susan rask m.s., r.s. environmental health specialist

Developing An Adolescent Developing An Adolescent Sun Safety Project:Sun Safety Project:

Education, Risk Perception and Education, Risk Perception and BehaviorBehavior

Presentation for Massachusetts Health Officers Presentation for Massachusetts Health Officers Association Annual Conference 2010Association Annual Conference 2010

Susan Rask M.S., R.S.Susan Rask M.S., R.S.Environmental Health Specialist Environmental Health Specialist

Barnstable County Department of Health and Environment Barnstable County Department of Health and Environment

Jean M Roma MSN, APRN-BCJean M Roma MSN, APRN-BCDirector, Cape Cod and Martha’s Vineyard Medical Reserve Director, Cape Cod and Martha’s Vineyard Medical Reserve

CorpsCorps

Build funding and organizational Build funding and organizational partnershipspartnerships

Conceptual frameworkConceptual framework Simple Sun Safety messagesSimple Sun Safety messages Deliver messages to where behavior is Deliver messages to where behavior is

occurringoccurring Entice adolescents to participateEntice adolescents to participate Assess program effectivenessAssess program effectiveness Lessons learnedLessons learned

Developing Adolescent Sun Safety

2010

It is during childhood that It is during childhood that much of much of

one’s lifetime sun exposure one’s lifetime sun exposure occurs!occurs!

CDC Sun Safety for America’s Youth Toolkit-2009CDC Sun Safety for America’s Youth Toolkit-2009

Protecting young people from UV exposure Protecting young people from UV exposure and teaching them how to practice lifelong and teaching them how to practice lifelong

sun safety behaviors is critical to reducing the sun safety behaviors is critical to reducing the rates of skin cancer in our country.rates of skin cancer in our country.

We built a partnershipWe built a partnership

Cape Cod and Martha’s Vineyard Medical Cape Cod and Martha’s Vineyard Medical Reserve CorpsReserve Corps

Barnstable County Department of Health and Barnstable County Department of Health and EnvironmentEnvironment

MDPH/UMass School of Public Health—internMDPH/UMass School of Public Health—intern

Local Health Departments and Local Health Departments and Recreation/Beach Departments on Cape Recreation/Beach Departments on Cape Cod and Martha’s VineyardCod and Martha’s Vineyard

Funding Partner:Funding Partner:

Cape Cod HealthcareCape Cod Healthcare

Conceptual frameworkConceptual framework

What is What is Healthy Healthy People People ??Healthy PeopleHealthy People is a comprehensive set of is a comprehensive set of

national ten year health promotion and national ten year health promotion and objectives aimed at improving the health of the objectives aimed at improving the health of the American peopleAmerican people•Grounded in the notion that establishing Grounded in the notion that establishing objectives and providing benchmarks to track objectives and providing benchmarks to track and monitor progress over time can motivate, and monitor progress over time can motivate, guide and focus actions.guide and focus actions.•Defines vision and strategy for building a Defines vision and strategy for building a healthier Nationhealthier Nation•Framework uses risk factors and determinants Framework uses risk factors and determinants of health to guide improvements of health to guide improvements •Revised every 10 years-Now in the third decadeRevised every 10 years-Now in the third decade

3.9 Increase the proportion of persons who 3.9 Increase the proportion of persons who use at least one of the following protective use at least one of the following protective measures that may reduce the risk of skin measures that may reduce the risk of skin cancer: avoid the sun between 10 a.m. and 4 cancer: avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing when p.m., wear sun-protective clothing when exposed to sunlight, use sunscreen with a exposed to sunlight, use sunscreen with a sun-protective factor (SPF) of 15 or higher, sun-protective factor (SPF) of 15 or higher, and avoid artificial sources of ultraviolet and avoid artificial sources of ultraviolet light. light.

