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Sun Safety Curriculum for Grades K-5 is Now Free for Schools

Sun Safety Curriculum for Grades K-5 is Now Free for Schools

Sunny Days Healthy Ways, an evidence-based sun safety curriculum that provides sun protection education for grades K-5, is now available free online by its authors at Klein Buendel, Inc. Schools can use the curriculum to fulfill the school-based goals of the Surgeon General’s Call to Action to Prevent Skin Cancer.

“I was inspired to remove any barriers to schools having access to the curriculum by previous Surgeon General Dr. Boris Lushniak’s impassioned presentation at the 4th Annual Conference on UV and Skin Cancer Prevention,” explained Mary Buller, President of Klein Buendel.

Sunny Days Healthy Ways provides an average of 15 lessons per grade, that teachers can tailor to their timeframe and needs. Prepared lesson plans, student activity sheets, storybooks, learning objectives, and common core standards minimize prep time and make teaching students about sun safety easy. Project-based learning and technology connections make it fun.

Skin cancer is the most common cancer in the U.S. and is increasing at an alarming rate. Even though skin cancer occurs mainly in adults, much of the damage was likely done during childhood. Long periods of unprotected sun exposure and severe sunburning as a child can lead to skin cancer and eye damage later in life. Good health habits started in childhood are more likely to last a lifetime.

Sunny Days Healthy Ways was first created and evaluated with research grants from the National Cancer Institute (CA62968 & CA23074) and the Arizona Disease Control Research Commission (9403). To access the free curriculum, visit the Sunny Days Healthy Ways website at https://www.sdhw.info/.

Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

Exposure to the sun’s UV rays is the biggest risk factor for skin cancer. It is also the easiest risk factor to modify through practicing sun-safe behaviors. Outdoor workers are at an elevated risk for skin cancer, especially melanoma, due to the amount of UV exposure they endure over the years. In a recent ePub-ahead-of-print paper in the Journal of Occupational and Environmental Medicine, Klein Buendel’s Dr. Barbara Walkosz, Dr. David Buller, Ms. Mary Buller and their co-authors discuss the outcomes of the follow-up assessment to Sun Safe Workplaces, a workplace sun safety program that promoted sun safety policy adoption and education.

Two years after the Sun Safe Workplaces intervention, a follow-up assessment was conducted to determine the impact of the program on employee sun safety behavior. All participants of the original intervention (n=98) were invited to partake in the two-year assessment and 63 (n=33 for intervention, n=30 for control) participated. The sample included local government organizations throughout Colorado with outdoor workers in at least one of the following service areas: parks and recreation, public works, and public safety. Project staff visited each employer to evaluate the sun protection policies in place, sun protection messages, and personal sun protection equipment available at each organization. An assessment of the sun safety policies was conducted that included three domains (administrative procedures, environmental controls, and personal protection practices) with 15 content categories. Additionally, policy implementation was measured through senior manager and line supervisor reports on whether or not employers communicated or provided training about sun safety to employees and/or provided any of the types of the recommended personal sun protection equipment for employees (sunscreen, wide-brimmed hats, sunglasses, long-sleeved shirts, long pants, or outdoor shade). Lastly, key contact managers were asked to assist study staff with distributing self-administered surveys to front-line supervisors and employees who worked outdoors, which included time spent outdoors at work, frequency of sun protection at work, prevalence of sunburn in the past 12 months on the job, attitudes toward occupational sun safety and self-efficacy for sun safety on the job, attitudes toward workplace health and sun safety policy, and job and demographic information. A total of 1,784 (n=913 for intervention, n=871 for control) outdoor workers completed surveys.

Results showed that compared to control workplaces, employees in the intervention workplaces reported more sun protection practices overall as well as more frequent use of sunscreen on the body, wearing of wide-brimmed hats, and more often had sunscreen, sunglasses, and a hat with them when at work. Employees in the intervention workplaces also reported fewer sunburns than those in the control workplaces. Additionally, sun protection messages and equipment, as well as employee training in sun safety, were more likely to occur in intervention workplaces and such actions increased the frequency of employees having sunscreen, sunglasses, and a hat on the job.  For employees at employers with a best-practice policy, the total composite sun safety score was significantly higher than in the no-policy group and employees also reported more frequent use of sunscreen on the face and other exposed body parts and having sunscreen, sunglasses, and a hat with them while at work compared to those at no-policy employers. However, unlike the intervention group, there was no effect of policy on the prevalence of sunburns among the employees.

