A Cluster Randomized Trial to Evaluate a Health Education Programme “Living with Sun at School”

Abstract: Over-exposure to sunlight increases the risk of skin cancers, particularly when exposure occurs during childhood. School teachers can play an active role in providing an education programme that can help prevent this. “Living with the Sun,” (LWS) is a sun safety education program for school children based on a handy guide for classroom activities designed to improve children’s knowledge, but moreover to positively modify their sun safety attitudes and behaviours. The goal of our study was to determine the effectiveness of this programme by examining children’s knowledge, attitude and sun exposure behaviours prior to and after the completion of the programme. We carried out a cluster randomised trial in which the classes were randomly assigned to one of two groups; one using the LWS programme and another that didn’t, serving as the control. Data was collected before completion of the programme and an additional three times in the year after completion. The 70 participating classes (1,365 schoolchildren) were distributed throughout France. Statistical analysis confirmed that knowledge of sun risk increased significantly in the LWS classes (p < 0.001). Both groups positively changed their attitudes when considering the best sun protection, but the LWS group proved to consistently be more convinced (p = 0.04). After the summer holidays, differences between the two groups decreased throughout the year but stayed globally significant. We also observed some significant behaviour modification during the holidays. For instance, the LWS group applied sunscreen more frequently than the control group, and were more likely to wear a hat (72% versus 59%) and use a sun umbrella on the beach (75% versus 64%).