Mary Klein Buller

Sunny Days, Healthy Ways: Evaluation of a skin cancer prevention curriculum for elementary school-aged children

BACKGROUND Primary prevention of skin cancer must start early in life to reduce total life-time sun exposure and severe overexposure in childhood. Childhood is an excellent time to form life-long prevention habits. A school-based curriculum can be an effective prevention strategy. OBJECTIVE Our purpose was to determine the effectiveness of a skin cancer prevention curriculum at increasing knowledge and attitudes supporting prevention and decreasing sun exposure by children in grades four, five, and six. METHODS Twenty-four classes (N = 447 students) from four public elementary schools in southern Arizona participated. Half received a pretest, half were tested at the conclusion of the 5-week curriculum in early spring, and half were tested 8 weeks later in late spring. Objective measures of suntanning were obtained. RESULTS The curriculum increased knowledge about skin cancer prevention and attitudes supporting prevention and decreased suntanning. Self-reported preventive behavior was inconsistent and only weakly associated with measures of suntanning. CONCLUSION The curriculum was effective at increasing skin cancer prevention. Resulting reduction in sun exposure was superior to that achieved with previous prevention curricula. Change in attitude needed time to emerge, appearing after 8 weeks. Self-reported preventive behavior by children in elementary school may lack validity. Pretesting did not alter effectiveness. Sixth-graders may be ready for more advanced content, but the curriculum is probably too advanced for kindergarten through third grade.

“Sunshine and skin health”: A curriculum for skin cancer prevention education

Skin cancer rates are increasing. Instilling preventive behavior in youngsters is essential to prevent overexposure during childhood. The effectiveness of a curriculum for increasing knowledge and skills, creating supportive attitudes, and engendering a supportive environment to enhance skin cancer prevention was tested on 139 fourth-, fifth-, and sixth-graders. One class in each grade was assigned to treatment (curriculum) and another to control. The curriculum increased knowledge of the effects of exposure to sunlight, skin cancer, and prevention immediately and eight weeks later, across all grades. It also cultivated less favorable attitudes toward tanning and, among fourth-graders, reduced unfavorable attitudes toward sunscreen. Behavioral changes were less consistently evident, with students reporting less suntanning, fourth-graders more frequently using sunscreen, and fifth- and sixth-graders more frequently wearing protective clothing compared with controls. The curriculum was more effective at influencing knowledge and attitudes than changing behavior, highlighting the need for student- and parent-oriented cues to action.

Public education projects in skin cancer. The evolution of skin cancer prevention education for children at a comprehensive cancer center

Background. Skin cancer affects more Americans than any other type of cancer. Children are prime targets for prevention education, because sun overexposure in early childhood may affect the development of skin cancer later in life. Preventive behaviors adopted early in life may be less resistant to change than those acquired in adulthood. Thus, there is a need to educate children at an early age about sun overexposure.

Implementing a 5-a-Day Peer Health Educator Program for Public Sector Labor and Trades Employees

Peer education in the Arizona 5-a-Day project achieved lasting improvements in fruit and vegetable intake among multicultural employees. Measures monitored implementation of peer education from peer educators’ logs, the program’s reach from employee surveys, and employees’ use in terms of employees’ dietary change. Peer educators logged 9,182 coworker contacts. Contacts averaged 10.9 minutes, according to coworkers. Coworkers read an average of 4.7 booklets and 2.23 newsletters. Many employees talked with peer educators (59%) and read materials (54%) after the program finished. Employee reports of peer educator contact were positively associated with fruit and vegetable intake. Peer education was implemented as intended and reached many coworkers. It continued after program completion, reached into coworkers’ families, and was used by employees to improve intake. This method can be used with employees who rely on informal sources and whose work presents barriers to wellness activities.

Long-term effects of language intensity in preventive messages on planned family solar protection.

A series of sun safety messages containing highly intense language and deductive logical style achieved the most immediate compliance by parents, particularly when they intended to improve protection. Inductive messages were more successful when no intentions existed (D. B. Buller, Borland, & Burgoon, 1998; D. B. Buller et al., 2000). Interviewers recontacted 568 parents during the winter following message dissemination and assessed solar protection. A 2 (language intensity) ×2 (logical style) ×3 (behavioral intention) ×2 (person) mixed-model analysis of variance showed that parents receiving high-intensity, deductive messages reported the most improved solar protection and improvement was greatest when parents intended to improve protection. Over the long term, high language intensity may reinforce decisions to take preventive action and does not appear to provoke psychological reactance or resistance to these highly directive messages.

Toward an Organizational Perspective on Identifying and Managing Formal Gatekeepers

In this article, we present an institutionalist organizational perspective on formal gatekeeping, arguing along two fronts: First, identifying gatekeepers provides useful analytic devices for learning about the vocabularies of structure in an organization. Second, successfully managing gatekeepers requires that one understands the vocabularies of structure in use in an organization. We ground our perspective in field experiences gleaned from eleven public sector organizations who participated in our health promotion and research program, the Arizona 5 a Day Project. Field data and insights from institutional organizational and decision-making theory frame a matrix of organizational types and formal gatekeeping. We conclude by linking our perspective with analytic perspectives on organizational charters and organizational change.

