A Cluster Randomized Trial of Sun Protection at Elementary Schools

Abstract

Background Elementary schools are one potential venue for sun protection interventions that reduce childhood sun exposure. Purpose To assess Year-2 results from a cluster randomized trial promoting hat use at schools. Design Block randomization was used to assign intervention/control status to participating schools. Data were collected from 2006 to 2008 and analyzed in 2007–2010. Setting/participants Of the 24 schools in the School District of Hillsborough County, Florida enrolled, fourth-graders were targeted in the first year and followed through their 5th-grade year. Intervention Classroom sessions were conducted to improve sun protection knowledge, foster more positive attitudes about hat use, and change the subjective norm of wearing hats when at school. Main outcome measures Year-2 outcomes assessed included hat use at school (measured by direct observation), hat use outside of school (measured by self-report) and skin pigmentation and nevi counts (measured for a subgroup of 439 students). Results The percentage of students observed wearing hats at control schools remained unchanged during the 2-year period (range 0%–2%) but increased significantly at intervention schools (2% at baseline, 41% at end of Year 1, 19% at end of Year 2; p<0.001 for intervention effect). Measures of skin pigmentation, nevi counts, and self-reported use of hats outside of school did not change during the study period. Conclusions This intervention increased use of hats at school through Year 2 but had no measurable effect on skin pigmentation or nevi. Whether school-based interventions can ultimately prevent skin cancer is uncertain.

Pigmented naevi and sun protection behaviour among primary and secondary school students in an Eastern Hungarian city

“…At present, the best approach for reducing the mortality of MM seems to be the improvement of primary and secondary prevention and screening strategies . In Hungary, there are not yet any sun protection and awareness programmes such as those that have been implemented in the USA and Australia . Observations in these studies support the need for consistent counselling with children and their parents regarding the appropriate use of sun protection, which is also confirmed by other studies .…”

Melanoma Epidemiology and Prevention

“…Several interventions directed at primary school-aged children have resulted in reduced sun exposure measured by self-reports, UVR (UV)-sensitive dosimeters, skin color change, or development of fewer melanocytic nevi [43,44,45,51,109,126,140,169,170], but a few did not affect sun exposure [85,109,205]. These interventions involved instructional materials inserted into the school curriculum or had dermatologists talk with staff and parents.…”

Sample size calculations for group randomized trials with unequal group sizes through Monte Carlo simulations

“…Two specific examples are the Florida Patient Navigation Study 4 and the cancer Screening Office System study. 13,14 The information about the target clinics was available as the study institute was affiliated to those local clinics; in the Sun Hat Project, 15,16 the schools’ information was publically available. Another source of the prior information about n j is from literature review or pilot study.…”

“…As we discussed in the Methods and Results part, the information about the groups in some studies is approximately known at the study design stage. 4,[13][14][15][16] For many other GRT studies, this information can be obtained through literature review, pilot studies, or publically available information about target study groups (e.g. schools, census).…”