Skin Cancer: Child Care Center-Based Interventions

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends child care center-based skin cancer prevention interventions that include implementation of sun protection policies along with education of staff and parents. This recommendation is based on sufficient evidence that these interventions increase children’s protection from excessive UV exposure.

The full CPSTF Finding and Rationale Statement and supporting documents for Preventing Skin Cancer: Child Care Center-Based Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Childcare center-based interventions to promote sun-protective behaviors include educational interventions, supportive behavioral interventions, and environmental and policy changes in daycare or preschool settings.

Educational and behavioral interventions generally provide information about sun safety and the effects of ultraviolet (UV) radiation, and may be directed to children, their caregivers (e.g., staff, parents), or both. Messages delivered in lectures or through small media can be reinforced by modeling or role-playing.

Sun-protective environmental and policy changes include increasing the availability of sun-protective items (e.g., sunscreen or protective clothing), adding sun-protective features to the physical environment (e.g., shade structures), and implementing sun-protection policies (e.g., clothing guidelines, restrictions on outdoor activities during peak sunlight hours).

About The Systematic Review

The CPSTF finding is based on evidence from a Community Guide systematic review published in 2004 (Saraiya et al., one study with behavioral outcomes; search period January 1966–June 2000) combined with more recent evidence (6 studies, search period June 2000–May 2011). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing skin cancer. This finding updates and replaces the 2001 CPSTF finding on Education and Policy Approaches in Child Care Centers.

Study Characteristics

  • Most studies in the updated search period evaluated broad-based interventions combining educational, environmental, and policy components with educational efforts directed at parents or caregivers, staff, and children (4 studies)
  • Two studies examined associations between policy implementation and outcomes of interest
  • Five studies reported children’s ages. In these settings, ages ranged from birth to 12 years, with a mean or median age group of 3 to 5 years
  • Five of the studies were conducted in pre-school settings

Summary of Results

Updated Evidence (search period June 2000–May 2011)

Included studies (6 studies, 7 study arms) evaluated intervention effects on various measures of sun protection and on physiological consequences of UV radiation exposure among children. Results were generally favorable across all outcomes.

  • Sunscreen use
    • Increase of 1.6 and 3.3 percentage points (2 studies, 3 study arms)
    • Other measures of sunscreen use also showed favorable results (2 studies)
  • Hat use
    • Median increase of 8.1 percentage points (3 studies, 4 study arms)
    • Other measures of hat use also showed favorable results (1 study)
  • Clothing use
    • Increase of 0.5 and 1.2 percentage points (1 study, 2 study arms)
    • Other measures of clothing use also showed favorable results (1 study)
  • Shade use while outdoors: Increase of 8.6 percentage points (1 study)
  • Sunburn incidence: Decreases in the number of sunburn episodes ranged from −1.7 to −1.5 percentage points (1 study, 2 study arms)

Included studies also found overall favorable results for: combined sun-protective behaviors (2 studies, 3 study arms); excessive sun exposure (3 studies, 4 study arms); incidence of new mole formation (1 study, 2 study arms).

Previous Review (search period January 1966–June 2000)

One study reported changes in behavioral outcomes and found mixed and nonsignificant effects on an index of sun protection behaviors and nonsignificant effects on whether play occurs in sun, shade, or partial shade.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on the settings and populations from included studies, results are applicable to daycare centers, nursery schools, play schools, and preschools.

Evidence Gaps

  • Limited evidence is available to determine the variability in effectiveness of interventions based on:
    • Organization affiliation and size of center
    • Race or ethnicity, skin type, or socioeconomic status (SES)
  • Limited evidence is available on the following:
    • Interventions without policy components
    • Differential effectiveness of individual components used in multicomponent interventions
  • More research is needed to address the following questions:
    • How does implementation effectiveness vary by organization type (e.g., private vs. government)?
    • Which incentives (e.g., certification, accreditation) lead to greatest intervention effectiveness?

Implementation Considerations and Resources

  • Due to limited resources and competing priorities, policies and practices are most likely to be implemented if they are easily adopted and enforced, and require little staff time
  • Child care centers should assess their sun protection practices, and enhance and formalize them to the extent possible
  • In light of staff turnover, regular booster training sessions may be necessary to sustain staff awareness and support of sun protection measures
  • Parental education and involvement is important in supporting effective implementation of sun protection practices in child care centers and increases the likelihood that parents will support similar sun protection practices in other settings (e.g., outdoor recreational facilities)

Crosswalks

Find programs from the Evidence-Based Cancer Control Programs (EBCCP) website that align with this systematic review. (What is EBCCP?)