Abstract
Background:
Despite the critical importance of sun protection in childhood for preventing skin cancer, significant gaps exist between provincial health guidelines and education-specific policies regarding sun safety in Canadian elementary schools.
Objective:
To systematically examine the current landscape of sun safety policies and interventions in Canadian elementary education settings and identify gaps between public health recommendations and educational policy implementation.
Methods:
We conducted a scoping review of literature published between 2005 and 2025 using 7 databases (Ovid MEDLINE, Embase, CINAHL Plus, Scopus, Proquest Education Database, ERIC, and CBCA:Social Sciences) and performed a jurisdictional scan of sun safety policies across 9 Canadian cities, examining provincial, school board, and individual school websites.
Results:
This scoping review identified limited research on sun safety interventions in Canadian elementary schools, with most studies demonstrating effectiveness of educational programs but highlighting implementation challenges. The jurisdictional scan revealed significant disparities in policy accessibility and clarity across provinces. Public health websites typically provided more comprehensive information, while school-level policies were largely absent or difficult to locate.
Conclusion:
A substantial disconnect exists between provincial health guidelines and education system policies regarding sun safety. Comprehensive, standardized approaches to sun safety policy development and implementation are urgently needed across Canadian elementary schools.
Introduction
Skin cancer represents one of the most preventable forms of cancer, with ultraviolet (UV) radiation exposure during childhood being a critical risk factor for melanoma development later in life. 1 Canadian epidemiological data consistently demonstrate rising melanoma incidence rates, making sun safety education and policy implementation in elementary schools a public health priority. 1 The formative years of elementary education present an optimal window for establishing lifelong sun-protective behaviors, with research indicating that sun safety habits developed during this period tend to persist into adulthood. 1
While provincial health authorities maintain comprehensive sun safety recommendations and resources, the translation of these guidelines into concrete, actionable policies at the school board and individual school levels remains inconsistent. This gap is particularly notable as children spend substantial portions of their day outside like recess and physical activities during peak UV exposure hours.
Li et al. conducted a study on sun safety interventions in Edmonton elementary schools which exemplify both the potential for effective school-based programs and the challenges in implementation. 1 Their research demonstrated that targeted interventions including educational presentations, reminder systems, addition of sun safety items to school supply lists, and accessible sunscreen provision could improve sun-protective behaviors among grade 6 students. The intervention group showed statistically significant increases in shade-seeking behavior compared to controls. Due to small sample size and study limitations, the researchers were unable to demonstrate statistically significant improvements in sunscreen use, protective clothing, and hat wearing, though numerical differences were observed. However, study limitations, including small sample size, self-reported outcomes, and lack of longitudinal follow-up, highlight the need for more comprehensive, policy-supported approaches to sun safety in educational settings.
The findings by Sowah et al. regarding vitamin D deficiency in indoor workers underscore a separate but related public health consideration. 2 Their research revealed that indoor workers, including healthcare professionals and shift workers, demonstrated significantly lower 25-hydroxyvitamin D levels compared to outdoor workers. However, it is important to note that Canadian public health organizations, including the Canadian Dermatology Association and Canadian Cancer Society, do not recommend sun exposure as a method for vitamin D synthesis due to the associated cancer risks. Given that most Canadians require oral vitamin D supplementation during winter months regardless of sun exposure history, and that genetic factors may play a more significant role in vitamin D synthesis than previously understood, sun safety policies should prioritize UV protection while addressing vitamin D needs through dietary supplementation rather than UV exposure.
Recent genetic evidence further reinforces the critical importance of preventing childhood sun exposure, with Mendelian randomization studies demonstrating that childhood sunburn significantly increases the risk of both melanoma and nonmelanoma skin cancers. 3 These causal associations remained significant even after adjusting for confounding factors including skin color, facial aging, and lifestyle variables, highlighting childhood sunburn as an independent and preventable risk factor for skin cancer development. 3
The current fragmentation of sun safety policies across Canadian educational jurisdictions creates inequitable protection for children and places an undue burden on individual schools and educators to develop and implement protective measures. This review seeks to comprehensively examine the existing landscape of sun safety policies and interventions in Canadian elementary education settings, identify critical gaps between public health recommendations and educational policy implementation, and provide evidence-based recommendations for improving policy coherence and effectiveness.
