• Richard G Roetzheim, Kymia M Love-Jackson, Seft G Hunter, Ji-Hyun Lee, Ren Chen, Rania Abdulla, and Kristen J Wells.
• Department of Family Medicine, University of South Florida,12901 Bruce B.Downs Blvd., Tampa, FL 33612, USA. rroetzhe@health.usf.edu
• Am J Prev Med. 2011 Dec 1; 41 (6): 615618615-8.

BackgroundElementary schools are one potential venue for sun protection interventions that reduce childhood sun exposure.PurposeTo assess Year-2 results from a cluster randomized trial promoting hat use at schools.DesignBlock randomization was used to assign intervention/control status to participating schools. Data were collected from 2006 to 2008 and analyzed in 2007-2010.Setting/ParticipantsOf the 24 schools in the School District of Hillsborough County, Florida enrolled, 4th-graders were targeted in the first year and followed through their 5th-grade year.InterventionClassroom sessions were conducted to improve sun protection knowledge, foster more positive attitudes about hat use, and change the subjective norm of wearing hats when at school.Main Outcome MeasuresYear-2 outcomes assessed included hat use at school (measured by direct observation), hat use outside of school (measured by self-report) and skin pigmentation and nevi counts (measured for a subgroup of 439 students).ResultsThe percentage of students observed wearing hats at control schools remained unchanged during the 2-year period (range 0%-2%) but increased significantly at intervention schools (2% at baseline, 41% at end of Year 1, 19% at end of Year 2; p<0.001 for intervention effect). Measures of skin pigmentation, nevi counts, and self-reported use of hats outside of school did not change during the study period.ConclusionsThis intervention increased use of hats at school through Year 2 but had no measurable effect on skin pigmentation or nevi. Whether school-based interventions can ultimately prevent skin cancer is uncertain.Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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