Empowering Rural Adolescents to Build Healthy Skin Habits and Self-Advocacy Through a School-Based Intervention

Background Chronic skin conditions are common among adolescents and are associated with psychosocial distress, stigma, and reduced quality of life. California's Central Valley is home to underserved populations that experience high UV exposure and reduced access to dermatologic care due to physician shortages and limited health literacy. School-based education offers an accessible approach to improving skin health knowledge and preventive behaviors. This study evaluated the impact of a medical student-led skin health education program on dermatologic knowledge, attitudes, self-efficacy, and preventive behaviors among rural high school students. Methods A 30-minute interactive skin health education session was delivered by medical students in a rural California high school health sciences program. Content included skin anatomy, acne, sun protection, common dermatologic conditions, and environmental skin exposures. Anonymous surveys were administered before (n=172), immediately after (n=165), and one month after (n=118) the intervention. The intervention assessed knowledge, attitudes, and self-efficacy, with an open-ended reflection at one-month follow-up. Surveys were anonymous so individual responses could not be linked longitudinally, requiring the three time points to be analyzed as independent samples. Knowledge outcomes were analyzed by three investigators using two-proportion z-tests, Likert-scale responses using two-sided Mann-Whitney U tests with tie corrections, and open-ended reflection responses using qualitative content analysis. Statistical significance was defined as p<0.05. Results Immediately following the intervention, knowledge significantly improved in acne etiology (p<0.001), skin anatomy (p<0.001), the role of dermatologists (p<0.001), and melanin function (p=0.003). Improvements in acne etiology and the role of dermatologists remained significant at one month. At one-month follow-up, participants reported more favorable attitudes toward acne (p=0.001) and sunscreen use (p=0.001). Self-efficacy also improved with greater confidence in caring for their skin (p=0.001) and who to seek help from (p<0.001). Among respondents to the one-month reflection, 101 (88.6%) of participants reported adopting at least one new skin health behavior, with increased use of sun protection being the most reported behavior change in 90 (78.9%) participants. Conclusion A brief medical student-led skin health education program significantly improved dermatologic knowledge, attitudes, self-efficacy, and preventive health behaviors among rural adolescents. These findings suggest that school-based educational interventions can empower adolescents to take an active role in their health and may serve as an effective strategy for promoting prevention and health literacy in underserved communities.