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Knowledge Matters: October 2009

_________________________________________________________________________________________________________________________________________________________________________________________________________

Knowledge Matters Canada's Monthly School Health Report Volume 4, Issue 2 (October).
_______________________________________________________________________________________________________________________________________

This issue features news items, resources and research on sun safety and schools. See below for an extensive listing of research, news reports and educational and planning resources.

Canadian SH News Items from last Month (September 2009)
(For the latest news, go to our weekly blog, check the daily changes on our news page or follow us on Twitter)

Summary

Media reports this month continued to be filled with stories about influenza, as governments, school boards and schools across Canada prepared for outbreaks. the criteria and process for closing schools continues to be a question mark. And, at the end of the month, a Canadian report that suggests that handwashing may not be as effective as a preventive measure has caused considerable concern. In other news, two schools in New Brunswick and Ontario were closed due to radon concerns.

Despite its recent interest in the H1N1 situation and the declaration of member concerns for student health, the recent Council of Ministers communiqué from their last meeting and their new joint report with Statistics Canada on education indicators fail to report any decisions about monitoring student learning about health.

Chronological Listing of Canadian News Items (Provided from the international school health blog (www.schoolhealthinsider.org)

News Story (Oct 1-09) Number of H1N1 cases rising slowly: latest Public Health Agency of Canada figures http://jne4v.tk

News Story (Oct 1-09) CMAJ questions value of hand washing in flu prevention http://eardo.tk

News Story (Sep 25-09) CDC: Hand-Washing Won't Stop H1N1 http://y0tab.tk

News Story (Sep 30-09) New Brunswick Parents block school doors over radon fears http://59smw.tk

News Story (Sep 30-09) HPV vaccinations begin in Hamilton. http://n752c.tk

News Perspective. Ottawa Citizen. H1N1 diagnosis: confusion, frustration, anxiety http://v2edo.tk

News Story (Sep 29-09) University of Alberta study shows inner-city kids scared to play outside http://8coxp.tk

News Story (Sep 28-09) Canadian School principal in Hong Kong dies after swine flu http://9gi4w.tk

News Story Sep 27-09) Calgary schools phasing out junk foods http://8llik.tk

News Story (Sep 22-09) Montreal Schools Promote Heandwashing http://6skuj.tk

News Story (Sep 16-09) New Brunswick School district takes flu threat seriously http://dpi6i.tk

News Story (Sep 23-09) Flu keeping B.C. kids home from school as virus season gets early start http://gt4fb.tk

News Release (Sep 23-09) PEI Introduces New Accelerated Training Program for Early Childhood Educators http://c0clz.tk

News Story (Sep 22-09) Radon levels could close schools in Misissaugha http://v17sm.tk

Report (2009) Salt in Canadian Diets (CSPI) http://vrf2u.tk

News Story (Sep 20-09) Mental health worries grow among Canadian university students http://rkzqs.tk

News Story (Sep 17-09) Community Schools Part of Nova Scotia Throne Speech. http://it7av.tk

News Story (Sep 17-09) H1N1 is expected to hit BC schools the hardest http://ux3yi.tk

News Release. Sep 15-09. BC Healthy Living Alliance releases its report “Healthy Futures for BC Families http://s0pb3.tk

News Story Sep 15 Peterborough Elementary schools receive grants from local health unit http://3k6lv.tk

Perspective. Newspaper Editorial (Sep 14-09). Toronto, Canada. Principals need power to keep kids safe http://bit.ly/qDVo0

News Story Sep 14 Ottawa School's health clinic goes unstaffed http://ppew4.tk

News Release (Sep 11-09) PEI Minister Currie Recognizes World Suicide Prevention Day http://lpfu4.tk

News Release (Sep 11-09) Federal Funding for Northwestern Health Unit for the Youth Action on Drugs project. http://926a8.tk

News Story (Sept 10-09) Canadian Young people take pass on flu-shot trials http://u75i0.tk

News Release (Sep 10-09) Manitoba Launches School Campaign on Physical Activity. http://pgq4x.tk

News Story (Sept 11-09) Ontario teens' charges in hazing shed light on new age of zero tolerance http://pccgy.tk

News Story (Sept 9-09) Olympic school program launch coincides with cuts in BC http://tctdk.tk

News Story (Sept 9-09) B.C. schools face cuts to libraries, lunch programs http://wx1zm.tk

Perspective. Columnist. Cops in schools: Sometimes needed, if not always trusted http://vx65n.tk

News release Sep 8-09) Ontario Kids Learn ABCs About H1N1 http://bit.ly/2lzSlC

News Story (Sept 7-09) Globe & Mail Hosted Discussion on Flu http://twu6v.tk

News Story (Sept 11-09) H1N1 could peak early, study suggests http://eydyn.tk

News Story (Sept 11-09) 56 per cent of Canadian adults 18 to 34 years say they don’t intend to get the H1N1 vaccine http://62p85.tk

News Story (Sept 8-09) 3 hours on bus too long, says home and school http://tlu98.tk

News Story (Sept 8-09) Swine flu confirmed at Vancouver school http://biv9h.tk

News Story (Sept 9-09) Canadian Kids' eating habits have worsened since '98 http://8sih8.tk

News Release (Sep 9-09) Newfoundland Safe, Healthy Schools a Priority as New School Year Begins http://m14ff.tk
News Story (Sept 8-09) Public-health and education officials encourage parents and teachers to send students with flu home. http://4bsx9.tk

News Story (Sept 8-09) Young Canadian smokers choosing contraband cigarettes http://n1pda.tk

Research Summary. Best practice guidelines for mental health promotion programs: Children & Youth (CAMH-Canada) http://6cb8w.tk

News Release (Sept 8-09) Canadian Education Statistics Council Releases New Indicators in Education http://kis1i.tk

News Release (Sep 3-09) Education Ministers Meeting Communique Mentions H1N1, OECD Meeting http://8yrs1.tk
News release (Sep 2-09) New Brunswick Ed Ministers notes PE in School September Comments http://sp54z.tk

News Release (Aug 18-09) New Brunswick will not seek appeal in Morgentaler case http://a1id3.tk

Knowledge Network News

The National School Health Conference for 2009-10 will be held in Halifax in mid-April. Watch for more details here.
Communities of Practice related to a variety of health and social issues, including Nutrition, Substance Abuse, Mental Health, Aboriginal Students and more are underway. To find out more see: http://www.safehealthyschools.org/communitiesofpracticeintro.htm or contact candrew@cash-aces.ca.
The Fall (2009) issue of the CTF-CASH Health and Learning Magazine will be distributed by email to school boards and schools across Canada this month.
All of the presentations from the successful Settings for All Conference held in Gatineau, Quebec in May 2009 have been posted on the CCL Health & Learning Knowledge Centre web pages
The 2009-10 series of SH webinars is underway. Find out more at: http://www.safehealthyschools.org/webinars/introduction.htm.The current schedule contains eight of the planned 30 sessions.
CASH has working with the National Collaborating Centre on Aboriginal Health, the CCL Aboriginal Learning Centre and the Centre of Excellence on Special Needs to prepare a culturally relevant approach to SH for aboriginal students, schools and communities. A literature review and inventory has been completed. A statement of principles has been developed and can be found at: http://aboriginalschoolhealth.wetpaint.com/ CASH is pleased to announce that it will be working with the Centre on Addictions & Mental Health at the University of Western Ontario on a handbook/webinar project that will provide advice and tools to implement the principles established in the paper.
Members of the Community of Practice on Substance Abuse Prevention and all Knowledge Network members are invited to comment on the national School Standards being prepared by the Canadian Centre on Substance Abuse. Go to our wiki-based work space to add your comments and edits at: http://draftshpapers.wetpaint.com/
Members of the Mental Health Community of Practice and all other members of the Knowledge Network are invited to describe their knowledge needs for school-based mental health programs through our mini-polls onhot topics in School Mental Health and on preferred methods in knowledge exchange.
The CSH Knowledge Network list of SH contacts has grown to over 2900 people and over 250 agencies/individuals have either paid a membership fee or contributed their time/expertise to receive additional services. The next step begins this month, as we move the contacts list and other communications into a professional networking web site at www.canadianschoolhealth.ca. Agencies, organizations and individuals wil be able to post theor own profiles, interact with others and visit/receive RSS feeds from the daily blog of SH news. Go here for more details: http://canadianschoolhealthprofiles.wetpaint.com/

Reports, Research and Resources on Sun Safety and Schools
Using a Twitter account to collect information from the web very quickly, CASH is pleased to provide this report prepared for a pilot project funded by the Canadian Partnership Against Cancer. This project included the development of a national Community of Practice on Sun Safety and Environmental Health.

Preliminary Scan of Some of the Evidence Identifying Better Practices in school-based and school-linked Health Promotion, Sun Safety and Cancer Prevention

This preliminary review of some of the research was done as part of a feasibility project assessing the role that schools could play in promoting sun safety. Although it was not possible to conduct a thorough research literature review as part of the preparation of this overview, we did want to ensure that strategic considerations as discussed in the preceding section of this report were based on research evidence suggesting that school-based interventions to prevent cancer, promote sun safety and overall health are effective. Consequently, we undertook a preliminary review of the research literature. The preliminary review did locate a number of research citations and reviews sufficient to re-assure ourselves of this conclusion. In summary, we found that:

The behavioral research underlying school-based sun safety programs is consistent with theories and models such as social learning theory and has been applied effectively to this issue.
A realistic role for schools, working with parents and other community agencies, in preventing skin cancer includes specific curriculum/instructional content, promoting staff awareness, referring students with sun burns to health staff, building shade structures on school grounds, informing parents, helping to denormalize beliefs about the health of tanned skin, and organizing sun-safe school activities such as recess, lunch hours, sports days and field trips.
This approach is consistent with the coordinated, multi-intervention school health programs and whole school strategies developed for other health issues. A comprehensive approach suggests that sun safety can be linked successfully with programs promoting ecological sustainability and addressing other environmental health issues. Cooperation between "healthy" schools and "green" schools will be synergistic.
The research evidence available suggests that these interventions will be effective in reducing sun exposure for younger students and can help to establish behaviour patterns among younger students. More research and program development is required for older students to counteract the social influences promoting unsafe sun practices such as tanning and the use of tanning stores.
It would appear that schools in sunny, hot climates around the world are already responding with good programs but more work is required to convey the message that colder climates and exposure even in winter (eyes, faces) is of concern.
Like many other school health issues, implementation and sustainability issues are just beginning to be addressed by researchers concerned with school sun safety programs.
There are several good Canadian program and educational materials available and there are well-evaluated programs that have been developed in Europe, the United States and Australia that can be adapted to Canadian communities and schools.

