Use of Sun-Protective Clothing at Outdoor Leisure Settings from 1992 to 2002: Serial Cross-sectional Observation Survey

Abstract

Previous population-based surveys to monitor sun protection behavior over time have relied on self-report, which can be subject to recall and misclassification bias and social desirability bias. The present study aimed to describe the prevalence and determinants of teenagers' and adults' observed sun protection behavior while engaged in outdoor leisure activities on summer weekends, over a decade of the SunSmart skin cancer prevention program, which involved public education and advocacy. Serial cross-sectional observational field surveys of teenagers and adults at leisure were undertaken during summer weekends between 11 a.m. and 3 p.m., from 1992 to 2002 (N = 46,810). The four types of setting for observation were parks and gardens, golf courses, tennis courts, and pools and beaches, located within a 25-km radius of Melbourne city center, Australia. The main outcome measure was a binary clothes cover index representing persons above or below the median level of body cover for each type of leisure setting. The index was based on the proportion of body surface covered by the type of hat, shirt, and leg cover garments worn. Body cover varied by environmental factors and the activity demands and demographic characteristics of individuals. After adjusting for covariates, significant improvements in the extent of body cover occurred over the decade, such that the odds of the proportion of people wearing clothes cover above the median level increased by 3% per year (95% confidence interval, 2-4%). Results suggest that significant gains in sun-protective behavior have occurred, coincident with the conduct of an ongoing comprehensive skin cancer prevention program.