Multiple levels of influence in the adoption of sun protection policies in elementary schools in Massachusetts.

Objective: To understand the factors that may influence sun protection policy development if the Centers for Disease Control and Prevention guidelines are to be realized.

Design: Qualitative research methodology incorporating a socioecological framework using individual or small-group interviews, surveys, and environmental assessments with school superintendents, elementary school principals, elementary school nurses, and parent-teacher organization presidents and co-chairs as well as coding of school documents.

Setting: Elementary schools in Massachusetts.

Participants: Nine school superintendents, 18 elementary school principals, 18 elementary school nurses, and 16 parent-teacher organization presidents or co-chairs.

Main Outcome Measures: Presence of school sun protection policies, sun protection curriculum, and communication portals for sun protection information to parents.

Results: None of the schools in the 9 districts had a sun protection policy, and only 1 had any type of sun protection curriculum. However, nearly all principals were receptive to developing sun protection policies and to making structural changes to increase the amount of accessible shade if funding were available.

Conclusions: The schools' communication infrastructure could provide a key portal for disseminating sun protection information to parents. Although there are other resources that could be brought to bear, many challenges must be surmounted to develop effective sun protection policies.