Helping Children be Sun Safe during Outdoor Play: Preventing Melanoma Later

What if caregivers of all at-risk pre-school children enabled sun protected outdoor play? Preventing deadly melanoma

Photo of June Robinson
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

While working with Latino and non-Hispanic White adults with melanoma, we were told by the patients that they wished they knew more about sun protection for their children. The adult melanoma survivors did not want their children to get skin cancer. We explored ways of educating adults and their children in a community of migrant Latino agricultural workers. Latina mothers said the activity they did the most with their young children was reading little books over and over. Focus groups of non-Hispanic white mothers confirmed this. We worked with the Head Start program teachers serving a migrant community of Latinos to develop the characters, colors and messages for a read-along book with the children. The graphics in the book communicate the story. Then, we distributed the read-along book in pediatrician offices to children getting vaccinated. The children were delighted to receive their own book, eagerly opened the book in the doctors' office, and talked about the characters. Caregivers reported repeatedly reading the book with their child and making up stories about the characters. The response of the children and caregivers inspired us to continue to develop this project by working with the Gads Hill Center Head Start program. While the Head Start curriculum has lesson plans devoted to nutrition and physical activity, it does not have lesson plans for sun protected outdoor play. This project has the potential to fill this gap in the Head Start program.

Which categories describe you? (the answer will not be public)

  • Hispanic, Latinx, or Spanish origin (for example: Mexican, Puerto Rican, Cuba, Salvadoran, Dominican, Colombian)
  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)


Location: Where is your organization headquartered? [State]

  • Illinois

Location: Where is your organization headquartered? [City]


Location: Where is your project primarily creating impact? [State]

  • Illinois

Location: Where is your project primarily creating impact? [City]


Problem: What problem is this project trying to address?

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. This health disparity may be attributed to Latinos working outdoors with high levels of unprotected sun exposure, lack of consistent sun protection of children, and the erroneous belief of Latinos that they have no melanoma risk. The primary health issue is improving sun protection of pre-school children during outdoor play. With global warming, sun protection is a concern for all at-risk children. Head Start programs include nutrition and physical activity in their curriculum, but they do not have lesson plans for sun protection during outdoor play. This project develops culturally sensitive, age appropriate sun protection lesson plans for Latino, non-Hispanic white, and mixed race children.

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:

  1. Small group discussion with caregivers will adapt existing sun protection and early detection of melanoma materials to be culturally sensitive and available in Spanish.
  2. 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.
  3. Explore ways to build upon existing forms of communication used by community organizations to inform and engage caregivers.
  4. Assess the feasibility of using social media to inform and remind caregivers with Facebook chat rooms, YouTube videos, and text messaging
  5. 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.


Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Low-income communities

Does your model work within any of the following sectors?

  • Childcare
  • Community Development and Empowerment
  • Education

Year Founded


Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

The children, who received the read-along book and swim shirt, requested reading the books many times at bedtime with their parents and with their siblings. At the 4 week return visit, a 4 year old boy came in wearing his orange swim shirt because he wanted to go swimming like "Paco", the hero of the book. The model engages caregivers and young children in bed-time story telling about the characters in the book in a secure and supportive environment to practice concepts. We will engage community stakeholders, such as Gads Hill Center Head Start program, to tailor the model according to their resources, e.g. parent training workshops , Facebook chat rooms, YouTube videos, and text message warnings of "sun days" requiring sun protection.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

Our qualitative research developed the read-along book to be read by caregivers with their 2-5 year old children. Focus groups and structured interviews with stakeholders supported the iterative design process. The principals of the message learning approach (Yale Model of Persuasion) were used to create a read-along book with persuasive messages conveying sun protection concepts. The 13-page story portrays going to the waterpark with easily comprehended colorful illustrations and activities for the child. The randomized clinical trial consisted of 300 caregivers and their children. Participants randomized to the intervention group (n=153, 51%) had significantly higher reported sun protection behavior on both sunny and cloudy days, and less change in skin pigmentation than controls. Enhanced childhood sun protection reduces the likelihood of developing a deadly melanoma later in life.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $10k - $50k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Research grant applications will be submitted.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

This project builds upon our successful pilot research using pediatrician offices to distribute a read-along book and a swim shirt to engage caregivers and 2-5 year old children in improving their sun protection. Now, a Latino Head Start program will tailor the program and its delivery according to the resources of the organization, e.g. parent training workshops , lesson plans, YouTube videos, and text message warnings of "sun days" requiring sun protection. Community engagement is essential to change normative beliefs about the importance of sun protection and the relevance of melanoma.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

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. The read-along book promotes familial support with learning in the home. Social media promotes learning across generations, e.g. 2-5 year old children, mothers, and grandmothers; and among those with limited literacy. Text messages can deliver behavioral interventions by smartphones to low-income caregivers promoting children's wellbeing.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

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Team (2)

June's profile
Nicole's profile
Nicole Forsyth

Role added on team:

"Your experience will be beneficial in developing the lesson plans for the teachers with discussion questions/activities to get children more active (agents/problem-solvers) regarding their own attitudes/behaviors regarding sunscreen."

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Attachments (2)

Page 1_Cover Page copyright_03.09.15.jpg

Cover of the read-along book in English

Ho_ JAMA Peds 02082015.pdf

Published manuscript of the quantitative research completed in 2015


Join the conversation:

Photo of Maud Schaafsma

This project is narrowly focused on children's risks for development of melanoma in Hispanic populations.  It would be a stronger proposal if you provided risk profiles for Hispanic children developing this and other diseases. Why is skin cancer singled out as needing more attention than risks of developing other diseases?

I think the project could be broader - and deal with other medical problems (and preventions) that are experienced disproportionately by Latino children. Think out of the box - about how the issue of sun exposure could be connected to other health problems - possibly with a series of books about each problematic health issue and actions to address or prevent it. You may need to team with other pediatricians or individuals with medical expertise to create this broader application of your idea.

Photo of June Robinson

Thank you for your suggestion. This program seeks to address a gap in the current curriculum of Head Start programs. Chicago area Head Start programs already do a terrific job of providing nutritional guidance and increasing physical activity, but they do not address the need for sun protection during outdoor play.
As we work with Gads Hill Center, we may identify other gaps and develop other read-along books and social media boosters to address the needs.

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