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Your Environment. Your Health.

Economic evaluation of the US Environmental Protection Agency's SunWise Program: sun protection education for young children

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost-effectiveness analysis (CEA), Cost-benefit analysis (CBA)
Kyle JW, Hammitt JK, Lim HW, Geller AC, Hall-Jordan LH, Maibach EW, De Fabo EC, and Wagner MC
This cost-benefit and cost-effectiveness analysis examined the costs, effectiveness, and benefits of the EPA's SunWise program. The researchers estimated that for every dollar invested in the program, $2 to 4 are potentially saved in medical costs and productivity losses. The findings suggested that it is worthwhile to educate children about sun safety and that small to modest behavioral impacts may result in significant reductions in skin cancer incidence and mortality.
Children and adolescents (5-15 years)

Health Outcomes

  • Cancer outcomes (skin cancer, basal cell carcinoma, squamous cell carcinoma, cutaneous malignant melanoma)
  • premature death

Environmental Agents

List of Environmental Agents:

  • Non-ionizing radiation (UV)

Source of Environmental Agents:

  • Sunlight

Economic Evaluation / Methods and Source


  • Cost-effectiveness analysis (CEA)
  • Cost-benefit analysis (CBA)

Cost Measured:

  • Skin cancer cases
  • program implementation costs (including the funding amount of the program)

Potential Cost Measures:

  • Private costs
  • cost of teachers’ time spent on SunWise
  • community programs or parent influence

Benefits Measures:

  • Averted premature deaths
  • averted skin cancer cases
  • quality adjusted life years (QALYs) saved
  • return per dollar spent
  • costs averted (equal to the cases averted multiplied by medical and productivity loss cost per case)
  • medical care and productivity costs averted

Potential Benefits:

  • Impacts of other program components (i.e., SunWise Cities/Communities Program)
  • change in impact if students receive SunWise lessons more than once

Location: (Not available)

Models Used:

  • Atmospheric and Health Effects Framework Model (AHEF)

Methods Used:

  • The authors used standard cost/benefit and cost-effectiveness analysis methods to assess the health and economic benefits of the EPA’s SunWise School Program. The authors — 1) measured intervention costs as program costs estimated to be incurred by the US government using three funding scenarios; 2) measured health outcomes as skin cancer cases and premature mortalities averted and QALYs; 3) modeled health outcomes using an effectiveness evaluation of SunWise based on pretest and posttest surveys administered to students who participated in the program and the EPA’s peer-reviewed Atmospheric and Health Effects Framework model; 4) measured costs averted as direct medical costs and costs of productivity losses averted as a result of SunWise; and 5) measured net benefits as the difference between costs averted and program costs.

Sources Used:

  • National Human Activity Pattern Survey; US Environmental Protection Agency; US Bureau of Labor Statistics; Medicare Current Beneficiary Survey (1999–2000); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Kyle JW, Hammitt JK, Lim HW, Geller AC, Hall-Jordan LH, Maibach EW, De Fabo EC, and Wagner MC. 2008. Economic evaluation of the US Environmental Protection Agency's SunWise Program: sun protection education for young children. Pediatrics.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding: (Not available)

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