The authors concluded that policy adoption is an important step towards improving sun protection and preventing sunburns on the job for outdoor workers but recommend that a robust approach that includes a policy, training for employees, and personal protection equipment that can support sun safety is needed to effectively change employees’ sun protection behaviors.

This research was funded by a grant from the National Cancer Institute at the National Institutes of Health (RO1CA134705; Dr. David Buller and Dr. Barbara Walkosz, Principal Investigators). Coauthors included Ms. Mary Buller, Dr. Alan Wallis from University of Colorado Denver, Dr. Richard Meenan from the Kaiser Permanente Center for Health Research, Dr. Gary Cutter from Pythagoras, Dr. Peter Andersen from San Diego State University, and Dr. Michael Scott from Mikonics.

 

Uptake of MC1R Testing for Melanoma Risk

Uptake of MC1R Testing for Melanoma Risk

The use of personalized medicine or tailoring medicine based on sequencing and analyzing an individual’s DNA, is drastically changing cancer research and treatment, risk assessment and clinical practices1, and skin cancer is one area being affected by this research.2 Currently, melanoma in U.S. Hispanic populations is on the rise and despite melanoma being more common in Caucasians than Hispanics, a melanoma diagnosis is more likely to be fatal for Hispanics.3

In a study recently published in JAMA Dermatology, several researchers (lead author Dr. Jennifer Hay) including Dr. David Buller from Klein Buendel, examined interest and uptake, as well as demographic and skin cancer risk factor covariates of interest and uptake, of the melanocortin-1 receptor gene (MC1R) saliva test among 499 adult participants recruited from diverse clinics in Albuquerque, New Mexico. Forty-four percent (44%) of participants were non-Hispanic white, 48% were Hispanic, and all were registered clinic patients for longer than six months, were 18-years of age or older, and spoke English or Spanish fluently. A study website log-in was given to participants to give them the option to log on and read three educational modules presenting the rationale and pros and cons of MC1R testing.

Results showed that almost 50% (n=232) of participants logged on to the website and that non-Hispanic whites and those with higher education were more likely to do so. Furthermore, participants with a history of sunburn and with at least one first-degree relative were also more likely to log on to the website. Of those who logged on, almost 90% (n=204) decided to request testing and a little over 80% (n=167) of those who requested testing returned the kit. Non-Hispanic whites and older participants had a higher rate of returning the kit.

Authors cite the large, diverse sample and the behavioral outcomes versus self-reported outcomes as strengths of the study while citing the single location and use of one primary care health system for recruitment as a limitation on generalizability. Lastly, authors conclude by calling for future research in socioeconomic and demographic discrepancies in interest and uptake of genetic testing in order to ensure ease of availability of genetic information seeking in the general population.

References

  1. Orchard C. Genomic medicine in the real world: “hope” and “hype”. Harvard T.H. Chan School of Public Health Web site. Available at: https://www.hsph.harvard.edu/ecpe/genomic-medicine-in-the-real-world-hope-and-hype/. Published June 1, 2015. Accessed June 20, 2018.
  2. Genetics of skin cancer (PDQ) – health professional version: genetic testing. National Cancer Institute Web site. Available at: https://www.cancer.gov/types/skin/hp/skin-genetics-pdq#link/_393_toc. Updated June 14, 2018. Accessed June 20, 2018.
  3. Perez MI. Hispanics get skin cancer, too. Skin Cancer Foundation Web site. Available at: https://www.skincancer.org/prevention/are-you-at-risk/hispanic. Published May 25, 2016. Accessed June 20, 2018.
Skin Cancer Prevention Messages on Facebook

Skin Cancer Prevention Messages on Facebook

Social media use among American adults has grown over the years – from just 5-in-10 in 2011 to seven-in-ten in 2018 – and reasons for using social media range from connecting with others to accessing news content to sharing information.1 With skin cancer still the most common among all cancers,2 it seems logical to use social media to promote and spread skin cancer prevention awareness. But is it effective?

