***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: There is limited empirical evidence regarding differences in sun protection practice s in different regions of the USA . This study examined whether there are regional differences in the efficacy of exposure to UV photographs and photoaging information ( e.g. wrinkles and age spots ) for increasing sun protection behaviours . Students attending a public university in either the Midwestern ( Iowa ) or Southwestern ( Southern California ) US reported baseline sun exposure and protection practice s and were then r and omly assigned to either receive information about photoaging , have a UV photo taken , both receive photoaging information and have a UV photo taken , or to receive neither intervention .  Sun protection intentions were assessed immediately after the interventions , and both self-reported sun protection behaviours and an objective assessment ( via spectrophotometry ) of skin colour change were measured at the end of summer and one year following the interventions . The results showed a pervasive pattern of more risky UV exposure and less sun protection use at the Iowa site than at the Southern California site both prior to and following the interventions . Both interventions increased future sun protection intentions regardless of region . However , the intervention effects on skin colour and UV exposure differed across region , with generally more reliable effects at the Iowa site OBJECTIVES To examine the efficacy of UV photographs and information about photoaging ( eg , wrinkles and age spots ) for increasing the sun protection intentions and behaviors of young adults and to determine whether any effects of this appearance-based intervention could be enhanced by providing a non-UV alternative for achieving a tan ( ie , sunless tanning lotion ) . DESIGN R and omized control trial with 1-month follow-up . SETTING Two universities in Southern California . PARTICIPANTS A volunteer sample of 146 college students , 91.1 % of whom completed the " surprise " 1-month follow-up . INTERVENTION A UV facial photograph and a brief videotape describing the causes and consequences of photoaging . The study tested the effects of the photoaging information/UV photographic intervention only , the intervention plus use of sunless tanning lotion , and a control condition . MAIN OUTCOME MEASURES Participants sun protection intentions as assessed immediately after the intervention and sun protection behaviors during the month after the intervention as assessed during a surprise telephone follow-up . RESULTS The intervention result ed in significantly stronger sun protection intentions ( P<.001 ) and greater sun protection behaviors ( P<.05 ) relative to controls . Furthermore , the group that also used sunless tanning lotion tended to engage in greater sun protection behaviors than the group that received the intervention alone ( P<.08 ) . CONCLUSION The UV photographic intervention holds promise as a cost-effective approach to motivate practice s that may ultimately result in health benefits ( ie , reduced skin cancer rates ) OBJECTIVE To examine the impact of a skin cancer prevention intervention that promoted sunless tanning as a substitute for sunbathing . DESIGN R and omized controlled trial . SETTING Public beaches in Massachusetts . PARTICIPANTS Women ( N = 250 ) were recruited to participate in the study during their visit to a public beach . Intervention The intervention included motivational messages to use sunless tanning as an alternative to UV tanning , instructions for proper use of sunless tanning products , attractive images of women with sunless tans , a free trial of a sunless tanning product , skin cancer education , and UV imaging . The control participants completed surveys . MAIN OUTCOME MEASURES The primary outcome was sunbathing 2 months and 1 year after the intervention . Secondary outcomes included sunburns , sun protection use , and sunless tanning . RESULTS At 2 months , intervention participants reduced their sunbathing significantly more than did controls and reported significantly fewer sunburns and greater use of protective clothing . At 1 year , intervention participants reported significant decreases in sunbathing and increases in sunless tanning relative to control participants but no differences in the other outcomes . CONCLUSION This intervention , which promoted sunless tanning as an alternative to UV tanning , had a short-term effect on sunbathing , sunburns , and use of protective clothing and a longer-term effect on sunbathing and sunless tanning . