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Gefeller O, Li J, Uter W, Pfahlberg AB. The impact of parental knowledge and tanning attitudes on sun protection practice for young children in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4768-81. [PMID: 24802677 PMCID: PMC4053880 DOI: 10.3390/ijerph110504768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/04/2014] [Accepted: 04/28/2014] [Indexed: 11/16/2022]
Abstract
Public health campaigns have improved knowledge on UVR-associated skin cancer risk and increased sun protection awareness. However, tanned skin is still a common beauty ideal. The relationship between knowledge, attitudes and protective behavior is not fully understood yet. A population-based survey was thus performed in the district of Erlangen involving 2,619 parents of 3- to 6-year old children. By means of a self-administered standardized questionnaire parental knowledge about risk factors for skin cancer, their attitudes towards tanning and details of protective measures taken for their children were assessed. The study analyzed specifically the impact of parental tanning attitudes on sun-protective measures for their children while controlling for parental knowledge about skin cancer risk factors. While parental knowledge was significantly (inversely) associated with agreement to the statement "Tanned skin is healthy skin", this was not the case for "Tanning makes me look better". Overall, tanning affirmative attitudes were inversely associated with protective measures taken for the children, whereas parental knowledge had a positive impact on sun protection at the beach only. Multivariable analyses provided evidence for an effect of parental attitude on protective behavior independent of parental knowledge. Tanning attitudes and tanned skin as the misguided ideal of beauty need to be addressed in future public health campaigns to enhance the effectiveness of preventive activities in changing sun protective behavior.
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Affiliation(s)
- Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany.
| | - Jiang Li
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany.
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany.
| | - Annette B Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany.
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Mahé E, Assathiany R, Fay-Chatelard F, Taylor M, Bouvresse S, Navel M, Saiag P, Chevallier B, Beauchet A. Counselling on sun protection, a survey of French paediatricians. J Eur Acad Dermatol Venereol 2012; 27:e424-7. [PMID: 23078647 DOI: 10.1111/jdv.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND High sun exposure during childhood is an important risk factor for skin cancers at adulthood. Paediatricians are first in line to provide sun protection (SP) information. OBJECTIVE To describe paediatricians' attitudes towards SP counselling and compare French and American paediatricians' behaviours. METHODS Methodology used by the American Academy of Pediatrics in 2001. Validation of the French version of the questionnaire. Survey of all 1108 paediatrician members of the Association Française de Pédiatrie Ambulatoire (AFPA) RESULTS More than 90% of paediatricians agreed that skin cancers are a Public Health concern, that preventing episodic high sun exposures during childhood would reduce the risk of adult melanoma, and that it is a paediatrician's role to educate parents/patients on SP. Three quarters reported counselling all of their patients. The most important SP recommendation was to avoid sun during peak hours, followed by sunscreen use. Only 48.3% of paediatricians rated SP as very important to their patients' health, at the 8th rank among selected preventive care topics. The most frequently identified barrier to SP counselling was cost of sunscreens followed by lack of sufficient time. CONCLUSIONS The majority of paediatricians believe that prevention of skin cancers is a worthy issue and it is their role to educate patients, but less than half of them consider SP as an important topic among selected preventive care issues. Although paediatricians seem to know SP measures well, their (counselling?) seems to respond to patients' preoccupations more than to expert recommendations. French and American behaviours show some major differences.
