Sunny Days Healthy Ways - Elementary School (Grades K-5)

Skin cancer is the most common form of cancer in the United States. Ultraviolet radiation (UVR) exposure is the most preventable risk factor for skin cancer and can be reduced by avoiding the sun during daily peak sun hours, wearing protective clothing, and applying sunscreen properly. Sun protection must start early in life. It has been estimated that one quarter of an individual's lifetime exposure to sun occurs before age 18. Severe sunburns, especially those occurring before age 20, may be linked to melanoma and basal cell and squamous cell carcinoma. Children are seldom adequately and consistently protected from the sun. Through sun safety curricula, preschool and elementary school children can learn about the importance of solar protection, and they may increase their preventive behavior.

The Sunny Days, Healthy Ways (SDHW, K-5) program is a comprehensive, cross-curricular approach to providing sun protection education and skin cancer prevention skills for children in kindergarten through fifth grade.  SDHW, K-5 aims to increase students' knowledge, teach students solar protection skills, produce positive changes in attitudes, and stimulate sun safety behavior. Sun safety skills taught include:

• Limiting sun exposure during peak hours of daytime UVR
• Seeking shade
• Wearing protective clothing
• Applying sunscreen
• Asking parents for help practicing sun safety

SDHW, K-5 offers three age-appropriate versions:

• Kindergarten and first grade (K-1)
• Second and third grades (2-3)
• Fourth and fifth grades (4-5)

Each component contains four units: Living with Sunshine, Limiting Time in the Sun, Wearing Cover-Up Clothes, and Using Sunscreen. The instructional activities incorporate health, science, reading, mathematics, geography, physical education, art, computers, and writing. Prepared lesson plans, student activity sheets, experiment materials, story books, and assessments are provided.

The SDHW curriculum provides an average of 8 hours of sun safety instruction, per grade, that can be tailored according to time frame and need.  A 1.5 hour training session was provided to teachers.

The primary audience for the SDHW, K-5 intervention is kindergarten through fifth grade elementary school children. 

The SDHW, K-5 intervention is designed to be used in elementary schools. 

• Sun Safe School Guide
• Sunny Days, Healthy Ways Curriculum, Grade K
• Sunny Days, Healthy Ways Curriculum, Grade 1
• Sunny Days, Healthy Ways Curriculum, Grade 2
• Sunny Days, Healthy Ways Curriculum, Grade 3
• Sunny Days, Healthy Ways Curriculum, Grade 4
• Sunny Days, Healthy Ways Curriculum, Grade 5

The SDHW, K-5 curriculum was evaluated with 744 students in 77 classes (kindergarten through fifth grade) in 10 elementary schools. Students in six schools received instruction twice over 2 school years (repeated-presentation group). Classes in the remaining four schools were randomized so that students either received SDHW only once in a single school year (single-presentation group) or were enrolled in a no-treatment control group.  Children in kindergarten and first grade did not provide demographic characteristics.  In grades 2-5, approximately 51% of the participants were male and 49% were female.  Of participants in grades 2-5, approximately 73% were White, and approximately 27% were coded as "other."

The pretest and posttest surveys for children in grades 2-5 measured children's knowledge of sun safety concepts, skills, and information taught in SDHW. Attitude measures were summed into a single attitude score, with higher scores indicating more favorable attitudes toward sun safety. A colorimeter at pretest and posttest measured skin tone changes in response to UVR exposure, with smaller values of pre/post differences indicating less darkening and less UVR exposure. 
The effect of a single presentation of SDHW was tested by comparing the change in outcomes from pretest to posttest between the single-presentation group and the no-instruction group.  The effect of the repeated instruction was tested by comparing the change in outcomes from pretest (year 1) to posttest (year 2) among the repeated-instruction group (those receiving the curriculum over 2 years) and comparing the pretest-posttest change (year 2) to that of the single-presentation group. 

Key Findings
The intervention group indicated the following results:

• Significant decreased ultraviolet ray (UVR) exposure
• Significant increases in sun safety knowledge
• Significant improvements in sun safety attitudes

Effects of the SDHW, K-5 Intervention on UVR Exposure

• Children in grades 2-5 who received repeated instruction displayed lighter skin tones on the L* scale (light-dark), indicating lower exposure to UVR, than children receiving SDHW once: p=.0001. 
• For children in kindergarten and first grade, there were no significant differences on any UVR exposure scales between those receiving either a single presentation of SDHW or repeated instruction of SDHW and those who did not receive instruction.

Effects of the SDHW, K-5 Intervention on Sun Safety Knowledge

• Following the 6-week intervention, compared to children in grades 2-5 who did not receive SDHW instruction, children in grades 2-5 who received SDHW as a single instruction had larger increase in knowledge of sun safety: p=.0001. 
• Repeated exposure to SDHW improved children's sun safety knowledge in grades 2-5, compared to pre/post change in students receiving SDHW once: p=.0005.
• Kindergartners and first graders receiving SDHW once displayed smaller increase in sun safety knowledge than those who did not receive SDHW: p=.047.
• Repeated exposure to SDHW did not improve sun safety knowledge of kindergarteners and first-graders, either compared to those who received one exposure, or when scores from first exposure were compared to scores from second exposure.

Effects of the SDHW, K-5 Intervention on Sun Safety Attitudes

• Compared to children in grades 2-5 who did not receive SDHW instruction, children in grades 2-5 who received a second exposure to SDHW expressed more favorable sun safety attitudes: p=.05.