List of Research References, Reports and Resources

The remainder of this document presents the findings of a preliminary scan of the research literature as well as the Internet. In the list of web-linked research references found below, we have identified major case studies and research reviews. In the listing of web-linked reports and resources (educational, planning, policy and training tools), we have tried to provide a time-saving and convenient resources for the school health community. While much further examination and further searching is required,m we hope that this listing provides a quick start for program planning and development. The listing is presented under these headings:

Prevalence and nature of the problem among young people
Specific Risks, Behaviours and Conditions
Impact of School's Social and Physical Environment
Holistic, Contextual and Comprehensive Approaches
Effectiveness of Coordinated Programs and Services
Evidence-based Single Interventions/Programs (Policy, Intruction, Services, Social Support, Physical Environment)
Use of Evidenced-based Implementation Strategies (Diffusion theory, Capacity Building, Sustainability, Community Context, Future Research)

Prevalence & Nature of the Problem Among Young People
This sub-section lists items that explain the problem of skin cancer among young people and approaches that seem to be more effective or efficient. A holistic approach to behaviour change is often suggested by the research evidence.

Preliminary Findings:

A number of studies of adolescent and adult behaviours indicate that substantial numbers of young people do not follow basic health advice about risky prolonged exposure to the sun. These include minimizing exposure at mid-day, accessing shade, wearing protective clothing, using an effective sunscreen, wearing sunglasses and avoiding sunlamps and tanning beds
The Canadian studies located in this preliminary search (Rhainds et al, 1999; Purdue, 2002; Lovato et al, 1998) show that Canadian behaviours are similar to those in other countries.
It would appear that younger children are more apt to follow health advice about exposure than teens and young adults who are less likely to do so because of media, peer, and other social influences (Hoerster et al, 2007; Myers & Horswill, 2006).
Our preliminary searching located several good explanations of sun-related behaviours among young people that were founded on well-recognized behaviour theories (Myers & Horswill, 2006; Dadlani & Orlow, 2008; Stanton et al, 2005; De Vries et al, 2006; Olsen et al, 2007; Pagota et al, 2004).
Students and staff that were more likely to practice safer sun-related behaviours were also more likely to follow good health advice about other health behaviours such as smoking, diet and activity.

Research	Reports & Resources
Andreeva VA, Reynolds KD, Buller DB, Chou CP, Yaroch AL.(2008) Concurrent psychosocial predictors of sun safety among middle school youth. J Sch Health. 2008 Jul;78(7):374-81 Cokkinides V, Weinstock M, Glanz K, Albano J, Ward E, Thun M.(2006) Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among US adolescents, 1998-2004. Pediatrics. 2006 Sep;118(3):853-64 Cokkinides, V.E., Johnston-Davis, K., Weinstock, M., O'Connell, M.C., Kalsbeek, W., Thun , M.J., & Wingo, P.A. (2001). Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age. Prev Med, 33(3), 141-51. de Vries, H., Lezwijn, J., Hol, M., & Honing, C. (2005). Skin cancer prevention: behaviour and motives of Dutch adolescents. Eur J Cancer Prev,14(1), 39-50. Diffey, B.L. Human exposure to solar ultraviolet radiation. J Cosmet Dermatol ,1(3), 124-30. Review. Dixon, H., Borland, R., & Hill, D. (1999). Sun protection and sunburn in primary school children: the influence of age, gender, and coloring. Prev Med, 28(2),119-30. El Sayed, F., Ammoury, A., Nakhle, F., Dhaybi ,R., & Marguery, M.C. (2006). Photoprotection in teenagers. Photodermatol Photoimmunol Photomed, 22(1), 18-21. Gefeller, O., & Pfahlberg, A. (2002). Sunscreen use and melanoma: a case of evidence-based prevention? Photodermatol Photoimmunol Photomed, 18(3), 153-6; discussion 156. Guy, C., Diab, M. R., & Martincigh, B. (2003). Ultraviolet radiation exposure of children and adolescents in Durban, South Africa. Photochem Photobiol, 77(3), 265-70. Hall, H.I., Saraiya, M., Thompson, T., Hartman, A., Glanz, K., & Rimer, B. (2003). Correlates of sunburn experiences among U.S. adults: results of the 2000 National Health Interview Survey. Public Health RE , 118(6), 540-9. Livingston, P.M., White, V., Hayman, J., & Dobbinson, S. (2003). Sun exposure and sun protection behaviours among Australian adolescents: trends over time. Prev Med, 37(6 Pt 1), 577-84. Livingston, P.M., White, V.M., Ugoni , A.M., & Borland, R. (2001). Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia. Health Educ Res, 16(3), 269-78. Lowe, J.B., Borland, R., Stanton, W.R., Baade, P., White, V., & Balanda, K.P. (2000). Sun-safe behaviour among secondary school students in Australia. Health Educ Res. 15(3), 271-81. McGee, R., Reeder, A., Williams, S., Bandaranayake, M., & Tan A.H. (2002). Observations of summer sun protection among children in New Zealand: 1998-2000. N Z Med J, 8;115(1149), 103-6. Moise, A.F., & Aynsley, R. (1999). Ambient ultraviolet radiation levels in public shade settings. Int J Biometeorol, 43(3), 128-38. O'Riordan, D.L., Steffen, A.D., Lunde, K.B., & Gies, P. (2008). A day at the beach while on tropical vacation: sun protection practices in a high-risk setting for UV radiation exposure. Arch Dermatol. 144(11), 1449-55. Purdue, M.P. (2002). Predictors of sun protection in Canadian adults. Can J Public Health, 93(6), 470-4. Purdue, M.P., Marrett, L.D., Peters, L.,& Rivers, J.K. (2001). Predictors of sunburn among Canadian adults. Prev Med. 33(4), 305-12. Ramirez, R., & Schneider, J.(2003). Practical guide to sun protection. Surg Clin North Am. 83(1), 97-107, vi. Robinson, J.K., Rigel, D.S., & Amonette, R.A. (2000). Summertime sun protection used by adults for their children. J Am Acad Dermatol, 42(5 Pt 1), 746-53. Santmyire, B.R., Feldman, S.R., & Fleischer, A.B. Jr. (2001). Lifestyle high-risk behaviors and demographics may predict the level of participation in sun-protection behaviors and skin cancer primary prevention in the United States: results of the 1998 National Health Interview Survey. Cancer. 92(5), 1315-24. Shoveller, J.A., Savoy, J.A., & Roberts, R.E. (2002). Sun protection among parents and children at freshwater beaches. Can J Public Health. 93(2), 146-8. Solomon, C.C., White, E., Kristal, A.R., & Vaughan, T. (2004). Melanoma and lifetime UV radiation. Cancer Causes Control, 15(9), 893-902. Threlfall, T.J., & English, D.R. (1999). Sun exposure and pterygium of the eye: a dose-response curve. Am J Ophthalmol, 128(3), 280-7. Whiteman, D.C., Whiteman, C.A., & Green, A.C. (2001). Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control, 12(1), 69-82. Review. Dixon H, Dobbinson S, Wakefield M, Jamsen K, McLeod K (2008) Portrayal of tanning, clothing fashion and shade use in Australian women's magazines, 1987–2005 Health Education Research 2008 23(5):791-802 Vergnes C, Daures JP, Sancho-Garnier H, Bousquet J, Pourin-Bourdonneau C, Grabar S, Picot E, Meynadier J.(1999) Sun exposure behavior of children between 3-15 years of age living in Montpellier Ann Dermatol Venereol. 1999 Jun-Jul;126(6-7):505-12 Rhainds M, De Guire L, Claveau J. (1999) A population-based survey on the use of artificial tanning devices in the Province of Québec, Canada. J Am Acad Dermatol. 1999 Apr;40(4):572-6 Myers LB and Mark S. Horswill (2006) Social Cognitive Predictors of Sun Protection Intention and Behavior. Volume 32, Number 2 / Summer 2006 57-63 Dadlani C, Orlow SJ. (2008) Planning for a brighter future: a review of sun protection and barriers to behavioral change in children and adolescents. Dermatol Online J. 2008 Sep 15;14(9):1 Stanton WR, Jenny Moffatt A2, Alexandra Clavarino (2005) Community Perceptions of Adequate Levels and Reasons for Skin Protection Behavioral Medicine Volume 31, Number 1 / Spring 2005 5-17 de Vries, H., Lezwijn, J., Hol, M., & Honing, C. (2005). Skin cancer prevention: behaviour and motives of Dutch adolescents. Eur J Cancer Prev,14(1), 39-50 Purdue, M.P. (2002). Predictors of sun protection in Canadian adults. Can J Public Health, 93(6), 470-4.	Sunsense Summary (Canadian Cancer Society) describes the risk factors for skin cancer, the need for sunscreens, proper clothing for protection from the sun, how tanning salons are not safe and suspicious changes on skin to look for when we monitor our own health. Canadian Dermatology Association This bilingual site provides practical information on sun protection, including the role of sunscreen in an overall sun protection program; a list of CDA recognized sunscreens in alphabetical order by brand name; and sun safety tips for athletes and spectators. The site also provides advice for parents and daycare personnel on how to integrate safe sun practices into children's programs. Environment Canada – UV Index and Sun Protection This bilingual site provides information on the UV Index, North American and Caribbean forecasts, sun protection and the UV Index Sun Awareness Program for students.

