Effectiveness of sun risk prevention programmes in primary schools in a tropical region: The PRESOLRE trial

The growing incidence of skin cancers calls for improved sun protection from childhood onwards. The aim of this PRESOLRE study was to assess the effectiveness of three sun-related risk prevention programmes on the knowledge, attitudes and behaviour of primary school pupils on the island of Réunion.

PRESOLRE was a cluster randomized controlled trial in which the classes of pupils were randomized into four parallel groups (1:1:1:1): a reference group with no intervention (Arm 1), a group exposed to the 'Living with the Sun' (LWS) educational programme (Arm 2), a group exposed to LWS and an educational Peer Intervention (PI) (Arm 3) and a group exposed to both of these interventions (LWS + PI) as well as receiving photoprotection equipment (Arm 4). The main analysis, based on a linear mixed model with random intercept, involved a comparison of the percentage of correct answers to the knowledge questionnaire administered at the end of the school year (at 6 months from baseline), after adjustment for the average level of knowledge in the class at the start of the school year.

The trial involved 1452 pupils aged 7-11 in 100 classes from 20 primary schools. After adjusting for baseline, the mean level of knowledge after intervention was significantly higher (p < 0.0001) in Arm 4 than in Arm 1, absolute increase: +5.4% [95% CI = +2.4; +8.3]. Better knowledge of sun protection behaviours was reported among pupils with a light phototype compared with those with a dark phototype.

This randomized cluster trial shows the positive impact of a risk prevention programme run by external speakers and peer pupils, with photoprotection equipment delivery in primary schools, making it possible to envisage wider dissemination of this type of public health initiative. However, modifying behaviours is more difficult to initiate and demonstrate than improving knowledge.