Preventing Skin Cancer: Education and Policy Approaches in Primary School Settings

(2004 Archived Review)

Interventions in primary school settings are designed to increase sun-protective knowledge, attitudes, and intentions, and affect behavior among children from kindergarten through eighth grade. The interventions focus on some combination of increasing application of sunscreen, scheduling activities to avoid peak sun hours, increasing availability of shade and encouraging children to play in shady areas, and encouraging children to wear sun-protective clothing. It should be noted, however, that increased sunscreen use alone, while useful as part of a healthy sun-protective behavior regimen, is not considered to be sufficiently protective to justify a Task Force recommendation.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force  recommends educational and policy approaches in primary schools to improve children’s “covering up” behavior based on sufficient evidence of effectiveness.

The Task Force finds insufficient evidence to determine the effectiveness of this intervention in:

• Improving other sun-protective behaviors (e.g., avoiding the sun) because of inconsistent findings
• Decreasing sunburns because only a single study, with limitations in design and execution, reported on this behavior

Task Force Finding

About the Intervention

Interventions included at least one of the following:

• Providing children with instruction and/or brochures, flyers, newsletters, letters or videos
• Activities intended to change:
  • Children’s behavior (e.g., modeling, demonstration, role playing)
  • Knowledge, attitudes, or behavior of teachers or parents
• Environmental or policy approaches (e.g., providing sunscreen or shade, scheduling outdoor activities to avoid peak sunlight)

Results from the Systematic Review

Twenty studies qualified for the review.

• Among studies with concurrent comparison groups, findings include:
  • Avoiding the sun: median relative increase of 4% (interquartile range: –8% to 16%; 7 study arms)
  • Covering up: median relative increase of 25% (13 study arms)
  • Using sunscreen: median relative increase of 17% (interquartile interval: 2% to 32%; 6 study arms)
  • Composite behaviors: median relative increase of 2% (interquartile interval: –6% to 72%; 15 study arms)
• Among before-and-after studies, findings include:
  • Covering up: median relative increase of 70% (interquartile interval: 42% to 100%; 5 study arms)
  • Using sunscreen: median relative increase of 34% (interquartile interval not available; 2 study arms)
  • Avoiding the sun: relative increase of 16% (interquartile interval not available; 1 study arm)
• Other results
  • The overwhelming majority of intervention arms showed a significant increase in knowledge (22 out of 25 arms) and a significant change in attitude (13 out of 17 arms). Only four reports evaluated intentions and their findings were inconsistent in direction and generally not statistically significant.

Find a Research-tested Intervention Program (RTIP) about the use of education and policy approaches in primary school settings (What is an RTIP?).

These results are based on a systematic review of all available studies led by scientists from CDC's Division of Cancer Prevention and Control with input from a team of specialists in systematic review methods and experts in research, practice and policy related to preventing skin cancer.

Supporting Materials

• Analytic framework [PDF - 68KB]
• Evidence Gaps
• Summary evidence tables [PDF - 54KB]
• Included Studies

Publications

CDC. Preventing skin cancer. Findings of the Task Force on Community Preventive Services on reducing exposure to ultraviolet light. MMWR 2003;52(RR-15):1–12.

Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. [PDF - 788KB] Am J Prev Med 2004;27(5):422-66.

Task Force on Community Preventive Services. Recommendations to prevent skin cancer by reducing exposure to ultraviolet radiation. [PDF - 70KB] Am J Prev Med 2004;27(5):467-70.

Task Force on Community Preventive Services. Cancer. [PDF - 402KB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:143-87.

More Community Guide publications about Cancer Prevention and Control

---



Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing skin cancer: education and policy approaches in primary school settings (2004 archived review). www.thecommunityguide.org/cancer/skin/education-policy/primaryschools_archive.html. Last updated: MM/DD/YYYY.

Review completed: February 2002