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00403377 Objective : Skin cancer is to a large degree behaviourally preventable , meaning that evidence -based interventions have scope to make a difference . Previous research indicates that appearance-based interventions such as facial morphing may be more effective than health-based interventions , and that it can personalise the issue of skin cancer . Method : This study examined attitudes to UV exposure , as well as reactions to a facial morphing intervention , through interviews with 25 women aged 35 years and older . Results : Thematic analysis revealed four themes ; two regarding attitudes to UV exposure ( confusion and contradiction , and change and continuity ) , and two relating to the facial morphing intervention ( negative reactions to UV-exposed photo and positive outcomes of the intervention ) . Women experienced a number of barriers to adopting safer behaviour in the sun ; their current attitudes to UV exposure had been shaped by available information sources throughout their ageing . They expressed negative evaluations of the UV photo , which fed directly into motivation to reduce UV exposure . Conclusions : These results can be interpreted along the lines of goal -directed behaviour . This type of intervention has the potential to reduce UV exposure among this participant group , something that needs to be further investigated with r and omised control trials Skin cancer represents a significant health threat with over 1.3 million diagnoses , 8000 melanoma deaths , and more than $ 1 billion spent annually for skin cancer healthcare in the US . Despite findings from laboratory , case‐control , and prospect i ve studies that indicate a link between  youthful indoor tanning ( IT ) and skin cancer , IT is increasing among US youth .  Appearance‐focused interventions represent a promising method to counteract these trends Objective : The study ’s purpose was to investigate moderator , implementation , and mediator variables related to the efficacy of UV4.me , an Internet intervention that decreased ultraviolet radiation ( UV ) exposure and increased skin protection behaviors among young adults . Method : A total of 965 18–25 year olds at risk for skin cancer were recruited nationally online . Participants were r and omized to an experimental website ( UV4.me ) , a control website , or assessment only . Participant characteristics ( moderators ) , engagement with and perceptions of interventions ( implementation measures ) , and exposure and protection attitudinal variables ( mediators ) were assessed . Linear regression and mediation analyses were conducted . Results : Intervention effects on skin protection were greater for participants with a family history of skin cancer ( p = .01 ) . Intervention effects on UV exposure were greater among recent indoor tanners ( p = .04 ) . Improvements in skin protection ( but not UV exposure ) were associated with perceiving the interventions as satisfying or helpful ( ps < .01 ) . The experimental group had better outcomes if they completed more modules ( ps < .01 ) or set more behavioral goals ( ps < .01 ) . Knowledge and exposure decisional balance mediated intervention effects for UV exposure ( ps < .05 ) , and protection decisional balance , self-efficacy , and intentions mediated intervention effects for protection ( ps < .05 ) . Conclusions : The experimental intervention was more efficacious for certain high risk groups . The more individuals liked and engaged with the interventions ( e.g. , by setting goals ) , the better their outcomes . Mediation results inform theory about change mechanisms and differed by behavioral outcome Background The risk for skin cancer is increased among older males and outdoor workers who have high levels of ultraviolet ( UV ) exposure . Purpose This study was design ed to examine the long-term efficacy of UV photography interventions on male outdoor workers , the potential mediators of its impact , and the efficacy of UV photography and skin cancer vs. aging information with this population . Methods One hundred forty-eight male outdoor workers were r and omly assigned to one of four intervention conditions or a control condition in a two by two plus one factorial design . The men in the intervention conditions received or did not receive a UV photo of their face and watched either a photoaging or skin cancer educational video . Participants completed pre-intervention , immediate post-intervention , and 2-month and 1-year follow-up assessment s. Results Analysis of covariance and structural equation modeling revealed that participants in the UV photography and cancer information interventions reported higher levels of sun protection cognitions , which were significant partial mediators of increases in sun protection behaviors and decreases in skin color . Conclusions This study provides evidence for effective sun protection interventions on male outdoor workers that may help reduce skin cancer risk OBJECTIVE To evaluate the robustness of an appearance-focused intervention to prevent skin cancer in individuals reporting seasonal affective disorder ( SAD ) symptoms and pathological tanning motives . DESIGN R and omized , controlled clinical trial . SETTING College campus . PARTICIPANTS Four hundred thirty adult female indoor tanners ( 200 in the intervention group and 230 control participants ) . INTERVENTION A booklet discussing the history of tanning , current tanning norms , UV radiation 's effects on skin , recommendations for indoor tanning use focusing on abstinence and harm reduction recommendations , and information on healthier , appearance-enhancing alternatives to tanning . MAIN OUTCOME MEASURES Self-reported attitudes , intentions , and tanning behaviors ; pathological tanning motives assessed by a question naire developed for this study ; and SAD symptoms assessed by the  Seasonal Pattern Assessment Question naire . RESULTS Two of the 4 pathological tanning scales , opiatelike reactions to tanning and dissatisfaction with natural skin tone , were significant moderators demonstrating stronger treatment