Abstract CN02-02: Research on establishing policies for comprehensive UV protection
Authors: Buller David 
Published: October 2015

Abstract
Skin cancer is the most common cancer in the United States. In July 2014, the U.S. Surgeon General issued a Call to Action to prevent skin cancer by reducing exposure to solar and non-solar ultraviolet radiation (UV), a primary risk factor. Policies in educational, occupational, and public spheres are an important component in these prevention efforts. Comprehensive policies are comprised of environmental controls, administrative procedures, and personal protection practices. Policy approaches can overcome low perceived risk, equalize differences among subgroups, maximize health education, and clarify personal and organizational responsibilities. Policy initiatives require effective strategies to achieve changes in organizations.
This presentation reviews research by the author and other scientists evaluating strategies for promoting policy change. This works was guided by the diffusion of innovations theory, which holds that policy promotion is achieved through two phases initiation in which organization leaders identify a problem and decide that policy addresses it and implementation where actions dictated by the policy are initiated, organizations adjust their practices or the policy to improve fit, and policy actions become institutionalized.
Children are a key target for sun protection interventions and schools have been a common venue for these efforts. A policy promotion program containing in-person meetings with district administrators, printed and online policy materials, and follow-up communication was evaluated in a randomized controlled trial enrolling 112 public school districts in Colorado (n=56) and California (n=56). At follow-up, school districts assigned to the intervention had more (M=2.41) and stronger (M=3.21) school board approved sun protection policies than control districts (content M=1.35, p=0.020; strength M=1.68, p=0.013). Policies on sunscreen (p=0.026), outdoor shade (p=0.026), and parent outreach (p=0.096) were improved.
Individuals who work outdoors are chronically exposed to UV and have high prevalence of skin cancer. Workplace sun protection policies are being promoted to city, county, and special district employers (n=98) in a randomized controlled trial in Colorado. The campaign includes training for employees and a sun safety consultant who works with senior managers on policy creation. Assessment of written workplace policies showed that while 86% of employers already had a policy on a sun safety component (e.g., headwear and eyewear) at baseline, most pertained only to personal protection and only 21% were explicitly intended for sun protection. Proximity to the urban Colorado Front Range was the sole predictor of having a sun safety policy (p&lt;0.01).
In the public arena, efforts are underway to convince state legislators to restrict access to indoor tanning (IT) facilities by minors. Up to 15% of teens indoor tanned in the past year (23% of girls; 6% of boys). Nearly all states (n=44) have some IT policies. Currently, 23 states have age restrictions but only 11 ban all minors under 18. Also, 28 states have exceptions for parental permission. Age restrictions are more effective at reducing IT by minors than parental permission. Many parents are unaware of the risks and maternal permissiveness is a strong predictor of IT initiation by girls.
There are several important lessons from this research. Policy change is feasible with a theory-based, systematic intervention but it takes time to succeed. Most organizations prefer policies on personal protection; strategies are needed to change environments and administrative procedures. Many decision makers need to be educated on skin cancer prevention, and policy initiatives can face strong competing pressures. Making policy adoption easy and supporting policy implementation are necessary to achieve their potential benefits.
Citation Format: David Buller. Research on establishing policies for comprehensive UV protection. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr CN02-02.