Design and implementation of a health promotion program to prevent the harmful effects of ultraviolet radiation at primary school students of rural areas of Greece

Maria Sakoufaki; Aravella Stergiopoulou; Alexander Stratigos

doi:10.18203/issn.2455-4529.IntJResDermatol20172505

Authors

Maria Sakoufaki Department of Public Health, Attica Region, Greece
Aravella Stergiopoulou Department of Dermatology - Venereology, Andreas Sygros Hospital, Athens, Greece
Alexander Stratigos Department of Dermatology - Venereology, Andreas Sygros Hospital, Athens, Greece

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20172505

Keywords:

School health promotion, Skin cancer prevention, Sunscreen, Sun protection, Sun effects

Abstract

Background: Skin cancer is the most common type of cancer presenting with a dramatic increase in its incidence among Caucasian populations worldwide. Primary prevention in childhood and early detection is important in reducing the risk of skin cancer later in life.The objectives of the study were to investigate the effect of a focused educational intervention in school children aiming to increase their knowledge about the harmful effects of sun exposure and promote prevention behaviors regarding skin cancer

Methods: The study consisted of a before/after 6-month assessment of a school intervention program applied in two hundred children from four primary Schools (Grades 3-6) at a rural area in Western Greece. The program included the presentation and distribution of educational material (activity guide, manual for pupils, posters). A detailed questionnaire with close-ended questions was distributed before and after the intervention. Both between and in groups analysis was conducted.

Results: Of the participating pupils, 48% were boys, whereas 78.5% reported a fair skin complexion and 79% reported freckles and 1-20 nevi. After the intervention, an increased number of pupils were taught to enjoy sun exposure while avoiding its harmful effects. A significantly greater number of children stated proper use of sunscreen (74% vs. 31%, p=0.001) and sun protection (that avoided going outside especially at the intense hours of daily UV exposure (65% vs. 25.5% prior to the intervention). Melanoma awareness was also significantly raised.

Conclusions: Students’ knowledge about the effects of sun exposure as well as the need for sun protection increased following a targeted and well-designed educational intervention. The development of preventive educational programs on skin cancer for school children is important to increase awareness in this sensitive age group.

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References

Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279-82.

Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Adv Exp Med Biol. 2014;810:120-40.

Erdei E, Torres SM. A new understanding in the epidemiology of melanoma. Expert Review Anticancer Therapy. 2010;10(11):1811-23.

Branstrom R, Ullen H, Brandberg Y. Attitudes, subjective norms and perception of behavioural control as predictors of sun-related behaviour in Swedish adults. Prev Med. 2004;39(5):992-9.

Bastuji-Garin S, Grob JJ, Grognard C, Grosjean F, Guillaume JC. Melanoma prevention: evaluation of a health education campaign for primary schools. Arch Dermatol. 1999;135(8):936-40.

Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011;29(3):257-63.

Dietrich AJ, Olson AL, Sox CH, Stevens M, Tosteson TD, Ahles T, et al. A community-based randomized trial encouraging sun protection for children. Pediatr. 1998;102(6):64.

Blair A, Zahm SH. Agricultural exposures and cancer. Environmental health perspectives. 1995;103(8):205-8.

Moore J, Zelen D, Hafeez I, Ganti AK, Beal J, Potti A. Risk-awareness of cutaneous malignancies among rural populations. Med Oncol. 2003;20(4):369-74.

Dennis LK, Lynch CF, Sandler DP, Alavanja MC. Pesticide use and cutaneous melanoma in pesticide applicators in the agricultural heath study. Environ Health Perspect. 2010;118(6):812-7.

Chen PC, Doyle PE, Wang JD. Respirable dust exposure and respiratory health in male Taiwanese steelworkers. Industrial health. 2006;44(1):190-9.

Roussaki-Schulze AV, Rammos C, Rallis E, Terzis A, Archontonis N, Sarmanta A, et al. Increasing incidence of melanoma in central Greece: a retrospective epidemiological study. Int J Tissue React. 2005;27(4):173-9.

Lasithiotakis K, Kruger-Krasagakis S, Manousaki A, Ioannidou D, Panagiotides I, Tosca A. The incidence of cutaneous melanoma on Crete, Greece. Int J Dermatol. 2006;45(4):397-401.

Corona R, Dogliotti E, D'Errico M, Sera F, Iavarone I, Baliva G, et al. Risk factors for basal cell carcinoma in a Mediterranean population: role of recreational sun exposure early in life. Arch Dermatol. 2001;137(9):1162-8.

Weinstock MA, Rossi JS, Redding CA, Maddock JE. Randomized controlled community trial of the efficacy of a multicomponent stage-matched intervention to increase sun protection among beachgoers. Prev Med. 2002;35(6):584-92.

Steptoe A, Wardle J. Health behaviour, risk awareness and emotional well-being in students from Eastern Europe and Western Europe. Social Sci Med. 2001;53(12):1621-30.

Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN, Leiden Skin Cancer S. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Investigat Dermatol. 2003;120(6):1087-93.

Saraiya M1, Glanz K, Briss PA, Nichols P, White C, Das D, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med. 2004;27(5):422-66.

Jorgensen CM, Wayman J, Green C, Gelb CA. Using health communications for primary prevention of skin cancer: CDC's Choose Your Cover campaign. J Women's Health Gender-Based Med. 2000;9(5):471-5.

Estève E, Armingaud P, Baranger JM, Bellier N, Darchy M, Delavierre C, et al. Sunshine at school: a network for training on sun exposure. Assessment of knowledge among 683 children. Ann Dermatol Venereol. 2003;130(2):171-6.

Emmons KM, Colditz GA. Preventing excess sun exposure: it is time for a national policy. J National Cancer Institute. 1999;91(15):1269-70.

Saridi M, Toska A, Pappa V, Liachopoulou A, Aggeli D, Birbas K. Knowledge, attitudes and self-care practices related to sun protection among teenagers in Greece. Arch Hellenic Med. 2009;26(3):355-65.

Manganoni AM, Cainelli T, Zumiani G, Bufalino R, Calzavara-Pinton P, Camerini T, et al. Study of sunbathing in children: the preliminary evaluation of a prevention program. Tumori. 2005;91(2):116-20.

Buendia-Eisman A, Feriche Fernandez CE, Serrano Ortega S. Awareness, attitudes and behaviour of teenagers to sunlight. Eur J Dermatol. 1999;9(3):207-10.

Buendia-Eisman A, Feriche-Fernandez E, Munoz-Negro JE, Cabrera-Leon A, Serrano-Ortega S. Evaluation of a school intervention program to modify sun exposure behaviour. Actas dermo-sifiliograficas. 2007;98(5):332-44.

Geller AC, Shamban J, O'Riordan DL, Slygh C, Kinney JP, Rosenberg S. Raising sun protection and early detection awareness among Florida high schoolers. Pediatric Dermatol. 2005;22(2):112-8.

Emmons KM, Geller AC, Viswanath V, Rutsch L, Zwirn J, Gorham S, et al. The Sun Wise Policy intervention for school-based sun protection: a pilot study. J Sch Nurs. 2008;24(4):215-21.