DISCUSSION
The SunSafe in the Middle School Years project has
begun to address the challenge of rapidly declining sun
protection in the adolescent years. The 2 years of intervention
altered the marked decline in observed protection
seen in the control group. The difference in protection
was because of better coverage with sunscreen at a
water-activity location. Consistent with our SunSafe
model, adolescents in the intervention communities
were more likely to report multiple sources of adult
sun-protection advice than those in the control communities.
The middle school time period is particularly challenging
time for influencing adolescent’s sun protection.
Two school-based surveys have provided more detailed
sun-protection information within this age range. The
first survey in Australia showed declining sun protection
as adolescence progressed, with the greatest increases in
TABLE 1 Description of the Study Population Cross-sectional Observation Samples and Environment at Baseline and After 1 and 2 Years
Characteristic Baseline, n (%) 1 y Follow-up, n (%) 2 y Follow-up, n (%)
Control Intervention Control Intervention Control Intervention
Gender
Male 185 (42.3) 156 (43.7) 100 (42.9) 193 (47.8) 70 (50.0) 153 (43.5)
Female 252 (57.7) 201 (56.3) 133 (57.1) 211 (52.2) 70 (50.0) 199 (56.5)
Grade
6th 432 (98.2) 347 (97.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
7th 3 (0.7) 6 (1.7) 215 (92.7) 360 (89.1) 0 (0.0) 0 (0.0)
8th 5 (1.1) 4 (1.1) 17 (7.3) 44 (10.9) 141 (100.0) 352 (100.0)
Skin reaction after first exposure without
sunscreen
Always burn, never tan 40 (9.2) 26 (7.4) 23 (10.1) 54 (13.8) 25 (18.0) 40 (11.4)
Usually burn, sometimes tan 83 (19.0) 72 (20.6) 59 (26.0) 70 (17.9) 18 (12.9) 47 (13.4)
Occasionally burn, often tan 138 (31.7) 106 (30.3) 55 (24.2) 96 (24.5) 33 (23.7) 111 (31.5)
Rarely burn, always tan 175 (40.1) 146 (41.7) 90 (39.6) 172 (43.9) 63 (45.3) 154 (43.8)
Temperaturea
Cool (70°F) 19 (4.3)b 97 (27.7)b 11 (4.7)b 0 (0.0)b 0 (0.0) 0 (0.0)
Warm (70–79°F) 357 (81.1)b 99 (28.3)b 112 (48.3)b 221 (56.7)b 84 (60.0) 197 (56.4)
Hot (79°F) 64 (14.5)b 154 (44.0)b 109 (47.0)b 169 (43.3)b 56 (40.0) 152 (43.6)
UV ratinga
0 to 6 219 (49.8)b 95 (26.6)b 81 (34.8)c 109 (27.0)c 67 (47.5)c 125 (35.5)c
7 to10 221 (50.2)b 262 (73.4)b 152 (65.2)c 295 (73.0)c 74 (52.5)c 227 (64.5)c
a Intervention versus control differs significantly during 1 or more years.
b P.001.
c P.05.
DISCUSSIONThe SunSafe in the Middle School Years project hasbegun to address the challenge of rapidly declining sunprotection in the adolescent years. The 2 years of interventionaltered the marked decline in observed protectionseen in the control group. The difference in protectionwas because of better coverage with sunscreen at awater-activity location. Consistent with our SunSafemodel, adolescents in the intervention communitieswere more likely to report multiple sources of adultsun-protection advice than those in the control communities.The middle school time period is particularly challengingtime for influencing adolescent’s sun protection.Two school-based surveys have provided more detailedsun-protection information within this age range. Thefirst survey in Australia showed declining sun protectionas adolescence progressed, with the greatest increases inTABLE 1 Description of the Study Population Cross-sectional Observation Samples and Environment at Baseline and After 1 and 2 YearsCharacteristic Baseline, n (%) 1 y Follow-up, n (%) 2 y Follow-up, n (%)Control Intervention Control Intervention Control InterventionGenderMale 185 (42.3) 156 (43.7) 100 (42.9) 193 (47.8) 70 (50.0) 153 (43.5)Female 252 (57.7) 201 (56.3) 133 (57.1) 211 (52.2) 70 (50.0) 199 (56.5)Grade6th 432 (98.2) 347 (97.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)7th 3 (0.7) 6 (1.7) 215 (92.7) 360 (89.1) 0 (0.0) 0 (0.0)8th 5 (1.1) 4 (1.1) 17 (7.3) 44 (10.9) 141 (100.0) 352 (100.0)Skin reaction after first exposure withoutsunscreenAlways burn, never tan 40 (9.2) 26 (7.4) 23 (10.1) 54 (13.8) 25 (18.0) 40 (11.4)Usually burn, sometimes tan 83 (19.0) 72 (20.6) 59 (26.0) 70 (17.9) 18 (12.9) 47 (13.4)Occasionally burn, often tan 138 (31.7) 106 (30.3) 55 (24.2) 96 (24.5) 33 (23.7) 111 (31.5)Rarely burn, always tan 175 (40.1) 146 (41.7) 90 (39.6) 172 (43.9) 63 (45.3) 154 (43.8)TemperatureaCool (70°F) 19 (4.3)b 97 (27.7)b 11 (4.7)b 0 (0.0)b 0 (0.0) 0 (0.0)Warm (70–79°F) 357 (81.1)b 99 (28.3)b 112 (48.3)b 221 (56.7)b 84 (60.0) 197 (56.4)Hot (79°F) 64 (14.5)b 154 (44.0)b 109 (47.0)b 169 (43.3)b 56 (40.0) 152 (43.6)UV ratinga0 to 6 219 (49.8)b 95 (26.6)b 81 (34.8)c 109 (27.0)c 67 (47.5)c 125 (35.5)c7 to10 221 (50.2)b 262 (73.4)b 152 (65.2)c 295 (73.0)c 74 (52.5)c 227 (64.5)ca Intervention versus control differs significantly during 1 or more years.b P.001.c P.05.
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