***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 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 OBJECTIVES We examined whether US Postal Service letter carriers who received a sun safety intervention  would wear  wide-brim hats and sunscreen  significantly more often than those who did not receive the intervention . METHODS We used a 2-group r and omized design with 2662 evaluation cohort participants from 70 US postal stations . Evaluations were conducted at baseline , 3 months , 1 year , and 2 years . Question naire items assessed occupational use of sun-screen and wide-brim hats .  The 2-year sun safety intervention included the provision of wide-brim hats , accessible sunscreen , reminders , and 6 educational sessions . RESULTS At the 3-month follow-up evaluations , the odds ratio ( OR ) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group ( 95 % confidence interval [CI]=2.2 , 3.5 ) ; at the 2-year follow-up evaluations , the rate was still significantly higher ( OR=2.0 ; 95 % CI=1.6 , 2.6 ) . Intervention group participants also had significantly higher rates of hat use , with the differences remaining consistent across all follow-ups ( OR=2.9 ; 95 % CI=2.3 , 3.6 ) . CONCLUSIONS The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors BACKGROUND Aquatic staff , including lifeguards , are exposed to intense sunlight for many hours each day and are likely to be at a relatively high risk for developing skin cancer . However , no interventions have been specifically directed to staff at outdoor swimming pool sites . METHODS We conducted a r and omized controlled trial among aquatic staff at 28 outdoor pool sites in Hawaii and Massachusetts .  Intervention pools received sun protection education and control pools received education on child injury prevention . Staff in both arms received orientation sessions and led instruction during swim lessons . Analysis of covariance was used to compare and test for changes in outcome variables ( sun protection habits and sunburning rates of aquatic staff ) and pool protection policies . Surveys were completed at the beginning and end of the summer . RESULTS Surveys were completed by 220 aquatics staff at baseline ; 194 surveys were completed at posttest . Compared with staff at control pools , sun protection policies ( P < 0.04 ) and sunburning rates ( P < 0.05 ) improved at sun protection pools from baseline to posttest . However , the difference in the mean score of all sun protection habits between the two study groups was nonsignificant . CONCLUSION The Pool Cool sun protection intervention had significant effects on lifeguards ' sunburn rates and pool sun safety policies but did not improve reported sun protection behaviors . More intensive strategies may be needed to influence aquatics workers who have already begun to adopt skin cancer prevention practice ABSTRACT A successful  occupational sun-protection program  was translated to 67 ski areas where the effectiveness of two dissemination strategies was assessed . An industry professional association distributed material s to the resorts . Half of the resorts received the basic dissemination strategy ( BDS ) in which the material s were simply distributed to the resorts . In a r and omized trial , the BDS was compared with an enhanced dissemination strategy ( EDS ) that added interpersonal contact with managers . Employees ( n = 2,228 ) at worksites that received the EDS had elevated program exposure  ( 74.0 % at EDS vs. 57.5 % at BDS recalled a message ) . Exposure increased at two levels of program use : from less than four ( 55 % exposed ) to four to eight ( 68 % ) and to nine or more ( 82 % ) program items in use . More employees exposed to messages engaged in sun-safety behaviors than those unexposed . At worksites using nine or more items ( versus 4–8 or < 4 ) , employees engaged in additional sun-safety behaviors . Program effects were strongly mediated by increased self-efficacy . Partnerships with industry associations facilitate dissemination of evidence -based programs . Dissemination methods are needed to maximize implementation and exposure to reduce health risk behaviors Men over the age of 45 present with thicker , more advanced melanomas than younger people . A r and omised trial was conducted in this group to evaluate whether an educational brochure would increase knowledge about melanoma and the ability to recognise and discriminate between pigmented skin lesions .  Men in an industrial complex were allocated to an intervention group ( n = 110 ) and two control groups ( n = 96 and n = 108 ) . The intervention group was given two educational brochures about melanoma . Their effect on knowledge and ability to detect pigmented lesions was assessed by a question naire and a self-examination body chart given before the brochure , and at four weeks and three months after return of the brochure . The control groups did not receive any educational material , but control group 2 received the question naire and chart . At the end of the study all participants were examined for pigmented lesions by doctors , whose counts were compared with those of the participants . There was a significant ( 19.8 per cent ) increase in knowledge about melanoma in the intervention group ( but not in the control groups ) , except for discrimination of photos of benign and malignant lesions . The educational material did not improve the ability of those in the intervention group to recognise and count their pigmented lesions nor to discriminate between benign and malignant pigmented lesions . The increased knowledge about melanoma was retained for at least three months OBJECTIVE To assess individual time-related ( time-stamped ) UV radiation ( UVR ) dose pattern and sun exposure behavior . DESIGN Open prospect i ve observational study . SETTING University hospital . Study Subjects Two hundred eighty-five Danish volunteers with apparently healthy skin : children , adolescents , indoor workers , sun worshippers , golfers , and gardeners ( age range , 4 - 68 years ) . Measurements We developed a personal electronic