Sun Protection Policies Research Articles

The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.

Certification of sun protection practices in a German child day-care centre improves children’s sun protection - the ‘SunPass’ pilot study

Nonmelanoma skin cancer (NMSC) and malignant melanoma (CMM) are among the most common malignancies in the white population. The major risk factor for those malignancies is ultraviolet radiation (UV) causing directly DNA damage and promoting the development of skin cancer. It is suggested that the exposure to UV during childhood elevates an individual's lifetime risk of developing skin cancer more than exposure in adulthood. Since an increasing number of children spend the time of the most intense UV in a day-care centre, it seems an excellent place for establishing primary skin cancer prevention. Important targets are staff members and parents of the day-care centre, since sun protection of children depends directly on their knowledge and their attitude towards sun protection practices. To establish a feasible certification program for sun protection in a German child day-care centre, for a better sun protection of the children and the reduction of skin cancer incidence in the long term. Initially sun protection practices of the centre at baseline were assessed. A written sun protection policy was developed in consultation with all members of the day-care centre as basis for certification. It was followed by training sessions for staff members (n=12) and parents (n=46). After a fixed period of time the final assessment of the child day-care centre was conducted and the centre then was certified for improved sun protection practices and better protection of the children. The primary assessed outcomes were the gain in knowledge of staff members and parents after the training sessions, the number of children wearing a hat when playing outside, the use of sunscreen and the percentage of shaded areas on the playground. Sun protection was an issue more discussed during the time of intervention than before. Staff members (n=12) and parents (n=27) had a significant gain in knowledge (staff members: P=0.002; parents: P=0.001) concerning sun related issues. The number of children wearing a hat increased from 13.2% to 73%. The sunscreen use increased, 58.8% of staff members reported a more regular application of sunscreen to the children. There was a higher percentage of shaded area on the playground (70-80% before intervention, 90% after intervention). The intervention failed in keeping the children inside during the most intense UV and in educating the staff members to be a convincing example of sun protection by wearing appropriate clothes. The intervention showed that the introduction of a simple certification program including a written sun protection policy and training sessions for staff members and parents helps to improve children's sun protection. We suggest that a certificate for adequate sun protection acts as a motivating factor. It seems important to refresh sun protection practices each year by repeating training sessions and reviewing the sun protection policy.

Predisposing factors of actinic keratosis in a North-West German population

The growing incident rates of skin cancer and their corresponding precursor lesions, e.g. actinic keratosis (AK), among Caucasians have become an important public health problem. A multicenter case-control study was conducted to identify the risk factors of AK of a prototypical Central European population. The study population comprised a total of 331 cases and 383 controls. Using multivariate analysis we identified ten independent variables predicting the AK risk. The five most crucial were age (OR 1.11; 95% CI 1.08-1,14), gender (OR 3.92; 95% CI 2.42-6.36), history of previous skin malignancies (OR 6.47; 95% CI 3.21-13.03), pale skin phototype (OR 2.5; 95% CI 1.53-4.06), and sun exposure for occupational reasons (OR 1.72; 95% CI 1.01-2.92). Additionally, sun exposure for recreational reasons, denial of the use of sunscreens, painful sunburn episodes before the age of 20, and a familial history of skin malignancies are also significant independent correlates of AK. Our epidemiological data suggest that constitutional susceptibility and sunlight exposure are equally involved in the onset of AK. Additional prophylactic and educational efforts should focus on increasing sun protection policies and educational programs especially aimed at outdoor workers, men, fair skinned individuals and patients with a history of previous skin malignancies. These measures should be able to reduce the excessive incidence rates of AK among Caucasians in Central Europe.

