Motivating public school districts to adopt sun protection policies: a randomized controlled trial.

BACKGROUND In 2002, CDC recommended that the nation's schools establish policies that reduce sun exposure to decrease students' risk of skin cancer. PURPOSE A program to convince public school districts to adopt such a policy was evaluated. DESIGN RCT. SETTING/PARTICIPANTS Public school districts in Colorado (n=56) and Southern California (n=56). INTERVENTION Policy information, tools, and technical assistance were provided through printed materials, a website, meetings with administrators, and presentations to school boards. An RCT enrolled public school districts from 2005 to 2010. Policy adoption was promoted over 2 years at districts randomized to the intervention. MAIN OUTCOME MEASURES School board-approved policies were obtained from 106 districts and coded at baseline and 2-year follow-up. Analyses were conducted in 2010. RESULTS There was no difference in the percentage of districts adopting a policy (24% in intervention; 12% in control; p=0.142); however, intervention districts (adjusted M=3.10 of 21 total score) adopted stronger sun safety policies than control districts (adjusted M=1.79; p=0.035). Policy categories improved on sun safety education for students (intervention adjusted M=0.76; control adjusted M=0.43, p=0.048); provision of outdoor shade (intervention adjusted M=0.79; control adjusted M=0.28, p=0.029); and outreach to parents (intervention adjusted M=0.59; control adjusted M=0.20, p=0.027). CONCLUSIONS Multifaceted promotion can increase adoption of stronger policies for reducing sun exposure of students by public school districts. Future research should explore how policies are implemented by schools.