Evaluation of Interventions to Improve Solar Protection in Primary Schools

Abstract

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 aimed 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 validated during a pilot, after which 11 schools were randomly allocated to one of three groups: intensive intervention (247 students), standard intervention (180 students), or control (185 students), with students in years 5 and 6 participating in the study. Students completed the validated diary (for 5 days) and a knowledge and attitudes questionnaire 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 standard intervention groups. There was no difference in the protection level of the control and standard 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.

Effects of the Sunny Days, Healthy Ways Curriculum on Students in Grades 6 to 8

“…The surveys contained a variety of selfreported measures on sun protection. The primary measures were adapted from a sun protection diary, 17 and included time outside, mostly in sun/shade, wearing a head covering, wearing clothing that covered shoulders/arms, wearing clothing that covered legs, and wearing sunscreen. Children completed these reports for times that they were outdoors while at school yesterday during lunch, physical education class, and recess.…”

“…A weighted body coverage measure was created for each time outdoors, ranging from 0 to 15. 17 This diary measure was validated in a pilot study. 18 Also, a series of five-point frequency items assessed how often children applied sunscreen with sun protection factor (SPF) of Ն15, wore clothes covering most of the body, wore a hat, limited time in the sun during midday, stayed in the shade, and wore sunglasses.…”

A Community-based Randomized Trial Encouraging Sun Protection for Children

“…These interventions have led to shortterm changes in knowledge, attitudes, and self-reported behaviors in day care and elementary school populations. 17,18 One multicomponent intervention at swimming pools produced short-term changes in observed sun protection behavior. 19 In a review of skin cancer prevention interventions, Rossi and colleagues 20 emphasized that multicomponent interventions had the most potential for success.…”

SUCCESSFUL BEHAVIORAL INTERVENTIONS TO PREVENT CANCER: The Example of Skin Cancer

“…Diary-based self-reports of protective behaviors increased five weeks and eight months after implementation of the intensive intervention program, with participants in the intensive intervention group more than three times as likely to use sun protective behaviors than participants in the control group. There were no differences between the standard care and control groups (20).…”

“…One of the more successful studies recruited 648 children (9-11 years old) from 11 different schools and randomly assigned each school to an intensive intervention group (20), a standard intervention group, or a control group. The intensive intervention was a four-week program (incorporated into the school curriculum) to increase skin cancer knowledge and develop attitudes and skills for preventing skin cancer.…”