Summer sun exposure: knowledge, attitudes, and behaviors of Midwest adolescents

Beliefs, knowledge and attitudes as predictors of sunbathing habits and use of sun protection among Swedish adolescents

In 1996, a random population sample of 2615 adolescents completed a questionnaire concerning habitual sun-related behaviours, attitudes towards sunbathing, and knowledge about skin cancer. Females, older adolescents, those with less sun-sensitive skin, those with higher knowledge and those with a positive attitude towards sunbathing were more likely to be frequent sunbathers. Younger adolescents, those who today sunbathe moderately, and those with sensitive skin were more likely to believe that they would sunbathe more often in the future. Males, adolescents with less sensitive skin, those with a positive attitude towards sunbathing and those sunbathing often, were less likely to use protection when sunbathing. Interventions to decrease sun exposure among adolescents should focus on changing attitudes toward sunbathing and having a tan, since knowledge of skin cancer and the damaging affect of sunbathing did not seem to effect current sunbathing habits, or use of sun protection.

Assessment of knowledge of melanoma risk factors, prevention, and detection principles in Texas teenagers

INTRODUCTION

The incidence of melanoma has increased in the past 10 years more rapidly than any other cancer. Exposure to intense solar radiation in youth significantly increases the lifetime risk of developing melanoma. We postulate that teenagers have little awareness of melanoma prevention or detection principles. The purpose of this study was to assess the knowledge of teenagers about melanoma and to identify which age groups are most receptive to altering their sun exposure behaviors.

METHODS

Two hundred and ten examinations testing general knowledge of sun exposure and melanoma were completed and returned by junior high and high school students ages 12 to 18 in Dallas and Houston, Texas. All students completing and returning the examination were provided with the correct answers to the test and a detailed explanation of each of the test items as part of an educational exercise. A second questionnaire was then administered to determine the effect of the educational exercise on future sun exposure practices. Students were divided into two age groups (12 to 15 and >or=16 years old) for comparison of scores on the knowledge examination and responses to behavioral items. Comparison of response rates between age groups was performed using chi(2) analysis.

RESULTS

The return rate was 100%, with 109 students age 12-15 years, and 101 students >or=16 years. Seventy-six percent of all respondents sunbathed outdoors, and 18% had used a tanning bed in the past 6 months. Thirty-three percent of students admitted to at least three blistering sunburns in the past. The average score on the knowledge assessment examination was 65% correct for students >or=16 years old and 54% correct for those 12-15 years old. Students 12 to 15 years old were significantly more likely to indicate they planned to change future behaviors regarding performance of skin self-examinations and limiting sun exposure as compared to the older students.

CONCLUSION

A significant number of teenagers have already enhanced their risk for future melanoma by suffering severe sunburns. Students younger than 16 years of age were significantly more likely to indicate they planned to change future behaviors after receiving information about melanoma. The data from this pilot study support education aimed at younger age groups to most effectively achieve risk reduction and prevent future melanomas.

Trends in sun protection behaviour among Australian young adults

OBJECTIVE

To study changes in sun protection behaviour, exposure and sunburn that occur from late adolescence to young adulthood.

METHOD

A longitudinal design was used to survey a cohort on their sun-protection behaviour from the middle of their final year at school to more than three years after finishing school.

RESULTS

Males reported higher exposure, less use of sunscreen and deeper tans than females. Yet males wore hats more frequently. People with skin that just burnt were more likely to protect themselves from the sun than people with skin that tanned. Longitudinally, the level of reported exposure and the depth of tan declined, frequency of covering up, hat wearing and sunscreen use remained unchanged, and a slight U-shaped trend was observed for sunburn.

CONCLUSIONS

Young adulthood may be an important time where deteriorating trends for sun protection found in the teen years are averted. Males are at greater risk of sun exposure than females.

IMPLICATIONS

It is recommended that health promotion programs capitalise on the trend of improved sun-protective behaviours during the transition from adolescence to young adulthood, with a particular focus on young men.

