You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
A community-based randomized trial encouraging sun protection for children.
Abstract 1:
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


Title 2:
Evaluation of Interventions to Improve Solar Protection in Primary Schools
Abstract 2:
Childhood and adolescence are critical periods in the etiology of subsequent melanoma and nonmelanocytic skin cancers . The aims of the study were ( a ) to develop a valid measure of solar protection in 9 to 11-year-old school students , ( b ) to evaluate the differential effectiveness of two interventions aim ed at changing solar protection in this age group , and ( c ) to identify the predictors of use of a high level of solar protection . A Solar Protection Behavior Diary was developed and vali date d during a pilot , after which 11 schools were r and omly allocated to one of three groups : intensive intervention ( 247 students ) , st and ard intervention ( 180 students ) , or control ( 185 students ) , with students in years 5 and 6 participating in the study . Students completed the vali date d diary ( for 5 days ) and a knowledge and attitudes question naire at pretest and at two posttest periods ( 4 weeks and 8 months after pretest ) . Results indicated that students in the intensive intervention group were significantly more likely to have used a high level of protection at both posttest periods compared to the control and st and ard intervention groups . There was no difference in the protection level of the control and st and ard intervention groups at either posttest , indicating that this minimal intervention was not effective in changing the solar protection behavior of the students . Students with a high level of solar protection at pretest were also significantly more likely to have a high level of protection at both posttest periods , and those with a greater number of opportunities to protect were less likely to protect at the second posttest


Title 3:
Effective education of adults with asthma who are allergic to dust mites.
Abstract 3:
The effects of supplementary computer instruction in house dust mite-avoidance measures on adherence to implementing measures , on home dust mite-allergen levels , and on symptomatology were investigated in 52 adult patients with mite-associated asthma . Twenty-six patients received conventional instruction ( counseling and written instruction ) and the other 26 patients received conventional plus 22 minutes of interactive computer-assisted instruction . Instructions were aim ed at mite-avoidance measures . Pre- and postinstruction dust sample s were collected , and adherence was monitored . All patients kept symptom diaries twice a day . Patients ' progress was followed for 12 weeks , and all patients completed the study . Adherence , number of observed and self-reported mite-avoidance measures implemented after visit , was higher for the computer group ( p = 0.023 ) . The computer-instructed group achieved significantly lower levels of mite allergen in bedroom carpets ( p = 0.004 ) with mean levels of mite allergen declining from 6.5 + /- 7.6 to 2.2 + /- 4.3 micrograms/gm of dust ( two-site monoclonal antibody assays ) , whereas levels for the conventional-instructed group did not change . Moreover , by study weeks 9 and 10 , the computer-instructed group was significantly less symptomatic ( p = 0.033 ) . Mean symptom scores for this group decreased from 12.4 to 7.7 , compared with 16.4 to 14.3 . Conventional instruction supplemented with computer instruction is suggested in mite education


Title 4:
Brief report: An empirically derived educational program for detecting and preventing skin cancer
Abstract 4:
College and high-school students were administered a question naire to assess their knowledge about skin cancer , and afterward an educational program was design ed to correct the identified deficiencies . Results showed that the students were relatively uninformed about how to recognize and prevent skin cancer — high-school students more so than college students — but that their knowledge of the disease ( e.g. , risk factors , preventive measures , and identification of “ warning signs ” for early detection ) increased significantly after training . Some forgetting was noted at a 2-week follow-up but knowledge levels were still significantly higher than baseline . If these findings are representative of the general population , more preventive education will be needed in this area . This is especially true because the potentially deadly melanoma appears to be increasing at an alarming rate


Title 5:
Sun Smart Day: a pilot program for photoprotection education.
Abstract 5:
Excessive exposure to the sun 's ultraviolet radiation ( UVR ) contributes to the etiology of melanoma and nonmelanoma skin cancers . Many behaviors that increase lifetime risk of skin cancer -- sun exposure , sunburn , and lack of sun protection -- occur early in childhood . A 1-day school-based skin cancer prevention effort -- Sun Smart Day -- was implemented and evaluated in three elementary schools to improve fourth- grade rs '  knowledge , attitudes , and behaviors related to skin cancer prevention . A classroom-based skin cancer prevention lesson was compared to an interactive sun safety fair was vehicles for promoting comprehensive photoprotection . Sun Smart Day interventions had their greatest impact on  fourth- grade rs '  awareness and knowledge of skin cancer and children 's increased knowledge persisted through the summer break . While both the classroom curriculum and the health fair boosted awareness and knowledge of sun safety among fourth grade rs , the classroom curriculum demonstrated a slight immediate advantage over the health fair on these outcomes . Also the curriculum was less difficult to implement , but the health fair was more engaging . A Sun Smart Day program may be an important first step in increasing public awareness and underst and ing of skin cancer and its prevention


