Children's Sun Protection Research Articles

Effects of the Sunny Days, Healthy Ways Curriculum on Students in Grades 6 to 8

There are few effective sun-safety education programs for use in secondary schools. Project aims were to create a sun-safety curriculum for grades 6 to 8, and to test whether exposure to the curriculum would increase children's sun-protection behavior. A pair-matched, group-randomized, pre--post test, controlled trial was performed with middle schools as the unit of randomization. Teachers implemented the six-unit sun-safety curriculum in 2001-2003, and analyses were performed in 2003-2004. A total of 2038 children from 30 middle schools in Colorado, New Mexico, and Arizona. Self-reported sun-protection behavior using frequency ratings and diary. Compared to control schools, children receiving the curriculum reported more frequent sun protection (p=0.0035), and a greater proportion wore long-sleeved shirts during recess (p<0.0001) and applied sunscreen (p<0.0001). Exposure to the curriculum improved knowledge (p<0.0001), decreased perceived barriers to using sunscreen (p=0.0046), enhanced self-efficacy expectations (p=0.0577) about sun safety, and reduced favorable attitudes toward sun tanning (p=0.0026 to <0.0001). In intent-to-treat analyses, the treatment effect was eliminated only under the most conservative assumptions about dropouts. Educational approaches to sun safety in middle school may be effective for improving children's sun safety. Potential trial limitations include measuring short-term outcomes, focusing on young adolescents, using active parental consent, and testing in the American Southwest.

An intervention for parents to promote preschool children's sun protection: Effects of Sun Protection is Fun!

Background Young children are an important focus of sun-protection efforts, but there has been relatively little study of sun-protection interventions developed for preschool-aged children and their parents. This paper reports on the evaluation of Sun Protection is Fun! (S.P.F.), designed to improve parents' practices and psychosocial outcomes related to protecting preschool children from sun exposure. Methods A group-randomized trial was conducted in 20 preschools to evaluate the S.P.F. parent intervention that included a video, newsletters, and handbooks. A separate, on-site intervention for preschool staff aimed to create a preschool climate that encouraged parents' sun protection for their children. Cross-sectional samples of parents completed surveys at baseline ( n = 384), 12 months ( n = 640), and 24 months ( n = 694). Results S.P.F. demonstrated significant effects on parents' sun-avoidance strategies at 12 months ( P < .05) and sunscreen use at 24 months ( P < .05). There were significant intervention effects on parents' sun-protection knowledge ( P < .001), perceived norms of teachers' sunscreen use ( P < .001), sunscreen impediments ( P < .05), and sunscreen expectancies ( P < .05) at 12 months. Parents' perceived norms of teacher sunscreen use were significantly improved at 24 months ( P < .001). Conclusions More intense intervention strategies may need to complement take-home materials to result in greater effects on parents' sun protection for their children.

Psychosocial Characteristics Associated with Sun Protection Practices Among Parents of Young Children

Despite the importance of sun protection during childhood, many parents fail to adequately protect their children from the sun. The current study assessed sun-related knowledge, stage of change, and psychosocial characteristics of parents of young children. We examined how knowledge and psychosocial characteristics differed by stage of change, and tested a model of the relationship among demographics, knowledge, psychosocial variables, and child sun protection. Surveys were completed by 391 parents of preschool-aged children. Parent knowledge about skin cancer was relatively high and did not vary by stage of change. Parents in earlier stages of change perceived more barriers to child sun protection, had more positive beliefs about children's sun exposure, perceived their child to be less susceptible to sun damage, and had lower self-efficacy for child sun protection than did parents in later stages of change. In a path model, the strongest predictors of child sun protection were parents' own sun protection habits, perceived barriers, and self-efficacy. Results highlight the importance of parent psychosocial characteristics in predicting child sun protection.

Awareness of message source and its association with the impacts of sun protection campaigns in Australia

PurposeTo examine whether awareness of the source of sun protection campaigns in New South Wales, Australia was associated with message recall and sun protection knowledge and behaviours.Design/methodology/approachTelephone surveys of random samples (n=800) of parents and other carers of children under 12 years of age were conducted before and after the first two campaigns and after the third campaign.FindingsRecognition of the NSW Cancer Council (NSWCC) as the message source increased after each campaign. Cross‐sectional analyses revealed that after the first and third campaigns those who could identify the NSWCC were 1.4‐1.7 times more likely than those who could not to demonstrate knowledge about child sun protection practices (p&lt;0.05). After the first campaign those with accurate message source awareness were 1.4 times more likely to report using sunscreen or clothing to protect their children, while after campaign three this awareness was associated with a greater likelihood (OR 1.6, p&lt;0.05) of using hats, sunscreen and protective clothing.Research limitations/implicationsWhile causality cannot be determined using a cross‐sectional design, the use of serial population surveys to analyse the relationship between message source awareness and sun protection knowledge and behaviours strengthens the basis for examining the role of this factor.Practical implicationsPresenting a readily identifiable and credible message source is likely to enhance the impact of health campaigns and this factor should be given attention in the pre‐testing of communications.Originality/valueThe importance of a credible communication source has been postulated by various theorists, but this one of few studies to examine the role played this factor in a population‐wide, health promotion campaign.

