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Original Investigation
March 3, 2017

Sun Safety Practices Among Schools in the United States

Author Affiliations
  • 1Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Dermatol. Published online March 3, 2017. doi:10.1001/jamadermatol.2016.6274
Key Points

Question  What school characteristics are associated with having adopted school practices that promote sun safety?

Findings  Nationally representative, cross-sectional survey data from the 2014 School Health Policies and Practices Study show that, overall, sun safety practices were uncommon among schools and that high schools were less likely than elementary and middle schools to adopt several practices. Other school characteristics were either not significantly associated with the adoption of any of the sun safety school practices studied (eg, metropolitan status) or were inconsistently associated with such policies and practices (eg, region, percentage of students eligible for free or reduced-price lunch, and school enrollment).

Meaning  Increasing the adoption of sun safety practices among schools is needed regardless of the level, location, size, and poverty concentration of the school.

Abstract

Importance  Exposure to the sun’s UV radiation is a leading cause of skin cancer. Positive attitudes and beliefs about sun safety behavior, which would make sun protective behavior more likely, could be promoted and supported by school policies and practices.

Objective  To identify school characteristics associated with having adopted practices that promote sun safety.

Design, Setting, and Participants  School-level data from the February 3 to July 23, 2014, School Health Policies and Practices Study’s Healthy and Safe School Environment questionnaire were analyzed. The School Health Policies and Practices Study uses a 2-stage sampling design to select a nationally representative sample of schools. All public, state-administered, Catholic, and non-Catholic private schools with any of the grades from kindergarten through 12 were eligible for inclusion. All analyses were conducted using weighted data.

Main Outcomes and Measures  Prevalence of sun safety practices.

Results  In a nationally representative sample of 828 US schools, representatives of 577 schools (69.7%) responded. Overall, sun safety practices were not common among schools. The most frequent practice was having teachers allow time for students to apply sunscreen at school (47.6%; 95% CI, 42.4%-52.9%). Few schools made sunscreen available for students to use (13.3%; 95% CI, 10.2%-17.0%), almost always or always scheduled outdoor activities to avoid times when the sun was at peak intensity (15.0%; 95% CI, 11.4%-19.6%), or asked parents to ensure that students applied sunscreen before school (16.4%; 95% CI, 12.9%-20.6%). High schools were less likely than elementary schools and middle schools to adopt several practices: for instance, 37.5% of high schools (95% CI, 29.7%-46.0%), 51.6% of middle schools (95% CI, 43.3%-59.7%), and 49.5% of elementary schools (95% CI, 42.0%-57.0%) had teachers allow time for students to apply sunscreen at school, and 11.8% of high schools (95% CI, 7.7%-17.5%), 18.2% of middle schools (95% CI, 13.3%-24.4%), and 14.7% of elementary schools (95% CI, 9.6%-21.8%) almost always or always scheduled outdoor activities to avoid times when the sun was at peak intensity. Other school characteristics were either not significantly associated with the adoption of any of the sun safety school practices studied (eg, metropolitan status) or were inconsistently associated with such policies and practices (eg, region, percentage of students eligible for free or reduced-price lunch, and school enrollment).

Conclusions and Relevance  School practices that could protect children and adolescents from sun exposure and that could change norms about sun safety are not common. Interventions aimed at increasing the adoption of sun safety practices among schools are needed regardless of the level, location, size, and poverty concentration of the school. Such practices would cost little to implement and would support other messages targeted toward children, adolescents, adults, and parents, with an aim to reduce skin cancer morbidity and mortality.

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