Research

Reports & Resources

Andreeva VA, Reynolds KD, Buller DB, Chou CP, Yaroch AL.(2008) Concurrent psychosocial predictors of sun safety among middle school youth. J Sch Health. 2008 Jul;78(7):374-81
Cokkinides V, Weinstock M, Glanz K, Albano J, Ward E, Thun M.(2006) Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among US adolescents, 1998-2004. Pediatrics. 2006 Sep;118(3):853-64
Cokkinides, V.E., Johnston-Davis, K., Weinstock, M., O'Connell, M.C., Kalsbeek, W., Thun , M.J., & Wingo, P.A. (2001). Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age. Prev Med, 33(3), 141-51.
de Vries, H., Lezwijn, J., Hol, M., & Honing, C. (2005). Skin cancer prevention: behaviour and motives of Dutch adolescents. Eur J Cancer Prev,14(1), 39-50.
Diffey, B.L. Human exposure to solar ultraviolet radiation. J Cosmet Dermatol ,1(3), 124-30. Review.
Dixon, H., Borland, R., & Hill, D. (1999). Sun protection and sunburn in primary school children: the influence of age, gender, and coloring. Prev Med, 28(2),119-30.
El Sayed, F., Ammoury, A., Nakhle, F., Dhaybi ,R., & Marguery, M.C. (2006). Photoprotection in teenagers. Photodermatol Photoimmunol Photomed, 22(1), 18-21.
Gefeller, O., & Pfahlberg, A. (2002). Sunscreen use and melanoma: a case of evidence-based prevention? Photodermatol Photoimmunol Photomed, 18(3), 153-6; discussion 156.
Guy, C., Diab, M. R., & Martincigh, B. (2003). Ultraviolet radiation exposure of children and adolescents in Durban, South Africa. Photochem Photobiol, 77(3), 265-70.
Hall, H.I., Saraiya, M., Thompson, T., Hartman, A., Glanz, K., & Rimer, B. (2003). Correlates of sunburn experiences among U.S. adults: results of the 2000 National Health Interview Survey. Public Health RE , 118(6), 540-9.
Livingston, P.M., White, V., Hayman, J., & Dobbinson, S. (2003). Sun exposure and sun protection behaviours among Australian adolescents: trends over time. Prev Med, 37(6 Pt 1), 577-84.
Livingston, P.M., White, V.M., Ugoni , A.M., & Borland, R. (2001). Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia. Health Educ Res, 16(3), 269-78.
Lowe, J.B., Borland, R., Stanton, W.R., Baade, P., White, V., & Balanda, K.P. (2000). Sun-safe behaviour among secondary school students in Australia. Health Educ Res. 15(3), 271-81.
McGee, R., Reeder, A., Williams, S., Bandaranayake, M., & Tan A.H. (2002). Observations of summer sun protection among children in New Zealand: 1998-2000. N Z Med J, 8;115(1149), 103-6.
Moise, A.F., & Aynsley, R. (1999). Ambient ultraviolet radiation levels in public shade settings. Int J Biometeorol, 43(3), 128-38.
O'Riordan, D.L., Steffen, A.D., Lunde, K.B., & Gies, P. (2008). A day at the beach while on tropical vacation: sun protection practices in a high-risk setting for UV radiation exposure. Arch Dermatol. 144(11), 1449-55.
Purdue, M.P. (2002). Predictors of sun protection in Canadian adults. Can J Public Health, 93(6), 470-4.
Purdue, M.P., Marrett, L.D., Peters, L.,& Rivers, J.K. (2001). Predictors of sunburn among Canadian adults. Prev Med. 33(4), 305-12.
Ramirez, R., & Schneider, J.(2003). Practical guide to sun protection. Surg Clin North Am. 83(1), 97-107, vi.
Robinson, J.K., Rigel, D.S., & Amonette, R.A. (2000). Summertime sun protection used by adults for their children. J Am Acad Dermatol, 42(5 Pt 1), 746-53.
Santmyire, B.R., Feldman, S.R., & Fleischer, A.B. Jr. (2001). Lifestyle high-risk behaviors and demographics may predict the level of participation in sun-protection behaviors and skin cancer primary prevention in the United States: results of the 1998 National Health Interview Survey. Cancer. 92(5), 1315-24.
Shoveller, J.A., Savoy, J.A., & Roberts, R.E. (2002). Sun protection among parents and children at freshwater beaches. Can J Public Health. 93(2), 146-8.
Solomon, C.C., White, E., Kristal, A.R., & Vaughan, T. (2004). Melanoma and lifetime UV radiation. Cancer Causes Control, 15(9), 893-902.
Threlfall, T.J., & English, D.R. (1999). Sun exposure and pterygium of the eye: a dose-response curve. Am J Ophthalmol, 128(3), 280-7.
Whiteman, D.C., Whiteman, C.A., & Green, A.C. (2001). Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control, 12(1), 69-82. Review.
Dixon H, Dobbinson S, Wakefield M, Jamsen K, McLeod K (2008) Portrayal of tanning, clothing fashion and shade use in Australian women's magazines, 1987–2005 Health Education Research 2008 23(5):791-802
Vergnes C, Daures JP, Sancho-Garnier H, Bousquet J, Pourin-Bourdonneau C, Grabar S, Picot E, Meynadier J.(1999) Sun exposure behavior of children between 3-15 years of age living in Montpellier Ann Dermatol Venereol. 1999 Jun-Jul;126(6-7):505-12
Rhainds M, De Guire L, Claveau J. (1999) A population-based survey on the use of artificial tanning devices in the Province of Québec, Canada. J Am Acad Dermatol. 1999 Apr;40(4):572-6
Myers LB and Mark S. Horswill (2006) Social Cognitive Predictors of Sun Protection Intention and Behavior. Volume 32, Number 2 / Summer 2006 57-63
Dadlani C, Orlow SJ. (2008) Planning for a brighter future: a review of sun protection and barriers to behavioral change in children and adolescents. Dermatol Online J. 2008 Sep 15;14(9):1
Stanton WR, Jenny Moffatt A2, Alexandra Clavarino (2005) Community Perceptions of Adequate Levels and Reasons for Skin Protection Behavioral Medicine Volume 31, Number 1 / Spring 2005 5-17
de Vries, H., Lezwijn, J., Hol, M., & Honing, C. (2005). Skin cancer prevention: behaviour and motives of Dutch adolescents. Eur J Cancer Prev,14(1), 39-50
Purdue, M.P. (2002). Predictors of sun protection in Canadian adults. Can J Public Health, 93(6), 470-4.

Sunsense Summary (Canadian Cancer Society) describes the risk factors for skin cancer, the need for sunscreens, proper clothing for protection from the sun, how tanning salons are not safe and suspicious changes on skin to look for when we monitor our own health.
Canadian Dermatology Association This bilingual site provides practical information on sun protection, including the role of sunscreen in an overall sun protection program; a list of CDA recognized sunscreens in alphabetical order by brand name; and sun safety tips for athletes and spectators. The site also provides advice for parents and daycare personnel on how to integrate safe sun practices into children's programs.
Environment Canada – UV Index and Sun Protection This bilingual site provides information on the UV Index, North American and Caribbean forecasts, sun protection and the UV Index Sun Awareness Program for students.

Specific Risks, Behaviours and Conditions
This sub-section examines specific risks and behaviours related to sun safety. These include fair skin, exposure to sunlight at mid-day and other factors and conditions.

Preliminary Findings:

Similar to other broad health issues, it appears that programs and interventions are more likely to be effective if they are target specific behaviours or conditions. These include the proper use of sun screens, wearing protective clothing, de-normalizing tanning and the use of tanning beds, creating and accessing shade, educating students or staff, awareness campaigns just prior to specific events such as graduation dances and so on.

Research	Reports/Resources
Azzarello, L.M., Dessureault, S.,& Jacobsen, P.B.(2006). Sun-protective behavior among individuals with a family history of melanoma. Cancer Epidemiol Biomarkers Prev,15(1), 142-5. Geller AC, Brooks DR, Colditz GA, Koh HK, Frazier AL. (2006) Sun protection practices among offspring of women with personal or family history of skin cancer.Pediatrics. 2006 Apr;117(4):e688-94 Boyett, T., Davy, L., Weathers, L., Campbell, R., Van Durme, D., & Roetzheim, R.G. (2002).Sun protection of children at the beach. J Am Board Fam Pract.15(2), 112-7. Das, G., Crocombe, S., McGrath, M., Berry, J.L.,& Mughal, M.Z. (2006). Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child. 91(7), 569-72. Epub 2005 Sep 20. Dixon, H., Dobbinson, S., Wakefield, M., Jamsen, K.,& McLeon, K. (nd). Portrayal of tanning, clothing fashion and shade use in Australian women's magazines, 1987–2005. Victoria, Australia: Centre for Behavioural Research in Cancer, The Cancer Council Victoria. Dobbinson, S., Wakefield, M., Hill, D., Girgis, A., Aitken, J.F., Beckmann, K., Reeder, A.I., Herd, N., Fairthorne, A., & Bowles, K.A. (2008). Prevalence and determinants of Australian adolescents' and adults' weekend sun protection and sunburn, summer 2003-2004. J Am Acad Dermatol, 59(4), 602-14. Epub 2008 Aug 8. Glanz, K., Geller, A.C., Shigaki, D., Maddock, J.E.,& Isnec, M.R. (2002). A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program. Glanz, K., Lew, R.A., Song, V., Cook, V.A. (1999). Factors associated with skin cancer prevention practices in a multiethnic population. Health Educ Behav, 26(3), 344-59. Lagerlund, M., Dixon, H.G., Simpson, J.A., Spittal, M., Taylor, H.R., & Dobbinson, S.J. (2002). Observed use of sunglasses in public outdoor settings around Melbourne, Australia: 1993 to 2002. Prev Med, 42(4), 291-6. Epub 2006 Feb 20. Lawler, S., Spathonis, K., Eakin, E., Gallois, C., Leslie, E., & Owen N. (2007). Sun exposure and sun protection behaviours among young adult sport competitors. Aust N Z J Public Health, 31(3),230-4. Lund, P.M., & Taylor, J.S. (2008). Lack of adequate sun protection for children with oculocutaneous albinism in South Africa. BMC Public Health, 30(8), 225. Maddock, J.E., O'Riordan, D.L., Lunde, K.B., & Steffen, A. (2007). Sun protection practices of beachgoers using a reliable observational measure. Ann Behav Med, 34(1), 100-3. Livingston, P., White, V., Ugoni, A., & Borland, R. (2001). Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia. Health Education Research, 16, 269–278. Whiteman, D., Whiteman C., & Green, A. (2001). Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic. Cancer Causes andControl, 12(1), 69–82.

