RESUMEN
OBJECTIVE: We tested the effectiveness of a school-based skin cancer prevention intervention entitled "SunSafe in the Middle School Years" adapted for multiethnic high school students. METHODS: In Hawai'i, 208 10th graders (51.6% Asian, 30.4% Native Hawaiian/Pacific Islander, 8.4% white, 3.5% Hispanic, 2.7% black) participated. Changes in sun protection knowledge, attitudes, and self-reported behaviors were measured using a standardized 18-item survey. The Systematic Observation of Sun Protection Factors (SOSPF) instrument assessed aggregate sun protection behaviors. RESULTS: At posttest, improvements were found in 13 of 18 survey items (p < .05), and retained in 10 items at 12-months following baseline assessments; sun-protection attitudes and intended tanning behavior did not show improvement. Six observers using SOSPF reliably measured students' sun protection behaviors at school including use of hats, sunglasses, long sleeves, lower body coverage, and shade (ICC > .77). CONCLUSIONS: We uncovered a lack of knowledge about UVR exposure, tanning, and lifetime skin cancer risk among multiethnic high school students. We found that students' tanning attitudes may be influenced by self-perceptions regarding their own complexion, but were willing to modify their sun protection behaviors once informed about skin cancer risk.