Baseline survey of sun protection policies and practices in primary school settings in New Zealand

The SunSmart Schools Accreditation Programme (SSAP) was launched as a national programme in October 2005 to help reduce the risk of excessive child exposure to ultraviolet radiation. As part of the need for evaluation, this paper reports the findings of a national survey of a randomly selected sample of approximately 12% of New Zealand primary schools prior to the national launch of the SSAP. Principals at 242 schools completed a mail survey (81% response rate) relating to school sun protection policies, practices, curriculum and environment. Survey responses were evaluated according to the 12 criteria of the SSAP, with schools assigned a score from 0 to 12. No school fully met all 12 accreditation criteria, although 2% of schools attained 11 criteria and another 2% attained 10. Nine per cent of schools attained three or fewer criteria. Overall, 7 was the most common score, achieved by 23%. School socio-economic decile rating and roll size were positively associated with higher scores (both P < 0.02). Continued support and resources are needed to encourage schools to address sun protection across the spectrum of curriculum, practices and environment and through commitment to written policy.

The SunWise Policy Intervention for School-Based Sun Protection: A Pilot Study

Skin cancer is highly preventable, but clearly there is a critical need to focus on better ways to disseminate information about known skin cancer prevention. The U.S. Environmental Protection Agency's (EPA) SunWise Program is one channel for reaching children, teachers, and school nurses. In a pilot study designed to increase adoption of school-based sun protection policies, 28 schools were randomly assigned to one of three groups: Control, which included the EPA's original SunWise curriculum toolkit; SunWise Policy, which included a revised toolkit emphasizing policy; and SunWise Policy plus Technical Assistance, which included the policy toolkit and 3 technical assistance phone calls. The enhanced SunWise Policy plus Technical Assistance intervention led to more new sun protection policies. Use of study interventions for improving sun protection practices such as policy toolkits or brief counseling can be easily interwoven into school hours by school nurses and other health educators.

Multiple Levels of Influence in the Adoption of Sun Protection Policies in Elementary Schools in Massachusetts

To understand the factors that may influence sun protection policy development if the Centers for Disease Control and Prevention guidelines are to be realized. Qualitative research methodology incorporating a socioecological framework using individual or small-group interviews, surveys, and environmental assessments with school superintendents, elementary school principals, elementary school nurses, and parent-teacher organization presidents and co-chairs as well as coding of school documents. Elementary schools in Massachusetts. Nine school superintendents, 18 elementary school principals, 18 elementary school nurses, and 16 parent-teacher organization presidents or co-chairs. Presence of school sun protection policies, sun protection curriculum, and communication portals for sun protection information to parents. None of the schools in the 9 districts had a sun protection policy, and only 1 had any type of sun protection curriculum. However, nearly all principals were receptive to developing sun protection policies and to making structural changes to increase the amount of accessible shade if funding were available. The schools' communication infrastructure could provide a key portal for disseminating sun protection information to parents. Although there are other resources that could be brought to bear, many challenges must be surmounted to develop effective sun protection policies.

Workplace sun protection policies and employees' sun-related skin damage.

To investigate whether mandatory sun protection for outdoor workers in tropical regions is associated with reduced sun damage. Survey of 26 employees working under mandatory sun protection policy was compared to survey of 21 employees working under voluntary sun protection policy. Voluntary sun protection associated with employees having more solar keratoses on dorsum of right hand (P=0.006) and more previously excised self-reported skin cancers (P=0.008). Employees working under mandatory sun protection policy had reduced sun damage, a likely consequence of less sun exposure.

Australian primary schools’ sun protection policy and practice: evaluating the impact of the National SunSmart Schools Program

This study investigated trends in sun protection policy and practice of Australian primary schools between 1998 and 2005 and the impact of the National SunSmart Schools Program. Between September and November 2005, primary schools from all states and territories in Australia were surveyed on their sun protection policy and practice. Data were compared to 1998 and 2001 data and analysed using descriptive statistics and chi-square tests. There has been an increase in the proportion of schools with written sun protection policy to 80%, although some aspects of policy were less likely to be included in 2005 than in 2001. Trends in sun protection practice were varied with a significant increase in hat wearing (to 85%) and a significant decrease in sunscreen use. SunSmart schools were found to have a higher level of policy (95% CF 65%, p<0.001) and practice than non-SunSmart schools. Including specific aspects of sun protection in written policy were linked significantly to the corresponding practice for all aspects of sun protection except shade adequacy. These findings highlight the need to continue encouraging the development of comprehensive written sun protection policies in primary schools and advocate for continued support for primary school sun protection activities.