3.9a Increase the proportion of adolescents 3.9a Increase the proportion of adolescents in grades 9 through 12 who follow protective in grades 9 through 12 who follow protective measures that may reduce skin cancer.measures that may reduce skin cancer.

Healthy People 2010 Healthy People 2010 GoalsGoals

Proposed Proposed Healthy People 2020Healthy People 2020 GoalsGoals

Objective Retained but Modified From Healthy Objective Retained but Modified From Healthy People 2010People 2010

New objective HP 2020-12New objective HP 2020-12

Reduce the rate of sunburnReduce the rate of sunburn a. Reduce the rate of sunburn among a. Reduce the rate of sunburn among

adolescents in grades 9-12.adolescents in grades 9-12. b. Reduce the rate of sunburn among adults b. Reduce the rate of sunburn among adults

aged 18 years and older.aged 18 years and older. c. Reduce the proportion of adolescents that c. Reduce the proportion of adolescents that

use artificial sources of ultraviolet light for use artificial sources of ultraviolet light for tanning.tanning.

Data Sources: Youth Behavior At Risk Survey Surveillance Data Sources: Youth Behavior At Risk Survey Surveillance System, CDC, National Health Interview SurveySystem, CDC, National Health Interview Survey

Health Belief ModelHealth Belief Model

Used as Conceptual Framework for Used as Conceptual Framework for projectproject

ComponentsComponents Perceived seriousnessPerceived seriousness Perceived susceptibilityPerceived susceptibility Perceived benefitsPerceived benefits Perceived barriersPerceived barriers Modifying variablesModifying variables Cues to actionCues to action Self-EfficacySelf-Efficacy


Individual Perceptions

Modifying Factors

Likelihood of ActionAge, Sex,

Ethnicity, Personality, Socioeconomic, Knowledge

Perceived Benefits minus Perceived Barriers

Perceived Susceptibility/ Perceived Severity

Perceived Threat

Likelihood of Behavior

Cues to Action

Source: Stretcher, V. and Rosenstock, I.M., 1997

Based on Based on Healthy People Healthy People and using theand using the Health Belief Health Belief

ModelModelWe set the following project goalsWe set the following project goals

Target population: Adolescents age 13-18Target population: Adolescents age 13-18 Simple Sun Safety messages to reduce UV Simple Sun Safety messages to reduce UV

exposureexposure Assess change in knowledge and risk Assess change in knowledge and risk

perceptionperception Assess whether change in risk perception Assess whether change in risk perception

might lead to changes in adolescent might lead to changes in adolescent behaviorbehavior

Developing the Educational Developing the Educational MessagesMessages

A literature review was done identifying A literature review was done identifying articles related to sun exposure and melanoma articles related to sun exposure and melanoma in children 18 years of age or younger.in children 18 years of age or younger.

Studies generally indicated there was an Studies generally indicated there was an increased melanoma risk in individuals who increased melanoma risk in individuals who spent their childhood in sunny locations near spent their childhood in sunny locations near the equator or close to the coast.the equator or close to the coast.

The majority of the sunburn studies suggest a The majority of the sunburn studies suggest a positive association between early age positive association between early age sunburn and the subsequent risk of melanoma.sunburn and the subsequent risk of melanoma.

Source: Arch Dis Child: 2006 Feb 9 (2) 131-8

Skin Cancer FactsSkin Cancer Facts Skin cancer is the most common type of cancer in the US Skin cancer is the most common type of cancer in the US

(CDC).(CDC). Since 1973,new cases of the most serious form of skin cancer, Since 1973,new cases of the most serious form of skin cancer,

melanoma, have increased approximately 150% (MMWR). melanoma, have increased approximately 150% (MMWR). The deaths from melanoma have increased by 44% in the same The deaths from melanoma have increased by 44% in the same

period of time (MMWR).period of time (MMWR). 65% to 90% of melanomas are caused by ultraviolet radiation 65% to 90% of melanomas are caused by ultraviolet radiation

(CDC).(CDC). Exposure to ultraviolet radiation during childhood and Exposure to ultraviolet radiation during childhood and

adolescents plays an important role in the development of skin adolescents plays an important role in the development of skin cancer.cancer.