UVR dosimeter in a wristwatch ( SunSaver ) and measured continuously time-related UVR doses in st and ard erythema dose ( SED ) and corresponding sun exposure behavior from diaries , result ing in 346 sun-years ( median , 119 days ) . The estimated yearly UVR doses were calculated based on personal and ambient measured doses . RESULTS The median estimated yearly UVR dose was 173 SEDs ( range , 132 SEDs [ indoor workers]-224 SEDs [ gardeners ] ) , with no significant difference by age ( P = .25 ) or sex ( P = .75 ) . The SED of girls ( 175 SEDs ) was significantly ( P = .04 ) higher than that of boys ( 116 SEDs ) . Subjects younger than 20 years had an increase of 5 SEDs per year ( P = .03 ) . Sunbathing or exposing shoulders ( risk behavior ) outside the beach result ed in a median of 2.5 SEDs per day in northern Europe and 3.2 SEDs per day in southern Europe ; however , at the beach , corresponding values were 4.6 and 6.9 SEDs per day . Children and adolescents received more than half their total UVR dose at the beach . Sunburning doses above 10 SEDs per day were connected with sunbathing or exposing shoulders . Of the UVR dose , 50 % was received between noon and 3 PM . Only the gardeners received most of their UVR dose ( 55 % ) on working days . CONCLUSIONS High UVR doses are connected with risk behavior , except for outdoor workers . There is no need to change sun exposure habits on days without risk behavior OBJECTIVES Outdoor workers are at high risk of developing skin cancer . Primary prevention in this group can potentially reduce the incidence of skin cancer , and also potentiates the spontaneous remission of existing solar keratoses . A r and omized controlled trial was conducted to evaluate a solar protection intervention targeting outdoor workers . METHODS Outdoor workers were r and omly allocated to an intervention ( n = 65 ) or control group ( n = 77 ) . The intervention group received individual skin screening by a dermatologist and participated in an education session . Pre- and posttest outcome measures included solar protection behavior ( assessed using a vali date d diary ) , knowledge , and attitudes . RESULTS There was a significant increase ( 16 % ) in the percentage of outdoor workers who were using a high level of solar protection at posttest compared to pretest in the intervention group , but there was no change in the control group . Although both groups improved in their knowledge score , the intervention group showed a significantly greater improvement at posttest . No changes in attitudes were detected . CONCLUSIONS The findings suggest that changes in solar protection are achievable with outdoor workers 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 Abstract Objectives : A grade d worksite intervention program to improve sun protection and skin cancer awareness of outdoor workers was implemented and evaluated longitudinally over a period of 20 months . Methods : Outdoor male workers ( 144/213 recruits ) from geographically separated units of the Israel National Water Company were allocated to complete ( n = 37 ) , partial ( n = 72 ) or minimal ( n = 35 ) intervention groups . Subsequent to the assignment and training of local safety officers , an educational and medical screening package was provided to the corresponding groups either once , or repeatedly a year later . Personal sun protective gear was provided upon repeated intervention . Outcome measures were evaluated through self-response question naires administered prior to the first intervention pulse , and 8 months after the first and second interventions . Results : A 15–61 % improvement in sun-protection habits was noted in the entire study population 8 months after initialization , compared to no sunscreen use , 20 % sun-exposed skin area and highest mean occupational exposure dose of 1.68 MED/day at pre-test . An even greater use of sunscreen was evident 1 year later in the complete and partial intervention groups , + 80 % and + 52 % , respectively . The baseline rate of self-examination of the skin in the same two groups ( 49 % ) increased significantly at post-test ( + 71 % and + 53 % , respectively ) . Conclusions : This integrated intervention program led to significantly improved sun protection and skin cancer awareness . Repeated intervention combined with the supply of sun-protective gear contributed to an even greater impact BACKGROUND Skin cancer is the most common form of cancer in the United States and one of the most preventable . Prevention programs for children at outdoor recreation sites may influence not only the youth , but the staff , or caregivers , as well . By teaching children about sun protection , staff may also change their sun protection behaviors . OBJECTIVE We report on the impact of a childhood  skin cancer  prevention program ( SunSmart ) on staff at outdoor recreation sites where a child-focused intervention was conducted . METHODS The intervention included staff training , on-site activities delivered by staff , distribution of sunscreen , and the promotion of sun-safe environments . It was hypothesized that by teaching children about sun protection , staff would change their sun protection behaviors . A r and omized trial at 14 recreation sites ( n = 176 staff ) in Hawaii tested the efficacy of education only , and education plus environmental changes , compared with a control condition . RESULTS Results showed significant positive changes in knowledge , sun protection habits , norms , and sun protection policies . The education plus environment group was not superior to education alone . CONCLUSION Changes in staff behavior and attitudes are important for their own health , as positive role models , and for the dissemination of skin cancer control programs 
    Output:
    
Large studies with extended follow-up times demonstrated the efficacy of educational and multi-component interventions to increase sun protection , with some higher use of personal protective equipment such as sunscreen .
However , there is less evidence for the effectiveness of policy or specific intervention components .