Sun protection practices in preadolescents and adolescents: a school-based survey of almost 25,000 Connecticut schoolchildren

Sun protection practices in children and adolescents fall well below national recommendations. We present the results of a survey of sun protection use and other health-related behaviors in a sample of Connecticut Caucasian students aged 9 through 18 years (N = 24,645). Our objectives were to estimate the prevalence of sun protection use and to evaluate the relationship between sun protection use and health-risk behaviors and attitudes about appearance. We present data from 1988 through 1995 from the Connecticut Health Check, a health risk appraisal survey sponsored by the Connecticut Department of Public Health. Students enrolled in public and private elementary junior as well as senior high schools took the self-administered anonymous survey, which included multiple-choice questions about use of sun protection, cigarettes, and alcohol and about body image and self-esteem. We report prevalence proportions for use of sun protection by demographic features. We compared the proportion of students in 3 categories of outcome (always, sometimes, and never use sun protection) who reported various health-risk behaviors. Twenty percent of the sample reported always using sun protection; this is well below national goals set forth in the Healthy People 2000 recommendations. Sun protection use was inversely related to age and was higher among girls than boys at all ages. At all ages, students who did not use sun protection were more likely than those who did to report other health risk behaviors, such as use of cigarettes and alcohol. The data suggested that use of sun protection is associated with positive attitudes about appearance and self-image. Use of sun protection may be one component of an overall mode of health awareness and behavior. Programs promoting safe sun practices should target boys and be integrated into an overall campaign aimed at other risk-taking behaviors.

Appearance, cosmetics, and body art in adolescents

Appearance in adolescents is a means of communication, a language expressing self identity. Teenagers explore fashions to make personal statements. Teenagers are significant consumers of various toiletry and skin care products that fill their cleansing, hydrating, and photoprotective needs. They also are enthusiastic consumers of products aimed at adolescent fads, such as decorative hair and nail cosmetics. For some teenagers, the expression of individualism is achieved through body art, such as tattooing and body piercing. Areas of concern are the lack of motivation for sun protection and the risky behavior associated with body piercing and tattooing.

Using communicative action in the primary prevention of cancer

The primary prevention of disease, including cancer, has been a major part of health promotion and health education for decades. However, the long-term results of these strategies have been mixed, and primary prevention as an instrument of cancer control continues to fail to live up to either public or professional expectations. The authors identify and critique two possible factors contributing to this failure and then offer a model for the development and implementation of primary prevention strategies that addresses these factors. The model used is based on Habermas's theory of communicative action and recognizes the importance of a critical dialogue in health education and health promotion. The primary prevention programs currently being conducted by the Cancer Centre for the Southern Interior are presented as an example of the model in action.

Predictors of the use of sunscreen in dermatological patients in Central Europe

BACKGROUND

There is mounting evidence that sun exposure is a cause of skin cancer. Therefore, the focus of skin cancer prevention is on sun protection. The present study investigated the use of sunscreens in a sample from the adult Central European population.

METHODS

As part of a case-control study of cutaneous melanoma, a total of 498 controls with classical dermatological disorders were selected from hospitals in Central Europe. All people underwent whole-body skin examinations and were interviewed using a standardized questionnaire.

RESULTS

Overall, 40.8% of the people never used sunscreen and of the 281 persons who used sunscreen, 41.5% applied it only once per sun bath. Persons who did not use sunscreen tended to be older (P<0.0001) and of male gender (P = 0.0004). Young people, women, and people who expressed a positive attitude to the sun spent more time in the sun and were more likely to apply sunscreens. People who worked almost always outdoors had a six times increased odds ratio of not using sunscreens (P<0.0001) compared to people who worked always indoors.

CONCLUSIONS

Men, older people, and outdoor workers should be targeted in health education campaigns. On the other hand, people who apply sunscreen as a means of sun protection should be advised about adequate usage.

Use of sunscreen in health care professionals. The health belief model

The purpose of this study was to examine the relationship among perceived susceptibility, demographic variables, and use of sunscreen in health care providers, using the Health Belief Model Questionnaire. The sample consisted of 90 participants from the Southeast, ages 24 to 60 years. This sample included nurses, pharmacists, psychologists, nurse practitioners, and physicians. Demographics revealed that 63% had postgraduate or professional degrees, 91% were white, 88% were women, 4% had a family history of skin cancer, and 4% had a personal history of skin cancer. Participants at actual high risk and those at actual low risk reported appropriate perceived susceptibility scores. However, those whose actual risk was average, perceived their risk to be low. There was no significant relationship found between actual risk of developing skin cancer and use of sunscreen. There was a significant relationship between age and perceived susceptibility to skin cancer. The older the subject, the higher the perceived susceptibility. Health care providers have the ability to influence individuals to use sunscreen. Accurately perceived susceptibility to skin cancer will increase the likelihood of health care providers recommending sunscreen to their patients.