Persons with a history of one or more blistering sunburns Persons with a history of one or more blistering sunburns during childhood and adolescence are two times likely to during childhood and adolescence are two times likely to develop melanoma than those that did not have the exposure develop melanoma than those that did not have the exposure (MMWR).(MMWR).

One person dies from melanoma every hour (EPA).One person dies from melanoma every hour (EPA). One out of every four will develop skin cancer in their lifetime One out of every four will develop skin cancer in their lifetime

(American Cancer Society).(American Cancer Society).

Very effective for older teens and young adults

Education about UV Education about UV indexindex

Skin Type

Description What You Are at Risk For

Type I

Always burns, never tans; sensitive to exposure; redheaded, freckles, Celtic background

-Extremely susceptible to skin damage as well as cancers like basal cell carcinoma & squamous cell carcinoma -High risk for melanoma*Use a sunscreen with a SPF of 30+ & clothing with a UPF rating of 30+

Type II

Burns easily, tans minimally; fair-skinned, fair-haired, blue, green or gray eyes, Caucasians

Type III

Burns moderately, tans gradually to light brown; average Caucasian skin

-Susceptible to skin damage as well as basal cell carcinoma & squamous cell carcinoma-Moderate risk for melanoma*Apply a sunscreen with an SPF of 15+ every day

Type IV

Burns minimally, always tans well to moderately brown; olive skin

-Susceptible to skin damage as well as basal cell carcinoma & squamous cell carcinoma-Moderate to low risk for melanoma *Use sunscreen a SPF of 15+

Type V

Rarely burns, tans profusely to dark; brown skin

-At risk for acral lentiginous melanoma, a very dangerous form of the disease that is more common among darker-skinned people -Melanomas tend to appear on parts of the body not often exposed to the sun, & often remain undetected until after the cancer has spread -Watch for any suspicious growths, especially on the palms, soles of the feet &mucous membranes *Use sunscreen with an SPF of 15+

Type VI

Rarely burns, least sensitive; deeply pigmented skin including African Americans

Why did we target the Why did we target the beaches of Cape Cod ?beaches of Cape Cod ?

RelaxingRelaxing FunFun RefreshingRefreshing CoolCool Go to Go to

where where adolescents adolescents are are engaging engaging in behavior in behavior we want we want to changeto change

How did we recruit How did we recruit adolescents adolescents

to participate?to participate? Short interventionShort intervention Invitation to participateInvitation to participate Public health research studyPublic health research study Contributing to the good of the Contributing to the good of the

communitycommunity Repeated often/no waitingRepeated often/no waiting Peer involvementPeer involvement

We used Incentives!We used Incentives!

Gallons of sunscreen with 1-2 oz Gallons of sunscreen with 1-2 oz cups -- free samples!cups -- free samples!

Beach Balls with Safe Sun Messages Beach Balls with Safe Sun Messages for younger than target groupfor younger than target group

Lip Balm SPF 30Lip Balm SPF 30 Individual packets of sunscreenIndividual packets of sunscreen Tee-shirts with Safe Sun messagesTee-shirts with Safe Sun messages

Adolescents will participate Adolescents will participate

in almost anything in almost anything if you give them a free T-if you give them a free T-

shirtshirt

T-shirts were an expensive incentive but worth the money in terms of teen response

Assessing effectiveness of Assessing effectiveness of Sun Safety messagesSun Safety messages

3-5 minutes of 3-5 minutes of Sun Safety Sun Safety EducationEducation

All All participants participants completed completed pre- and post- pre- and post- education education survey of survey of knowledge and knowledge and risk perceptionrisk perception

Assessing effectiveness of Assessing effectiveness of Sun Safety messagesSun Safety messages