Methods
Scoping Review
We conducted a comprehensive scoping review following established methodological frameworks to examine the breadth and nature of research evidence regarding sun safety policies and interventions in Canadian elementary schools. The review was designed to map the existing literature, identify knowledge gaps, and inform policy recommendations. This project has been registered in Open Science Framework: https://doi.org/10.17605/OSF.IO/6293M
Jurisdictional Scan
Results
Scoping Review Findings
The comprehensive database search across platforms yielded 96 initial results (Supplemental Figure S1). After removing duplicates and applying inclusion criteria, 6 studies met the criteria for full review and analysis.
Jurisdictional Scan Results
The systematic examination of sun safety policies across nine Canadian cities revealed striking disparities in policy accessibility and clarity between provincial health authorities and educational jurisdictions (Supplemental Table S3).
The sole formal educational guidance found originated from the Alberta Ministry of Education K-9 Health & Life Skills Guide to Implementation (2002), consisting of one page within a 600-page compendium. This brief section advised students to limit outdoor activity between 11 a.m. and 4 p.m., seek shade, cover skin, and apply broad-spectrum SPF 15+ sunscreen. In stark contrast, Alberta Health Services maintained 2 readily accessible web resources: “UVR Protection: Access to Sunscreen” and “Have Fun in the Sun Safely Toolkit,” offering comprehensive practical guidance and downloadable educational materials. Overall accessibility rating: Alberta Ministry/school board level = difficult; Alberta Health Services = easy.
Provincial government portals provided comprehensive resources, including “Protecting Yourself from Ultraviolet Radiation” (2016), which specifically detailed children’s special vulnerability to UV exposure, and “Tanning Beds” (2017), summarizing British Columbia’s indoor tanning restrictions for minors. Difficulty rating: Ministry or BC government pages = easy; board/school-site searches = difficult.
Ottawa-Carleton District School Board schools, including Metcalfe Public School and Manordale Public School, showed no local policy results. However, Kawartha Pine Ridge District School Board demonstrated exemplary resource development, with multiple board-level materials discovered through searches of Westmount Public School and Dr. G.J. MacGillivray Public School:
“Let’s Go to Kindergarten” parent guides (pages 7 and 17) featuring dedicated sun safety sections
“1-2-3 Get Set for Kindergarten” handbook including sun safety reminders
Outdoor Education Centre FAQ explaining required hat and sunscreen policies
Rainbow District School Board’s Lasalle Elementary briefly mentioned planned permanent shade structure installation in a 2016 school improvement document, while Northeastern Elementary yielded no policy results. Cancer Care Ontario maintained an evidence summary titled “Sun-protection policies, programmes and practices” supporting provincial guidelines. Search difficulty assessment: Ministry PDF = difficult to locate; Kawartha Pine Ridge resources = easy; other board sites = difficult or N/A.
Discussion
Policy Gap Analysis and Implications
A significant disconnect exists between provincial health guidelines and education-specific policies regarding sun safety in Canadian elementary schools. The findings from our scoping review and jurisdictional scan reveal a fundamental disconnect between the robust public health evidence supporting sun safety interventions and the fragmented, inconsistent implementation of sun safety policies within Canadian elementary education systems. This gap has significant implications for health promotions and equity across Canadian communities.
The Alberta example illustrates this paradox most clearly: Alberta Health Services provides exemplary sun safety resources that are easily accessible and professionally developed, yet individual schools within major urban districts lack discoverable sun safety policies. This suggests that the barrier to effective sun safety implementation lies not in knowledge or resource availability, but in the translation mechanisms between health policy and educational practice.
These disparities likely reflect broader patterns of educational resource allocation and policy capacity, suggesting that sun safety policy gaps may disproportionately affect students in under-resourced districts. Given that skin cancer risk is influenced by cumulative UV exposure throughout childhood, these policy inequities may contribute to long-term health disparities across Canadian communities.
