McNoe Bronwen M, Morgaine Kate C, Reeder Anthony I
Social & Behavioural Research Unit, Department of Preventive & Social Medicine, Dunedin, New Zealand.
Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
J Skin Cancer. 2021 Mar 4;2021:6625761. doi: 10.1155/2021/6625761. eCollection 2021.
The aim of this systematic review is to summarise the evidence of the effectiveness of interventions targeted to adolescents (13 to 18 years inclusive) and delivered in a secondary school setting with the purpose of improving sun protection behaviour, reducing ultraviolet radiation (UVR) exposure, and/or improving physiological outcomes related to UVR exposure (such as erythema or naevi development).
Peer-reviewed journal articles were identified from seven database searches (Cochrane, Embase, CINAHL, Scopus, Medline, PsycInfo, and Web of Science) to January 2020, forward citation searches of relevant articles, and monitoring of WHO INTERSUN UVR list server for recent publications. Relevant articles were collected and critically analysed using the Effective Public Health Practice framework. Two reviewers independently reviewed, and when deemed eligible, extracted data and performed quality appraisals for each study.
Thirteen studies met the criteria for inclusion in the review. There were no studies that met a "strong" quality rating, five received a "moderate" quality rating, and eight studies a "weak" quality rating. Three of those with a moderate rating found evidence for effectiveness. The most promising interventions overall (including the pilot/uncontrolled studies) were those that moved beyond a pure health education approach and used innovative approaches such as the provision of shade, or use of technology (e.g., appearance-based apps or real-time ultraviolet index (UVI) monitors).
There is a lack of high-quality published studies investigating the interventions delivered in a secondary school setting to protect students from UVR. The evidence could be strengthened if researchers used consistent, standardised outcome measures for sun protection exposure and behaviour. Other factors limiting the strength of evidence were short follow-up times (largely less than 6 months) and/or nonrobust study design.
本系统评价的目的是总结针对青少年（13至18岁，含13岁和18岁）且在中学环境中实施的干预措施有效性的证据，这些干预措施旨在改善防晒行为、减少紫外线辐射（UVR）暴露和/或改善与UVR暴露相关的生理结果（如红斑或痣的形成）。
从截至2020年1月的七项数据库检索（Cochrane、Embase、CINAHL、Scopus、Medline、PsycInfo和Web of Science）、相关文章的向前引文检索以及对世界卫生组织国际紫外线辐射（INTERSUN）UVR列表服务器的近期出版物监测中识别经过同行评审的期刊文章。使用有效的公共卫生实践框架收集并严格分析相关文章。两名评审员独立评审，在认为符合条件时，提取数据并对每项研究进行质量评估。
13项研究符合纳入本评价的标准。没有研究达到“强”质量评级，5项获得“中等”质量评级，8项研究获得“弱”质量评级。其中三项中等评级的研究发现了有效性证据。总体而言，最有前景的干预措施（包括试点/非对照研究）是那些超越单纯健康教育方法并采用创新方法的措施，如提供遮阳设施或使用技术（如基于外观的应用程序或实时紫外线指数（UVI）监测器）。
缺乏高质量的已发表研究来调查在中学环境中实施的保护学生免受UVR伤害的干预措施。如果研究人员对防晒暴露和行为使用一致、标准化的结果测量方法，证据可能会得到加强。其他限制证据强度的因素是随访时间短（大多少于6个月）和/或研究设计不稳健。