Each participant completed a Pre- and Each participant completed a Pre- and Post- Education Survey that measured Post- Education Survey that measured perceived risk for skin cancer, perceived risk for skin cancer, cataracts, and use of artificial tanning cataracts, and use of artificial tanning

Pre- and Post- Education answers were Pre- and Post- Education answers were compared to see if there was a compared to see if there was a measurable change in risk perception measurable change in risk perception

Demographics Demographics of of

population population sampledsampled485 surveys 485 surveys

completedcompletedGenderGender•77 % female77 % female•33 % male33 % male

RaceRace•Caucasian 93.2 %•African-American 1.2 %•Hispanic 2.1 %•Native American 1.1 %•Asian 1.1 %•Other 1.3 %

RESPONDENTS BY GENDER

0

100

200

300

400

500

600

FEMALE MALE TOTAL

GENDER

Nu

mb

er

DemographicsDemographics

• 485 Surveys completed, 485 Surveys completed, Ages 10-25Ages 10-25

• Age 10-13 30 % “tweens”Age 10-13 30 % “tweens”• Age 14-16 31 % young teensAge 14-16 31 % young teens• Age 17-19 25 % older teensAge 17-19 25 % older teens• Age 20-25 14 % young adultsAge 20-25 14 % young adults

Respondents by Age

0102030405060708090

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Age

Num

ber

Target Population: Ages 13-18 70% of all sampled

DemographicsDemographics

Self-Reported Hours of Sun Exposure per Self-Reported Hours of Sun Exposure per WeekWeek

Reported Hours of Sun Exposure per Summer Week

0

50100

150200

250

< 2hrs

2-4hrs

5-8hrs

9-12hrs

>12hrs

Hours of Sun Exposure per Week

Nu

mb

er

of

Re

sp

on

de

nts

We emphasized that : • 80% of a person’s lifetime sun exposure occurs before age 18• Lifetime risk of skin cancer may be largely dependent on amount of unprotected sun exposure before age 18

1% <2 hours/week

10 % 2-4 hours/week

20 % 5-8 hours/week

22 % 9-12 hours/week

46 % >12 hours/week

Measuring change in Measuring change in Risk PerceptionRisk Perception

Using results of surveys, statistically Using results of surveys, statistically analyzed difference in perceived analyzed difference in perceived risk (pre- vs. post- education) for risk (pre- vs. post- education) for each question using the Wilcoxon each question using the Wilcoxon Signed Rank test (non-parametric Signed Rank test (non-parametric statistic analogous to paired t-test)statistic analogous to paired t-test)

All results shown are statistically All results shown are statistically significant at the p<.001 levelsignificant at the p<.001 level

Risk PerceptionRisk PerceptionSkin CancerSkin Cancer

Question 1: What do you think is Question 1: What do you think is your risk for developing skin your risk for developing skin cancer from sun exposure?cancer from sun exposure? 1. Don’t know1. Don’t know 2. No risk2. No risk 3. Very low risk3. Very low risk 4. Low risk4. Low risk 5. Moderate risk5. Moderate risk 6. High risk6. High risk 7. Very high risk7. Very high risk

Measuring Change in Measuring Change in Risk Perception—Skin Risk Perception—Skin

