagnosed cancer in the US is skin cancer. As the population becomes more aware of the damaging effects of ultraviolet (UV) light, efforts have been made to promote UV protection from the sun and artificial sources such as indoor tanning devices.
The 2012 US Preventative Services Taskforce recommended counseling fair-skinned individuals ages 10-24 about minimizing their exposure to UV light.1 Childhood is a vital period to encourage protection from the sun. Weinstock et al2 found a relative risk of 2.2 for developing melanoma following 5 or more blistering sunburns between the ages of 15 to 20 years of age compared with none. Additionally, adult health behaviors are often established in childhood also giving a good reason for implementing such programs during this age. Continued programs are encouraged, particularly during adolescent years when health behaviors tend to dwindle.3 In the US, rates of melanoma have increased by 2.4% each year for white populations4 with the global incidence of melanoma continuing to rise as well.5 This article will review and assess several different UV protection programs based on their structure and studied effectiveness (Table 1).
Australia has set the pace by utilizing a multi-media campaign for sun protection since the 1980s, including marketing against tanning and strict regulations of indoor tanning devices. A 2004 study in Hawaii found that although school personnel in elementary schools were concerned about children’s sun exposure, the school policies did not address the problem.6
Several hurdles exist when trying to educate the public about skin cancer. One hurdle to public education is misinformation. The public has become more aware of the importance of vitamin D levels; however, the media have exaggerated the necessity of obtaining Vitamin D only from the sun. Further, the public needs more education on the limitations of sunscreen, such as the importance of reapplication and not to use sunscreen as an excuse to remain in the sun for longer periods. Not only is it a challenge to educate the public on the importance of skin protection, but it is also a challenge to conquer the public’s resistance to changing their behavior especially in light of other media encouraging poor sun habits.7
This hurdle of combatting the public’s unwillingness to change their behavior is evidenced by a study published in 2010 of 492 students at a mid-sized southern US university. They found that although 69% of the students strongly believed that people should take precautions against the sun, only 51% felt that they should personally practice sun safety. Additionally, as long as the media correlates being tan with being attractive, the public will continue to desire a tanned appearance despite the risks.8 In an Italian study of 1,204 secondary students, ages ranging from 15-19, it was found that their behavior was not aligned with their knowledge. Only 13.5% claimed always to use sun protection and 39.1% claimed never to use any protection.9 These data demonstrate that there is a misalignment between knowledge and behavior, which is not just an issue within the US.

Review of UV Protection Programs

Sun protection programs aim to improve the knowledge, attitude, and behavior regarding UV protection. In general, short-duration programs (single presentations) are more effective at increasing knowledge and, to a slightly lesser degree, changing attitude, but they are less effective at changing behavior. Multi-unit programs (multiple presentations over time) are more effective at