Formative research for developing targeted skin cancer prevention programsfor children in multiethnic Hawaii

Skin cancer is a significant and increasing public health problem. Improvem ent in sun protection practices among children holds great promise for prev ention, and parents and caregivers play important roles. Health promotion p rograms are most likely to succeed when based on a systematic planning proc ess including an understanding of current practices, beliefs, social norms and environments. This article describes formative research used to help de velop the SunSmart skin cancer prevention program in Hawaii, Group discussi ons and interviews were conducted with 216 children in grades 1, 2 and 3, 1 5 parents, and 27 recreation staff. Children's discussion groups took place in intact classrooms. A combination of quantitative and qualitative method s was used. Multiple raters and an iterative process were used to analyze d ata from survey forms, observer impressions and audio tapes, and to draw th e main conclusions. Sun protection practices in all groups were inconsisten t, though general awareness about prevention was widespread. Children repor ted a reluctance to cover up with long pants and sleeves, and wide-brim hat s, and did not understand what skin cancer was, Parents and recreation staf f were supportive of education and policy supports, to improve both their o wn and the children's prevention habits, They were enthusiastic about inter active and creative activities. We conclude that targeted skin cancer preve ntion messages and strategies for Hawaii's children should promote gradual changes, provide environmental supports, and involve parents and recreation staff. Both the findings and procedures have implications for prevention e lsewhere.