Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK.
Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK.
J Eur Acad Dermatol Venereol. 2021 Nov;35(11):2154-2165. doi: 10.1111/jdv.17599. Epub 2021 Aug 24.
Childhood ultraviolet radiation exposure has a strong connection to the development of skin cancer in later life. Therefore, there have been numerous sun protection educational programmes targeted to this age group. However, the association between these have not been well established. This systematic review aims to summarize the evidence on, and assess, the effectiveness of educational programmes in improving sun protection among children under age-18. The protocol was prospectively registered in the PROSPERO database (CRD42020178264). Per PRISMA guidelines, bibliographic databases CENTRAL, OVID (EMBASE, MEDLINE, PsycINFO), LILACS, trial registries, grey literature and other sources were systematically searched for randomized controlled and clinical controlled trials published between database inception to 9 June 2020. Dual independent review of abstracts and full texts was performed. Eligible studies were assessed for methodological quality using the Cochrane risk-of-bias tool. The primary outcome was postintervention scores [standardized mean difference (SMD)] for sun protection (i) knowledge (ii) attitudes and beliefs (iii) behavioural intentions and behaviours. Sidik-Jonkman random effects meta-analysis, sensitivity and subgroup analyses were performed for specific outcomes (sunscreen and sun-safe hat use) which were sufficiently reported. 1350 publications were identified and 24 eligible trials, conducted across 8 different countries, with sufficient aggregate data were included. Small-to-moderate effects of educational programmes were observed across all sun protection outcomes of interest, but negligible effect sizes were demonstrated when specific outcomes were meta-analysed - sunscreen use, SMD 0.18 (95% CI 0.07-0.29; n = 8) and sun-safe hat use, SMD 0.08 (95% CI, 0.00-0.16; n = 6). A promising approach in the future may be to consider targeting children in secondary education with a digitally delivered interactive intervention. Current evidence, however, is insufficient to assess the effects of potential moderators and change in sun protection outcomes is likely not one-size-fits-all. Further research is warranted to direct intervention design and public policy.
儿童时期的紫外线辐射暴露与晚年皮肤癌的发展有很强的关联。因此，已经有许多针对这一年龄组的防晒教育计划。然而，这些计划之间的关联尚未得到很好的证实。本系统评价旨在总结和评估针对 18 岁以下儿童的教育计划在提高防晒措施方面的有效性。该方案在 PROSPERO 数据库（CRD42020178264）中进行了前瞻性注册。根据 PRISMA 指南，系统地检索了 CENTRAL、OVID（EMBASE、MEDLINE、PsycINFO）、LILACS、试验登记处、灰色文献和其他来源的文献数据库，以获取从数据库开始到 2020 年 6 月 9 日发表的随机对照和临床对照试验。对摘要和全文进行了双重独立审查。使用 Cochrane 偏倚风险工具评估合格研究的方法学质量。主要结果是干预后防晒措施（i）知识、（ii）态度和信念、（iii）行为意向和行为的标准化均数差（SMD）评分。对有足够汇总数据的特定结局（防晒霜和防晒帽使用）进行了 Sidik-Jonkman 随机效应荟萃分析、敏感性分析和亚组分析。确定了 1350 篇出版物，纳入了 24 项符合条件的试验，这些试验在 8 个不同的国家进行，有足够的汇总数据。教育计划在所有感兴趣的防晒措施结局方面均观察到了小到中等的效果，但当对特定结局进行荟萃分析时，效果大小微不足道——防晒霜使用的 SMD 为 0.18（95%CI 0.07-0.29；n=8），防晒帽使用的 SMD 为 0.08（95%CI 0.00-0.16；n=6）。未来一个有前途的方法可能是针对中学教育中的儿童，采用数字互动干预措施。然而，目前的证据还不足以评估潜在调节因素的影响，而且防晒措施的变化可能不是一刀切的。需要进一步的研究来指导干预设计和公共政策。