In a recently published article in the Journal of the American Academy of Dermatology, KB’s Dr. Barbara Walkosz and Rachel Eye, along with other collaborators, aimed to review and classify skin cancer prevention messages from non-profit organizations on Facebook to determine which types garnered high engagement, such as likes, comments, and shares. Messages were identified using the following keywords: “skin cancer prevention,” “melanoma,” “melanoma prevention,” and “sun safety.” From May 2014 to May 2015, Facebook pages of 24 skin cancer groups’ and their 824 Facebook messages were coded for the following content: message format (narrative or didactic), motivation (skin cancer risk or appearance), persuasive appeal (social norm, fear, humor, altruism, celebrity story), behavioral target (sunscreen, hats, shade, avoid sunburn, indoor or outdoor tanning, skin exams), imagery, image content, and hyperlink. Engagement and frequency of message types were also determined.

Authors found that the majority of messages were didactic and focused on skin cancer occurrence and type but note that these approaches are not always effective in producing behavior change. Furthermore, the top three behavioral targets addressed were skin exams, indoor and outdoor tanning, and sunscreen use. Messages that were more didactic, appearance-based, myth-busting, used celebrity endorsements, and targeted self-exams received the most engagement. Messages without images received a higher rate of likes, shares and comments compared with messages that included images.

Limitations of the study include the inability to determine if those following the pages studied are representative of populations at risk for skin cancer and the potential of missed messages based on the keywords used for inclusion criteria. Authors state that collaborations between health institutes and researchers could identify characteristics of messages that are both effective for behavior change and produce high engagement rates in order to have the greatest impact on skin cancer prevention.

References

  1. Social media fact sheet. Pew Research Center Web site. Available at: http://www.pewinternet.org/fact-sheet/social-media/. Published February 5, 2018. Accessed April 24, 2018.
  2. Key statistics for melanoma skin cancer. American Cancer Society Web site. Available at: https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html. Updated January 4, 2018. Accessed April 24, 2018.
Effects of the Sun Safe Workplaces Program

Effects of the Sun Safe Workplaces Program

Occupational skin cancer prevention is an international priority. People who work outdoors are routinely exposed to high levels of ultraviolet radiation (UV), the primary risk factor for skin cancer. Dr. Barbara Walkosz from Klein Buendel presented findings from the Sun Safe Workplaces project and a follow-up assessment at the 68th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018.

Sun Safe Workplaces (SSW) was a communication theory-based workplace sun safety program for public organizations that employ people who work outdoors. Examples of outdoor work include road and bridge work, parks and recreation facilitation, sanitation and water works, and public safety. The original SSW project promoted the adoption of workplace sun safety policies in the public organizations and provided training in personal sun protection for outdoor workers in a randomized controlled trial. The follow-up study assessed the impact of SSW on employee sun safety behavior.

Sixty-one of the 98 public employers from the original study participated. Managers and line supervisors reported program implementation. A total of 1,784 outdoor workers (913 from the intervention group and 871 from the control group) completed surveys on personal sun protection practices.

In summary, employees’ sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW’s effect on employee sun protection was mediated by the number of workplace actions to implement elements of sun safety policy including sun protection messages and equipment in the workplace and employee reports of training in sun safety.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Principal Investigator). In addition to Dr. Walkosz and Dr. Buller from Klein Buendel (KB), collaborators/co-authors included Mary Buller from KB; Dr. Allan Wallis from the University of Colorado Denver; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Michael Scott from Mikonics, Inc.; Dr. Peter Andersen from San Diego State University; and Dr. Gary Cutter from the University of Alabama, Birmingham.

Cost of Occupational Sun Protection Policy Intervention Delivery

Cost of Occupational Sun Protection Policy Intervention Delivery

Dr. Richard Meenan presented cost analysis data from the Sun Safe Workplaces project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on an estimated cost of delivering a sun protection policy intervention to public-sector employers in Colorado. The cost of occupational skin cancer prevention interventions poses challenges for organizations delivering interventions and employers that implement sun protection for outdoor workers.

The Sun Safe Workplaces (SSW) intervention promoted occupational sun protection policies and education to 98 public-sector employers in a randomized controlled trial. Intervention components included in-person meetings and follow-up contact by email and telephone with senior managers, in-person trainings for employees, and printed educational materials sent to the workplace. Using a micro-costing approach, costs to the intervening organization were determined from the project accounting system supplemented by external sources. Costs to employers were estimated from responses to semi-structured interviews in a two-year follow-up with 34 senior managers on implementing sun protection education and other actions to support employee sun safety and were presented at the conference. Employers incurred highest average costs for implementing onsite sun safety training, primarily the estimated value of employee time in attendance.