Title 6:
Reducing tobacco smoke in the environment of the child with asthma: a cotinine-assisted, minimal-contact intervention.
Abstract 6:
Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences . An experimental design was used to evaluate a minimal-contact intervention aim ed at modifying parents ' smoking behavior in their homes . All subjects received counseling on the health effects of passive smoking and advice to quit smoking inside the home . Treatment subjects were also mailed the results of a  urine cotinine test on their child and a self-help manual . More treatment ( 35 % ) than control ( 17 % ) subjects reported smoking outside their homes at posttest ( and their children 's cotinine levels were lower ) , but this difference was not statistically significant


Title 7:
Reduction of environmental tobacco smoke exposure in asthmatic children. A 2-year follow-up.
Abstract 7:
STUDY OBJECTIVE To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic children 's exposure to environmental tobacco smoke ( ETS ) . PARTICIPANTS Families of asthmatic children ( 6 to 17 years ) , including at least one parent who smoked in the home , recruited from four pediatric allergy clinics . DESIGN Participants were r and omized to one of three groups : behavioral counseling to reduce ETS exposure , self-monitoring control , and usual medical care control . Counseling concluded at month 6 , and the original trial ended at month 12 . Two follow-up interviews occurred at months 20 and 30 . MEASUREMENTS AND RESULTS The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure . The 2-year follow-up period was analyzed similarly . Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up . Further exploratory analyses suggested that printed counseling material s given to all participants at month 12 ( conclusion of the original study ) were associated with decreased exposure in the control groups . CONCLUSION Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature , let alone for addictive behaviors . We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit


Title 8:
Reducing ultraviolet radiation exposure in children.
Abstract 8:
BACKGROUND Project SUNWISE evaluated the effectiveness of a multicomponent intervention in reducing children 's ultraviolet radiation ( UVR ) exposure .  METHODS Across four YMCAs , 48 aquatics classes ( N = 169 children , mean age = 7 ) were r and omly assigned to either the intervention or the control condition . The 6-week intervention included a UVR reduction curriculum presented at poolside by aquatics instructors and home-based activities for children and their parents . Outcome measures were ( a ) tanness-associated skin color dimensions assessed with a colorimeter , ( b ) specific daily solar protection behaviors of children as reported by parents , and ( c ) general solar protection behaviors . RESULTS Controlling for intraclass clustering in all analyses , at posttest , no statistically significant between-group differences were found in tanness , daily solar protection scores , or general sunscreen use . The intervention group showed significantly greater general hat use relative to controls . CONCLUSIONS The intervention failed to impact most of the outcome measures . Supplementing the behavior-focused intervention package with environmental supports may be warranted


Title 9:
Educating preschoolers about sun safety.
Abstract 9:
OBJECTIVES This feasibility study examined whether a sun safety curriculum design ed for and administered to preschoolers affects their cognition ( knowledge , comprehension , application ) regarding sun safety . METHODS Twelve classes of 4- to 5-year-olds were recruited from local preschools and r and omly assigned to an intervention group or a control group . The intervention group received an investigator-developed sun safety curriculum ; the control group did not . Children in both groups were tested at the beginning of the study about their cognition related to sun safety . They then received posttests 2 and 7 weeks following the pretest . RESULTS The curriculum had a significant effect on the knowledge ( P = .01 ) and comprehension ( P = .006 ) components of cognition . The application component of cognition was not significantly changed by the curriculum . CONCLUSIONS A structured curriculum was found to be an efficacious means of enhancing knowledge and comprehension of sun safety in preschool children . At the preoperational developmental stage , however , children may not be able to apply such knowledge and comprehension
CONCLUSIONS Positive short-term changes in health-protective awareness , knowledge and self-reported behaviour appear to be associated with relatively intensive interventions that use multiple methods and setting s , and /or are delivered over multiple sessions