SunSafe

Rates of malignant melanoma and other skin cancers are rising in the United States. For example, in New Hampshire, skin cancer rates have increased 300% in the last decade. Because most lifetime sun exposure occurs early in life and childhood sunburns may be an antecedent to melanoma, sun protection among children is important. Yet, recent data show that among New Hampshire children visiting freshwater beaches, only 54% were well-protected, 29% partially protected, and 17% were not protected at all.

The SunSafe intervention aims to enhance and promote sun protection of children ages 2 -9 years through the delivery of a multicomponent intervention in three settings: elementary schools and daycare centers, town beach areas, and primary care practices. The school/daycare component consists of an age (2- to- 9-years old) and grade-specific curriculum promoting sun protection. The beach area component consists of an in-service for lifeguards, posting daily UV indices, and providing free sunscreen and educational pamphlets. The primary care component consists of an office system to promote sun protection advice during well-child and illness office visits, a visit by a SunSafe assistant to discuss the importance of counseling about sun protection with clinicians and staff, and the distribution of educational posters and pamphlets.

Child-care providers and elementary school teachers need two theme days or two class periods to deliver SunSafe materials. Ongoing reminder activities are suggested as a means for reinforcing the SunSafe message. Time requirements for primary care practitioners are minimal once office staff have reviewed the sun protection office system manual. Clinicians are encouraged to provide sun protection counseling during children's well-child and illness visits, especially during the summer months. Time requirements for beach areas include a one hour in-service meeting for lifeguards and the dissemination of pamphlets and sun block samples, if available.

Participants were children ages 2- 9 years, their parents, childcare workers, elementary school teachers, lifeguards,and primary care clinicians residing in rural New Hampshire towns.

This intervention is suitable for implementation in schools, day care centers, physician offices, and community recreation areas.

Required resources for the day care and elementary components include the SunSafe Manual with suggested activities, posters, a reading list, and videos. Primary care practices require a sun protection office system manual, and beach areas require pamphlets for lifeguards, posting the daily predicted UV index for the area, and free sun-block samples.

Ten towns in New Hampshire were selected based on population size of 4,000 - 15,000 and a proportion of low income families greater than the state average, matched into five pairs and randomly assigned to either the intervention or control group. Towns assigned to the intervention group received a multicomponent, community-wide intervention promoting sun protection. Program components targeted child-care and elementary school settings, town beach areas, and primary care practices. All intervention components contained the same message: avoid the sun between 11:00 A.M. and 3:00 P.M., cover up using hats and protective clothing, use sun block with a sun protection factor (SPF) > 15, and encourage sun protection among family and friends. Children's observed sun protection behavior was the outcome of interest. Training support and materials were provided by the SunSafe project, but project staff had no direct contact with children or parents in providing the intervention.

Results indicated:

• Between baseline and 2-year follow-up, the proportion of children in the intervention group with at least some sun protection increased 0.15 from 0.58 to 0.73, whereas the proportion in the control group increased by 0.03, from 0.67 to 0.70 (p = 0.033).
  
• The mean proportion of children in the intervention towns using sunscreen on at least one skin surface increased 0.19 from 0.44 to 0.63 between baseline and 2 year follow-up. During the same time period, the proportion of comparably protected children in control towns decreased 0.02 from 0.55 to 0.53 (p value 0.056).