Evaluation of the Sunny Days, Healthy Ways Sun Safety Curriculum for Children in Kindergarten through Fifth Grade

Abstract:  Childhood sun protection is important to reduce the risk of developing skin cancer later in life. An evaluation of an expanded version of the Sunny Days, Healthy Ways sun safety instructional program was conducted with 744 students in 77 kindergarten to fifth grade classes in 10 elementary schools. Students in six schools received instruction twice over two school years. Students in four schools received it only once in a single school year or were enrolled in a no‐treatment control group. A single presentation of the sun safety materials improved sun safety knowledge in students in grades 2–5 (p < 0.05). Repeated presentation over 2 years improved all outcomes, including increasing self‐reported sun protection (p < 0.05) and decreasing skin darkening indicative of exposure to ultraviolet radiation (p < 0.05). The program did not improve childrens knowledge or skin darkening in kindergarten and grade 1. These results highlight the need to provide sun protection education over several school years, not just one time, to produce changes in sun safety behavior.

Smartphone mobile application delivering personalized, real-time sun protection advice: a randomized clinical trial.

IMPORTANCE Mobile smartphones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications (apps), they can access remote databases, track time and location, and integrate user input to provide tailored health information. OBJECTIVE A smartphone mobile app providing personalized, real-time sun protection advice was evaluated in a randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTS The trial was conducted in 2012 and had a randomized pretest-posttest controlled design with a 10-week follow-up. Data were collected from a nationwide population-based survey panel. A sample of 604 non-Hispanic and Hispanic adults from the Knowledge Panel 18 years or older who owned an Android smartphone were enrolled. INTERVENTIONS The mobile app provided advice on sun protection (ie, protection practices and risk of sunburn) and alerts (to apply or reapply sunscreen and get out of the sun), hourly UV Index, and vitamin D production based on the forecast UV Index, the phones time and location, and user input. MAIN OUTCOMES AND MEASURES Percentage of days using sun protection and time spent outdoors (days and minutes) in the midday sun and number of sunburns in the past 3 months were collected. RESULTS Individuals in the treatment group reported more shade use (mean days staying in the shade, 41.0% vs 33.7%; P = .03) but less sunscreen use (mean days, 28.6% vs 34.5%; P = .048) than controls. There was no significant difference in number of sunburns in the past 3 months (mean, 0.60 in the treatment group vs 0.62 for controls; P = .87). Those who used the mobile app reported spending less time in the sun (mean days keeping time in the sun to a minimum, 60.4% for app users vs 49.3% for nonusers; P = .04) and using all protection behaviors combined more (mean days, 39.4% vs 33.8%; P = .04). CONCLUSIONS AND RELEVANCE The mobile app improved some sun protection. Use of the mobile app was lower than expected but associated with increased sun protection. Providing personalized advice when and where people are in the sun may help reduce sun exposure.

Evaluation of Immediate and 12-Week Effects of a Smartphone Sun-Safety Mobile Application A Randomized Clinical Trial

IMPORTANCE Mobile applications on smartphones can communicate a large amount of personalized, real-time health information, including advice on skin cancer prevention, but their effectiveness may be affected by whether recipients can be convinced to use them. OBJECTIVE To evaluate a smartphone mobile application (Solar Cell) delivering real-time advice about sun protection for a second time in a randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTS A previous trial conducted in 2012 used a randomized pretest-posttest design. For the present trial, we collected data from a volunteer sample of 202 adults 18 years or older who owned a smartphone. Participants were recruited nationwide through online promotions. Screening procedures and a 3-week run-in period were added to increase the use of the mobile application. We conducted follow-ups at 3 and 8 weeks after randomization to examine the immediate and the longer-term effects of the intervention. INTERVENTIONS Use of the mobile application. The application gave feedback on sun protection (ie, sun-safety practices and the risk for sunburn) and alerted users to apply or to reapply sunscreen and to get out of the sun. The application also displayed the hourly UV Index and vitamin D production based on the forecast UV Index, time, and location. MAIN OUTCOMES AND MEASURES Percentage of days with the use of sun protection, time spent outdoors in the midday sun (days and hours), and the number of sunburns in the last 3 months. RESULTS Participants in the intervention group used wide-brimmed hats more at 7 weeks than control participants (23.8% vs 17.4%; F = 4.07; P = .045). Women who used the mobile application reported using all sun protection combined more than men (46.4% vs 43.3%; F = 1.49; P = .04), whereas men and older individuals reported less use of sunscreen (32.7% vs 35.5%; F = 5.36; P = .02) and hats (15.6% vs 17.9%; F = 4.72; P = .03). CONCLUSIONS AND RELEVANCE The mobile application initially appeared to confer weak improvement of sun protection. Use of the mobile application was greater than in a previous trial and was associated with greater sun protection, especially among women. Strategies to increase the use of the mobile application are needed if the application is to be deployed effectively to the general adult population.

Web-based strategies to disseminate a sun safety curriculum to public elementary schools and state-licensed child-care facilities.

The Sunny Days, Healthy Ways curriculum, which has been effective in previous trials, was disseminated to public elementary schools (n=2,030) and state-licensed child-care facilities (n=3,755) in 4 states. Two Web sites were created, varying in the amount and type of information. Mailings referred principals and directors to the sites. Overall 117 unique users made 172 visits to the sites. More repeat visits were made to the enhanced than to the basic site (p=.04). In a survey, 20.0% of principals and directors recalled receiving the mailings and 80.9% of these read them. Web-based strategies were weak, but the low response rate may be typical for such marketing. They will require supplementation by more personal approaches.