***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: BACKGROUND A representative sample of the British population was interviewed to identify the factors associated with sunburn and intention to tan , and the source from which people obtained their information about the risks of sun exposure . METHODS As part of its rolling Omnibus survey , the Office for National Statistics interviewed a r and omly selected representative sample of 1858 adults ( aged 16 or over ) in Great Britain in October 1996 . The analysis and interpretation of the result ing data form the basis of this study . RESULTS The response rate was just below 70 per cent . Forty-three per cent of men and 35 per cent of women reported sunburning in the 12 months to October 1996 . Factors associated with sunburn were : being male , having a skin that tans with difficulty and being younger . Concerning ' intention to tan ' , 34 per cent of men and 39 per cent of women admitted trying . There were associations with having a skin that tans easily , and , less strongly , with being younger . There was a clear association between trying to tan and severity of sunburn . Most people identified television as their main source of information about the dangers of sun exposure , and the majority had seen the sunburn forecasts on weather reports . Comparison with a previous Omnibus sunburn survey from 1993 shows little change in the proportion of the population becoming sunburnt , but some increase in the proportion of men intending to tan . CONCLUSIONS The data allow an insight into current sun-related behaviour and whether there has been a change since 1993 . Health promotion campaigns warning about the risk from the sun may have increased awareness , but have thus far failed to reduce the proportion becoming sunburnt . It is time to re-evaluate the thinking behind such programmes The feasibility of targeted screening for cutaneous malignant melanoma in the UK using a postal question naire and invitation to screening by a consultant dermatologist was investigated in a population based cross-sectional survey . A total of 1600 people aged 25–69 years , stratified by the social deprivation score of wards within one general practice , were r and omly selected from a population of 8000.1227 ( 77 % ) returned the question naire and 896 ( 56 % ) attended the screening clinic . Uptake was lower for men ( P < 0.001 ) , those aged under 50 ( P < 0.001 ) , people from deprived areas ( P < 0.001 ) and skin types III and IV ( men only , P < 0.001 ) . Twenty per cent of women and 10 % of men felt nervous about attending the clinic , but only 4 % were worried by the question naire . The level of agreement between the self- and dermatologist ’s assessment s of risk factors was best for hair colour ( Kappa = 0.67 , sensitivity 73 % and specificity 98 % ) . People tended to under-report their level of risk . Over 95 % knew about at least one major sign , but 54 % reported incorrect signs of melanoma . Targeted screening for melanoma in the UK will be hampered by difficulties in accurately identifying the target population . Strategies to improve skin self-awareness rather than screening should be developed and evaluated . © 2000 Cancer Research Sun exposure is the most important avoidable cause of skin cancers . We report characteristics of a representative sample ( N=2,324 ) of beachgoers in Southeastern New Engl and during the summer of 1995 . This sample was not employing adequate sun protection behaviors ( 83 % did not often avoid the sun during midday and only 45 % often used sunscreen ) . Important demographic and skin cancer risk factor differences in sun protective behaviors and stages of change for sun protection were found , especially differences based on age , gender , and degree of sun sensitivity . Consistent with previous research , increased age , female gender , and greater sun sensitivity were each independently associated with more  sun protective behaviors .  These findings underscore the need for interventions targeting high-risk population s , such as those receiving high-intensity sun exposures at the beach BACKGROUND Little information is available on the sun-related behavior of teenagers despite the considerable re sources spent to decrease sun exposure in this age group . OBJECTIVE Our purpose was to describe the sun exposure behavior of Australian adolescents and define characteristics that predict use of sun protection . METHODS Cross-sectional study of a r and om sample of 972 school students 13 to 15 years of age from three different locations in Australia ( two urban and one rural ) using a diary to document sun exposure and sun protection on two consecutive weekends . RESULTS More than 80 % of adolescent boys in each place and more than 60 % of adolescent girls in both of the large cities spent more than 2 