Research

Reports/Resources

Azzarello, L.M., Dessureault, S.,& Jacobsen, P.B.(2006). Sun-protective behavior among individuals with a family history of melanoma. Cancer Epidemiol Biomarkers Prev,15(1), 142-5.
Geller AC, Brooks DR, Colditz GA, Koh HK, Frazier AL. (2006) Sun protection practices among offspring of women with personal or family history of skin cancer.Pediatrics. 2006 Apr;117(4):e688-94
Boyett, T., Davy, L., Weathers, L., Campbell, R., Van Durme, D., & Roetzheim, R.G. (2002).Sun protection of children at the beach. J Am Board Fam Pract.15(2), 112-7.
Das, G., Crocombe, S., McGrath, M., Berry, J.L.,& Mughal, M.Z. (2006). Hypovitaminosis D among healthy adolescent girls attending an inner city school. Arch Dis Child. 91(7), 569-72. Epub 2005 Sep 20.
Dixon, H., Dobbinson, S., Wakefield, M., Jamsen, K.,& McLeon, K. (nd). Portrayal of tanning, clothing fashion and shade use in Australian women's magazines, 1987–2005. Victoria, Australia: Centre for Behavioural Research in Cancer, The Cancer Council Victoria.
Dobbinson, S., Wakefield, M., Hill, D., Girgis, A., Aitken, J.F., Beckmann, K., Reeder, A.I., Herd, N., Fairthorne, A., & Bowles, K.A. (2008). Prevalence and determinants of Australian adolescents' and adults' weekend sun protection and sunburn, summer 2003-2004. J Am Acad Dermatol, 59(4), 602-14. Epub 2008 Aug 8.
Glanz, K., Geller, A.C., Shigaki, D., Maddock, J.E.,& Isnec, M.R. (2002). A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program.
Glanz, K., Lew, R.A., Song, V., Cook, V.A. (1999). Factors associated with skin cancer prevention practices in a multiethnic population. Health Educ Behav, 26(3), 344-59.
Lagerlund, M., Dixon, H.G., Simpson, J.A., Spittal, M., Taylor, H.R., & Dobbinson, S.J. (2002). Observed use of sunglasses in public outdoor settings around Melbourne, Australia: 1993 to 2002. Prev Med, 42(4), 291-6. Epub 2006 Feb 20.
Lawler, S., Spathonis, K., Eakin, E., Gallois, C., Leslie, E., & Owen N. (2007). Sun exposure and sun protection behaviours among young adult sport competitors. Aust N Z J Public Health, 31(3),230-4.
Lund, P.M., & Taylor, J.S. (2008). Lack of adequate sun protection for children with oculocutaneous albinism in South Africa. BMC Public Health, 30(8), 225.
Maddock, J.E., O'Riordan, D.L., Lunde, K.B., & Steffen, A. (2007). Sun protection practices of beachgoers using a reliable observational measure. Ann Behav Med, 34(1), 100-3.
Livingston, P., White, V., Ugoni, A., & Borland, R. (2001). Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia. Health Education Research, 16, 269–278.
Whiteman, D., Whiteman C., & Green, A. (2001). Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic. Cancer Causes andControl, 12(1), 69–82.

Impact of School's Social and Physical Environment
This sub-section examines the impact of the social and physical environment of the school as a place in which students and staff spend considerable time. Physical conditions and facilities in the school can contribute to health. As well, prevailing social norms, beliefs and misconceptions from the media and the community can be either reproduced or debunked in the school social environment.

Preliminary Findings:

Shade structures or the lack of shade on school grounds can contribute to skin cancer
The social norm that tanned skin is "healthier" or better looking can either be reproduced in activities such as visits to tanning stores prior to student social events or they can be addressed through peer and school awareness programs.

Research	Reports & Resources
Boldemann, C., Blennow, M., Dal, H., Mårtensson, F., Raustorp, A., Yuen, K., & Wester, U. (2006). Impact of preschool environment upon children's physical activity and sun exposure. Prev Med, 42(4), 301-8. Epub 2006 Jan 30. Moise, A.F., Büttner, P.G., & Harrison, S.L. (1999). Sun exposure at school. Photochem Photobiol, 70(2), 269-74. Stanton, W.R., Saleheen, H.N., O'Riordan, D., & Roy, C.R. (2003). Environmental conditions and variation in levels of sun exposure among children in child care. Int J Behav Med. 10(4), 285-98.

Research

Reports & Resources

Boldemann, C., Blennow, M., Dal, H., Mårtensson, F., Raustorp, A., Yuen, K., & Wester, U. (2006). Impact of preschool environment upon children's physical activity and sun exposure. Prev Med, 42(4), 301-8. Epub 2006 Jan 30.
Moise, A.F., Büttner, P.G., & Harrison, S.L. (1999). Sun exposure at school. Photochem Photobiol, 70(2), 269-74.
Stanton, W.R., Saleheen, H.N., O'Riordan, D., & Roy, C.R. (2003). Environmental conditions and variation in levels of sun exposure among children in child care. Int J Behav Med. 10(4), 285-98.

Holistic, Contextual and Comprehensive Approaches

This sub-section examines holistic, contextual and comprehensive approaches include the whole child, all children (especially vulnerable), developmental stages/life course, clusters of behaviours and conditions(eg mental health, crime, tobacco, sexual risk-taking, dropouts), community and systems context analysis, synergistic combinations of strategies and initiatives (e.g. police officers, safe schools, character education, early childhood programs), multi-level , intersectorial strategies, programs and policies).

Preliminary Findings:

There are two broad sets of related health issues to which sun safety can be successfully linked. The connection to other cancers and hence to other chronic diseases such as obesity, heart disease and other conditions can lead to a focus on promoting healthier lifestyle choices (healthy eating, not smoking, being active, staying out of the sun, etc). Another broad set of issues are in the environmental health arena, where sub safety proponents can partner with other promoting ecological sustainability and changes to the physical environment and our consumption patterns.We found some programs that did the latter.

Research	Reports & Resources
Boe, K., & Tillotson, E.A. (2006). Encouraging sun safety for children and adolescents. J Sch Nurs. 22(3), 136-41. Review.Geller, A.C., Zwirn, J., Rutsch, L., Gorham, S.A., Viswanath, V.,& Emmons, K.M. (2008). Multiple levels of influence in the adoption of sun protection policies in elementary schools in Massachusetts. Arch Dermatol, 144(4), 491-6. Reynolds, K.D., Buller, D.B., Yaroch, A.L., Maloy, J., Geno, C.R., & Cutter, G.R. (2008). Effects of program exposure and engagement with tailored prevention communication on sun protection by young adolescents. Saraiya, M., Glanz, K., Briss, P.A., Nichols, P., White, C., Das, D., Smith, S.J., Tannor, B., Hutchinson, A.B., Wilson, K.M., Gandhi, N., Lee, N.C., Rimer, B., Coates, R.C., Kerner, J.F., Hiatt, R.A., Buffler, P., & Rochester, P. (2004). Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med, 27(5),,422-66. Review. Stanton, W.R., Janda, M., Baade, P.D., & Anderson, P. (2004). Primary prevention of skin cancer: a review of sun protection in Australia and internationally. Health Promot Int. 19(3), 369-78. Review.	Healthy Living Schools Initiative (BC Cancer Society) Cancer Prevention Coordinators offer customized support, materials, tips, tools and ideas for educators at all levels. We are actively seeking to increase participation in Healthy Living Schools both through our individual CPCs and through a province-wide mailout in spring 2008 Guidelines to Prevent Skin Cancer (US Centers for Disease Control & Prevention) These guidelines were designed to provide schools with a comprehensive approach to preventing skin cancer among adolescents and young people. CDC worked with specialists in dermatology, pediatrics, public health, and education from universities; national, federal, state, and voluntary agencies; schools; and other organizations to develop these guidelines. SunSafe in the Middle School Years Community-wide multi-component programs, Education & policy interventions in secondary schools

Research

Reports & Resources

Boe, K., & Tillotson, E.A. (2006). Encouraging sun safety for children and adolescents. J Sch Nurs. 22(3), 136-41. Review.Geller, A.C., Zwirn, J., Rutsch, L., Gorham, S.A., Viswanath, V.,& Emmons, K.M. (2008). Multiple levels of influence in the adoption of sun protection policies in elementary schools in Massachusetts. Arch Dermatol, 144(4), 491-6.
Reynolds, K.D., Buller, D.B., Yaroch, A.L., Maloy, J., Geno, C.R., & Cutter, G.R. (2008). Effects of program exposure and engagement with tailored prevention communication on sun protection by young adolescents.
Saraiya, M., Glanz, K., Briss, P.A., Nichols, P., White, C., Das, D., Smith, S.J., Tannor, B., Hutchinson, A.B., Wilson, K.M., Gandhi, N., Lee, N.C., Rimer, B., Coates, R.C., Kerner, J.F., Hiatt, R.A., Buffler, P., & Rochester, P. (2004). Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med, 27(5),,422-66. Review.
Stanton, W.R., Janda, M., Baade, P.D., & Anderson, P. (2004). Primary prevention of skin cancer: a review of sun protection in Australia and internationally. Health Promot Int. 19(3), 369-78. Review.