CancerCancer

0

10

20

30

40

50

60

70

80

Nu

mb

er o

f R

esp

on

ses

Don'tknow No Risk Very lowrisk

Low risk Moderaterisk

High RiskVery HighRisk

Perception of risk

Skin Cancer, Perception of Risk, Pre- vs. Post- Education Age 10-13

Pre-Education

Post-Education


CancerCancer

0

10

20

30

40

50

60

70

80

90

100

Nu

mb

er o

f R

esp

on

ses

Don'tKnow

No Risk Very lowrisk

Low riskModeraterisk

HighRisk

VeryHighRisk

Perception of risk


Pre-Education

Post-Education

N=152


CancerCancer

0102030405060708090

100

Nu

mb

er o

f R

esp

on

ses

Don'tKnow



HighRisk

VeryHighRisk

Perception of risk


Pre-Education

Post-Education


CancerCancer

0

5

10

15

20

25

30

35

40

45

Nu

mb

er o

f R

esp

on

ses

Don'tKnow



HighRisk

VeryHighRisk

Perception of risk


Pre-Education

Post-Education

Risk PerceptionRisk PerceptionCataractsCataracts

Question 2: What do you think is Question 2: What do you think is your risk for developing cataracts your risk for developing cataracts ( a clouding of the lens of the eye ( a clouding of the lens of the eye that can result in impaired vision or that can result in impaired vision or blindness) from sun exposure?blindness) from sun exposure? 1. Don’t know1. Don’t know 2. No risk2. No risk 3. Very low risk3. Very low risk 4. Low risk4. Low risk 5. Moderate risk5. Moderate risk 6. High risk6. High risk 7. Very high risk7. Very high risk

Measuring Change in Measuring Change in Risk Perception—CataractsRisk Perception—Cataracts

0

20

40

60

80

100

120

140

160

180

Nu

mb

er o

f R

esp

on

ses



High Risk Very HighRisk

Perceived Risk

Risk Perception, Cataracts, Pre- Vs. Post Education, Ages 10-25

Pre-education

Post-Education

Measuring Change in Measuring Change in Risk Perception—Use of Risk Perception—Use of

Artificial TanningArtificial Tanning Question: What do you think the health Question: What do you think the health

risk from using artificial tanning beds is?risk from using artificial tanning beds is? 1. Don’t know1. Don’t know 2. No risk2. No risk 3. Very low risk3. Very low risk 4. Low risk4. Low risk 5. Moderate risk5. Moderate risk 6. High risk6. High risk 7. Very high risk7. Very high risk


Artificial TanningArtificial Tanning

0

50

100

150

200

250

300

350

400

Num

ber

of R

espo

nses




Risk Perception

Risk Perception, Use of Artificial Tanning Pre- vs. Post- Education, Ages 10-25

Pre-education

Post-Education

GOOD NEWS!


Artificial Tanning Artificial Tanning

0

2

4

6

8

10

12

Nu

mb

er

of

Re

sp

on

se

s




Risk Perception

Risk Perception, Use of Artificial Tanning Pre- vs. Post- Education, for Respondents Who Initially

had Low Perceived Risk

Pre-education

Post-Education

For individuals who initially perceived artificial tanning as “Don’t Know” to “Low Risk”, education was extremely effective in changing risk perception

Will Change in Will Change in Risk Perception Alter Teens’Risk Perception Alter Teens’Sun-Protective Behaviors?Sun-Protective Behaviors?

Pre-EducationPre-Education Question 4: Question 4: When you go to the beach or participate in outdoor activities, what do you do to protect yourself from the sun? (select all that apply) Wear sunscreen SPF>15Wear sunscreen SPF>15 Reapply sunscreen frequentlyReapply sunscreen frequently Wear sunglassesWear sunglasses Wear a hatWear a hat Wear dark clothingWear dark clothing None of the aboveNone of the above

Will Change in Will Change in Risk Perception Alter Teens’Risk Perception Alter Teens’Sun-Protective Behaviors?Sun-Protective Behaviors? Post-EducationPost-Education Question 4: Question 4: What will you do now,

that you have not previously done, to protect yourself from the sun (select all that apply)

Post-Education options were: Wear sunscreen SPF>15Wear sunscreen SPF>15 Reapply sunscreen frequentlyReapply sunscreen frequently Wear sunglassesWear sunglasses Wear a hatWear a hat Wear dark clothingWear dark clothing Seek shade between 10 and 4 pmSeek shade between 10 and 4 pm Refrain from using artificial tanning bedsRefrain from using artificial tanning beds Decrease amount of times you use tanning bedsDecrease amount of times you use tanning beds