Summertime sun protection used by adults for their children

BACKGROUND

Because an estimated 50% to 80% of the skin's lifetime sun damage is thought to occur in childhood and adolescence, it is during these critical periods that intense, intermittent sun exposure causing burning increases melanoma risk.

METHODS

A 1997 telephone survey of 503 households evaluated parental attitudes about their child having a tan, and ease of practicing sun protection, sun protection methods used, and sunburning on 5 successive summer weekends.

RESULTS

In a random sample of 1 child from each household, 13% of children sunburned during the past week or weekend, and 9% of their parents experienced a sunburn during the past weekend. Children's sunburn was significantly associated with sunburn in the adult respondent, increasing age of the child, having fair skin, being white, and using sunscreens. Duration and peak hours of sun exposure were associated for children and parents. Sunscreen with a sun protection factor of at least 15 was the predominant form of sun protection used. Sunscreen use in children was significantly associated with longer duration of sun exposure, sunny weather conditions, younger age, fair skin, a history of sunburns before this study, a family history of skin cancer, and a higher family income. Feeling that a tan appeared healthy was associated with male gender of the adult and increasing age of the child. Complimenting the child on the appearance of a tan was associated with male gender of the adult, older children, children with skin type reported as olive or dark, and lower educational levels.

CONCLUSION

Although there has been a promising initial effort to alert parents to the need to protect their children from sunburns, many view a tan as healthy and do not effectively implement sun protection behaviors for their children, which results in sunburns. Sun protection that prevents sunburning could be achieved by more children seeking shade, wearing protective clothing, limiting exposure during peak hours, and effectively using sunscreen.

Sunscreen use and duration of sun exposure: a double-blind, randomized trial

BACKGROUND

In epidemiologic studies, sunscreen use is associated with increased risk of cutaneous melanoma, basal cell skin cancer, and higher numbers of nevi. It has been proposed that sunscreens may encourage prolonged sun exposure because they delay sunburn occurrence. We examined whether, under habitual conditions of sunscreen use, the sun-protection factor (SPF) had an influence on sun-exposure duration.

METHODS

Before the 1997 summer holidays, we randomly assigned 87 French and Swiss participants who were 18-24 years of age to receive an SPF 10 or an SPF 30 sunscreen. Neither medical personnel nor study participants were aware of their sunscreen assignment. Participants were asked to complete daily records of their sun exposure. To avoid influencing the recreational sun-exposure habits of the study participants, no recommendation was made about sun exposure or sun protection. Furthermore, participants were told that the trial end point was the number of pigmented skin lesions before and after the holidays. One subject was lost to follow-up. All statistical tests were two-sided.

RESULTS

The SPF 10 (n = 44) and SPF 30 (n = 42) groups had equivalent mean holiday durations (19.4 days versus 20.2 days) and mean quantities of sunscreen used (72.3 g versus 71.6 g). The mean cumulative sun exposures for the two groups were 58.2 hours and 72.6 hours, respectively (P =.011). The mean daily durations of sunbathing were 2.6 and 3.1 hours, respectively (P =.0013), and, for outdoor activities, they were 3.6 and 3.8 hours, respectively (P =.62). There was no difference in sunburn experience between the two groups.

CONCLUSIONS

Use of higher SPF sunscreen seems to increase the duration of recreational sun exposure of young white Europeans.

Promoting sun protection in elementary schools and child care settings: the SunSafe Project

Elementary schools and child care settings in rural New Hampshire participated in a sun protection program that reached more than 4,200 children. The program was part of a successful multifaceted community intervention targeting children ages 2-9. Program components included curricular materials, training and support for school/child care staff, and parent outreach. Evaluation showed good uptake of the curriculum by teachers and child care providers, improvements in sun protection policy in participating schools and child care settings, and significant knowledge and attitude improvements in fourth grade children tested, as well as actual behavior change. The study highlighted the importance of flexible, developmentally appropriate curricular materials and active engagement of principals and directors in policy review. In addition, for parent outreach programs to be successful, children needed to participate.

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.

Public health interventions for melanoma. Prevention, early detection, and education

Worldwide melanoma control programs that include some combination of primary prevention, education, and screening activities have only recently begun to undergo an evaluation process. More studies with rigorous design and evaluation are needed. Until then, the proper public health policy guidelines for melanoma control, especially screening, are open to debate. Future studies must determine how screening, early detection, case finding, and education can best be used to reduce mortality and achieve optimal melanoma control.