Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e247-e256 (doi:10.1542/peds.2006-1579)
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ARTICLE

SunSafe in the Middle School Years: A Community-wide Intervention to Change Early-Adolescent Sun Protection

Ardis L. Olson, MDa,b, Cecelia Gaffney, MEdb, Pamela Starr, MSb, Jennifer J. Gibson, MSb, Bernard F. Cole, PhDb and Allen J. Dietrich, MDb

a Departments of Pediatrics
b Community and Family Medicine, Dartmouth Medical School, Norris Cotton Cancer Center, Lebanon, New Hampshire

OBJECTIVE. Rising rates of skin cancer associated with early-life sun exposure make it important to improve adolescent sun-protection practices. Our study objective was to determine if a multicomponent community-wide intervention could alter the decline in sun protection that begins in early adolescence.

METHODS. A randomized, controlled trial was conducted in 10 communities to assess the impact of the SunSafe in the Middle School Years program. The intervention sought to (1) educate and activate adults and peers to role model and actively promote sun-protection practices and (2) create a pro–sun protection community environment. It targeted school personnel, athletic coaches, lifeguards, and clinicians and enlisted teens as peer advocates. Annual observations of cross-sectional samples of teens at community beach/pool sites were used to assess the impact of 1 and 2 years of intervention exposure compared to grade-matched controls. The outcome was percent of body surface protected by sunscreen, clothing, or shade.

RESULTS. Observers determined the sun protection level of 1927 adolescents entering 6th to 8th grades. After 2 years of intervention exposure, adolescents at the beach/pool in intervention communities were significantly better protected than those in control communities. Over 2 years, the percent of body surface area protected declined by 23% in the control arm but only 8% in intervention arm. After intervention, the average percent of body surface protected at intervention sites (66.1%) was significantly greater than control sites (56.8%). Teens in intervention communities reported sun-protection advice from more adult sources, were more likely to use sunscreen, and applied it more thoroughly than control-site teens.

CONCLUSIONS. Our multicomponent model addressing adolescent sun protection shows the power of engaging teens and adults from across the community as role models and educators. This new ecological approach shows promise in changing adolescent sun protection behaviors and reducing skin cancer risks.

Key Words: adolescence • sun protection/screen • skin cancer • community pediatrics • randomized • control trial • health education • primary care • school • recreation

Abbreviations: SPF—sun-protection factor • BSA—body surface area

Accepted Aug 9, 2006.


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