Will Change in Will Change in Risk Perception Alter Teens’Risk Perception Alter Teens’Sun-Protective Behaviors?Sun-Protective Behaviors? Question 4: Question 4: When you go to the beach or participate in outdoor

activities, what do you do to protect yourself from the sun? (select all that apply)

Pre-Education: most respondents indicated they used 1 to 3 sun-protective measures. In order of frequency chosen, these were generally: wear sunscreen SPF>15wear sunscreen SPF>15 wear sunglasses wear sunglasses reapply sunscreen frequentlyreapply sunscreen frequently wear a hatwear a hat

Will Change in Will Change in Risk Perception Alter Teens’Risk Perception Alter Teens’Sun-Protective Behaviors?Sun-Protective Behaviors? Question 4: Question 4: When you go to the beach or participate in outdoor

activities, what do you do to protect yourself from the sun? (select all that apply)

Post-Education: most respondents indicated that in the future they would use 3 to 5 (or more) sun-protective measures. In order of frequency chosen, these were generally:

wear sunscreen SPF>15wear sunscreen SPF>15 wear sunglasses wear sunglasses reapply sunscreen frequentlyreapply sunscreen frequently wear a hatwear a hat seek shade between 10 and 4 pmseek shade between 10 and 4 pm wear dark clothingwear dark clothing refrain from using artificial tanning bedsrefrain from using artificial tanning beds decrease amount of times you use tanning bedsdecrease amount of times you use tanning beds


0

10

20

30

40

50

60

70

Nu

mb

er o

f R

esp

on

ses

0 1 2 3 4 5 6 7 8

Number of Sun Protective Measures

Number of Sun Protective Measures, Pre- vs. Post- Education Age 10-13

Pre-Education

Post-Education

GOOD NEWS!

Almost all wear sunscreen


0

10

20

30

40

50

60

Nu

mb

er o

f R

esp

on

ses

0 1 2 3 4 5 6 7 8



Pre-Education

Post-Education


0

5

10

15

20

25

30

35

40

Nu

mb

er o

f R

esp

on

ses

0 1 2 3 4 5 6 7 8



Pre-Education

Post-Education


0

5

10

15

20

25

30

Nu

mb

er o

f R

esp

on

ses

0 1 2 3 4 5 6 7 8



Pre-Education

Post-Education

We believe the Sun Safety program was successful in changing adolescent's perception of risk about exposure to UV radiation

There is strong indication that it might result in changes to adolescent sun-protective behaviors.

Conclusion


Individual Perceptions

Modifying Factors

Likelihood of ActionAge, Sex,

Ethnicity, Personality, Socioeconomic, Knowledge

Perceived Benefits minus Perceived Barriers

Perceived Susceptibility/ Perceived Severity

Perceived Threat

Likelihood of Behavior

Cues to Action

Source: Stretcher, V. and Rosenstock, I.M., 1997

3.9 Increase the proportion of persons who 3.9 Increase the proportion of persons who use at least one of the following protective use at least one of the following protective measures that may reduce the risk of skin measures that may reduce the risk of skin cancer: avoid the sun between 10 a.m. and 4 cancer: avoid the sun between 10 a.m. and 4 p.m., wear sun-protective clothing when p.m., wear sun-protective clothing when exposed to sunlight, use sunscreen with a exposed to sunlight, use sunscreen with a sun-protective factor (SPF) of 15 or higher, sun-protective factor (SPF) of 15 or higher, and avoid artificial sources of ultraviolet and avoid artificial sources of ultraviolet light. light.

3.9a Increase the proportion of adolescents 3.9a Increase the proportion of adolescents in grades 9 through 12 who follow protective in grades 9 through 12 who follow protective measures that may reduce skin cancer.measures that may reduce skin cancer.