Sun protection for children and adolescents

Sun protection for children and adolescents

Sun Protection for Children on the Beach

Dermatologists have been promoting sun avoidance, protective clothing, and sunscreens for everyone, starting at an early age. How successful have our

Too Much Reliance on Sunscreen

Whether sunscreen is adequate for sun protection in children is unclear. To evaluate sun-protection methods used in children, researchers observed and

Sun Protection Counseling by Pediatricians

We conducted a pilot study in Florida to assess the extent to which caretakers reported sun protection counseling by their physicians. We also sought to determine whether caretakers who reported receiving counseling had more favorable sun protection knowledge, attitudes, and behaviors. We sampled 100 caretakers who were attending a university pediatric clinic in Florida and obtained 77 responses. We estimated the proportion of respondents who reported receiving sun protection counseling and examined sociodemographic predictors of counseling. Thirty percent of caretakers reported having been counseled by their physician. Sunscreen and avoiding peak sun exposure were the most common items discussed. Among those counseled, 42.9% stated that their child's sun protection habits increased as a result of the counseling. Counseled caretakers had greater sun protection knowledge, were more likely to report regular use of sun protection for their child (68.2% vs 40.9%, P < 0.05), and were more likely to report teaching their children about sun protection (90.9% vs 63.3%, P =.02). Physician sun protection counseling, while infrequently reported, was associated with more favorable sun protection knowledge, attitudes, and self-reported behaviors of caretakers and their children.

Impacts from repeated mass media campaigns to promote sun protection in Australia.

Campaigns using television, radio and print media were conducted over three summers in New South Wales, Australia, aiming to increase the use of sun protection measures among children under 12 years. The evaluation entailed cross-sectional telephone surveys before and after each of the first two campaigns and following the third campaign. The study group were parents of children under 12 years. Random digit dialling yielded samples of approximately 800 for each survey. Measures addressed campaign recall and sun protection knowledge, attitudes and behaviours. The surveys revealed significant levels of campaign recall. Knowledge about the protective benefits of sunscreens, hats and protective clothing was high at baseline and showed little improvement over the campaigns. Knowledge levels about the benefits of shade cover and of the relative risks of skin cancer from childhood sun exposure were lower, and also did not show improvement. Just one of the four attitude factors showed significant improvement, and this concerned the importance that parents placed on the issue of child sun protection. After the final campaign there were increases compared with baseline in childrens' use of sunscreen, protective clothing and shade, but it was notable that between campaigns levels of these behaviours were similar to or below those at baseline. There was no evidence of a campaign-related increase in hat wearing by children. All sun protection measures were used less often by adults than children, but these showed similar trends. Mass media campaigns may contribute to short-term increases in some sun protection behaviours; however, as their impact is not sustained they should be repeated and supplemented by educational, policy and environmental strategies.

Sun awareness and sun protection practices in Malta.

Concern regarding the rising incidence of melanoma and non-melanoma skin cancers in Malta has led to the organization of annual campaigns since the early 1990s. These aim to inform the public of the dangers of sun exposure and to promote sun protection. To help guide future campaigns, a survey was carried out to evaluate current sun protection measures among the Maltese people and to assess their level of knowledge regarding harmful effects of the sun on the skin. A total of 559 pedestrians were interviewed in the main street of the capital city of Malta in the summer of 1999. Self-reported rates of regular sunscreen and hat use in adults exposed to the spring/summer sun between 10.00 h and 15.00 h were 51% and 32%, respectively, for leisure activities, and 25% and 37%, respectively, for outdoor work. Men reported using sunscreen less often than women during both leisure and work. The fairer-skinned outdoor workers actually reported making less use of a sunscreen and/or hat than their darker counterparts, and rates of sunscreen and/or hat use during leisure and work were not found to increase with the amount of time spent in the sun. Almost 75% of sunscreen users were using a sun protection factor of at least 15. Parents reported much higher rates of regular sunscreen and hat use by their young children than by themselves, with 87% of children under 12 years of age reported to be using sunscreen and 78% reported to be wearing a hat. The great majority knew that injudicious sun exposure is associated with skin cancer and skin ageing, but 48% were still regarding a suntan achieved without skin burning as 'healthy' The mass media was by far considered to be the main source of information for the general public regarding effects of the sun on the skin. The positive impact of past campaigns can be seen in the high reported rates of sun protection in children. However, much remains to be done with adults in order to change their attitude about a 'healthy suntan' and to convince them that it is worthwhile to protect themselves from the sun.

