Assessing Sun Protection Policies in Texas School Districts Located in Counties With the Lowest and Highest Melanoma Risk: Content Analysis and Cross-Sectional Study.

IntroductionSchool policy can encourage sun safe habits, such as wearing hats and applying sunscreen. However, sun safety policies (SSP) have not been formally assessed for Texas independent school districts (ISDs), particularly in counties with the highest melanoma incidence relative risk (RR). This study aims to assess the presence, strength, and intent of SSPs across Texas ISDs located in counties with the highest and lowest melanoma incidence. We also identify factors correlated with stronger SSP.MethodsEleven components of SSPs from 102 ISDs were evaluated in this cross-sectional study by examining school district websites, official documents, social media, media appearances, statements by school officials, and the Texas Education Agency's online database. Coders were trained to score each policy's content, presence, and strength.ResultsPolicies for sunscreen use and hats existed in 94% (n = 96) and 92% (n = 94) of ISDs, respectively. In counties with the highest melanoma incidence RR, 30% (n = 15) and 44% (n = 22) of ISDs allocated resources for sun safety and outdoor shade, compared to 2% (n = 1) and 3% (n = 2) in low-risk counties. No ISDs had SSPs on UV protective clothing, accountability, or modeling sun safety behaviors. SSP strength was positively correlated with percentage of school nurses (ρ = 0.564, P < 0.001), community median household income (ρ = 0.431, P < 0.001), percentage of female students (ρ = 0.461, P < 0.001), and tax rate (ρ = 0.366, P = 0.0002). Negative correlations were found with percentage of central staff administration (ρ = -0.523, P < 0.001) and graduation rates (ρ = -0.335, P < 0.001).ConclusionOur findings underscore the need for interventions to strengthen SSPs across Texas.