Guiding Right to Sun Protection

A new report, published by the Center for Disease Control and Prevention in the April 2002 edition of Morbidity and Mortality Weekly Report (MMWR), presented skin cancer prevention recommendations for all schools. Compiled by researchers, Karen Glanz, Ph.D., M.P.H., Mona Saraiya, M.D., M.P.H., and Howell Wechsler, Ed.D., M.P.H., the “Guidelines for School Programs to Prevent Skin Cancer,” provide a comprehensive report for school officials on preventing the risk of skin cancer among school children. According to the report, the recommendations seek “. . . to reduce skin cancer risks through policies; creation of physical, social, and organizational environments that facilitate protection from UV rays; education of young persons; professional development of staff; involvement of families; health services; and program evaluation.” Target audience Physicians in dermatology and pediatrics, public and education health officials, and national, state and voluntary organizations worked together to develop the guidelines. Targeted primarily at state and local health and educational agencies and non-governmental organizations, the CDC intends to develop and distribute materials to school districts for implementation. According Dr. Glanz, the guidelines will be presented to “leaders of state and local school boards, government, health agencies and professional organizations that represent and convene these leaders.” The guidelines will not be presented to federal committees, but rather, to the aforementioned groups that can implement policies to prevent skin cancer. Dr. Glanz says they are currently developing a strategic communication plan for implementation, adding that it will take about a year or two to see how the guidelines are actually implemented. Goals and Implementation The first aim of the guidelines, according to Dr. Glanz, is to “get skin cancer prevention on the radar screens of school boards, principals and teachers across the country.” She hopes to provide them with “recommendations about what they can do, ideally, and what might be good starting points.” While the public and dermatologists are only indirect audiences, Dr. Glanz counts on “their opinions to help motivate action among school leadership.” She says it will take a year or two to see how the guidelines are actually implemented and for good and feasible ideas to spread. For the guidelines to take effect, state and local education and community officials will need to work together to encourage schools officials to follow the guidelines and form sun prevention policies. Sustained support between these organizations is a necessity for the guideline’s success. Dr. Glanz and her colleagues encourage people who work with schools to take advantage of the resources, such as training sessions on how to teach skin cancer prevention and literature available through state and local agencies, that are currently available to help in developing new sun prevention school policies. Implementation will occur “by developing local policies, environmental supports and curricula to improve skin cancer prevention,” Dr. Glanz concludes. The Role of Dermatologists With no legislation currently pending, the efforts and support of dermatologists, nationwide, have been instrumental in promoting awareness. While dermatologists have long believed in tougher sun protection policies, schools have fallen short of devising them. Two reasons no rules exist among school policy makers are the lack of principals’ awareness and certain organizational barriers found in school districts (See sidebar, “Adopting Sun Policies in Schools, “p. 37). Dr. Glanz emphasizes how receptive and supportive dermatologists have been regarding the new guidelines. “Dermatologists and their professional organizations have been eager partners in this [new policy] effort . . . and are very helpful in providing guidance and credibility to these efforts,” she says. Guideline Review The guidelines fall into seven broad categories. Each guideline includes key elements, steps for implementation and realistic expectations for change. A review of the CDC’s seven guidelines is as follows: • Guideline 1: Establish Policies that Reduce Exposure to UV Radiation. Under this guideline, seven policy options are described. Schools are encouraged to combine some of these components if implementing all seven options into one comprehensive policy isn’t feasible. Using California as an example of this policy in action is a law passed in January 2002. This law requires schools to allow students, when outdoors, to wear protective hats and clothing approved by the school. In Australia, where the rate of skin cancer is the highest in the world, officials have developed a sun protection policy kit for schools and a related staff development module. • Guideline 2: Environmental Change — Provide and Maintain Physical and Social Environments that Support Sun Safety and that Are Consistent with the Development of Other Healthful Habits. This guideline seeks the promotion of supportive resources such as protective clothing, hats and sunscreen within a school’s physical environment (for example, more shade protection in the design of new schools). Advocating sun awareness through peer education groups and organized group activities helps support sun-friendly social environments. • Guideline 3: Education — Provide Health Education to Teach Students the Knowledge, Attitudes and Behavioral Skills They Need to Prevent Skin Cancer. This provision encourages skin cancer prevention to be included in the health education curriculum and for timely opportunities to practice sun savvy behavior to be included. For example, introducing sun safety measures to children in Colorado (where outdoor winter sports are common) before winter vacation. • Guideline 4: Family Involvement. Involving family members in sun-prevention efforts, increases the likelihood children will develop and model smart sun behavior after their parents. The more aware parents and family members are about the dangers of the sun, the more informed their children will be. • Guideline 5: Professional Development. This guideline highlights the importance of integrating skin cancer prevention into professional development activities such as teacher certification programs and inservice education. These efforts include arming teachers, physical education teachers, school administrators, school nurses, coaches and all who work with children, with skin cancer knowledge. • Guideline 6: Health Services. Health professionals, such as pediatricians, pharmacists and dermatologists, within the community can advocate for skin cancer policies and support local school programs through professional training, presentations and classroom visits. Under this guideline, health services complement and support skin cancer prevention education. • Guideline 7: Evaluation. Perhaps the most effective way to track the success of the skin cancer prevention programs is periodic evaluation questionnaires. This guideline suggests local school boards, administrators, health agencies and personnel from federal, state and local agencies use the questions to uncover effective education programs within their school districts that prevent skin cancer and to identify which schools will benefit from more training and additional resources. Helping children get educated As a framework to develop, promote and implement skin cancer initiatives, the guidelines seek to prevent sun exposure among school-aged children. With support and cooperation from health professionals and state and local school administrators, educating children now may help protect them in the future.