School sun-protection policies: measure development and assessments in 2 regions of the United States.

BACKGROUND: In 2002, the US Centers for Disease Control and Prevention recommended that schools adopt policies that reduce exposure of children to ultraviolet radiation to prevent skin cancer. We report here the development of a school sun-safety policy measure and baseline descriptive statistics from the assessment of written policies collected in 2005-2007 from public school districts that enrolled in a randomized trial evaluating a policy promotion program. METHODS: Written policies were collected from 103 of 112 school districts in Colorado and Southern California prior to randomization. We developed methods for selecting policy headings/sections topics likely to contain sun-safety policies for students and for assessing the presence, strength, and intent of policies. Trained coders assessed the content of each policy document. RESULTS: Overall, 31% of districts had a policy addressing sun safety, most commonly, protective clothing, hats, sunscreen, and education at baseline. More California districts (51.9%) had these policies than Colorado districts (7.8%, p < .001). Policy scores were highest in districts with fewer Caucasian students (b = -0.02, p = .022) in Colorado (b = -0.02, p = .007) but not California (b = 0.01, p = .299). CONCLUSION: The protocol for assessing sun-safety policy in board-approved written policy documents had several advantages over surveys of school officials. Sun-protection policies were uncommon and limited in scope in 2005-2007. California has been more active at legislating school policy than Colorado. School district policies remain a largely untapped method for promoting the sun protection of children.

Motivating public school districts to adopt sun protection policies: a randomized controlled trial.

BACKGROUND: In 2002, CDC recommended that the nation's schools establish policies that reduce sun exposure to decrease students' risk of skin cancer. PURPOSE: A program to convince public school districts to adopt such a policy was evaluated. DESIGN: RCT. SETTING/PARTICIPANTS: Public school districts in Colorado (n=56) and Southern California (n=56). INTERVENTION: Policy information, tools, and technical assistance were provided through printed materials, a website, meetings with administrators, and presentations to school boards. An RCT enrolled public school districts from 2005 to 2010. Policy adoption was promoted over 2 years at districts randomized to the intervention. MAIN OUTCOME MEASURES: School board-approved policies were obtained from 106 districts and coded at baseline and 2-year follow-up. Analyses were conducted in 2010. RESULTS: There was no difference in the percentage of districts adopting a policy (24% in intervention; 12% in control; p=0.142); however, intervention districts (adjusted M=3.10 of 21 total score) adopted stronger sun safety policies than control districts (adjusted M=1.79; p=0.035). Policy categories improved on sun safety education for students (intervention adjusted M=0.76; control adjusted M=0.43, p=0.048); provision of outdoor shade (intervention adjusted M=0.79; control adjusted M=0.28, p=0.029); and outreach to parents (intervention adjusted M=0.59; control adjusted M=0.20, p=0.027). CONCLUSIONS: Multifaceted promotion can increase adoption of stronger policies for reducing sun exposure of students by public school districts. Future research should explore how policies are implemented by schools.