hours outdoors during the peak ultraviolet ( UV ) periods on each weekend . Neither  sunscreen nor hats  were used for more than half the time spent in the sun ; however , shirts were worn most of the time . Students who wore hats were more likely to be boys ( odds ratios [ OR ] = 2.2 , 95 % confidence intervals [ CI ] 1.40 to 3.44 ) and live in the rural region ( OR = 4.6 , 95 % CI 2.36 to 9.04 ) . Students who used sunscreen tended to have skin that sunburned easily ( OR = 3.2 , 95 % CI 1.27 to 7.88 ) and score highly on the knowledge questions ( OR = 2.9 , 95 % CI 1.46 - 5.69 ) . This model was not a good predictor of behavior on a subsequent weekend , possibly because behavior was highly variable , with 35 % to 50 % of students changing their pattern of protection use from one weekend to the next . CONCLUSION Adolescents spend long periods on summer weekends in the sun and do not follow recommended sun protection guidelines . The high variability of sun-related behavior makes modeling and consequent development of education programs a difficult task BACKGROUND Adolescence has been identified as a critical period in the etiology of subsequent melanoma and nonmelanocytic skin cancer . This study examines the prevalence and predictors of solar protection use among adolescents . METHODS A total of 3,642 adolescents between the ages of 11 and 16 years were recruited from a r and om sample of 27 schools in an Australian state . The participants completed a vali date d survey that provided information on a range of demographic , knowledge , attitudinal , and behavioral factors . Sun protection practice s adopted during the preceding weekend were assessed using a vali date d self-report diary . A formula that quantifies protection status was then employed to categorize adolescents into those who were using adequate versus low levels of solar protection . RESULTS Overall 54 % of males and 44 % of females were classified as adequately protected during the preceding weekend . Logistic regression analyses identified the following as significant predictors of having an adequate level of sun protection -- gender ( males more likely to be protected ) , age ( 11 to 13 year olds more likely to be protected than 14 to 16 years olds ) , ownership of a broad-brimmed hat or cap , attitudes relating to the discomfort associated with wearing a hat , image to peers , " hassle " associated with the use of sun protective measures , school attended , and sun protective policies of the school . CONCLUSIONS Implication s of these findings for future preventive strategies are discussed and include improved targeting of sun protection programs to non-adopters , modification of attitudes relating to suntans and image to peers , reducing the level of perceived difficulty associated with utilizing sunscreen , and the potential role that schools may play in fostering sun protection This study investigated knowledge , behaviors , and health beliefs of Australian university students ( n=312 ) regarding skin cancers and evaluated the effects of videotaped presentations . Students ' knowledge and health beliefs were assessed , and they then viewed either an informational video , an emotionally involving video , or a control video .  Knowledge and beliefs were assessed immediately and 10 weeks later . Postvideo skin protection intentions increased significantly from prevideo assessment among the two intervention groups compared to the controls . Maintenance of skin protection intentions was higher with the emotional video . Health belief variables , particularly perceived barriers , were significant predictors of knowledge , intention , and behavior . However , other variables such as skin type and previous experience with skin cancer were more important . Females had greater knowledge and stronger intentions to prevent skin cancer than males but reported fewer high-risk behaviors OBJECTIVE To describe the prevalence of  sun exposure and protective behaviours  during leisure time among Canadian adults 25 years of age or more . DESIGN A r and om-digit-dialling telephone household survey of 4023 people 15 years of age or more was completed ; 3449 adults 25 years of age or more responded to questions about sun exposure and protective behaviours from June to August 1996 . RESULTS Many of the adults ( 51 % ) reported getting 30 minutes to 2 hours of daily sun exposure , and 26 % reported getting more than 2 hours . Half ( 50 % ) reported having one or more sunburns during the study period ; 21 % said they actively spent time suntanning . Less than half reported taking adequate protective actions . Women , light-complexioned and adults 65 years or more were more likely than men , medium- or dark-complexioned adults and adults in younger groups to protect themselves . Nearly two-thirds ( 63 % ) of the adults said they