Healthy Living Schools Initiative (BC Cancer Society)
Cancer Prevention Coordinators offer customized support, materials, tips, tools and ideas for educators at all levels. We are actively seeking to increase participation in Healthy Living Schools both through our individual CPCs and through a province-wide mailout in spring 2008
Guidelines to Prevent Skin Cancer (US Centers for Disease Control & Prevention) These guidelines were designed to provide schools with a comprehensive approach to preventing skin cancer among adolescents and young people. CDC worked with specialists in dermatology, pediatrics, public health, and education from universities; national, federal, state, and voluntary agencies; schools; and other organizations to develop these guidelines.
SunSafe in the Middle School Years
Community-wide multi-component programs, Education & policy interventions in secondary schools

Effectiveness of Coordinated Programs and Services
This sub-section examines coordinated, multi-intervention programs. Where possible, we differentiate between Coordinated School-Community Programs (CSHP) and Whole-School Programs (HPS) involving only school-based personnel.

Preliminary Findings:

While some reviews of the evidence have indicated that school, pre-school, college and workplace, recreation and other settings-based multi-intervention programs can be effective (Knowledge Exchange Network, 2008, Primary Prevention Action Group, 2009) there are other reviews stating that there is insufficient evidence available for high school and college/university programs ( Centers for Disease Control, 2003).
The impact of school-based programs on sun-related health appears to be concentrated in significant changes to awareness, knowledge, and behaviour change among younger students. We did not locate any longitudinal studies. no studies examining the relationship between sun safety and educational achievement were found. One study noted the economic benefits of prevention programs

Research	Reports & Resources
Coordinated SH Programs (School-Agency-Community) Saraiya M, Glanz K, Briss P, Nichols P, White C, Das D; (2003) Preventing skin cancer: findings of the Task Force on Community Preventive Services on reducing Exposure to Ultraviolet Light. The CDC Community Guide Cassel, K,D. (2005). Made for the shade: the Hawaii Skin Cancer Coalition celebrates its ten year history. Hawaii Med J, 64(9), 236-8. Dietrich, A.J., Olson, A.L., Sox, C.H., Tosteson, T.D., & Grant-Petersson, J. (2000). Persistent increase in children's sun protection in a randomized controlled community trial. Prev Med, 31(5), 569-74. Olson, A.L., Gaffney, C., Starr, P., Gibson, J.J., Cole, B.F., & Dietrich, A.J. (2007). SunSafe in the Middle School Years: a community-wide intervention to change early-adolescent sun protection. Pediatrics, 119(1), e247-56. Smith, B.J., Ferguson, C., McKenzie, .J., Bauman, A., & Vita, P.(2002). Impacts from repeated mass media campaigns to promote sun protection in Australia. Health Promot Int,17(1), 51-60. Knowledge Exchange Network (2008) Effective Sun Safety Interventions, Winnipeg, Manitoba, Author Knowledge Exchange Network (2008) Moderate-strength Sun Safety Interventions, Winnipeg, Manitoba, Author Primary Prevention Action Group (2009) Literature Review of Evidence-Based Strategies and Practices in Promoting Skin Cancer Prevention, Toronto, ON, Canadian Partnership Against Cancer Centers for Disease Control and Prevention (2003) Preventing skin cancer. Findings of the Task Force on Community Preventive Services on reducing exposure to ultraviolet light. MMWR 2003;52(RR-15):1–12 Whole School (HPS) involving only school personnel in delivery Geller, A.C., Cantor, M., Miller, D.R., Kenausis, K., Rosseel, K., Rutsch, L., Brooks, D.R., Zhang, Z., & Demierre, M.F. (2002). The Environmental Protection Agency's National SunWise School Program: sun protection education in US schools (1999-2000). J Am Acad Dermatol ,46(5), 683-9. Giles-Corti, B., English, D.R., Costa, C., Milne, E., Cross, D., & Johnston, R. (2004). Creating SunSmart schools. Health Educ Res,19(1), 98-109. Jones, S.B., Beckmann, K., & Rayner, J.(2008). Australian primary schools' sun protection policy and practice: evaluating the impact of the National SunSmart Schools Program. Health Promot J Austr, 19(2), 86-90. Milne, E., English, D.R., Johnston, R., Cross, D., Borland, R., Costa, C., & Giles-Corti, B. (2000). Improved sun protection behaviour in children after two years of the Kidskin intervention. Aust N Z J Public Health, 24(5), 481-7. Geller, A., Rutsch, L., Kenausis, K., & Zhang, Z. (2003). Evaluation of the SunWise school program. Journal of School Nursing, 19, 93-99. Gilaberte, Y., Alonso, J.P., Teruel, M.P., Granizo, C., & Gallego, J. (2008). Evaluation of a health promotion intervention for skin cancer prevention in Spain: the SolSano program. Health Promotion International, 23(3), 209–219. Giles-Corti B., English, D, Costa, C., Milne, E., Cross, D., & Johnston, R. (2004). Creating SunSmart schools. Health Education Research, 19(1), 98–109. Milne E, Jacoby P, Giles-Corti B, Cross D, Johnston R, English DR.(2006) The impact of the kidskin sun protection intervention on summer suntan and reported sun exposure: was it sustained? Prev Med. Jan;42(1):14-20. Epub 2005 Dec 5. Milne E, English DR, Johnston R, Cross D, Borland R, Giles-Corti B, Costa C. (2001) Reduced sun exposure and tanning in children after 2 years of a school-based intervention (Australia). Cancer Causes Control. 2001 Jun;12(5):387-93. Kyle JW, Hammitt JK, Lim HW, Geller AC, Hall-Jordan LH, Maibach EW, De Fabo EC, Wagner MC.(2008) Economic evaluation of the US Environmental Protection Agency's SunWise program: sun protection education for young children.Pediatrics. May;121(5):e1074-84	Sun Safe Community & School Program (Canadian Best Practices Portal) The program aims to enhance and promote sun protection of children ages 2 -9 years through the delivery of a multicomponent intervention in three settings: elementary schools and daycare centers, town beach areas, and primary care practices.

Research

Reports & Resources

Coordinated SH Programs (School-Agency-Community)

Saraiya M, Glanz K, Briss P, Nichols P, White C, Das D; (2003) Preventing skin cancer: findings of the Task Force on Community Preventive Services on reducing Exposure to Ultraviolet Light. The CDC Community Guide
Cassel, K,D. (2005). Made for the shade: the Hawaii Skin Cancer Coalition celebrates its ten year history. Hawaii Med J, 64(9), 236-8.
Dietrich, A.J., Olson, A.L., Sox, C.H., Tosteson, T.D., & Grant-Petersson, J. (2000). Persistent increase in children's sun protection in a randomized controlled community trial. Prev Med, 31(5), 569-74.
Olson, A.L., Gaffney, C., Starr, P., Gibson, J.J., Cole, B.F., & Dietrich, A.J. (2007). SunSafe in the Middle School Years: a community-wide intervention to change early-adolescent sun protection. Pediatrics, 119(1), e247-56.
Smith, B.J., Ferguson, C., McKenzie, .J., Bauman, A., & Vita, P.(2002). Impacts from repeated mass media campaigns to promote sun protection in Australia. Health Promot Int,17(1), 51-60.
Knowledge Exchange Network (2008) Effective Sun Safety Interventions, Winnipeg, Manitoba, Author
Knowledge Exchange Network (2008) Moderate-strength Sun Safety Interventions, Winnipeg, Manitoba, Author
Primary Prevention Action Group (2009) Literature Review of Evidence-Based Strategies and Practices in Promoting Skin Cancer Prevention, Toronto, ON, Canadian Partnership Against Cancer
Centers for Disease Control and Prevention (2003) Preventing skin cancer. Findings of the Task Force on Community Preventive Services on reducing exposure to ultraviolet light. MMWR 2003;52(RR-15):1–12

Whole School (HPS) involving only school personnel in delivery

Geller, A.C., Cantor, M., Miller, D.R., Kenausis, K., Rosseel, K., Rutsch, L., Brooks, D.R., Zhang, Z., & Demierre, M.F. (2002). The Environmental Protection Agency's National SunWise School Program: sun protection education in US schools (1999-2000). J Am Acad Dermatol ,46(5), 683-9.
Giles-Corti, B., English, D.R., Costa, C., Milne, E., Cross, D., & Johnston, R. (2004). Creating SunSmart schools. Health Educ Res,19(1), 98-109.
Jones, S.B., Beckmann, K., & Rayner, J.(2008). Australian primary schools' sun protection policy and practice: evaluating the impact of the National SunSmart Schools Program. Health Promot J Austr, 19(2), 86-90.
Milne, E., English, D.R., Johnston, R., Cross, D., Borland, R., Costa, C., & Giles-Corti, B. (2000). Improved sun protection behaviour in children after two years of the Kidskin intervention. Aust N Z J Public Health, 24(5), 481-7.
Geller, A., Rutsch, L., Kenausis, K., & Zhang, Z. (2003). Evaluation of the SunWise school program. Journal of School Nursing, 19, 93-99.
Gilaberte, Y., Alonso, J.P., Teruel, M.P., Granizo, C., & Gallego, J. (2008). Evaluation of a health promotion intervention for skin cancer prevention in Spain: the SolSano program. Health Promotion International, 23(3), 209–219.
Giles-Corti B., English, D, Costa, C., Milne, E., Cross, D., & Johnston, R. (2004). Creating SunSmart schools. Health Education Research, 19(1), 98–109.
Milne E, Jacoby P, Giles-Corti B, Cross D, Johnston R, English DR.(2006) The impact of the kidskin sun protection intervention on summer suntan and reported sun exposure: was it sustained? Prev Med. Jan;42(1):14-20. Epub 2005 Dec 5.
Milne E, English DR, Johnston R, Cross D, Borland R, Giles-Corti B, Costa C. (2001) Reduced sun exposure and tanning in children after 2 years of a school-based intervention (Australia). Cancer Causes Control. 2001 Jun;12(5):387-93.
Kyle JW, Hammitt JK, Lim HW, Geller AC, Hall-Jordan LH, Maibach EW, De Fabo EC, Wagner MC.(2008) Economic evaluation of the US Environmental Protection Agency's SunWise program: sun protection education for young children.Pediatrics. May;121(5):e1074-84

Sun Safe Community & School Program (Canadian Best Practices Portal) The program aims to enhance and promote sun protection of children ages 2 -9 years through the delivery of a multicomponent intervention in three settings: elementary schools and daycare centers, town beach areas, and primary care practices.

