An intervention for parents to promote preschool children’s sun protection: Effects of Sun Protection is Fun! Ellen R. Gritz, Ph.D. a, T , Mary K. Tripp, M.P.H. a , Aimee S. James, Ph.D., M.P.H. b , Scott C. Carvajal, Ph.D., M.P.H. c , Ronald B. Harrist, Ph.D. d , Nancy H. Mueller, M.P.H. e , Robert M. Chamberlain, Ph.D. f , Guy S. Parcel, Ph.D. d a Department of Behavioral Science-Unit 1330, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301439, Houston, TX 77230-1439, USA b Department of Preventive Medicine and Public Health, University of Kansas Medical Center, KS 66160, USA c Mexican American Studies and Research Center, University of Arizona, AZ 85721, USA d The University of Texas Health Science Center at Houston School of Public Health, TX 77030, USA e Department of Community Health, Saint Louis University School of Public Health, MO 63104, USA f Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, TX 77030, USA Available online 5 April 2005 Abstract Background. Young children are an important focus of sun-protection efforts, but there has been relatively little study of sun-protection interventions developed for preschool-aged children and their parents. This paper reports on the evaluation of Sun Protection is Fun! (S.P.F.) , designed to improve parents’ practices and psychosocial outcomes related to protecting preschool children from sun exposure. Methods . A group-randomized trial was conducted in 20 preschools to evaluate the S.P.F. parent intervention that included a video, newsletters, and handbooks. A separate, on-site intervention for preschool staff aimed to create a preschool climate that encouraged parents’ sun protection for their children. Cross-sectional samples of parents completed surveys at baseline (n = 384), 12 months (n = 640), and 24 months (n = 694). Results . S.P.F. demonstrated significant effects on parents’ sun-avoidance strategies at 12 months (P b .05) and sunscreen use at 24 months (P b .05). There were significant intervention effects on parents’ sun-protection knowledge (P b .001), perceived norms of teachers’ sunscreen use (P b .001), sunscreen impediments (P b .05), and sunscreen expectancies (P b .05) at 12 months. Parents’ perceived norms of teacher sunscreen use were significantly improved at 24 months (P b .001). Conclusions . More intense intervention strategies may need to complement take-home materials to result in greater effects on parents’ sun protection for their children. D 2005 Elsevier Inc. All rights reserved. Keywords: Skin neoplasms/*prevention and control; Sunburn/*prevention and control; Knowledge, attitudes, practice; Child, preschool Introduction Skin cancer is the most commonly diagnosed cancer in the United States [1]. About 55,100 cases of melanoma and more than 1 million cases of basal cell carcinoma and squamous cell carcinoma of the skin were expected to occur in the United States in 2004 [2]. Excessive ultraviolet radiation (UVR) exposure during childhood has been identified as a risk factor for melanoma [3], basal cell carcinoma [4], and squamous cell carcinoma [5]. Thus, it is recommended that children reduce their sun exposure by wearing protective clothing, seeking shade, limiting time outdoors midday, and using broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 [2]. Despite increased public education on the importance of childhood sun protection, national surveys of parents show that almost half of children under 12 years of age experienced a sunburn during the previous year [6,7] and 0091-7435/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2005.01.007 T Corresponding author. Fax: +1 713 794 4730. E-mail address: egritz@mdanderson.org (E.R. Gritz). Preventive Medicine 41 (2005) 357 – 366 www.elsevier.com/locate/ypmed