According to a study published in Dermatology.1 In addition, the project resulted in updates to health education curricula for California public schools.
To assess students’ knowledge and behaviors around sun protection, investigators surveyed 2,688 students at Franklin High School, the largest high school in Elk Grove, California. The survey response rate was 38.1% (n=1025).
The investigators reported the following results:1
- Compared to baseline, the percentage of correct answers to 15 out of 17 skin cancer knowledge questions increased immediately after the video lesson and remained higher one month later.
- The number of students who reported never wearing sunscreen decreased by approximately 12.5% (P=0.007) one month after the video, while the number of students wearing sunscreen 5-7 days per week increased by more than 50% (P
- 68% of respondents said video content should be taught in schools.
- 84% agreed the lesson could be applied directly to their lives.
“We should be teaching skin cancer prevention starting in elementary school,” said Jeanine B. Downie, MD, who was not involved in the study. “I used to go and lecture my daughter’s friends all the time.” She also spoke to her daughter’s teachers, as well as staff and students from other schools in the area.
“I’m talking about skin cancer, sun safety, no tanning beds, no tobacco, no vaping. I say there’s no such thing as a safe tan,” added Downey, Director of Dermatology PC Image in Montclair, New Jersey.
“I explain that New Jersey is one of the tanning bed capitals of the country, and the average tanning bed gives you 12 to 15 times the ultraviolet radiation of the sun, according to the Skin Cancer Foundation.” Additionally, she discusses basal and squamous cell cancers, as well as melanoma, and the need to watch out for changing lesions and pimples that don’t heal. “We could all do more of this.”
Childhood and adolescence provide a valuable window for instilling sun protection behaviors to combat rising rates of melanoma and non-melanoma skin cancers, especially among young people, the study authors wrote. “With cumulative sun exposure well accepted as the primary cause of skin cancer,” they added, “habits formed in childhood lay the foundation for how people protect themselves from the sun.”
Several factors can explain the overall success of the lesson. Most notably, the 4-minute video featured an Elk Grove student (and lead author of the study, Shay N. Sharma) speaking at a high school level of language complexity. “The importance of peer influence in modifying adolescent behavior is well established,” the authors wrote, “and hearing a classmate’s sun protection recommendations might resonate more strongly than an adult health care provider.”3 Showing the video to the whole school may have reduced the influence of peer pressure and body image issues that typically make teens unlikely to engage in behaviors of sunscreen.
Bureaucratic challenges and state and federal laws hamper schools’ ability to identify and integrate health information in a timely manner, the authors noted. But ultimately, California public schools revised their health education framework to correct ambiguous information (e.g., sun protection is needed on cloudy days), highlight key practices (e.g., the importance of reapplying sunscreen) and add new information (for example, May is Skin Cancer Awareness Month).
Downie is a member of the Skin Cancer Foundation but reports no relevant financial interests.
1. Sharma SN, Sharma SN, Sharma AN, Sharma AN, Sharma JK. Implementing a lesson in skin cancer prevention to effect institutional change: A school-wide survey [published online ahead of print, 2022 Mar 28]. Dermatology. 2022;1-7. doi:10.1159/000521420
2. Madan V, Lear JT, Szeimies RM. Non-melanoma skin cancer. Lancet. 2010;375(9715):673-685. doi:10.1016/S0140-6736(09)61196-X
3. Supovitz J, Sirinides P, May H. How principals and peers influence teaching and learning. Quarterly Education Administration. 2010;46(1): 31–56.