The success of Australia’s SunSmart program, which integrates government policy, school requirements, and community education, provides a valuable model for addressing the policy gaps identified in our Canadian analysis. Australian research has demonstrated that comprehensive school sun safety policies can achieve population-level behavior change while maintaining educational flexibility and local adaptation (Rivers and Gallagher 1995). 9
The Li et al. Edmonton study exemplifies this challenge: while the intervention demonstrated statistically significant improvements in shade-seeking behavior, the study’s limited sample size prevented detection of significant effects for other sun protection behaviors. The small scale and resource requirements of even this limited intervention suggest that achieving comprehensive improvements across large school systems would require substantial systematic policy support and resource allocation. 1
Similarly, the Gregory Vancouver study’s finding that comprehensive interventions (education plus behavioral cues) produced more sustained behavior change than education alone supports the need for multilevel policy approaches that address both individual knowledge and environmental/policy factors. 4
Practical Policy Recommendations
Provincial Level Recommendations
School Board-Level Recommendations
Individual School-Level Recommendations
Cross-Jurisdictional Coordination Recommendations
Conclusion and Limitations
This comprehensive review of sun safety policies in Canadian elementary schools reveals a significant and concerning gap between public health evidence and educational policy implementation. While provincial health authorities maintain excellent sun safety resources and evidence-based recommendations, the translation of these guidelines into concrete, actionable policies at school board and individual school levels appears fragmented and inadequate.
Our scoping review identified 6 relevant studies demonstrating that well-designed sun safety interventions can effectively improve knowledge and protective behaviors among elementary school students. However, the sustainability and scalability of these interventions appear limited without comprehensive policy infrastructure to support implementation. The jurisdictional scan across nine Canadian cities confirmed that despite the availability of high-quality health authority resources, most schools lack discoverable sun safety policies, creating apparently inequitable protection for children across different districts and provinces.
Fragmented approaches that rely solely on educational interventions without supporting policy infrastructure are unlikely to achieve sustained, population-level improvements in sun-protective behaviors.
Study Limitations
Several limitations should be considered when interpreting these findings:
Despite these limitations, this research provides critical evidence for the need to address sun safety policy gaps in Canadian elementary schools and offers a foundation for future research and policy development initiatives. The findings support the need for coordinated, multilevel policy approaches to ensure equitable sun protection for all Canadian elementary school children.
Supplemental Material
sj-docx-1-cms-10.1177_12034754251391806 – Supplemental material for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies
Supplemental material, sj-docx-1-cms-10.1177_12034754251391806 for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies by Andy D. Lee, Joshua Yi, Nicholas Lum, Nicholas Chronis, Grace Xiong, Joony Hong, Liz Dennett, Sebastian Straube and Marlene Dytoc in Journal of Cutaneous Medicine and Surgery
Supplemental Material
sj-docx-2-cms-10.1177_12034754251391806 – Supplemental material for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies
Supplemental material, sj-docx-2-cms-10.1177_12034754251391806 for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies by Andy D. Lee, Joshua Yi, Nicholas Lum, Nicholas Chronis, Grace Xiong, Joony Hong, Liz Dennett, Sebastian Straube and Marlene Dytoc in Journal of Cutaneous Medicine and Surgery
Supplemental Material
sj-docx-3-cms-10.1177_12034754251391806 – Supplemental material for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies
Supplemental material, sj-docx-3-cms-10.1177_12034754251391806 for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies by Andy D. Lee, Joshua Yi, Nicholas Lum, Nicholas Chronis, Grace Xiong, Joony Hong, Liz Dennett, Sebastian Straube and Marlene Dytoc in Journal of Cutaneous Medicine and Surgery
Supplemental Material
sj-docx-4-cms-10.1177_12034754251391806 – Supplemental material for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies
Supplemental material, sj-docx-4-cms-10.1177_12034754251391806 for Sun Safety Policies in Canadian Elementary Schools: A Comprehensive Scoping Review and Jurisdictional Scan of Canadian Provincial Government Policies by Andy D. Lee, Joshua Yi, Nicholas Lum, Nicholas Chronis, Grace Xiong, Joony Hong, Liz Dennett, Sebastian Straube and Marlene Dytoc in Journal of Cutaneous Medicine and Surgery
Footnotes
Author Contribution
ADL: Lead author and primary manuscript writer; conducted screening and data analysis. JY: Conducted systematic screening and data extraction. NL: Conducted systematic screening and data extraction. NC: Conducted screening, resolved extraction discrepancies, and provided analytical support. GX: Edited manuscript and prepared figures/graphs. JH: Edited manuscript and prepared figures/graphs. LD: Developed search strategy and created Supplemental Table S1. SS: Provided methodological oversight, supervised systematic review process, and completed PROSPERO registration. MD: Provided clinical oversight and expertise on dermatological conditions and information.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethics Approval/ Statement
An ethics statement is not applicable because this study is based exclusively on published literature.
Patient consent
Not applicable.
Data availability
The data underlying this article are available in the article and in its online supplementary material.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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