Workplace Sun Protection Policies and Employees' Sun-related Skin Damage

Workplace Sun Protection Policies and Employees' Sun-related Skin Damage

Reducing ultraviolet radiation exposure among outdoor workers: State of the evidence and recommendations

ObjectiveOutdoor workers have high levels of exposure to ultraviolet radiation and the associated increased risk of skin cancer. This paper describes a review of: 1) descriptive data about outdoor workers' sun exposure and protection and related knowledge, attitudes, and policies and 2) evidence about the effectiveness of skin cancer prevention interventions in outdoor workplaces.Data sourcesSystematic evidence-based review.Data synthesisWe found variable preventive practices, with men more likely to wear hats and protective clothing and women more likely to use sunscreen. Few data document education and prevention policies.ConclusionReports of interventions to promote sun-safe practices and environments provide encouraging results, but yield insufficient evidence to recommend current strategies as effective. Additional efforts should focus on increasing sun protection policies and education programs in workplaces and evaluating whether they improve the health behavior of outdoor workers.

Baseline survey of sun-protection knowledge, practices and policy in early childhood settings in Queensland, Australia

Excessive exposure to sunlight during early childhood increases the risk of developing skin cancer. Self-administered questionnaires exploring sun-protection knowledge, practices and policy were mailed to the directors/coordinators/senior teachers of all known early childhood services in Queensland, Australia, in 2002 (n = 1383; 56.5% response). Most (73.7%) services had a written sun-protection policy (SPP). However, 40.6% of pre-schools and kindergartens had not developed a written SPP. Most directors had moderate knowledge about sun-protection (median score: 7/12 [IQR 6, 8]), but few understood the UV index, the sun-protection factor rating for sunscreens or the association between childhood sun-exposure, mole development and melanoma. Pre-school teachers had lower knowledge scores than directors of long day care centers and other services (P = 0.0005). Staff members reportedly wore sun-protective hats, clothing and sunglasses more often than children. However, sunscreen use was higher among children than staff. Directors' knowledge scores predicted reported hat, clothing, sunscreen and shade utilization among children. Remoteness impacted negatively on director's knowledge (P = 0.043) and written SPP development (P = 0.0005). Higher composite sun-protection scores were reported for children and staff from services with written sun-protection policies. SPP development and increased sun-protection knowledge of directors may improve reported sun-protective behaviors of children and staff of early childhood services.

Prevalence of health promotion policies in sports clubs in Victoria, Australia

In recent years, some health agencies offered sponsorship to sporting associations to promote healthy environments by encouraging clubs to develop health-related policies. However, the extent to which these sponsorship contracts reach their stated aims is of concern. This study aimed to quantify levels of policy development and practice in sports clubs for each of five key health areas, namely smoke-free facilities, sun protection, healthy catering, responsible serving of alcohol and sports injury prevention. Representatives from 932 Victorian sports clubs were contacted by telephone with 640 clubs (69%) participating in the survey. Results suggested that the establishment of written policies on the key health areas by sports clubs varied widely by affiliated sport and health area: 70% of all clubs with bar facilities had written policies on responsible serving of alcohol, ranging from 58% of tennis clubs to 100% of diving and surfing clubs. In contrast, approximately one-third of sports clubs had a smoke-free policy, with 36% of tennis, 28% of country football and 28% of men's cricket clubs having policy. Moreover, 34% of clubs overall had established sun protection policy, whereas clubs competing outside during summer months, [diving (86%) and life-saving (81%)] were most likely to have a written sun protection policy. Injury prevention policies were established in 30% of sports clubs, and were most common among football (56%), diving (43%) and life-saving (41%). This study suggests that policy development for health promotion can be achieved in sports clubs when it is well supported by health agencies and consideration is given to the appropriateness of the specific behaviours to be encouraged for a given sport. Communication between associations and clubs needs to be monitored by health agencies to ensure support and resources for policy development to reach the club level.

