Assessing the Impact of the SunWise Program on Youth Sun Safety Knowledge, Attitudes, and Behaviors in Clark County, Nevada
Creators: name: Malik, Sabina 
Publisher: name: University of Nevada, Las Vegas
Year: 2016

description: Introduction: Skin Cancer rates in Nevada continue to increase and remain above the
national average. One important method to combat rising rates is education related to the
prevention of sunburns, the main risk factor for developing skin cancer. This study aimed
to assess the impact of the SunWise Program, a sun safety education program developed
by the Environmental Protection Agency, to increase knowledge, improve attitudes, and
change behaviors of participants based on constructs of the Health Belief Model.
Methods: Participants included youth from ages 7-18 years old who attended 6 Boys and
Girls Clubs of Southern Nevada. Boys and Girls Club locations were matched on
percentage of students who qualified for free or reduced price lunch; three clubs served
as intervention sites and three served as control sites. All locations completed a pre- and
post-test measuring knowledge, attitude, and self-reported behaviors related to sun
safety. Systematic observations took place at all locations before and after the
intervention during outside activities to evaluate changes in objectively measured sunsafe
behaviors. Intervention sites received a 20-minute educational lesson from the SunWise
Program and participated in interactive games explaining how to prevent sunburns.
Results: There were a total of 228 participants who completed the pre- and post-test, 94
in the intervention group and 134 in the control group. This intervention was successful
in increasing knowledge on the following topics demonstrated with a significance level of
p<0.05. Data were analyzed using paired t-tests and McNemar Tests. The intervention
group's results showed significant increases in knowledge by correctly identifying that
wearing a shirt, hat, and sunscreen will keep skin safe in the sun (t(93)= 3.32, µ=0.27),
understanding how to read the UV index (?2(93)= 41.14, p=0.00), understanding UV rays cause damage through clouds (?2(93)= 32.09, p=0.00), understanding sunscreen
is necessary in all environments and outdoor locations (?2(93)= 17.52, p=0.00), and identifying areas of the body that require sunscreen application (t(93)= 3.14, µ=1.34). The
intervention group's results showed significant improvements in attitude by indicating that
the implementation of sun safety tips is easy (?2(93) = 28.67, p=0.00) and in developing an aversion for tanned skin (?2(93) = 12.91, p=0.01). Measurement on sunscreen usage could not be analyzed. Objectively measured behavior changes were analyzed using Wilcoxon Signed Rank Tests and showed statistically insignificant results.
Discussion: Analysis of pre- to post-test results for the control group on knowledge and
attitude related questions did not show significant differences, but the intervention group
showed significant increases, indicating that the intervention may have resulted in an
increase in knowledge and change in attitude. Results for behavior observations were
confounded by prior knowledge, and limited by the environmental design of the outside
play area which made it difficult or impossible for participants to access shade, and school
policies that prohibited the use of hats and sunglasses prior to arriving at the Boys and
Girls Club after school. Findings from this study were shared with the Boys and Girls
Clubs of Southern Nevada in order to encourage continued use of the SunWise Program,
as repetition is likely to positively impact behavior changes aimed at the prevention of
sunburns and increases in sun safety. Continued efforts aimed at prevention are critical,
as school aged children have the greatest risk for sunburns because they are outside
during peak intensity hours. It is especially important to continue these efforts for youth in
Southern Nevada given the increased sun exposure resultant from the desert climate and
increased rates of skin cancer experienced in the state.