Implementation of Project Students are Sun Safe (SASS) in Rural and Underserved High Schools

Background: Skin cancer is a major public health issue in the US and Arizona with overexposure to ultraviolet radiation (UVR) a known cause. Most people living near the rural Arizona-Mexico border are Hispanic; skin cancer incidence is rising within that population. Youth are prone to UVR overexposure and increased skin cancer risk, yet few skin cancer prevention programs target rural and underserved youth. Schools are ideal intervention settings, but teachers have limited time and resources to provide skin cancer prevention education. For 5 years, health educators and researchers at the University of Arizona (UA) have successfully implemented Project Students are Sun Safe (SASS) in urban schools. In the current model, UA health sciences students (peer leaders) take a one-semester skin cancer prevention academic course, consisting of online modules on skin cancer epidemiology, types, prevention and communication, followed by in-person skills training and evaluation. Trained peer leaders implement, in community classrooms, a brief PowerPoint™ SASS lesson (basic epidemiology, skin structure, skin cancer types, UVR and protection strategies, and tanning consequences), reinforced by three interactive activities. Adapting this model for high school students will allow further dissemination of SASS.

Purpose: To: a) adapt the SASS hybrid training for high school student peer leaders (accounting for culture, age, developmental stage, and literacy); b) engage the trainees to implement SASS in rural, border-area classrooms; c) evaluate feasibility and effectiveness of the peer training and the peer-to-peer education; and d) sustain SASS within the community.

Methods: Using a CBPR framework, our UA research team and community stakeholders adapted the SASS training modules and classroom lesson. Eighteen students from three border-area high schools completed the online training and online pretest and posttest measuring skin cancer prevention knowledge, attitudes, beliefs and behaviors.

Results: The majority of trainees were female, Hispanic, and had skin cancer risk factors: 83.3% lived in Arizona for 14+ years, and over 70% reported fair skin and propensity to sunburn, with 35.3% having two or more sunburns in the past 12 months. Following training, sun-safety knowledge improved (p = .002), perceived seriousness (p = .000) and risk (p = .02) were more favorable, and self-reported sun safety behaviors improved, including wearing a wide-brimmed hat (p = .005), applying SPF 30+ sunscreen, and wearing sunglasses (both p = .000). From December 2016 to April 2017, the trainees will implement SASS to about 500 peer students in border-area classrooms; we anticipate that 250 will complete pretest and the posttest evaluations by May 2017.

Conclusions: We successfully adapted SASS sun-safety training to Hispanic youth who had stronger skin cancer risk factors than we anticipated. We will report findings of SASS implementation in classrooms. Our community partner ultimately will integrate the SASS training into its menu of student training activities to sustain dissemination into rural and underserved communities.