***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE We evaluated the impact of an intervention promoting sun protection behavior among children 2 to 11 years of age through schools and day care centers , primary care practice s , and recreation areas . METHODS Ten towns in New Hampshire were paired , then assigned r and omly to intervention or control status . The multicomponent SunSafe intervention was provided to children and caregivers through primary care practice s , day care centers , schools , and beach recreation areas . Training support and material s were provided by the SunSafe project , but project staff had no direct contact with children or parents in providing the intervention . All intervention components promoted the same message : avoid the sun between 11 AM and 3 PM , cover up using hats and protective clothing , use sun block with a sun protection factor > /=15 , and encourage sun protection among family and friends . The impact of the intervention was determined by observing children 's sun protection behavior at the beach during baseline compared with 1 year later . The primary outcomes of interest were changes in the proportion of children per town using at least some sun protection and changes in the proportion of children fully protected .  Children were clustered by town , with the town thus being the unit of analysis . The primary care practice component included one practice meeting for clinicians and staff at which project staff presented background on skin cancer and how to promote its prevention ; a sun protection office system manual based on our previous work , which provided specific direction on how to share responsibility among office staff and clinicians in carrying out routines that promote sun protection ; and educational posters , pamphlets , and self-adhesive reminder notes design ed to enhance sun protection counseling . SunSafe removable tattoos and stickers were offered to children at well-child and illness visits during the summer months . Schools each received three project staff visits : a brief visit with the principal to describe the intervention and to answer questions ; an in-service program to educate teachers about skin cancer and to introduce curricular material s ; and help with one parent outreach program . Larger day care centers each received one project staff visit . An additional six smaller day care centers received curricular material s through the mail but no visits . Two similar sets of curricular material s were used , one for grade schools and the other for preschools and day care centers . Both emphasized the importance of sun protection rather than the danger of skin cancer . Material s emphasized dynamic activities modeled after the " Slip , Slop , Slap " and " SunSmart " programs and included new material developed to suit regional needs . Both manuals offered structured plans but also provided a variety of activities from which teachers could choose . Teachers agreed to devote a minimum of two class periods to these material s. For recreation areas , lifeguards in each of the intervention communities attended an in-service meeting , during which background about skin cancer prevention was presented by project staff . The project also provided displays about the ultraviolet ( UV ) light index and about sun protection  to be posted at each beach . Subsequently , project staff called beach staff in each community each morning with the predicted UV index for the day to post on the display . Educational pamphlets about the UV index  and free sun-block sample s were available to beachgoers through the lifeguards . One brief follow-up visit by project staff was made to each beach area to provide reinforcement . RESULTS We observed 1930 children .  Use of some sunscreen on at least one body area increased in all 5 intervention towns compared with paired control towns . In intervention towns , this mean proportion increased from 0.56 of those observed at baseline to 0.76 of those observed postintervention , with a minimal increase among control town children . ( ABSTRACT The aim of the following study was to examine the effects of the Ultraviolet ( UV ) Index and a personal ultraviolet radiation ( UVR ) intensity indicator on tanning behaviour compared with general , written information about sun protection . A population -based r and om sample in Sweden was r and omly assigned to four groups receiving different information packages ( n=3200 ) . Question naires were sent before and after the summer of 2001 . Positive attitudes towards sunbathing as well as tanning and sunburn frequencies decreased . Knowledge about UV radiation and the use of sun protection increased for all groups . There were no between-group differences . Sun-related behaviours and beliefs changed , but information about the UV Index