The Centers for Disease Control and Prevention (CDC) recommends sun safety education in schools, but the Task Force on Community Preventive Services has not found sufficient research evidence to recommend such education in secondary schools. A commercial sun safety curriculum (Sunny Days, Healthy Waysİ) with demonstrated effectiveness in elementary schools was adapted and tested with middle school students in three Southwestern US states.  The adaptations were based on social cognitive theory and included components of goal setting, strategies to overcome perceived barriers, and environmental analysis to improve the likelihood of effectiveness with students in grades 6 through 8.

Thirty schools agreed to participate, with 15 pairs of schools matched by similar student characteristics. Half of the schools were randomly assigned to intervention (teacher training and implementation of the curriculum) and half to control. Teachers attended a two-hour training and were asked to submit a checklist outlining how they used the curriculum (9 of 20 complied). The curriculum was organized into six 50-minute lessons that could be delivered in shorter segments.

Parental consent for student pre-and post-testing was received for 55% of the students. Over 2000 students completed the pre-test measures (February and March), and approximately 88% completed the post-test (May).

Students in the intervention schools reported more sun-protection behaviors (including wearing long sleeve clothing at recess, use of sun screen) than controls. These findings were consistent with skin color measures on a sub-sample from each class (n=191 students), e.g., students who reported more frequent sun-protection behaviors had less skin redness as measured by a colorimeter.  The intervention group also had higher knowledge scores about sun safety, less favorable attitudes about sun tans, and reported fewer barriers to practicing sun safety, and more positive expectations about using sunscreen with an SPF of at least 15.  These students appeared to prefer using sunscreen as the most common protection as compared to clothing that blocks the sun or limiting the time of exposure to the sun, and this finding is consistent with adult studies.

(Buller DB et al. Am J Prev Med 2006;30(1):13-22)

Comment: Although two members of the research team are financially associated with this sun safety curriculum, the study method was rigorous, different kinds of measures were used to test its effectiveness, and the results deserve attention.  --J.O.