Costs to employers are likely a barrier to acting on skin cancer prevention. In the SSW trial, employers appeared to incur more costs than the intervening organization. Strategies to control employer costs should be considered when designing occupational skin cancer prevention interventions. Costs will be used to determine: (1) the incremental cost of the SSW intervention (ignoring development and research costs) and (2) the incremental cost of the employers’ skin cancer prevention education and policy adoption actions induced by the SSW intervention.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Klein Buendel, Principal Investigator). Collaborators include Dr. Barbara Walkosz, Rachel Eye, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Allan Wallis from the University of Colorado Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safety Ink!

Sun Safety Ink!

Dr. Robert Dellavalle presented Sun Safety Ink! at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on formative research conducted by Klein Buendel and the University of Colorado Denver to develop a skin cancer prevention training program for tattoo artists.

Twenty-five percent (25%) of American adults have a tattoo, and higher rates are found among younger generations. Sun safety promotions to young adults are significant because risk factors are elevated for this population. Tattoo artists may be ideal sources for delivering effective sun safety interventions to this hard-to-reach, at-risk population because sun safety is recommended for tattoo aftercare and the long-term.

Semi-structured interviews with tattoo artists and focus groups with tattooed individuals gathered input on the design of the Sun Safety Ink! (SSI!) online training program for tattoo artists. Tattoo artists had limited knowledge of skin cancer but reported that they alert clients if they observe skin abnormalities. All artists provided written and verbal aftercare instructions that included sun safety recommendations, but only for tattoos. Artists were interested in the SSI! training program. They suggested the use of video training scenarios to help artists learn to communicate with clients and that information about skin cancer (such as statistics and causes), conversation starters, and examples of sun safety practices be included.

Focus group participants had low levels of sun protection. Participants reported most artists do not discuss health topics but were positive about receiving skin cancer prevention messages, especially during lengthy tattoo sessions. Participants noted that sun safety advice from an artist might make a difference in protecting all of their skin not just tattoos. They recommended that artist deliver sun protection information multiple times while the client is getting the tattoo, during follow-up visits, by text message, in aftercare instructions with pictures or skin cancer facts, and via social media.

Both artists and clients were supportive of SSI! Artists are viewed as a trusted source of information and have the potential to impact clients’ sun safety practices. Suggestions regarding training content and format will be incorporated into an online training for tattoo artists.

This research was funded by a grant from the National Cancer Institute (R01CA206569; Dr. Barbara Walkosz, Klein Buendel, Principal Investigator). Collaborators include Dr. David Buller, Mary Buller, Rachel Eye, and Savanna Olivas from Klein Buendel; and Dr. Dellavalle from the University of Colorado, Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Costs of Sun Safety Policy Implementation in California Elementary Schools

Costs of Sun Safety Policy Implementation in California Elementary Schools

Dr. Richard Meenan is presenting cost analysis data from the Sun Safe Schools project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focuses on the estimated costs of delivering a sun protection policy intervention to public elementary schools in California.

Implementation of sun safety practices is an important element of efforts by elementary schools to prevent skin cancer among their students. However, cost can significantly impede such implementation. The Sun Safe Schools (SSS) trial provided technical assistance to 118 California public elementary schools interested in implementing sun safety practices consistent with district policy. Intervention components were primarily an initial intervention meeting with school administrators, and follow-up email and telephone communications. Schools chose from 47 possible practices to implement.

Using a micro-costing approach, intervention delivery costs to the intervening organization were determined from the project tracking database supplemented by external sources. Labor and non-labor practice costs incurred by schools were estimated using a project template, which three authors reviewed for reasonableness. The 47 practice codes were collapsed into ten categories, such as outdoor shade and parent outreach. The 58 intervention schools implemented a total of 128 practices. Thirty-seven schools implemented at least one practice. Most common practices were parent outreach, education of students, and teacher training. Data on the average cost of participating in the school-based sun safety intervention will be presented at the conference.

In summary, costs to schools may hinder action on implementation, so cost control strategies should be considered when designing school-based sun safety interventions. Next steps are to determine: (1) the incremental implementation cost of the SSS intervention and (2) the incremental cost of the schools’ sun safety education and policy adoption actions induced by SSS.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.

