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Implementation of Sun Safety Policies in Public Elementary Schools

Implementation of Sun Safety Policies in Public Elementary Schools

Klein Buendel Research Program Manager, Julia Berteletti, presented insights from a randomized controlled trial that tested a technical assistance program designed to help principals implement district sun safety policies in elementary schools at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, March 6-9, 2019 in Washington, DC.

The Centers for Disease Control and Prevention (CDC) and U.S. Surgeon General have advised the nation’s schools to adopt and implement sun protection policy to reduce children’s exposure to solar ultraviolet radiation to prevent skin cancer. A total of 118 elementary schools from 40 California public school districts that had adopted a school board-approved policy for sun safety were recruited and the principal and a teacher at each school reported on school sun protection practices at baseline and posttest.

Half of the schools were randomly assigned to receive the 20-month Sun Safe Schools intervention, delivered by trained Sun Safety Coaches who met with principals, described the district policy, helped them select and plan implementation of sun safety practices, and provided support and resources matched to the principal’s readiness to implement practices based on Diffusion of Innovation Theory. Control schools received a minimal information treatment containing basic school sun safety information from the CDC, the National Association of State Boards of Education, and U.S. Surgeon General.

Compared to controls, principals at intervention schools reported implementing more sun safety practices in general, whether present in the district’s written policy or not. Similarly, teachers at intervention schools reported implementing a larger number of sun safety practices in general, including practices in their district’s written policy or not, compared with control schools. Overall, the intervention was effective at increasing sun safety practices in public elementary schools. However, convincing school districts to adopt policies may be only the first step in improving sun safety practices becasue districts need to actively disseminate the new policy to schools and provide assistance and materials to facilitate implementation.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (HD074416; Dr. Kim Reynolds, Principal Investigator). Collaborators in addition to Julia Berteletti, include Dr. Kim Reynolds and Kim Massie from Claremont Graduate University in California; Dr. David Buller and Mary Buller from Klein Buendel; Dr. Jeff Ashley from Sun Safety for Kids in, California; and Dr. Richard Meenan from Kaiser Permanente Center for Health Research in Oregon.

Cost Analysis of a Sun Safety Program at California Elementary Schools

Cost Analysis of a Sun Safety Program at California Elementary Schools

The Surgeon General’s 2014 Call to Action to Prevent Skin Cancer emphasized the importance of sun safety for schools. However, limited cost data exist to inform implementation decisions regarding school sun safety practices. In response, Dr. Richard Meenan from the Kaiser Permanente Center for Health Research (KPCHR), presented data on the costs of delivering a sun protection policy intervention to public elementary schools in California at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018.

The Sun Safe Schools (SSS) program, a joint research effort of Claremont Graduate University (CGU), KPCHR, and Klein Buendel (KB), provided technical assistance to California public elementary schools interested in implementing sun safety practices consistent with their district board policy for sun safety. The research design included a randomized trial of SSS that assessed its effectiveness in promoting implementation and an economic evaluation of the SSS program.

Fifty-eight intervention schools and 60 controls participated. Principals at intervention schools received regular phone and email contact from trained SSS coaches over 20 months to support implementation of selected sun safety practices. Rolling recruitment and intervention occurred over 47 months (2014-18). Study outcome data are from a posttest survey of school principals. Intervention delivery costs were virtually all labor (SSS coach and principal time). Implemented practices were organized into ten categories (such as student education and outdoor shade) and micro-costed using a project-developed template. Required school labor and non-labor resources for implementation were estimated for each practice. Three elementary school principal consultants reviewed the template for appropriateness.

Intervention delivery costs and costs of implemented practices for intervention schools and control schools were presented and are being submitted for publication. Principals’ beliefs about the importance of sun protection were positively correlated with policy implementation, both in numbers of implemented policies and overall dollars invested. Results indicated that a low-cost program of regular phone and email coaching of school administrators can successfully stimulate implementation of sun safety practices in elementary schools at a reasonable cost. Costs per student were similar to other school health practices. These findings can assist administrators with selecting and implementing appropriate sun safety practices for their schools.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators in addition to Dr. Reynolds and Dr. Meenan include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.