or a personal UVR intensity indicator did not decrease sunbathing and sunburn more than general , written information The preschool is an important yet understudied setting for sun-protection interventions . This study evaluates the effects of Sun Protection is Fun ! ( SPF ) on preschool staff  behavioral and psychosocial outcomes related to protecting children from sun exposure . Twenty preschools participated in a 2-year , group-r and omized trial to evaluate SPF , a behavioral intervention grounded in social cognitive theory and design ed to be more extensive than previous preschool sun-protection interventions . The staff intervention included training , a video , newsletters , a curriculum , and sunscreen . Cross-sectional sample s of staff completed surveys at baseline ( N= 245 ) , a 12month intervention assessment ( N = 192 ) , and a 24-month intervention assessment ( N = 225 ) . At the 12-month and 24-month assessment s , significant behavioral effects were seen for use of sunscreen , protective clothing , and shade . Knowledge , self-efficacy , and norms were among the psychosocial variables most affected by the intervention . This study demonstrates that the SPF intervention is effective in improving staff outcomes related to children 's sun protection AIMS To assess the public reach , awareness , underst and ing and response to the burn time and the  Ultra Violet Index ( UVI ) in media weather reports in New Zeal and . METHODS Data from a representative sample ( n = 396 ) , ages 16 - 44 years , were gathered over four consecutive summer weeks of 1999 via a r and om digit dialling telephone survey .  Items collected included sources of weather reports and their frequency of use ; knowledge , underst and ing , perception and use of the burn time and the UVI ; sun-related beliefs , attitudes and behaviours . RESULTS Exposure to weekend weather bulletins was sustained , and occurred mainly via television ( 83 % ) and radio ( 50 % ) . There was greater awareness of the burn time than the more recent UVI ( 89 % vs 43 % ) . The UVI was less often used to guide sun protection actions ( 49 % vs 63 % ) but better understood ( 94 % vs 66 % ) and more often recalled along with sun protective messages ( 56 % vs 32 % ) than the burn time . Few could describe the burn time or the UVI for the past Sunday . Self-perceived underst and ing of the burn time was higher than its measured , sub-optimal , comprehension ( 96 % vs 65 % ) . CONCLUSIONS Further efforts are needed to promote the UVI , particularly on TV1 and on radio , and to reach younger adults and less educated groups . For a transition period , presentation of the burn time should be restricted to complementing the UVI . Thereafter , the UVI should become the st and ard indicator of UV level in New Zeal and BACKGROUND Unprotected and excessive exposure to ultraviolet radiation ( UVR ) is the primary risk factor for skin cancer . DESIGN A pair-matched , group-r and omized , pre-test/post-test , quasi-experimental design , with ski resorts as the unit of r and omization , tested the effectiveness of Go Sun Smart , a multi-channel skin cancer prevention program . Independent sample s of guests were taken at baseline ( 2001 ) and follow-up ( 2002 ) ; data were analyzed in 2006 . SETTING AND PARTICIPANTS A total of 6516 adult guests at 26 ski areas in the western U.S. and Canada were recruited , consented , and interviewed on chairlifts . This study was nested within an occupational intervention for ski area workers . INTERVENTION Ski areas were pair-matched and r and omized to receive Go Sun Smart , which consisted of print , electronic , visual , and interpersonal skin cancer prevention messages . MAIN OUTCOME MEASURES Sun-protection behaviors , sunburning , recall of sun-protection messages , and the association of message exposure to sun protection . RESULTS The difference in recall of all sun-protection messages , messages on signs and posters , and the Go Sun Smart logo was significant between the intervention and control resorts . Reported use of sun-protection practice s was higher by guests at intervention ski areas using more ( a higher dose of ) Go Sun Smart material s. Intervention-group guests who recalled a sun-safety message were more likely to practice sun safety than intervention-group guests who did not recall a message and control-group guests . CONCLUSIONS While the mere implementation of Go Sun Smart did not produce sun-safety improvements , Go Sun Smart appeared to be effective for guests who encountered and remembered it . Many factors can work against message exposure . Signage seemed to produce the greatest increase in exposure to sun-safety messages UV Index information is currently recommended as a vehicle to raise public awareness about the risk of sun-exposure . It remains unknown to what extent