Klein Buendel is one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safety Policy at Work and School

Sun Safety Policy at Work and School

KB scientists, research staff, and collaborators are presenting research findings at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana. One presentation and one poster address sun protection and skin cancer prevention policy in workplaces and schools:

Moderators of Implementation of Occupational Sun Protection Policy

Outdoor workers are at high risk for skin cancer. Dr. David Buller, KB Director of Research and SBM Fellow, is giving a presentation on the Sun Safe Workplaces Project. In this study, organizational and employee characteristics were examined as moderators of implementation of occupational sun protection policy. Public employers (n=98) in Colorado participated in a randomized controlled trial evaluating the Sun Safe Workplaces (SSW) intervention. Based on Diffusion of Innovations Theory, project staff promoted sun safety policy adoption and trained workers in sun protection. Line supervisors (n=3,650) and workers (n=1,555) completed a two-year follow-up survey at 68 employers. Among other findings, greater communication with employees occurred by employers with a policy than without one. The research was funded by a grant from the National Cancer Institute (R01CA134705; Dr. David Buller, PI). Dr. Barbara Walkosz, Mary Buller, and Lucia Liu from KB participated on the research team. Additional collaborators include Dr. Allan Wallis from the University of Colorado, Denver, and Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon.

Correlates of Sun Safe Policy Implementation Among Elementary Schools

In 2014, the U.S. Surgeon General issued a Call to Action to Prevent Skin Cancer, citing its high and increasing prevalence and cost. The Centers for Disease Control and Prevention and the Surgeon General identified sun safety in schools as a priority to reduce UV exposure and sunburns of children, with school district policy a key aspect of school-based efforts to prevent skin cancer. Dr. Kim Reynolds, KB Collaborator from Claremont Graduate University (CGU), is presenting a poster on the Sun Safe Schools Project.  This study explored correlates of the implementation of sun-safe practices, consistent with district board policy, among principals and teachers in public elementary schools. The sample included elementary school principals (N=118) and teachers (N=113) recruited from 40 California public school districts that had adopted Board Policy 5141.7 for sun safety and posted it online. Principals and teachers from the elementary schools reported on student sun protection policies and practices when surveyed. The study looked at the number of practices implemented consistent with California Senate Bill 1632 (Billy’s Bill), which protects the right of students to apply sunscreen at school without a physician note and to wear UV-protective clothing including hats on school grounds. Improved awareness of the existence and content of district board policy for sun safety may increase implementation of school skin cancer prevention.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (R01HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, KB, PIs). Collaborators included Julia Berteletti and Mary Buller form KB, Kim Massie from CGU, Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California and Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon.

Sun Safe Policies in Elementary Schools

Sun Safe Policies in Elementary Schools

School policies that improve sun safety for children are essential to comprehensive school-based skin cancer prevention. California was one of the first states that enacted legislation governing sun protection for students in public schools. In a research letter recently published in JAMA Dermatology, KB’s Julia Berteletti, Dr. David Buller and Lucia Liu along with collaborators at Claremont Graduate University and the non-profit organization, Sun Safety for Kids, looked at how elementary schools in California adopted a policy for sun safety as recommended by the California School Boards Association (CSBA), a nonprofit membership-based education association representing elected officials who govern public school districts.

The Sample Policy, created through a collaboration with CSBA during a previous study, was based on sun safety recommendations put forth by California law and the Centers for Disease Control and Prevention recommendations and was disseminated to member school districts. The authors examined the content of sun safety policies for any deviation from the Sample Policy for 190 member districts that included elementary schools, subscribed to CSBA policy services, and posted their Board Policy online. The sun safety content of the Sample Policy and each districts’ sun safety policy was coded in 11 categories, such as sunscreen use, UV protective clothing, student education, and shade provision. Each policy was scored on content per category, strength of action specified, and intent for sun protection.

The majority of policies addressed sunscreen, protective clothing and hats. Most included shade, scheduling of outdoor activities to avoid peak UV hours, staff modeling and parent outreach. 75% of policies included student education. Educating teachers, resource allocation, and accountability were addressed in almost no policies. Also, 40% of districts altered their own policy to remove some content from the CSBA Sample Policy. The most frequently removed items were student education, outdoor shade or parent outreach. Authors also found that districts that removed content had significantly more students and administrators than those that adopted the Sample Policy verbatim.

Authors concluded that the CSBA played an influential role in the school districts’ adoption of sun safety policy and suggest that establishing a partnership with a similar association could be an important part of achieving school-based skin cancer prevention.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University and Dr. David Buller, KB, Principal Investigators).