Video Lesson Boosts Skin-Cancer Awareness at School

A skin-cancer prevention video produced durable knowledge gains and behavioral changes at a California high school, according to a study published in Dermatology.1 Additionally, the project resulted in updates to health education curricula for California Public Schools.

To assess students’ sun-safety knowledge and behaviors, investigators surveyed 2688 students at Franklin High School, the largest high school in Elk Grove, California. Survey return rate was 38.1% (n = 1025).

Investigators reported the following results:1

• Compared to baseline, the percentage of correct answers to 15 of 17 skin-cancer knowledge questions increased immediately after the video lesson and remained higher one month later.
• The number of students who reported never wearing sunscreen decreased by approximately 12.5% (P = 0.007) one month post-video, while the number of students wearing sunscreen 5 to 7 days weekly increased more than 50% (P <0.001).
• 68% of respondents said that the video’s content should be taught in schools.
• 84% agreed that the lesson could be applied directly to their life.

“We should be teaching skin-cancer prevention starting from elementary school,” said Jeanine B. Downie, MD, who was not involved with the study. “I would go in and lecture to my daughter’s friends all the time.” She also has spoken to her daughter’s teachers, as well as staff and students at other area schools.

“I talk about skin cancer, sun safety, no tanning beds, no smoking, no vaping. I say there’s no such thing as a safe tan,” added Downey, director of image Dermatology PC in Montclair, New Jersey.

“I explain that New Jersey is one of the tanning bed capitals of the country, and that the average tanning bed gives you 12 to 15 times the ultraviolet radiation of the sun, according to the Skin Cancer Foundation.” Additionally, she discusses basal cell and squamous cell cancers, as well as melanoma, and the need to be mindful of changing lesions and nonhealing pimples. “We all could do more of that.”

Childhood and adolescence provide a valuable window for instilling sun-protection behaviors to combat rising rates of melanoma and nonmelanoma skin cancers, particularly among young people, study authors wrote. “With cumulative sun exposure well accepted as a driving cause of skin cancer,”2 they added, “the habits formed in childhood lay the foundations on how populations protect themselves from the sun.”

Several factors may explain the lesson’s overall success. Most notably, the 4-minute video featured an Elk Grove student (and lead study author, Shay N. Sharma) speaking at a high-school level of language complexity. “The importance of peer influence on modifying adolescent behavior is well established,” authors wrote, “and hearing sun-safety recommendations from a classmate could resonate more strongly than from an adult healthcare provider.”3 Showing the video to the entire school may have reduced the influence of peer pressure and body-image concerns that typically make teenagers unlikely to adopt sun-protection behaviors.

Bureaucratic challenges and state and federal laws hinder schools’ ability to identify and incorporate timely health information, authors noted. But ultimately, California Public Schools revised its Health Education Framework to correct ambiguous information (e.g., sun protection is needed on cloudy days), highlight key practices (e.g., the importance of reapplying sunscreen), and add new information (e.g., May is skin cancer awareness month).

Disclosures:

Downie is a Skin Cancer Foundation fellow but reports no relevant financial interests.

References:

1. Sharma SN, Sharma SN, Sharma AN, Sharma AN, Sharma JK. Implementing a skin cancer prevention lesson to enact institutional change: a schoolwide survey [published online ahead of print, 2022 Mar 28]. Dermatology. 2022;1-7. doi:10.1159/000521420

2. Madan V, Lear JT, Szeimies RM. Non-melanoma skin cancer. Lancet. 2010;375(9715):673-685. doi:10.1016/S0140-6736(09)61196-X

3. Supovitz J, Sirinides P, May H. How principals and peers influence teaching and learning. Educational Administration Quarterly. 2010;46(1): 31–56.