this information can change personal sun-protective behavior . The aim of the study was to analyze the effects of UV-Index ( UV-I ) information provided by low cost , commercially available UV-I sensors on major indicators of sun-tanning behavior . A r and omized-controlled trial was carried out on 94 healthy volunteers aged 21 - 23 years . After the exclusion of subjects with photosensitive disorders ( n=3 ) , 91 subjects were r and omized in two arms after stratification based on phototype and sex . Both arms received a diary to be filled every day with a log of intentional sun-exposure during summer . Subjects in the intervention group also received a commercially available UV-I sensor . The UV-I sensors were switched on and the UV-value was recorded in 77 % of days with sun-exposure . During days of sun-exposure , subjects r and omized to the intervention group had longer average time of sun-exposure ( 227.7 vs 208.7 min per day , P=0.003 ) , also between noon and 4 pm ( P<0.001 ) , and less frequently adopted sun protective measures than controls ( hat [ 6.4%vs 10.2 % , P=0.007 ] , sunglasses [ 23.9%vs 30.8 % , P=0.003 ] , sunscreen [ 41.4%vs 47.2 % , P=0.02 ] ) and they experienced more frequent sunburns ( 27.8%vs 21.5 % , P=0.004 ) . The odd ratio of sunburns was 1.60 for subjects in the intervention group compared with controls ( after adjustment for sex , sunscreen use and skin type ) . The mean UV-I value recorded by volunteers was lower ( 5.6 [ SD+/-0.9 ] ) than that ( 7.3 [ SD+/-0.46 ] ) recorded by a professional instrument in the same period at the same latitude . Post study laboratory tests showed that the sensor was able to detect only about 60 % of the solar diffuse radiation . The use of UV-I sensors changed the sun protective behavior of sunbathers in the direction of less use of sun protective measures . One possible explanation is that the low cost UV-meters may have functioned incorrectly and under-reported UV exposure . This may have led to an underestimation of UV-I values , erroneously reassuring subjects and causing a less protective sunbathing behavior . Another hypothesis relies on a cognitive pitfall in the subjects ' dealing with intermediate UV-I values , as they may have been discouraged in the use of sunscreen as they did not feel that they had yet been exposed to very harmful UV radiation The ultraviolet ( UV ) index provides an opportunity to warn people about the degree of hazard that exists on a particular day and subsequently lead to the adoption of sun protective behaviors . While the UV index has been promoted in Australia for some time , little research has been conducted into the underst and ing and use of the index . As such , a r and om telephone survey of 501 adults was conducted in December 1999 to gather data into the public 's underst and ing and use of the UV index in Perth , Australia . A high awareness of the UV index existed among the respondents , with 90 % indicating they had heard of the term UV index . However , only 5 % indicated they had noticed the UV index/forecast for that particular day . The results indicate that a campaign to increase awareness of the UV index  by the public is not warranted , but that efforts should be focused on developing tools to communicate behavior change messages linked to the UV index levels . The research was conducted with funding from Healthway , Health Promotion Foundation of Western Australia Health communication campaigns intended to reduce chronic and severe exposure to ultraviolet radiation in sunlight and prevent skin cancer are a national priority . Outdoor workers represent an unaddressed , high-risk population . Go Sun Smart ( GSS ) , a worksite sun safety program largely based on the diffusion-of-innovations theory , was evaluated in a pair-matched , group-r and omized , pretest-posttest controlled design enrolling employees at 26 ski areas in Western North America . Employees at the intervention ski areas were more aware of GSS ( odds ratio [ OR ] = 8.27 , p < .05 ) and reported less sunburning ( adjusted OR = 1.63 , p < .05 ) at posttest than employees at the control areas . A dose response was evident ( OR = 1.46 , p < .05 ) with greater observed program implementation associated with fewer sunburns among employees . Program awareness per se was not predictive ( p > .05 ) of reduced sunburning in a mediational analysis . Analyses of nonrespondents , including intent-to-treat analyses , further supported the success of GSS 
    Output:
    
Studies rated moderate or strong suggest that the UVI does not influence knowledge , attitudes , sun protection behavior or sun exposure .
Overall , the findings imply that the UVI , as currently implemented , has not been successful at improving sun protection practice s and reducing sun exposure among the population at large .