Evidence-based Single Interventions/Programs

This sub-section examines single intervention programs in five areas with various aspects; policy (school board, other agencies), instruction (curriculum, educational materials and methods, teacher training, etc), health and other services (screening, early identification, school clinics, access to youth friendly services, case coordination and referrals etc); social support (parent involvement, peer programs, working with local media, working with social media etc), phtsical environment (school grounds, facilities, transportation etc)

Preliminary Findings:

Multi-intervention programs that influence several aspects of the school setting are likely to be more effective. However, they are also more time-consuming, complicated or costly to implement, more difficult to sustain and more difficult to evaluate.
Several specific intervention programs, particularly sun safety education for primary students and staff awareness programs, have been reported to be effective in large scale random controlled trials
Comprehensive guidelines and examples of evaluated comprehensive, multi-intervention programs are readily available from other countries. Canadian materials and adaptations are available on some of the interventions.

Research	Reports & Resources
Policy Interventions Buller, D., Buller, M.K., & Reynolds, K. (2006). A survey of sun protection policy and education in secondary schools. Journal of the American Academy of Dermatology, 54(3), 427–432. Dobbinson, S., Peipers, A., Borland, R., & Nolan, K. (2000). Are Victorian primary schools Sunsmart? Health Promotion Journal of Australia, 10, 43–50 Eakin, P., Maddock, J., Techur-Pedro, A., Kaliko, R., & Derauf, C. (2004). Sun protection policy in elementary schools in Hawaii. Preventing Chronic Disease, 1, 1-10. Emmons, K., Geller, A., Viswanath, V., Rutsch, L., Zwirn, J., Gorham, S., & Puleo, E. (2008). The SunWise Policy Intervention for School-Based Sun Protection: A Pilot Study. Journal of School Nursing, 24(4), 215–221. Instructional Interventions Bastuji-Garin, S., Grob, J.J., Grognard, C., Grosjean, F., & Guillaume, J.C. (1999). Melanoma prevention: evaluation of a health education campaign for primary schools. Arch Dermatol, 135(8), 936-40. Collins, D.C., Kearns, R.A., Mitchell, H. (2006). "An integral part of the children's education": placing sun protection in Auckland primary schools. Health Place, 12(4):436-48. Epub 2005 Jul 1. de Vries, H., Mesters, I., Riet, J.V., Willems, K., & Reubsaet, A. (2006). Motives of Belgian adolescents for using sunscreen: the role of action plans. Cancer Epidemiol Biomarkers Prev, 15(7), 1360-6. Geller, A., Rutsch, L., Kenausis, K., Zhang, Z. (2003). Evaluation of the SunWise School Program. J Sch Nurs, 19(2), 93-9. Geller, A.C., Rutsch, L., Kenausis, K., Selzer, P., & Zhang, Z.(2003) Can an hour or two of sun protection education keep the sunburn away? Evaluation of the Environmental Protection Agency's Sunwise School Program. Environ Health. 3;2(1), 13. Harrison, S.L., Saunders, V.,& Nowak, M. (2007).Baseline survey of sun-protection knowledge, practices and policy in early childhood settings in Queensland, Australia. Health Educ Res, 22(2), 261-71. Epub 2006 Jul 31. Miles, A., Waller, J., Hiom, S., Swanston, D. (2005). SunSmart? Skin cancer knowledge and preventive behaviour in a British population representative sample. Health Educ Res, 20(5), 579-85. Epub 2005 Jan 11. Olson AL, Gaffney CA, Starr P, Dietrich AJ (2008) The impact of an appearance-based educational intervention on adolescent intention to use sunscreen Health Education Research 2008 23(5):763-769 Stankeviciūte V, Zaborskis A, Petrauskiene A, Valiukeviciene S. (2004) Skin cancer prevention: children's health education on protection from sun exposure and assessment of its efficiency. Medicina (Kaunas). 2004;40(4):386-93 Buller DB, Reynolds KD, Yaroch A, Cutter GR, Hines JM, Geno CR, Maloy JA, Brown M, Woodall WG, Grandpre J.(2006) Effects of the Sunny Days, Healthy Ways curriculum on students in grades 6 to 8. Am J Prev Med. Jan;30(1):13-22. Oncology Cooperative Group Of The Italian Group For Epidemiologic Research In Dermatology (GISED) (2003) Improving sun protection behaviour in children: study design and baseline results of a randomized trial in Italian elementary schools. The 'Sole Si Sole No GISED' project. Dermatology. 2003;207(3):291-7. Health and Other Services Interventions Crane, L.A., Schneider, L.S., Yohn, J.J., Morelli, J.G., Plomer, K.D. (1999). "Block the sun, not the fun": evaluation of a skin cancer prevention program for child care centers. Am J Prev Med, 17(1), 31-7. Gritz, E.R., Tripp, M.K., de Moor, C.A., Eicher, S.A., Mueller, N.H., & Spedale, J.H. Skin cancer prevention counseling and clinical practices of pediatricians. Pediatr Dermatol. 2003 Jan-Feb;20(1):16-24 U.S. Preventive Services Task Force. (2003) Counseling to prevent skin cancer: recommendations and rationale of the U.S. Preventive Services Task Force.MMWR Recomm Rep. 2003 Oct 17;52(RR-15):13-7 Social Support Interventions Glanz, K., Geller, A.C., Shigaki, D., Maddock, J.E., & Isnec, M.R. (2002). A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program. Health Psychol, 21(6), 579-87. Physical Environment Interventions Coppa, K.R.,& Greenwood, J.S. (2006). Effective shade structures. Med J Aust, 184(8), 423. Turnbull, D.J., & Parisi, A.V. (2006). Effective shade structures. Med J Aust,184(1), 13-5. Cam Escoffery, Karen Glanz, and Tom Elliott (2008) Process evaluation of the Pool Cool Diffusion Trial for skin cancer prevention across 2 years Health Education Research Health Educ. Res. 2008 23: 732-743; doi:10.1093/her/cym060	Policy Resources Guidelines to Prevent Skin Cancer (US Centers for Disease Control & Prevention) These guidelines were designed to provide schools with a comprehensive approach to preventing skin cancer among adolescents and young people. CDC worked with specialists in dermatology, pediatrics, public health, and education from universities; national, federal, state, and voluntary agencies; schools; and other organizations to develop these guidelines. School Sun-Safety Policy Development Resources (California Dept of Health) One-page list of skin cancer prevention policy templates and background information for use in school settings. Sample School Board Policy on Sun Safety Sample policy from the Los Angeles Metropolitan Dermatological Society Instructional Resources Sunny Days Healthy Ways (Canadian Best Practices Portal) This skin cancer prevention curriculum is a comprehensive course for children in Grades 4, 5, and 6. The five-session curriculum presents material from science, history, social studies, health and geography in a comprehensive and cause-and-consequence presentation about the relationship between humans and the sun Sunsense Quiz (Canadian Cancer Society) How much do you really know about sun protection and skin cancer?Test your knowledge. Environment Canada – UV Index and Sun Protection This bilingual site provides information on the UV Index, North American and Caribbean forecasts, sun protection and the UV Index Sun Awareness Program for students. Fortune teller: A fun resource for primary school age children (BC Cancer Society) This resource provides general information for primary school age children on healthy sun-safe lifestyles and risk reduction, not skin cancer. Instruction for assembly of the resource is included. Sun Safety Learning Activity Package (Cancer Care Nova Scotia) This package is a compilation of learning activities developed by recognized leaders in sun safety and skin cancer prevention.They are intended to be used with students to raise awareness and educate on the importance of sun safety practices. Sun Safety Teaching Materials (California Dept of Health) Two-page list of skin cancer prevention curriculums, resource guides, videos, and UV-reactive promotional items designed for use to instruct pre-school children through age 12. Sunsmart Online Teacher Training (Western Australia) Professional development for early childhood, primary and secondary teachers and school health nurses. Sunsmart Online Student Module (Western Australia) Online interactive student education. Sunny Days Healthy Ways - Elementary School (Grades K-5) Designed to increase awareness and promote sun protection behavior and practices among K-5th grade students. Health and Other Services Interventions Social Support Interventions Health Canada – Smart Summer Fun This bilingual site gives tips on how to be smart while having fun this summer in Canada. There are sections on air quality, sun safety and skin cancer, playing safe, food and drink and enjoying the great outdoors. The Summer Fun quiz tests your knowledge on smart summer fun. Pool Cool (Canadian Best Practices Portal) This pool-based program can be used with schools andf after school programs. It aims to increase sun-protection habits in parents, swimming instructors and children. Its main objective is to increase awareness, motivation, and sun protection practices among children ages 5-10 who take swimming lessons, their parents, aquatics staff, and other pool users Choose Your Cover The Choose Your Cover Campaign was a five–year skin cancer prevention and education campaign sponsored by the United States Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC). Although campaign activities concluded in May 2003, some campaign materials are still available online. Successful School-Based Skin Cancer Prevention Activities (California Dept of Health) Discover what award winning schools do to integrate sun-safety activities. Together for Sun Safety Interventions oriented to children's parents and caregivers. Awareness building and Behavior Modification. Physical Environment Interventions Shade Planning for America's Schools* [pdf 1Mb]. This manual was created to support school communities in their implementation of CDC's Guidelines for School Programs to Prevent Skin Cancer, and can help district school health or wellness councils, and school health teams, ensure that school grounds have adequate shade. Healthy School Environments Assessment Tool (Environmental Protection Agency) The Healthy School Environments Assessment Tool (HealthySEATv2) is a fully customizable and easy to use software program designed to help school districts evaluate and manage ALL of their environmental, safety and health issues.

