The objective of this study is to test a novel intervention designed to facilitate the implementation of school district board sun safety policy by individual elementary schools. It is expected to produce a change in sun safety practices at the school level and improve the sun safety behavior of children attending schools in the special intervention (SI) condition. Evaluation of the SI will occur in a randomized practical trial in whih N=142 schools are randomized to either: (a) an SI condition where strategies to facilitate sun safe policy implementation are delivered, and (b) an attention-control condition that receives copies of national guidelines for school sun safety. Schools will be divided into three cohorts to facilitate the project logistics. The primary outcome will be self-reported school-level practices for sun safety (e.g., scheduling to avoid peak UV hours, allowing use of hats) from questionnaires completed by the principal and one teacher at each school at baseline and 24-months post-baseline. A PTA representative will report on PTA involvement in school-level practices post-baseline. School-based practices will be assessed with a measure based on policy procedures recommended by CDC and built on a similar measurement strategy used successfully to evaluate school district board policy in our recent Sun Safe Schools study. Questionnaires will be completed using internet, telephone, or mail. To provide a comparison between the school district board policy and school-level practices, the board policy of each participating district will be coded for policy elements. A random sample of parents from each school will complete a questionnaire reporting the sun safety behavior of the target child and indicating the number of sun safety communications from the school. The parent questionnaire will be completed online, by mail or by telephone. Parent reports of child behaviors will be collected using self-report measures validated against daily/weekly diaries. Participating schools (N=142) will be recruited from 30 school districts within a radius of 100 miles of Claremont, California, a city in eastern Los Angeles County approximately 35 miles from downtown Los Angeles. This radius will provide access to 296 eligible elementary schools. The intervention will include three components: (1) in-person visits and follow-up communications, (2) printed and online resources, and (3) mini-grants to support initial changes in school sun safety practices. Intervention components will promote implementation of the 10 policy components recommended by CDC including sunscreen use, UV protective clothing, hats, student education, teacher education, provision of shade, scheduling to avoid peak UV exposure, parent outreach, resource allocation for sun safety, and an accountability system for sun safe practices. In this study 80% power is available to detect the predicted treatment differences at p<.05 one-tailed. Economic analyses will be conducted to provide cost-effectiveness information useful to school administrators for future use of the program. The project is significant and innovative and, will extend our earlier research on adoption of school sun protection policies, determine if policy adoption alone produces implementation or schools need technical assistance, and fills a gap in sun protection policy research.

Public Health Relevance

This work will test a novel intervention to facilitate the implementation of school district board policy for sun safety at the individual school level. Success of the program will be characterized by an increase in school-level practices that reflect the school board sun safety policy and by changes in the sun safety behaviors of the children attending the schools. Economic analyses will also be conducted to determine the cost effectiveness of the program. If successful, the intervention will be an important and potentially cost effective public health tool for decreasing skin cancer risk. The study will also increase our understanding of the factors that mediate programs that translate district school board policy to the school level. Relatively little work has been conducted on this important topic and enhanced understanding of mediators will aid in the development of impactful policy interventions for a host of risk behaviors in addition to sun safety. Given the dearth of interventions on policy and the implementation of policy for health behaviors, the approach described in this proposal is novel and has the potential to greatly improve our ability to engage schools as an asset in the prevention of skin cancer.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Community-Level Health Promotion Study Section (CLHP)
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Haverkos, Lynne
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Claremont Graduate University
Other Domestic Higher Education
United States
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Berteletti, Julia; Buller, David B; Massie, Kim et al. (2018) Sun Protection Policies in Public School Districts With Elementary Schools in California. JAMA Dermatol 154:103-105
Buller, David B; Reynolds, Kim D; Berteletti, Julia et al. (2018) Accuracy of Principal and Teacher Knowledge of School District Policies on Sun Protection in California Elementary Schools. Prev Chronic Dis 15:E07