New strategies in the U.S. are needed to combat the rising rates of skin cancers, such as methods to promote the adoption of sun protection policies and environmental features by school. In this revised application we propose to create a program to promote sun protection policies and environments to public school districts and to evaluate its effectiveness at producing district-level changes and implementation of changes in schools. The project will test predictions from diffusion of innovations theory (DIT) about the adoption process and program effects on sun protection policy and environment changes, as well as about secular trends in policy and environmental changes in control districts. DIT, national and local advisory board, and formative assessments of school districts by project staff (analysis of structure and in-depth interviews with administrators) will inform methods for communicating with with district personnel. Program features will be pretested for information design and usability and program implementation procedures will be piloted tested. The Los Angeles Metropolitan Dermatological Society will implement the program in 10 counties in Southern California with on-site assistance from Cooper Institute and University of Southern California staff. Eligible districts will have 40% or more white non-Hispanic students. Districts will be randomized to receive either the CDC national guidelines on school sun safety (control) or in-person, telephone and email contacts with school district administrators, printed materials (policy guidebook, fact sheets, sun protection products catalogue, and employee training), and a Web site (intervention). The program will be evaluated in a group-randomized pretest-posttest two-group trial with 140 districts as the unit of analysis. District policies on sun protection of students and employees will be obtained at pretest and posttest and coded to create composite policy scores. Samples of 980 adminstrators will be surveyed by telephone at pretest and posttest to measure secondary policy and environment outcomes, theoretical mediators and moderators, and district policy-making process. Also, 980 school principals will be pretested and posttested to determine whether policy and environment changes are communicated to and implemented at schools, and how policies are enforced. On-site observations of sun protection policies, environmental features, and employee clothing will validate principal reports. ? ?