Research

Reports & Resources

Policy Interventions

Buller, D., Buller, M.K., & Reynolds, K. (2006). A survey of sun protection policy and education in secondary schools. Journal of the American Academy of Dermatology, 54(3), 427–432.
Dobbinson, S., Peipers, A., Borland, R., & Nolan, K. (2000). Are Victorian primary schools Sunsmart? Health Promotion Journal of Australia, 10, 43–50
Eakin, P., Maddock, J., Techur-Pedro, A., Kaliko, R., & Derauf, C. (2004). Sun protection policy in elementary schools in Hawaii. Preventing Chronic Disease, 1, 1-10.
Emmons, K., Geller, A., Viswanath, V., Rutsch, L., Zwirn, J., Gorham, S., & Puleo, E. (2008). The SunWise Policy Intervention for School-Based Sun Protection: A Pilot Study. Journal of School Nursing, 24(4), 215–221.

Instructional Interventions

Bastuji-Garin, S., Grob, J.J., Grognard, C., Grosjean, F., & Guillaume, J.C. (1999). Melanoma prevention: evaluation of a health education campaign for primary schools. Arch Dermatol, 135(8), 936-40.
Collins, D.C., Kearns, R.A., Mitchell, H. (2006). "An integral part of the children's education": placing sun protection in Auckland primary schools. Health Place, 12(4):436-48. Epub 2005 Jul 1.
de Vries, H., Mesters, I., Riet, J.V., Willems, K., & Reubsaet, A. (2006). Motives of Belgian adolescents for using sunscreen: the role of action plans. Cancer Epidemiol Biomarkers Prev, 15(7), 1360-6.
Geller, A., Rutsch, L., Kenausis, K., Zhang, Z. (2003). Evaluation of the SunWise School Program. J Sch Nurs, 19(2), 93-9.
Geller, A.C., Rutsch, L., Kenausis, K., Selzer, P., & Zhang, Z.(2003) Can an hour or two of sun protection education keep the sunburn away? Evaluation of the Environmental Protection Agency's Sunwise School Program. Environ Health. 3;2(1), 13.
Harrison, S.L., Saunders, V.,& Nowak, M. (2007).Baseline survey of sun-protection knowledge, practices and policy in early childhood settings in Queensland, Australia. Health Educ Res, 22(2), 261-71. Epub 2006 Jul 31.
Miles, A., Waller, J., Hiom, S., Swanston, D. (2005). SunSmart? Skin cancer knowledge and preventive behaviour in a British population representative sample. Health Educ Res, 20(5), 579-85. Epub 2005 Jan 11.
Olson AL, Gaffney CA, Starr P, Dietrich AJ (2008)
The impact of an appearance-based educational intervention on adolescent intention to use sunscreen Health Education Research 2008 23(5):763-769
Stankeviciūte V, Zaborskis A, Petrauskiene A, Valiukeviciene S. (2004) Skin cancer prevention: children's health education on protection from sun exposure and assessment of its efficiency. Medicina (Kaunas). 2004;40(4):386-93
Buller DB, Reynolds KD, Yaroch A, Cutter GR, Hines JM, Geno CR, Maloy JA, Brown M, Woodall WG, Grandpre J.(2006) Effects of the Sunny Days, Healthy Ways curriculum on students in grades 6 to 8. Am J Prev Med. Jan;30(1):13-22.
Oncology Cooperative Group Of The Italian Group For Epidemiologic Research In Dermatology (GISED) (2003) Improving sun protection behaviour in children: study design and baseline results of a randomized trial in Italian elementary schools. The 'Sole Si Sole No GISED' project. Dermatology. 2003;207(3):291-7.

Health and Other Services Interventions

Crane, L.A., Schneider, L.S., Yohn, J.J., Morelli, J.G., Plomer, K.D. (1999). "Block the sun, not the fun": evaluation of a skin cancer prevention program for child care centers. Am J Prev Med, 17(1), 31-7.
Gritz, E.R., Tripp, M.K., de Moor, C.A., Eicher, S.A., Mueller, N.H., & Spedale, J.H. Skin cancer prevention counseling and clinical practices of pediatricians. Pediatr Dermatol. 2003 Jan-Feb;20(1):16-24
U.S. Preventive Services Task Force. (2003)
Counseling to prevent skin cancer: recommendations and rationale of the U.S. Preventive Services Task Force.MMWR Recomm Rep. 2003 Oct 17;52(RR-15):13-7

Social Support Interventions

Glanz, K., Geller, A.C., Shigaki, D., Maddock, J.E., & Isnec, M.R. (2002). A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program. Health Psychol, 21(6), 579-87.

Physical Environment Interventions

Coppa, K.R.,& Greenwood, J.S. (2006). Effective shade structures. Med J Aust, 184(8), 423.
Turnbull, D.J., & Parisi, A.V. (2006). Effective shade structures. Med J Aust,184(1), 13-5.
Cam Escoffery, Karen Glanz, and Tom Elliott (2008) Process evaluation of the Pool Cool Diffusion Trial for skin cancer prevention across 2 years Health Education Research Health Educ. Res. 2008 23: 732-743; doi:10.1093/her/cym060

Policy Resources

Guidelines to Prevent Skin Cancer (US Centers for Disease Control & Prevention) These guidelines were designed to provide schools with a comprehensive approach to preventing skin cancer among adolescents and young people. CDC worked with specialists in dermatology, pediatrics, public health, and education from universities; national, federal, state, and voluntary agencies; schools; and other organizations to develop these guidelines.
School Sun-Safety Policy Development Resources
(California Dept of Health) One-page list of skin cancer prevention policy templates and background information for use in school settings.
Sample School Board Policy on Sun Safety
Sample policy from the Los Angeles Metropolitan Dermatological Society

Instructional Resources

Sunny Days Healthy Ways (Canadian Best Practices Portal) This skin cancer prevention curriculum is a comprehensive course for children in Grades 4, 5, and 6. The five-session curriculum presents material from science, history, social studies, health and geography in a comprehensive and cause-and-consequence presentation about the relationship between humans and the sun
Sunsense Quiz (Canadian Cancer Society)
How much do you really know about sun protection and skin cancer?Test your knowledge.

Environment Canada – UV Index and Sun Protection This bilingual site provides information on the UV Index, North American and Caribbean forecasts, sun protection and the UV Index Sun Awareness Program for students.

Fortune teller: A fun resource for primary school age children (BC Cancer Society) This resource provides general information for primary school age children on healthy sun-safe lifestyles and risk reduction, not skin cancer. Instruction for assembly of the resource is included.

Sun Safety Learning Activity Package (Cancer Care Nova Scotia) This package is a compilation of learning activities developed by recognized leaders in sun safety and skin cancer prevention.They are intended to be used with students to raise awareness and educate on the importance of sun safety practices.

Sun Safety Teaching Materials (California Dept of Health) Two-page list of skin cancer prevention curriculums, resource guides, videos, and UV-reactive promotional items designed for use to instruct pre-school children through age 12.

Sunsmart Online Teacher Training (Western Australia)
Professional development for early childhood, primary and secondary teachers and school health nurses.

Sunsmart Online Student Module (Western Australia)
Online interactive student education.

Sunny Days Healthy Ways - Elementary School (Grades K-5) Designed to increase awareness and promote sun protection behavior and practices among K-5th grade students.

Health and Other Services Interventions

Social Support Interventions

Health Canada – Smart Summer Fun This bilingual site gives tips on how to be smart while having fun this summer in Canada. There are sections on air quality, sun safety and skin cancer, playing safe, food and drink and enjoying the great outdoors. The Summer Fun quiz tests your knowledge on smart summer fun.
Pool Cool (Canadian Best Practices Portal)
This pool-based program can be used with schools andf after school programs. It aims to increase sun-protection habits in parents, swimming instructors and children. Its main objective is to increase awareness, motivation, and sun protection practices among children ages 5-10 who take swimming lessons, their parents, aquatics staff, and other pool users
Choose Your Cover The Choose Your Cover Campaign was a five–year skin cancer prevention and education campaign sponsored by the United States Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC). Although campaign activities concluded in May 2003, some campaign materials are still available online.
Successful School-Based Skin Cancer Prevention Activities (California Dept of Health) Discover what award winning schools do to integrate sun-safety activities.
Together for Sun Safety Interventions oriented to children's parents and caregivers. Awareness building and Behavior Modification.