Sun exposure and sun protection in young European children: an EORTC multicentric study

Most European children experience exposure to the sun during the summer holidays. The aim of this study was to examine the behaviour of European children when in the sun during their holidays. In 1995–1997, a total of 631 young children were recruited during a multicentric study in Belgium, Germany, France and Italy. For each holiday period from birth, parents gave detailed information on sun exposure and child behaviour. Predictors and trends over time of sun protection were investigated. Forty percent of children were exposed to sunlight in the first and 86% in the sixth year of life. At the same time, the number of children who experienced sunburns rose from 1 to 23%. In the whole period of 6 years, only 8% of children always wore trousers and shirt when in the sun, while 25% children always used a sunscreen. The proportion of sun-exposed children who used sunscreen was stable with age (∼50%), while those who always wore trousers and shirts dropped from 46% (1st year) to 19% (6th year). Multinomial logistic regression showed that sunscreen use, but not the wearing of clothes was associated with sun-sensitivity. In summary, sun exposure increases steadily, while sun protection decreases in the first 6 years of life in our cohort of children. In this cohort, use of a sunscreen was much more frequent than the wearing of clothes and a reduction in sun exposure.

Sun Protection for Children: What Parents Do

Sun Protection for Children: What Parents Do

Sunburn in children -- the Aberdeen experience.

Sun exposure in children is known to be a risk factor for the development of malignant melanoma in later life. The incidence of melanoma in the UK is increasing more rapidly than that of most other malignant tumours and there is now increasing awareness in adults of the necessity to protect against over-exposure and sunburn. However sun protection of children in the UK is generally less than optimum and it would appear that parents and children are unaware of the long-term risks of over-exposure to the sun. This study demonstrates significant morbidity from sunburn even in the temperate climes of the north-east of Scotland. It is suggested that strategies to reduce melanoma incidence should begin at an early age with preventative education for children, their parents, carers and teachers.

Persistent Increase in Children's Sun Protection in a Randomized Controlled Community Trial

Background. Reducing sun exposure during childhood may prevent skin cancer later in life. Sun protection increased immediately following implementation of the SunSafe multicomponent, community-based intervention delivered in 1996 through schools, day care centers, primary care offices, and beach recreation areas. Whether sun protection levels would remain higher than preintervention levels the following summer was unknown.Methods. A randomized controlled trial based in 10 New Hampshire towns addressed children's use of protective clothing, shade, and sunscreen at freshwater beach areas. The intervention was provided initially between March and May 1996. A brief project follow-up contact was provided to schools, day care centers, beaches, and primary care offices between March and May 1997 to restock intervention materials and to answer questions. Observations of 1490 children during June through August of 1997 were compared with observations made prior to any intervention between June and August of 1995.Results. In intervention towns, the proportion of children using at least some sun protection increased by 0.15 from 0.58 in 1995 to 0.73 in 1997 while the proportion in control towns increased by 0.03 (P = 0.033). This increase was due to more use of sunscreen, but not more use of protective clothing or shade. In 1997, care-givers of children in intervention towns reported receiving more sun protection information from school and health care sources than control town caregivers (62% versus 33%, P < 0.006).Conclusions. In intervention communities, a higher proportion of children used sun protection in 1997 than at baseline. Increases from 1995 to 1997 were similar in magnitude to short-term increases between 1995 and 1996 that we have been previously reported.

Sun protection in children

~un protection in children has recently become a very important topic for health care professionals dealing with skin health issues. The strongest driving factor for this issue is skin cancer prevention. This relatively recent skin cancer epidemic has been causally linked to excessive ultraviolet (UV) radiation exposure. 1 Of greatest concern is the link between severe childhood sunburns and the later development of melanoma. In addition to skin cancer, many other adverse health effects have been described in association with excessive UV exposure: cataracts, premature aging of the skin, photosensitivity disorders (including exacerbation of autoimmune diseases), infections, and inmmnologic alterations. Why then is it important to specifically target children and their parents and other caregivers with sun-protection messages? Besides the melanoma link with severe UV overexposure in childhood, there is also the estimate that we obtain most of our fifetime sun exposure during the first couple decades of life. 2 It has been estimated that if sunscreen were used on sun-exposed areas of children from birth to age 20, their lifetime risk of nonmelanoma skin cancer would be reduced by 85%. 2 Furthermore, eliminating blistering sunburns before age 20 may reduce the risk of developing melanoma by half. 3 Along with risk reduction, another important reason to target children for sun protection efforts is the fact that preventive behaviors learned early in life will more typically be practiced in adulthood. 4

Improved sun protection behaviour in children after two years of the Kidskin intervention

