No. 2, April 2004
STEP-BY-STEP: MAKING YOUR
A Model Community Skin
Cancer Prevention Project in Maine
Christine A. Hayden
Suggested citation: Hayden CA. A model community
skin cancer prevention project in Maine. Prev Chronic Dis [serial
online] 2004 Apr [date cited]. Available from: URL: http://www.cdc.gov/pcd/issues/2004/
The purpose of our program was to create and test a community skin
cancer prevention project for replication throughout the state of Maine. The
project was a collaborative effort of the Maine Cancer Consortium, American
Cancer Society (ACS), and the City of Portland, Health and Human Services
Department, Public Health Division. Portland, Me, served as
the pilot site.
The National Cancer Institute (NCI) defines skin cancer as a disease in
which abnormal cells divide uncontrollably in the outer layers of the skin (1).
The American Cancer Society's
Facts and Figures 2001
(the latest year for which these figures are available) estimated that more than
1 million cases of highly curable basal cell or squamous cell cancers would
be diagnosed in the United States that year (2). An estimated 9800 U.S.
deaths from cancer were projected as well: 7800 from melanoma, the most
serious form of skin cancer, and 2000 from other skin cancers. Melanoma was
expected to be diagnosed in about 51,400 Americans in 2001. The incidence
rate of melanoma has increased about 3% per year on average since 1981. In
2002, NCI announced that researchers showed for
the first time that individual risk of melanoma is associated with
the intensity of sunlight that a person receives over a lifetime (3).
Target audiences for our program were newborns and their parents,
children between 5 and 14 years old and their caregivers, and all people
living in the Portland area. Protecting skin from excess sun exposure during
childhood and adolescence is important in reducing the risk of all types of
skin cancer during adulthood. From our anecdotal evidence, many parents of
newborns are unaware that sunscreen is not recommended for babies under 6
months of age, and they need better information about how to protect their
newborns from the sun. Teaching children and their caregivers to follow ACS
guidelines will help protect their skin for years to come. It will also help
children to develop healthy habits they can maintain throughout their
Our skin cancer prevention project, which took place during 2002, mirrored the goals of Healthy Maine 2010 to
increase the proportion of people who limit sun exposure and use protection
when exposed to sun (4). Our specific objectives were the following:
- Increase the proportion of new parents who are aware of the dangers of
sun exposure to newborns and the proper ways to protect their babies from sun
- Improve sun protection policies for the 700 youths participating in
Portland's Parks and Recreation summer camp program.
- Increase community awareness of the dangers of unprotected sun
To help us design and implement our action plan, in fall 2001 we
recruited members for a sun protection team from among our group of partners
and from the ACS Cancer Control Advisory Council. The
team consisted of one staff person from the City of Portland's Public Health
Division, 2 staff members from the ACS, nurses from the 2 participating
hospitals, staff from the City of Portland's Parks and Recreation Department,
and staff of the Sea Dogs, Portland's minor league baseball team. Not all
staff members were involved with all components of the program.
The project was funded through the ACS for $10,000 for a one-year period.
One City of Portland staff member was paid for approximately 3 hours of work per week to
coordinate the program. In addition, approximately $3500 was spent on
supplies, $2000 for advertising and brochures, and $300 for educational
Our skin cancer prevention project consisted of 3 major components,
which are described below.
No Sun for Baby
This hospital-based initiative targeted parents of
babies born during May (Skin Cancer Awareness Month) 2002. Of the
3 hospitals in Portland, 2 are known for their maternity or birthing units:
Maine Medical Center and Mercy Hospital. We contacted the nurse managers of
the maternity unit at Maine Medical Center and the birthing unit at Mercy
Hospital to discuss and obtain approval for our plans and were told that
a total of between 350 and 400 babies are typically born
during May at these 2 hospitals. ACS staff delivered No Sun for Baby
kits to each hospital unit. Each kit included a beach pail and shovel with a
Slip! Slop! Slap! Wrap! message as well as a baby sun hat and brochure
from the Skin Cancer Foundation.
Slip! Slop! Slap! Wrap! means "Slip on a shirt,
slop on sunscreen with an SPF of 15 or higher, slap on a hat with a wide
brim, and wrap on sunglasses" (5). Both hospitals agreed to promote sun safety information by distributing
brochures and/or by talking about Skin Cancer Foundation recommendations
and/or ACS guidelines in childbirth education classes, Lamaze classes,
parenting classes, and discharge packages. An evaluation postcard was
also included in the kit for parents to fill out and return to the ACS. We
distributed 380 No Sun for Baby kits, and both hospitals have committed to
incorporating sun safety messages in childbirth education classes on a
Parks and Recreation Sun Protection Guidelines
In working with
the team member from the City of Portland's Parks and Recreation summer
program, we learned that there were no sun protection policies or guidelines
for the approximately 700 campers aged 5 to 14 years who
participate annually. For the 2002 summer camp season, we distributed sun
protection guidelines for outdoor recreation or work and provided technical
assistance to Parks and Recreation management on adapting the guidelines to
meet their needs (6). We conducted educational sessions for 50 Parks and
Recreation staff members and gave them Slip! Slop! Slap! Wrap! educational
brochures. We also discussed the rationale for having and enforcing
guidelines. Enforcing the guidelines would prove to be difficult because
some children arrived at camp without shirts, sunscreen, hats, sunglasses,
or other sun protection. In the educational sessions with counselors, we
stressed the importance of counselors providing positive role models for
campers. We encouraged counselors to use the Slip! Slop! Slap! Wrap! model.
