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Skin Cancer: Child Care Center-Based Interventions


What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2004 (Saraiya et al., one study with behavioral outcomes; search period January 1966 – June 2000) combined with more recent evidence (6 studies, search period June 2000 – May 2011). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing skin cancer. This finding updates and replaces the 2001 Task Force finding on Education and Policy Approaches in Child Care Centers [PDF - 289 kB].


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Summary of Results

Updated Evidence (search period June 2000 – May 2011)

Included studies (6 studies, 7 study arms) evaluated intervention effects on various measures of sun protection and on physiological consequences of UV radiation exposure among children. These results were generally favorable across all of the outcomes.

  • Sunscreen use
    • Increase of 1.6 and 3.3 percentage points (2 studies, 3 study arms)
    • Other measures of sunscreen use also showed favorable results (2 studies)
  • Hat use
    • Median increase of 8.1 percentage points (3 studies, 4 study arms)
    • Other measures of hat use also showed favorable results (1 study)
  • Clothing use
    • Increase of 0.5 and 1.2 percentage points (1 study, 2 study arms)
    • Other measures of clothing use also showed favorable results (1 study)
  • Shade use while outdoors
    • Increase of 8.6 percentage points (1 study)
  • Sunburn incidence
    • Decreases in the number of sunburn episodes ranged from -1.7 to -1.5 percentage points (1 study, 2 study arms)

Included studies also found overall favorable results for the following outcomes.

  • Combined sun-protective behaviors (2 studies, 3 study arms)
  • Excessive sun exposure (3 studies, 4 study arms)
  • Incidence of new mole formation (1 study, 2 study arms)

Previous Review (search period January 1966- June 2000)

One study reported changes in behavioral outcomes and found the following.

  • Mixed and nonsignificant effects on an index of sun protection behaviors:
    • arms (mean increase of 0.3 points; p=0.23)
    • legs (no change; p=0.95)
    • head (mean decrease of -0.4 points; p=0.21)
  • Nonsignificant effects on whether play occurs in sun, shade, or partial shade (p=0.21)

Summary of Economic Evidence

An economic review of this intervention was not conducted.


Based on the settings and populations from included studies, results are applicable to:

  • Daycare centers
  • Nursery schools
  • Play schools
  • Preschools

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

  • Limited evidence is available to determine the variability in effectiveness of interventions based on:
    • Organization affiliation and size of center
    • Race or ethnicity, skin type, or socioeconomic status (SES)
  • Limited evidence is available on the following:
    • Interventions without policy components
    • Differential effectiveness of individual components used in multicomponent interventions
  • More research is needed to address the following questions.
    • How does implementation effectiveness vary by organization type (e.g., private vs. government)?
    • Which incentives (e.g., certification, accreditation) lead to greatest intervention effectiveness?

Study Characteristics

  • Most of the studies in the updated search period evaluated broad-based interventions that combined educational, environmental, and policy components with educational efforts directed at parents or caregivers, staff, and children (4 studies).
  • Two studies examined associations between policy implementation and outcomes of interest.
  • Five studies reported children’s ages. In these settings, ages ranged from birth to 12 years, with a mean or median age group of 3 to 5 years.
  • Five of the studies were conducted in pre-school settings.