ObjectiveTo evaluate a school-based intervention in terms of reducing children's sun exposure and improving their use of sun protection measures. Methods‘Kidskin’ is a five-year, school-based intervention study in Perth, Western Australia, of a cohort of children who were five or six years old in 1995. The study involves three groups: control, ‘moderate’ and ‘high’ intervention. Children in the control schools received the standard health curriculum; those in the intervention schools received a multicomponent intervention, including a specially designed curriculum. Children in the high intervention group also received program materials over the summer holidays and were offered sun-protective swimwear at a low cost. After two years, parents completed a questionnaire about their child's sun-related behaviour. ResultsChildren in the intervention groups — especially the ‘high’ group — were reported to have had less sun exposure. This involved covering the back more often, spending more time in the shade when outdoors and wearing a style of swimsuit that covered the trunk. There was also evidence that children in the intervention groups spent less time outdoors in the middle of the day. There was little difference between groups in the wearing of hats or sunscreen. ConclusionsOur school-based intervention improved children's sun protection, but had little effect on specific behaviours that have already been vigorously promoted. ImplicationsSchool-based prevention campaigns would benefit from focusing on sun protection using clothing and shade, and reducing sun exposure in the middle of the day. There may be little potential to improve hat and sunscreen use.

Direct Measurement of Sun Protection in Primary Schools

Background. “Kidskin” is an intervention study involving children at 33 primary schools in Perth, Western Australia. This study includes measurement of changes in implementation of schools' sun protection policies. This paper reports on measurement of observable aspects of sun protection.Methods. Hat use was assessed from videos of children in the playground. Shade use was measured using UVR-sensitive polysulfone badges worn by a random sample of children. Shade provision was measured from aerial photographs of the schools. Principals were surveyed about school policies and practices.Results. Eighty-seven percent of children wore a hat during lunch time at school, although only 14% wore the most protective styles of hats. The mean proportion of ambient UVR exposure received by Year 1 children was 15.5%; children spent less time in the sun on sunnier days. On average, 14.5% of the playground was shaded; this was not associated with children's sun exposure. Correlations between these results and the principals' estimates were poor.Conclusions. Children should be encouraged to wear more protective styles of hats and to avoid sun exposure, even on less sunny days during spring and summer. Principals' estimates of shade provision and children's sun protection behavior at school are of little value.

Skin cancer prevention for children: a critical review.

Increasing sun protection for children may reduce their risk for skin cancer, so many health authorities recommend comprehensive sun safety for children. Sun protection of children in North America and Europe is generally lower than desired and lower than in Australia. This article provides a critical review of evaluations on the effects of 24 sun protection programs for children under age 14. Programs are classified based on the target population, setting, and features. Most programs improved sun safety knowledge, but changes in sun protection attitude and behaviors were smaller. Multiunit presentations were more effective than short-duration presentations. Peer education was effective but needs further evaluation. Some programs for parents have been shown to increase sun protection for children. Strategies to improve sun safety policies need further study. A few community-wide programs have effectively improved sun protection. Future research should address innovative strategies and issues of design and measurement. There is no gold standard for measuring sun protection behavior, but self-report, prospective diaries, and observational techniques show small positive correlations.

Promoting sun protection in children: rationale and challenges.

This article outlines the epidemiological and educational arguments for promoting sun protection during childhood and highlights factors that may facilitate or hinder achievement of this behavioral outcome. A model describing behavioral factors in the causation of skin cancer is presented. Summary results from previous behavioral studies and interventions relating to primary prevention of skin cancer are described, and recent data on the cost-effectiveness of sun protection in Australia and its implications for health insurers are discussed. This article also includes a commentary on the demonstration projects promoting skin cancer prevention among children and their caregivers featured in this special issue of Health Education and Behavior.

Sun Protection and Sunburn in Primary School Children: The Influence of Age, Gender, and Coloring.

Background.Childhood is a high-risk period for skin damage due to excessive sun exposure. This damage may lead to skin cancer later in life.Methods.The present study measured children's knowledge and attitudes, and reported usual behavior relevant to sun protection and parents' encouragement of their children's sun protection among a sample of 735 primary school students and their parents, in Victoria, Australia. The incidence of sunburn among the children over late spring and early summer was monitored weekly for 8 weeks.Results.The results indicate that children's knowledge of sun protection is moderately high and that positive sun protection attitudes, reported frequency of parents encouraging protection, and children carrying out sun protection are generally high. Trends for age indicate that while knowledge of sun protection increases with age, attitudes and behaviors supportive of sun protection decline. Sunburn rates increase with age. There was some evidence to suggest that children with fairer coloring receive greater encouragement from parents to protect themselves and are marginally better protected than children with darker coloring. However, this highly susceptible group still suffers more burns. There was little variation based on children's gender.Conclusions.The mid-primary school years may be a critical time for interventions promoting sun protection.