Engaging caregivers, who are the teachers and role models for their 2-5 year old children, to provide sun protection for their children during outdoor play can be achieved within Head Start programs. Children’s behavior has a formative role in establishing habits that will set the foundation for their lifestyle and risk of disease as adults, e.g. sun protection during childhood outdoor activities will reduce the risk of developing melanoma as an adult. Children are encouraged to be physically active for at least 60 minutes daily, which is usually with outdoor sports (soccer, volleyball, baseball, running, bicycling, or swimming) with intense sun exposure. Preschool-age children (0-5 years) get higher sun exposure during outdoor play activities than those 6–12 years old, and especially adolescents (13–19 years old). Our program, which focuses on improving sun protection for preschool Latino, non-Hispanic white and mixed race children, aligns with a 2016 strategic goal of the Centers for Disease Control and Prevention.
Public education has focused on reducing sunburns in light-skinned white people, thus, Latinos, who may perceive themselves as either at low or no risk for sunburn, feel that sun protection is not relevant. Despite perceptions that Latinos have skin tones that confer protection from the sun, Latinos have significant heterogeneity of skin tone and have rates of sunburn comparable to or exceeding rates for non-Hispanic whites. In our 2016 survey performed at a Chicago health fair for Latinos, Vive tu Vida, 87% of Latinos had light and medium skin tones; therefore, we expect that 87% of our pre-school children are at –risk to develop melanoma, which could be prevented with adequate sun protection.
Unprotected sun exposure among Latinos leading to melanoma is a health disparity. The annual incidence of melanoma in Latinos (5.5/100,000 population) increased 3.3% per year in the last decade. Latinos are twice as likely to have late diagnosis compared to non-Hispanic whites, resulting in functional impairment from surgery and death (13.5 deaths/100,000 for Latinos vs. 9.8/100,000 for whites). This health disparity may be attributed to Latinos working in outdoor occupations with high levels of unprotected sun exposure, and lack of consistent sun protection of children.
As a way to engage caregivers and extend behavioral change into the home, our team developed a read-along book in Spanish and English, "Paco's Frist Trip to the Waterpark". The book uses graphic illustrations to provide information about sun protection during play at a water park for children of all skin colors. The book was developed with the help of pre-school children who picked the names of the characters and the colors of the clothing. The read-along book was distributed during well child visits with the pediatrician and demonstrated improvement in sun protection among those who received the book, a swim shirt, and weekly text messages in comparison with controls. The children returned at the next visit saying they wanted to be "like Paco". The read-along book, which is for pre-school children to read at home with their caregiver, extends education about the desired health behavior into the home. Thus, it appears that this novel form of education could be used to promote other health behaviors by creating a series of books with each book focusing on one behavior.
In order to extend this work, community engagement is essential to change normative beliefs about the importance of sun protection among Latinos and those of mixed race. For example, a commonly expressed belief is that since the sun is not as strong in Chicago as it was in the country of origin (Mexico and Puerto Rico), there is no need to use sun protection. We will work with Gads Hill Center, which serves 471 Head Start 3-5 year old children, who are 51% Latinos, 35% Black, and 14% mixed race children from low income families. Stakeholders (teachers, caregivers and children) will engage in small group discussion to enable the process of changing sun protection behaviors by developing lesson plans for a curriculum that includes teaching 4-5 year old children to apply sunscreen stick to sun exposed skin. Our stakeholders feel that in order to become motivated to take action caregivers must be engaged with “high-touch” forms of communication, such as videos delivered via YouTube with Tweeter links sent to caregivers. Our plan is to distribute the read-along book to the caregivers of each child and to create a series of "boosters" that will be delivered weekly via social media.
Our academic and community partnership with Gads Hill Center will build community capacity and enhance awareness of the need for sun protection of young children who are outdoors at times of peak sun intensity, define adequate culturally sensitive sun protection for Latino children, and plan a system to deliver community warnings to alert people when the Ultraviolet Index (UVI) provided by the U.S. Environmental Protection Agency is expected to be harmful to unprotected skin. In order to enhance the relevance of sun protection, caregivers will be given information about melanoma, a potentially deadly skin cancer, and skills training in how to check the skin for abnormal moles. The following sequence of steps is planned:
- Small group discussion with caregivers will adapt existing sun protection and early detection of melanoma materials to be culturally sensitive and available in Spanish.
- Develop modules for caregivers to learn how to provide adequate sun protection for their children and to check their skin for early detection of melanoma.
- Explore ways to build upon existing forms of communication used by community organizations to inform and engage caregivers.
- Assess the feasibility of using social media to inform and remind caregivers with Facebook chat rooms, YouTube videos, and text messaging
- Plan an alert system to warn caregivers and day care workers to provide sun protection for children when the weather service predicts a UVI of 6 or more.
With over 12.2 million Latino family households in the United States, Latinos are the largest and fastest growing ethnic or racial minority. This community-based program will develop ways of enhancing sun protection in children and early detection of melanoma in their caregivers.