Physical Environment Interventions

Shade Planning for America's Schools* [pdf 1Mb]. This manual was created to support school communities in their implementation of CDC's Guidelines for School Programs to Prevent Skin Cancer, and can help district school health or wellness councils, and school health teams, ensure that school grounds have adequate shade.
Healthy School Environments Assessment Tool
(Environmental Protection Agency) The Healthy School Environments Assessment Tool (HealthySEATv2) is a fully customizable and easy to use software program designed to help school districts evaluate and manage ALL of their environmental, safety and health issues.

Use of Evidenced-based Implementation Strategies

This sub-section examines the use of research-based implementation strategies drawn from health promotion (eg PRECEDE planning model) or education (eg Concerns-based Adoption Model). We also looked for references and resources that described the use of "local mechanisms" such as training champions or truly engaging staff. As well, we looked to items that examined "local drivers" of change/resistance such provincial directives, local incidents or local personalities/relationships. This sub-section also examines system, agency, school and professional capacity in areas such as coordinated policy, mechanisms for cooperation, assigning staff to coordination, regular monitoring and reporting, workforce development, planning for sustainability and strategic management of issues. We also looked to adaptations to local community contexts or higher risk populations.

Preliminary Findings:

The state of research on school sun safety is similar to other health issues in that it is just now that researchers are turning their attention to implementation and sustainability issues
Not surprisingly, and similar to other physical health issues and social behaviours, our preliminary search identified some research and measurement issues that are relevant to the school setting. Essentially, these issues revolve around the reliability of self-reporting of social behaviours and then technicalities related to measuring a physical change in health status

Research	Reports & Resources
Use of Diffusion and Education Change Knowledge/Theory Escoffery, C., Glanz, K., & Elliott, T. (2008). *Process evaluation of the Pool Cool* Diffusion Trial for skin cancer prevention across 2 years .Health Educ. Res, 23, 732-743 Use of Capacity-Building Knowledge/Theory and Sustainability** Milne E, Jacoby P, Giles-Corti B, Cross D, Johnston R, English DR.(2006) The impact of the kidskin sun protection intervention on summer suntan and reported sun exposure: was it sustained? Prev Med. Jan;42(1):14-20. Epub 2005 Dec 5. Buller, D.B., Geller, A.C., Cantor, M., Buller, M.K., Rosseel, K., Hufford, D., Benjes, L.,& Lew, R.A. (2002). Sun protection policies and environmental features in US elementary schools. Arch Dermatol, 138(6), 771-4. Gritz, E.R., Tripp, M.K., James, A.S., Harrist, R.B., Mueller, N.H., Chamberlain, R.M., & Parcel, G.S. Effects of a preschool staff intervention on children's sun protection: outcomes of sun protection is fun! Health Educ Behav, 34(4), 562-77. Epub 2006 May 31. Harrison, S.L., Saunders, V., & Nowak, M. (2007). Baseline survey of sun-protection knowledge, practices and policy in early childhood settings in Queensland, Australia. Health Educ Res, 22(2), 261-71. Epub 2006 Jul 31. Horsley, L., Charlton, A., & Waterman C. (2002). Current action for skin cancer risk reduction in English schools: pupils' behaviour in relation to sunburn. Health Educ Res, 17(6),715-31. Horsley, L., Charlton, A., Wiggett, C. (2000).Current action for skin cancer risk reduction in English schools: a report on a survey carried out for the Department of Health. Health Educ Res, 15(3), 249-59. Morris, J.M., Gould, D., Bennett, S., Bastin, J., Salter, L., & Watt, A. (2005). Sun protection initiatives in Cornwall. Clin Exp Dermatol. 30(4), 340-3. Nyiri PSun protection in Singapore's schools. Singapore Med J. 2005 Sep;46(9):471-5 Geller AC, Cantor M, Miller DR, Kenausis K, Rosseel K, Rutsch L, Brooks DR, Zhang Z, Demierre MF (2002) The Environmental Protection Agency's National SunWise School Program: sun protection education in US schools (1999-2000). J Am Acad Dermatol. 2002 May;46(5):683-9 Horsley L, Charlton A, Waterman C.(2002) Current action for skin cancer risk reduction in English schools: pupils' behaviour in relation to sunburn. Health Educ Res. 2002 Dec;17(6):715-31. Consideration of Ecology and System Characteristics Reynolds, K., Buller, D., Yaroch, A., Maloy, J., & Cutter, G. (2005). Mediation of a middle school skin cancer prevention program. Health Psychology, 5, 616-625 Consideration of Different Community, Cultural Contexts Questions related to Future and Current Research Dusza, S.W., Oliveria, S.A., Geller, A.C., Marghoob, A.A., & Halpern, A.C. (2005). Student-parent agreement in self-reported sun behaviors. J Am Acad Dermatol, 52(5), 896-900. Gies, P., & Mackay, C. (2004). Measurements of the solar UVR protection provided by shade structures in New Zealand primary schools. Photochem Photobiol, 80(2), 334-9. Milne, E., Corti, B., English, D.R., Cross, D., Costa, C.,& Johnston, R. (1999). The use of observational methods for monitoring sun-protection activities in schools. Health Educ Res, 14(2), 167-75. Milne, E., English, D.R., Corti, B., Cross, D., Borland, R., Gies, P., Costa, C.,& Johnston, R. (1999). Direct measurement of sun protection in primary schools. Prev Med. 29(1),45-52. Yaroch, A.L., Reynolds, K.D., Buller, D.B., Maloy, J.A.,& Geno, C.R. (2006). Validity of a sun safety diary using UV monitors in middle school children. Health Educ Behav, 33(3), 340-51. Milne, E., English, D., Corti, B., Cross, D., Borland, R., Gies, P., et al. (1999). Direct measurement of sun protection in primary schools. Preventive Medicine, 29, 45-52.

Research

Reports & Resources

Use of Diffusion and Education Change Knowledge/Theory

Escoffery, C., Glanz, K., & Elliott, T. (2008). Process evaluation of the Pool Cool Diffusion Trial for skin cancer prevention across 2 years .Health Educ. Res, 23, 732-743

Use of Capacity-Building Knowledge/Theory and Sustainability

Milne E, Jacoby P, Giles-Corti B, Cross D, Johnston R, English DR.(2006) The impact of the kidskin sun protection intervention on summer suntan and reported sun exposure: was it sustained? Prev Med. Jan;42(1):14-20. Epub 2005 Dec 5.
Buller, D.B., Geller, A.C., Cantor, M., Buller, M.K., Rosseel, K., Hufford, D., Benjes, L.,& Lew, R.A. (2002). Sun protection policies and environmental features in US elementary schools. Arch Dermatol, 138(6), 771-4.
Gritz, E.R., Tripp, M.K., James, A.S., Harrist, R.B., Mueller, N.H., Chamberlain, R.M., & Parcel, G.S. Effects of a preschool staff intervention on children's sun protection: outcomes of sun protection is fun! Health Educ Behav, 34(4), 562-77. Epub 2006 May 31.
Harrison, S.L., Saunders, V., & Nowak, M. (2007). Baseline survey of sun-protection knowledge, practices and policy in early childhood settings in Queensland, Australia. Health Educ Res, 22(2), 261-71. Epub 2006 Jul 31.
Horsley, L., Charlton, A., & Waterman C. (2002). Current action for skin cancer risk reduction in English schools: pupils' behaviour in relation to sunburn. Health Educ Res, 17(6),715-31.
Horsley, L., Charlton, A., Wiggett, C. (2000).Current action for skin cancer risk reduction in English schools: a report on a survey carried out for the Department of Health. Health Educ Res, 15(3), 249-59.
Morris, J.M., Gould, D., Bennett, S., Bastin, J., Salter, L., & Watt, A. (2005). Sun protection initiatives in Cornwall. Clin Exp Dermatol. 30(4), 340-3.
Nyiri PSun protection in Singapore's schools. Singapore Med J. 2005 Sep;46(9):471-5
Geller AC, Cantor M, Miller DR, Kenausis K, Rosseel K, Rutsch L, Brooks DR, Zhang Z, Demierre MF (2002) The Environmental Protection Agency's National SunWise School Program: sun protection education in US schools (1999-2000). J Am Acad Dermatol. 2002 May;46(5):683-9
Horsley L, Charlton A, Waterman C.(2002) Current action for skin cancer risk reduction in English schools: pupils' behaviour in relation to sunburn. Health Educ Res. 2002 Dec;17(6):715-31.

Consideration of Ecology and System Characteristics

Reynolds, K., Buller, D., Yaroch, A., Maloy, J., & Cutter, G. (2005). Mediation of a middle school skin cancer prevention program. Health Psychology, 5, 616-625

Consideration of Different Community, Cultural Contexts

Questions related to Future and Current Research

Dusza, S.W., Oliveria, S.A., Geller, A.C., Marghoob, A.A., & Halpern, A.C. (2005). Student-parent agreement in self-reported sun behaviors. J Am Acad Dermatol, 52(5), 896-900.
Gies, P., & Mackay, C. (2004). Measurements of the solar UVR protection provided by shade structures in New Zealand primary schools. Photochem Photobiol, 80(2), 334-9.
Milne, E., Corti, B., English, D.R., Cross, D., Costa, C.,& Johnston, R. (1999). The use of observational methods for monitoring sun-protection activities in schools. Health Educ Res, 14(2), 167-75.
Milne, E., English, D.R., Corti, B., Cross, D., Borland, R., Gies, P., Costa, C.,& Johnston, R. (1999). Direct measurement of sun protection in primary schools. Prev Med. 29(1),45-52.
Yaroch, A.L., Reynolds, K.D., Buller, D.B., Maloy, J.A.,& Geno, C.R. (2006). Validity of a sun safety diary using UV monitors in middle school children. Health Educ Behav, 33(3), 340-51.
Milne, E., English, D., Corti, B., Cross, D., Borland, R., Gies, P., et al. (1999). Direct measurement of sun protection in primary schools. Preventive Medicine, 29, 45-52.

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