The review suggests that primary prevention interventions need to be multi-strategic across all health, education and leisure/travel settings. Such interventions should include strategies for motivating individual behaviour change through effective sun-protection policies that include the development of shaded areas, low-cost clothing, and sunscreens. Media dissemination is an important vehicle for reinforcing sun-protection messages through education, public media campaigns and healthcare providers. There is a need for RCTs or controlled studies with multiple outcome measures for prevention aimed at increasing public awareness of reducing exposure to UVR as an effective method of solar protection. Such studies should have specific outcome measures for each component (i.e. hats, clothes and shade). It is imperative that research continues into the relationship between sun exposure and new skin cancers and precancerous lesions such as solar keratoses to establish a dose-response curve for the protective effect of the use of shade, appropriate protective clothing and hats. We have little direct evidence of population knowledge, attitudes and behaviour regarding their use.

Hill et al (1993) carried out a randomised telephone survey on the prevalence of sunburn and attitudes to sun protection. They collected baseline data for this study in Dec 1987 and Feb 1988. After the SunSmart Campaign in the summers of 1989 and 1990 behavioural and sunburn data were reported for the previous weekend. After adjustment for UVA, temperature, survey month, age, sex and skin type a significant reduction in sunburn was found. Sunburn dropped from 11% to 10% to 7% over the 3-year period. Adjusted odds ratios with 95% CI were:

Year 1-Year 2: 0-75 (CI 0-57-0-99) Year 1-Year 3: 0-59 (CI 0-43-0-81)

Hat wearing increased significantly each year (19%, 26% and 29% from Year 1 to Year 3) as did sunscreen use (12%, 18% and 21%, respectively).

The main trends in proportion of body surface area covered by clothing were less obvious (0-67, 0-64 and 0-71, respectively Year 1 to Year 3). The authors concluded that a well planned campaign can paly a part in changing sun behaviour.

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