forgot to take protective actions , 47 % felt it was inconvenient to do so , and 29 % were not concerned about sun exposure . DISCUSSION Canadian adults , especially younger men , are exposed to significant amounts of sun during summer leisure time , but they do not always protect themselves adequately . Interventions should emphasize and facilitate convenient , effective sun protection strategies In 1983 a classification scheme was proposed for patients with atypical naevi , according to their personal and family history of melanoma and atypical naevi . To assess the predictive value of these features we undertook prospect i ve surveillance of patients at high risk of primary melanoma . We followed up 116 patients each with 3 or more clinical ly atypical naevi for at least 5 years .  Patients are examined and naevi are photographed every 3 - 6 months ; lesions showing disturbing change are excised for histopathology . Among 85 patients with no personal or family history of melanoma , 5 invasive ( level 2 or deeper ) melanomas developed during 583 person-years of follow up . The expected number of invasive melanomas in this population would be 0.054 ; the increased risk is significant ( p < 0.001 ; relative risk 92 [ 95 % CI 30 - 216 ] ) . There was a similarly increased risk of new melanoma also among 24 patients with atypical naevi plus a history of previous melanoma ( observed 2 , expected 0.022 , p < 0.001 ; relative risk 91 [ 11 - 328 ] ) . By comparison , no second melanoma developed among 25 patients with previous melanoma but a normal naevus pattern during 213 person-years of similarly intensive follow-up . The risk of melanoma was highest among 7 patients with atypical naevi and a family history of melanoma ( observed 6 , expected 0.009 , p < 0.001 ; relative risk 444 [ 121 - 1138 ] ) . The median thickness of surveillance-detected melanomas was 0.75 mm ( range 0.40 - 1.05 mm ) in this group . This study shows the value of clinical follow-up of high-risk patients to detect early thin melanomas This study explored the prevalence and predictors of solar protection behaviour  in a community sample of beachgoers . A total of 670 participants was r and omly selected from six beaches in the Newcastle district . The solar protection behaviour of each participant was assessed by direct observation and interview . A sub sample was also asked to complete a written question naire to assess attitudes to solar protection use , knowledge of skin cancer and awareness of recommended solar protection behaviours . Forty-five per cent of the beachgoers in this sample were using a high level of  solar protection  , and a substantial proportion ( 16 per cent ) of the sample was not using any kind of solar protection . Sunscreen with SPF 15 + was applied to at least one body region by 69 per cent of the sample , 17 per cent of the sample were wearing a recommended hat , 15.1 per cent were using shade , and 3.4 per cent were wearing a recommended style of shirt at the time of observation . Chi-square analyses of the data for under-15-year-olds indicated that a significantly greater proportion of 0- to 9-year-olds were well protected compared to 11- to 14-year-olds , but there was no difference in use of protection by boys and girls under 15 years of age . Stepwise regression analysis of the adult sample ( 15 years and over ) showed that the predictors of overall level of solar protection were marital status and frequency of skin self-examination in the past 12 months . The practical implication s of these findings for future community-based skin cancer prevention programs are discussed Abstract Objective : Whole-body skin self-examination ( SSE )  with presentation of suspicious lesions to a physician may improve early detection of melanoma . The aim of this study was to establish the prevalence and determinants of SSE in a high-risk population in preparation for a community-based r and omised controlled trial of screening for melanoma . Methods : A telephone survey reached 3110 residents older than 30 years ( overall response rate of 66.9 % ) r and omly selected from 18 regional communities in Queensl and , Australia . Results : Overall , 804 ( 25.9 % ) participants reported whole-body SSE within the past 12 months and 1055 ( 33.9 % ) within the past three years . Whole-body SSE was associated in multivariate 
    Output:
    
Adherence to sun protection and screening recommendations is associated with a range of factors , including : female gender , sun-sensitive phenotype , greater perceived risk of skin cancer , greater perceived benefits of sun protection or screening , and doctor recommendation for screening .
The literature suggests that a large proportion of the general population engage in suboptimal levels of sun protection , although there is substantial variability in findings .