A survey of sun protection policy and education in secondary schools

The Centers for Disease Control and Prevention (CDC) issued recommendations for school programs to reduce skin cancer. Personnel at US secondary schools were surveyed to describe sun protection policy and education before the CDC recommendations. School principals or other personnel at 484 secondary schools in 27 cities responded to a telephone survey in January and February 2002 (response rate = 31%). A sun protection policy was reported at 10% of the schools, but sun protection education occurred at nearly all schools (96%). Policies were more prevalent in regions with high ultraviolet radiation (P < .0001), but education was not. Many personnel were willing to adopt a policy (41%) and interested in obtaining a sun safety curriculum (96%). Self-report measures, nonresponse, and new schools not in the sampling frame. Sun protection was a low policy priority for US schools. Sun safety education was prevalent, but written materials were used infrequently. A substantial proportion of school personnel were receptive to the CDC's advice.

Sun Protection Policies and Practices at Child Care Centers in Massachusetts

We assessed the relationship between sun protection policies and practices at child care centers in Massachusetts. We hypothesized that centers with sun protection policies were more likely to have regular sun protection practices in place compared to centers without these policies. We conducted a telephone survey with directors or assistant directors at 327 child care centers during the summer of 2002. The main outcome measure was sun protection practices, which included time spent outside during mid-day and the use of sunscreen, hats, and protective clothing by the majority of children assessed over the last 5 program days. The 36-item survey also inquired about the center's sun protection policy and included demographic questions. Most centers (73%) reported having a written sun protection policy. Sun protection policies were positively associated with reported sunscreen (chi squared = 14.63, p = 0.0001) and hat use (chi squared = 30.98, p < 0.0001) and inversely associated with time outside (chi squared = 10.76, p = 0.001). Seventy-seven percent of centers followed recommended sunscreen practices. However, centers were far less likely to have recommended hat use (36%) and protective clothing (1.5%) practices. A formal sun protection policy may be an effective way to increase sun protection practices in the child care setting. Further research should assess this relationship in other states. Improving and expanding existing state regulations may be a reasonable strategy to increase sun protection at child care centers.

Sun Protection Policies in Miami‐Dade County Public Schools: Opportunities for Skin Cancer Prevention

Childhood exposure to ultraviolet radiation from the sun and a history of sunburns are risk factors for skin cancer. Because children spend time outdoors when they are at school, school sun protection policies are an important health issue, particularly in areas of the country with year-round warm and sunny climates, such as Florida. To better understand the sun protection policies and practices in South Florida schools, a sample (n = 51) of elementary and middle schools in Miami-Dade County public schools were surveyed as part of a CDC-funded cancer control program at the University of Miami. Of the principals and teachers surveyed, most (78%) knew about the county school system's guidelines for avoiding excessive heat exposure, which include two sun protection measures. Two-thirds reported that they shared these guidelines with teachers; 21% shared them with parents. Few schools monitor implementation of the guidelines, although 70% schedule outdoor activities to avoid peak sun hours. No schools required sunscreen, hats, or protective clothing. Physical education teachers and students spend an average of 4.5 and 0.6 hours per day outdoors, respectively. Improved school sun protection policies and monitoring of such policies is needed to reduce sun exposure and skin cancer risk for both students and staff.

Health promotion in childcare centres: a survey of sun protection policy and practice

Objectives: To describe sun protection policy and practice in child care centres in the Hunter region of New South Wales (NSW) and examine differences in sun protection policy and practice between those who attended a NSW Cancer Council SunSmart workshop and those who did not.Method: One hundred and seventy‐seven Hunter child care centres completed a CATI interview (95% consent rate).Results: Ninety seven per cent of centres reported having a written sun protection policy (only 5% deemed comprehensive by review). Sun protection policy components were reported more often than sun protection practices. There were no significant differences in policy or practice according to workshop attendance.Conclusions: Having a sun protection policy in place does not necessarily translate to sun protection practice at child care centres.