Healthy People 2010 Healthy People 2010 GoalsGoals

Proposed Proposed Healthy People 2020Healthy People 2020 GoalsGoals

Objective Retained but Modified From Healthy Objective Retained but Modified From Healthy People 2010People 2010

New objective HP 2020-12New objective HP 2020-12

Reduce the rate of sunburnReduce the rate of sunburn a. Reduce the rate of sunburn among a. Reduce the rate of sunburn among

adolescents in grades 9-12.adolescents in grades 9-12. b. Reduce the rate of sunburn among adults b. Reduce the rate of sunburn among adults

aged 18 years and older.aged 18 years and older. c. Reduce the proportion of adolescents that c. Reduce the proportion of adolescents that

use artificial sources of ultraviolet light for use artificial sources of ultraviolet light for tanning.tanning.

Data Sources: Youth Behavior At Risk Survey Surveillance Data Sources: Youth Behavior At Risk Survey Surveillance System, CDC, National Health Interview SurveySystem, CDC, National Health Interview Survey

Program CostsProgram Costs

Direct costs = $2480Direct costs = $2480$1000$1000T-shirts (250) T-shirts (250) Cape Cod HealthcareCape Cod Healthcare$ 400$ 400beachballs (350) beachballs (350) BCDHEBCDHE$ 930$ 930SPF 30 lipbalm (1000) SPF 30 lipbalm (1000) MRCMRC $ $ 150150 gallons of sunscreen (2) gallons of sunscreen (2) Cape Cod Cape Cod HealthcareHealthcare

$1000 $1000 stipend for MDPH intern (optional) stipend for MDPH intern (optional) BCDHEBCDHE

Indirect CostsIndirect Costs20 days BCDHE staff time20 days BCDHE staff time

No CostNo Cost30 days MRC volunteer time30 days MRC volunteer timeMDPH internMDPH intern

Lessons LearnedLessons Learned Make it short--choose a few simple messagesMake it short--choose a few simple messages Develop clear script and pre-train volunteers to Develop clear script and pre-train volunteers to

use it use it Younger teens (10-15) seemed more interested Younger teens (10-15) seemed more interested

and receptive to messages. and receptive to messages. Girls were more receptive than boys; extra effort Girls were more receptive than boys; extra effort

is needed to draw boys in.is needed to draw boys in. Use of younger person--MDPH intern-- was very Use of younger person--MDPH intern-- was very

effective in delivering messageeffective in delivering message Use of incentives (T-shirts, beachballs, lipbalm) Use of incentives (T-shirts, beachballs, lipbalm)

was very effective in getting adolescent was very effective in getting adolescent participation participation

Lessons LearnedLessons Learned Although 500 adolescents completed Although 500 adolescents completed

surveys, we educated about 2000-3000 surveys, we educated about 2000-3000 people people

Be prepared to teach to all agesBe prepared to teach to all ages < age 6, 6-11, adults< age 6, 6-11, adults

Many adults who visited hoped we were Many adults who visited hoped we were offering skin cancer screening offering skin cancer screening

Consider partnering with dermatologist, nurse or Consider partnering with dermatologist, nurse or hospital wellness van that could provide this servicehospital wellness van that could provide this service

Many communities could Many communities could adopt this modeladopt this model

Not costlyNot costly Develop funding partnershipsDevelop funding partnerships

Local hospitalsLocal hospitals Local outdoor businesses Local outdoor businesses Offer to put their logo on T-shirtsOffer to put their logo on T-shirts

Leverage low cost or free helpLeverage low cost or free help MDPH or other internMDPH or other intern MRC volunteers, especially younger peopleMRC volunteers, especially younger people

Go where the kids are! Go where the kids are! Camps, youth athletic programs, town Camps, youth athletic programs, town

recreation programs, community swimming recreation programs, community swimming pools etc.pools etc.

Thanks to our project Thanks to our project partners without whom this partners without whom this

program would not have program would not have been successful been successful

QUESTIONS?

susan rask m.s., r.s. environmental health specialist

Documents