Award Date

December 2016

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Environmental and Occupational Health

First Committee Member

Courtney Coughenour

Second Committee Member

Timothy Bungum

Third Committee Member

Jennifer Pharr

Fourth Committee Member

Carolee Dodge-Francis

Fifth Committee Member

Helen Neill

Number of Pages

129

Abstract

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 (χ2(93)= 41.14, p=0.00), understanding UV rays cause damage through clouds (χ2(93)= 32.09, p=0.00), understanding sunscreen

is necessary in all environments and outdoor locations (χ2(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 (χ2(93) = 28.67, p=0.00) and in developing an aversion for tanned skin (χ2(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.

Keywords

Education; Prevention; Skin Cancer; Sunburn; Sun Safety; SunWise Program

Disciplines

Public Health

Language

English


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