Sun protection policies and environmental features in US elementary schools.

To assess current sun protection policies and the receptiveness to new policies at elementary schools in the United States. A cross-sectional telephone survey. General educational community. In 1998, a random sample of 1000 public elementary schools in the United States was selected (proportional to population size) from 27 metropolitan areas chosen from the 58 US cities regularly reporting the UV index in 1997. A final sample of principals from 412 elementary schools completed the survey. None. Only 3.4% of schools had a sun protection policy. The most common reasons for not having a policy included the principal's lack of awareness (n = 113) or organizational barriers in the school districts (n = 77). Most principals (84.2%) said that students were outdoors during midday hours. Many principals (48.3%) were willing to adopt a sun protection policy. Most schools (72.8%) had shade structures but the majority (67.3%) reportedly covered less than one fifth of the grounds. Most principals (76.4%) were willing to increase the amount of shade structures. The low frequency of sun protection policies and shade structures calls for national efforts to change policies and environments to increase sun protection at US schools. Research is needed to demonstrate the efficacy of these changes.

A randomized trial of skin cancer prevention in aquatics settings: The pool cool program.

Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences.

Impact of Skin Cancer Prevention on Outdoor Aquatics Staff: The Pool Cool Program in Hawaii and Massachusetts

Background. Aquatic staff, including lifeguards, are exposed to intense sunlight for many hours each day and are likely to be at a relatively high risk for developing skin cancer. However, no interventions have been specifically directed to staff at outdoor swimming pool sites.Methods. We conducted a randomized controlled trial among aquatic staff at 28 outdoor pool sites in Hawaii and Massachusetts. Intervention pools received sun protection education and control pools received education on child injury prevention. Staff in both arms received orientation sessions and led instruction during swim lessons. Analysis of covariance was used to compare and test for changes in outcome variables (sun protection habits and sunburning rates of aquatic staff) and pool protection policies. Surveys were completed at the beginning and end of the summer.Results. Surveys were completed by 220 aquatics staff at baseline; 194 surveys were completed at posttest. Compared with staff at control pools, sun protection policies (P < 0.04) and sunburning rates (P < 0.05) improved at sun protection pools from baseline to posttest. However, the difference in the mean score of all sun protection habits between the two study groups was nonsignificant.Conclusion. The Pool Cool sun protection intervention had significant effects on lifeguards' sunburn rates and pool sun safety policies but did not improve reported sun protection behaviors. More intensive strategies may be needed to influence aquatics workers who have already begun to adopt skin cancer prevention practices.

A randomized trial of the Hawaii SunSmart program's impact on outdoor recreation staff

Background: Skin cancer is the most common form of cancer in the United States and one of the most preventable. Prevention programs for children at outdoor recreation sites may influence not only the youth, but the staff, or caregivers, as well. By teaching children about sun protection, staff may also change their sun protection behaviors. Objective: We report on the impact of a childhood skin cancer prevention program (SunSmart) on staff at outdoor recreation sites where a child-focused intervention was conducted. Methods: The intervention included staff training, on-site activities delivered by staff, distribution of sunscreen, and the promotion of sun-safe environments. It was hypothesized that by teaching children about sun protection, staff would change their sun protection behaviors. A randomized trial at 14 recreation sites (n = 176 staff) in Hawaii tested the efficacy of education only, and education plus environmental changes, compared with a control condition. Results: Results showed significant positive changes in knowledge, sun protection habits, norms, and sun protection policies. The education plus environment group was not superior to education alone. Conclusion: Changes in staff behavior and attitudes are important for their own health, as positive role models, and for the dissemination of skin cancer control programs. (J Am Acad Dermatol 2001;44:973-8.)