Effects of the Sunny Days, Healthy Ways Curriculum on Students in Grades 6 to 8


      There are few effective sun-safety education programs for use in secondary schools. Project aims were to create a sun-safety curriculum for grades 6 to 8, and to test whether exposure to the curriculum would increase children’s sun-protection behavior.


      A pair-matched, group-randomized, pre-–post test, controlled trial was performed with middle schools as the unit of randomization. Teachers implemented the six-unit sun-safety curriculum in 2001–2003, and analyses were performed in 2003–2004.


      A total of 2038 children from 30 middle schools in Colorado, New Mexico, and Arizona.

      Main Outcome Measures

      Self-reported sun-protection behavior using frequency ratings and diary.


      Compared to control schools, children receiving the curriculum reported more frequent sun protection (p=0.0035), and a greater proportion wore long-sleeved shirts during recess (p<0.0001) and applied sunscreen (p<0.0001). Exposure to the curriculum improved knowledge (p<0.0001), decreased perceived barriers to using sunscreen (p=0.0046), enhanced self-efficacy expectations (p=0.0577) about sun safety, and reduced favorable attitudes toward sun tanning (p=0.0026 to <0.0001). In intent-to-treat analyses, the treatment effect was eliminated only under the most conservative assumptions about dropouts.


      Educational approaches to sun safety in middle school may be effective for improving children’s sun safety. Potential trial limitations include measuring short-term outcomes, focusing on young adolescents, using active parental consent, and testing in the American Southwest.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Glanz K.
        • Saraiya M.
        • Wechsler H.
        Guidelines for school programs to prevent skin cancer.
        MMWR Recomm Rep. 2002; 51: 1-18
        • American Cancer Society
        Cancer facts & figures 2003. American Cancer Society, Atlanta GA2003
        • Cummings S.R.
        • Tripp M.K.
        • Herrmann N.B.
        Approaches to the prevention and control of skin cancer.
        Cancer Metastasis Rev. 1997; 16: 309-327
        • Godar D.E.
        • Urbach F.
        • Gasparro F.P.
        • van der Leun J.C.
        UV doses of young adults.
        Photochem Photobiol. 2003; 77: 453-457
        • Weinstock M.A.
        • Colditz G.A.
        • Willett W.C.
        • et al.
        Nonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age.
        Pediatrics. 1989; 84: 199-204
        • Lowe J.B.
        • Balanda K.P.
        • Gillespie A.M.
        • Del Mar C.B.
        • Gentle A.F.
        Sun-related attitudes and beliefs among Queensland school children.
        Aust J Public Health. 1993; 17: 202-208
        • Robinson J.K.
        • Rigel D.S.
        • Amonette R.A.
        Trends in sun exposure knowledge, attitudes, and behaviors.
        J Am Acad Dermatol. 1997; 37: 179-186
        • Saraiya M.
        • Hall H.I.
        • Uhler R.J.
        Sunburn prevalence among adults in the United States, 1999.
        Am J Prev Med. 2002; 23: 91-97
        • Buller D.B.
        • Geller A.C.
        • Cantor M.
        • et al.
        Sun protection policies and environmental features in US elementary schools.
        Arch Dermatol. 2002; 138: 771-774
        • Centers for Disease Control and Prevention
        Preventing skin cancer: findings of the Task Force on Community Preventive Services on reducing exposure to ultraviolet light and counseling to prevent skin cancer: recommendations and rationale of the U.S. Preventive Services Task Force.
        MMWR Morb Mortal Wkly Rep. 2003; 52: 1-12
        • Buller D.B.
        • Borland R.
        Skin cancer prevention for children.
        Health Educ Behav. 1999; 26: 317-343
        • Buller D.B.
        • Hall J.R.
        • Powers P.J.
        • et al.
        Evaluation of the “Sunny Days, Healthy Ways” sun safety CD-ROM program for children in grades 4 and 5.
        Cancer Prev Control. 1999; 3: 188-195
        • Buller M.K.
        • Loescher L.J.
        • Buller D.B.
        Sunshine and Skin Health.
        J Cancer Educ. 1994; 9: 155-162
        • Buller D.B.
        • Taylor A.M.
        • Buller M.K.
        • et al.
        Evaluation of the Sunny Days, Healthy Ways sun safety curriculum for children in kindergarten through fifth grade. 2001 (Paper presented at the annual meeting of the International Communication Association, Washington, DC, May)
        • Buller D.B.
        • Buller M.K.
        • Beach B.
        • Ertl G.
        Sunny days, healthy ways.
        J Am Acad Dermatol. 1996; 35: 911-922
        • Bandura A.
        Social foundations of thought and action. Prentice-Hall, Englewood Cliffs NJ1986
        • Girgis A.
        • Sanson-Fisher R.W.
        • Tripodi D.A.
        • Golding T.
        Evaluation of interventions to improve solar protection in primary schools.
        Health Educ Q. 1993; 20: 275-287
      1. Yaroch AL, Reynolds KD, Buller DB, Maloy JA, Geno CR. Validity of a sun safety diary using UV monitors in middle school children. Health Educ Behav. In press.

        • Bollen K.
        • Lennox R.
        Conventional wisdom on measurement.
        Psychol Bull. 1991; 110: 305-314
        • Hewitt M.
        • Denman S.
        • Hayes L.
        • Pearson J.
        • Wallbanks C.
        Evaluation of ‘Sun-safe’.
        Health Educ Res. 2001; 16: 623-633
        • Weinstock M.A.
        Assessment of sun sensitivity by questionnaire.
        J Clin Epidemiol. 1992; 45: 547-552
        • Donner A.
        • Birkett N.
        • Buck C.
        Randomization by cluster. Sample size requirements and analysis.
        Am J Epidemiol. 1981; 114: 906-914
        • Murray D.
        Design and analysis of group randomized trials. Oxford University Press, New York1998
      2. Reynolds KD, Buller DB, Yaroch AL, Maloy J, Cutter G. Mediation of a middle school skin cancer prevention program. Health Psychol. In press.

        • Hedges L.
        Effect sizes in cluster-randomized designs. University of Chicago Press, Chicago2005
        • Glanz K.
        • Mayer J.A.
        Reducing ultraviolet radiation exposure to prevent skin cancer.
        Am J Prev Med. 2005; 29: 131-142
        • Buller D.B.
        • Borland R.
        Public education projects in skin cancer prevention.
        Clin Dermatol. 1998; 16: 447-459