effects for individuals scoring higher on these scales . Treatment effects were equivalently positive ( ie , no significant moderator effects ) for all levels of SAD symptoms and all levels of the other 2 pathological tanning motive scales ( ie , perceiving tanning as a problem and tolerance to the effects of tanning ) . CONCLUSIONS The appearance-focused skin cancer prevention intervention is robust enough to reduce indoor tanning among tanners who exhibit SAD symptoms or pathological tanning motives . Tailored interventions may address individuals ' motivations for tanning and their relation to maladaptive behavior , such as dissatisfaction with appearance or the need for relaxation because of anxiety This experiment examined the impact of adding upward and /or downward social comparison information on the efficacy of an appearance-based sun protection intervention ( UV photos and photoaging information ) . Southern California college students ( N = 126 ) were r and omly assigned to one of four conditions : control , intervention , intervention plus upward social comparison , intervention plus downward social comparison . The results demonstrated that all those who received the basic UV photo/photoaging intervention reported greater perceived susceptibility to photoaging ( d = .74 ) , less favorable tanning cognitions ( d = .44 ) , and greater intentions to sun protect ( d = 1.32 ) relative to controls . Of more interest , while the basic intervention increased sun protective behavior during the subsequent 5 weeks relative to controls ( d = .44 ) , the addition of downward comparison information completely negated this benefit . Upward comparison information produced sun protection levels that were only slightly ( and nonsignificantly ) greater than in the basic intervention condition and , as such , does not appear to be a cost-effective addition . Possible mechanisms that may have reduced the benefits of upward comparison information and contributed to the undermining effects of downward comparison information are discussed A prototype model of risk behavior  is described and was tested in a longitudinal study of 679 college students , beginning at the start of their freshman year .  Perceptions  of the prototype  associated with 4 health risk behaviors ( smoking , drinking , reckless driving , and ineffective contraception ) were assessed along with self-reports of the same behaviors . Results indicated that prototype perception was related to risk behavior in both a reactive and a prospect i ve manner . That is , perceptions changed as a function of change in behavior , and perceptions predicted those behavior changes as well . This prospect i ve relation was moderated by social comparison , as the link between perception and behavior change was stronger among persons who reported frequently engaging in social comparison Cheap , easy to apply , well-tolerable , with the potential of altering cortical excitability , and for testing causalities — these are attributes that have made transcranial direct current stimulation ( tDCS ) a highly popular research tool in cognitive neuroscience . Since its re introduction over 15 years ago by Nitsche and Paulus ( 2000 ) , the number of publications reporting tDCS results has risen exponentially ( a Scopus ® literature search indicates over 500 such journal articles published in 2015 alone ) . Recently however , the efficacy of tDCS to alter cognitive performance has been called into question , in particular among healthy participants , but also in certain clinical sample s ( Horvath et al. , 2015 ; Hill et al. , 2016 ; Mancuso et al. , 2016 ) . A number of empirical studies reported not having been able to detect any facilitatory effects of anodal tDCS or inhibitory effects of cathodal tDCS on various cognitive processes ( e.g. , Wiethoff et al. , 2014 ; Minarik et al. , 2015 ; Sahlem et al. , 2015 ; Horvath et al. , 2016 ; Vannorsdall et al. , 2016 ) . In fact , in a recent meta- analysis Horvath et al. ( 2015 ) argue that in young , healthy participants there is no effect of  tDCS on cognition whatsoever , whereas other meta- analyses do find specific modulation of cognitive processes by tDCS ; however , these effects seem to be rather weak ( Hill et al. , 2016 ; Mancuso et al. , 2016 ) . In a recent commentary the field of tDCS research was even called a research area of bad science ( Underwood , 2016 ) in desperate need of further meticulous evaluation . Although there seems to be some inconsistency of effects there is also current work by Cason and Medina ( 2016 ) suggesting no evidence for 
    Output:
    
Appearance-focused interventions may in some cases be more effective than health-focused interventions in reducing UV exposure , as the underlying motivations for tanning are associated with appearance concerns .
Previous review s and meta-analyses have indicated that appearance-focused interventions such as photoageing and UV photo are associated with positive effects in reducing UV exposure and /or increasing sun protection .
This review concludes that photoageing information in combination with UV photo is associated with a medium positive effect size on sun protection intentions .
Photoageing can be manipulated according to theoretical constructs ( e.g. , Theory of Alternative Behaviours ) , which may contribute to its effectiveness .