We also emphasized the importance of creating shady areas for campers. As a
result, Parks and Recreation management purchased portable tents for each
campsite and created shade structures at the municipal pools.
All parents of campers were provided a copy of the sun safety guidelines
as well as a copy of the Slip! Slop! Slap! Wrap! educational brochure. The
Parks and Recreation Department received only one phone call during the
summer from a parent of a child who had been sunburned while at camp.
Protect the Skin You're In Day
We distributed 500 sunscreen samples and
Slip! Slop! Slap! Wrap! educational brochures to approximately 6200 baseball game attendees and
200 staff in collaboration with Portland's minor league baseball team, the Sea
Dogs, on June 9, 2002. Slugger, the Sea Dogs mascot, performed the
Slip! Slop! Slap! Rap! throughout the game. Game announcers read Slip! Slop!
Slap! Wrap! messages (Figure) between innings, and we held drawings for T-shirts
donated by the ACS. The Sea Dogs donated space in their
program for a half-page Protect the Skin You're In advertisement. The number of
programs distributed during summer 2002 was 22,750. In addition, Sea
Dogs management agreed to sponsor an annual Protect the Skin You're In Day.
Unprotected skin can burn within 12 minutes. Slip on a shirt! Slop on sunscreen!
Slap on a hat! Wrap on sunglasses!
About 80% of skin cancers could be prevented by protection of skin from the
Skin cancer is the most common form of cancer — there are more than 1.3
million diagnoses each year.
|To protect your skin from the
sun's rays, apply sunscreen with SPF 15 or higher every 2 hours.
|Sunscreen is not recommended
for children under the age of 6 months — they should be shaded
from the sun.
|Sunlamps and tanning booths are
as harmful to your skin as the sun.
|It is most important to protect
your skin between 10:00 AM and 4:00
PM, when the sun's rays are
|Protect your children from
sunburns! Research shows a link between sunburns in children and
an increased risk of melanoma and other skin cancers later in
Public service announcements, Portland Sea Dogs baseball game, community
skin cancer prevention project, Portland, Me, June 9, 2002.
All components of the Portland sun protection pilot program could easily
be replicated and sustained by other communities. The cost for each
component is low. Several steps can decrease costs. For example, hospital
volunteers could make sun hats for the No Sun for Baby program.
Hospitals could also solicit merchants for donated pails and shovels. Many
different kinds of organizations can participate: hospitals, health
agencies, municipalities, sports teams, private and public camps, summer
camps, YWCAs and YMCAs, Boys & Girls Clubs of America, scouting
organizations, and others.
Buy-in from each organization is essential to program
success. We often found that individuals within a partner organization who
had friends or relatives with sunburns, suspicious moles, or skin cancer
itself would often take leadership roles within the organization.
This program offers tremendous news media opportunities for promoting sun
protection messages. We contacted local television stations to publicize the
No Sun for Baby program. Our staff members also happened to know parents who
were expecting babies in May 2002. These prospective parents
agreed to be interviewed by the news media, and an interview was aired on
Health Beat, a segment of a local television evening news
We also exhibited our program at poster sessions at the 17th National
Conference on Chronic Disease Prevention and Control in St. Louis, Mo, February 17–19, 2003, and the Centers for Disease Control and Prevention
Cancer Conference in Atlanta, Ga, September 15–18, 2003. This gave us the opportunity to
share our work with other organizations throughout the country so they could
replicate it within their own communities.
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Corresponding Author: Christine A. Hayden, City of Portland, Health and
Human Services Department, Public
Health Division, 389 Congress St, Portland, ME 04101. Telephone:
207-874-8942. E-mail: CAH@portlandmaine.gov.
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- What you need to know about skin cancer [Internet]. Washington (DC):
National Institutes of Health (US); [updated 2000 Sep 16; cited 2004 6
Feb]. Available from: URL:
- American Cancer Society Inc. Cancer facts & figures 2001. Atlanta (GA): American Cancer
Society; 2001. p.17, 44. Available from: URL: http://www.cancer.org/downloads/STT/F&F2001.pdf*.
- Individuals' risk of melanoma increases with time outdoors, especially
in high-sunlight areas [Internet]. Washington (DC): National Cancer
Institute; 2002 Jul 14 [cited 2004 Feb 6]. Available from: URL:
- Mills DA. Healthy Maine 2010: longer and healthier lives. Augusta (ME): Bureau of Health,
Maine Department of Human Services; 2002 Dec. p. 45. Available from: URL:
- Slip! Slop! Slap!: ACS helps launch national program to help shed
light on skin cancer [Internet]. Atlanta (GA): American Cancer Society;
c2004 [cited 2004 Feb 6]. Available from: URL:
- Sun protection policies [Internet]. Prevention, Current Activities.
Topsham (ME): Maine Cancer Consortium [cited 2004 Feb 6]. Available from:
*URLs for nonfederal organizations are provided solely as a
service to our users. URLs do not constitute an endorsement of any organization
by CDC or the federal government, and none should be inferred. CDC is
not responsible for the content of Web pages found at these URLs.
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