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Affiliation(s)
- E Mahé
- Department of Dermatology, Ambroise Paré University Hospital, University of Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France Research Unit EA 4339 'Skin, cancer, and environment', Ambroise Paré University Hospital, University of Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France Association Française de Pédiatrie Ambulatoire, Issy Les Moulineaux, France Department of Pediatrics, Ambroise Paré University Hospital, University of Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France Public Health Department, Ambroise Paré University Hospital, University of Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France
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Li J, Uter W, Pfahlberg A, Gefeller O. A comparison of patterns of sun protection during beach holidays and everyday outdoor activities in a population sample of young German children. Br J Dermatol 2012; 166:803-10. [DOI: 10.1111/j.1365-2133.2012.10805.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Li J, Uter W, Pfahlberg A, Gefeller O. Parental perspective on sun protection for young children in Bavaria. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:196-202. [DOI: 10.1111/j.1600-0781.2011.00598.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Hunter S, Love-Jackson K, Abdulla R, Zhu W, Lee JH, Wells KJ, Roetzheim R. Sun protection at elementary schools: a cluster randomized trial. J Natl Cancer Inst 2010; 102:484-92. [PMID: 20332388 PMCID: PMC2902823 DOI: 10.1093/jnci/djq010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 12/28/2009] [Accepted: 01/12/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elementary schools represent both a source of childhood sun exposure and a setting for educational interventions. METHODS Sun Protection of Florida's Children was a cluster randomized trial promoting hat use at (primary outcome) and outside of schools among fourth-grade students during August 8, 2006, through May 22, 2007. Twenty-two schools were randomly assigned to the intervention (1115 students) or control group (1376 students). Intervention schools received classroom sessions targeting sun protection attitudes and social norms. Each student attending an intervention school received two free wide-brimmed hats. Hat use at school was measured by direct observation and hat use outside of school was measured by self-report. A subgroup of 378 students (178 in the intervention group and 200 in the control group) underwent serial measurements of skin pigmentation to explore potential physiological effects of the intervention. Generalized linear mixed models were used to evaluate the intervention effect by accounting for the cluster randomized trial design. All P values were two-sided and were claimed as statistically significant at a level of .05. RESULTS The percentage of students observed wearing hats at control schools remained essentially unchanged during the school year (baseline = 2%, fall = 0%, and spring = 1%) but increased statistically significantly at intervention schools (baseline = 2%, fall = 30%, and spring = 41%) (P < .001 for intervention effect comparing the change in rate of hat use over time at intervention vs control schools). Self-reported use of hats outside of school did not change statistically significantly during the study (control: baseline = 14%, fall = 14%, and spring = 11%; intervention: baseline = 24%, fall = 24%, and spring = 23%) nor did measures of skin pigmentation. CONCLUSIONS The intervention increased use of hats among fourth-grade students at school but had no effect on self-reported wide-brimmed hat use outside of school or on measures of skin pigmentation.
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Affiliation(s)
- Seft Hunter
- Department of Family Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, MDC 13, Tampa, FL 33612, USA
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Hunter S, Wells KJ, Jacobsen PB, Lee JH, Boulware D, Love-Jackson K, Abdulla R, Roetzheim RG. Assessment of elementary school students' sun protection behaviors. Pediatr Dermatol 2010; 27:182-8. [PMID: 19686304 PMCID: PMC3683831 DOI: 10.1111/j.1525-1470.2009.00940.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Studies suggest that excessive sun exposure in childhood contributes to the development of skin cancer later in life. METHODS This study explores 4th grade student assessment of their sun protection behaviors. This study used baseline data collected in the Fall of 2006 for the Sun Protection for Florida's Children (SPF) project. In brief, the SPF project is a group randomized trial to test the effectiveness of a school based intervention promoting sun protection in general, and hat use in particular, in Hillsborough County Schools, Florida. The data reported in this study were collected at baseline before any intervention activities was initiated. RESULTS The self-reported use of various methods of sun protection was low. Only a small percentage of students wore long sleeves or a hat with a brim before leaving for school. In addition, few students wore a hat with a wide brim when outside but not at school. Students spent an average of 59.1 minutes per week outdoors while attending school and 35.5 minutes during peak sun exposure. CONCLUSION Sun exposure at school poses a significant risk to student health and more needs to be carried out to promote the use of a wide-brimmed hat and limiting student sun exposure.
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Affiliation(s)
- Seft Hunter
- Department of Family Medicine, University of South Florida, Tampa, Florida 33612, USA
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Mahé E, Qattini S, Beauchet A, Saiag P. Web-based resources for sun protection information – A French-language evaluation. Eur J Cancer 2009; 45:2160-7. [DOI: 10.1016/j.ejca.2009.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/07/2009] [Accepted: 02/11/2009] [Indexed: 11/30/2022]
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Cac NN, Walling HW, Vest C, Ting W. Differences in perceived importance and personal use of sun protection among primary care physicians are reflected in their clinical practice. Int J Dermatol 2008; 47:137-43. [DOI: 10.1111/j.1365-4632.2008.03348.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sun habits in the children of Southern Italy. J Am Acad Dermatol 2007; 57:883-7. [DOI: 10.1016/j.jaad.2007.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/21/2007] [Accepted: 07/02/2007] [Indexed: 11/27/2022]
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Balk SJ, O'Connor KG, Saraiya M. Counseling parents and children on sun protection: a national survey of pediatricians. Pediatrics 2004; 114:1056-64. [PMID: 15466105 DOI: 10.1542/peds.2004-1305] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe pediatricians' attitudes toward skin cancer (SC), sun protection (SP) counseling, and the quantity and content of such counseling and to identify barriers to counseling. METHODS An American Academy of Pediatrics Periodic Survey was mailed to 1616 randomly selected US members between October 2001 and February 2002. The response rate was 54.6%. RESULTS More than 90% of pediatricians agreed that SC is a significant public health problem and that preventing episodic high exposures to the sun during childhood will reduce the risk of adult melanoma. However, only 22.3% of respondents reported counseling most patients in all age groups. Female pediatricians were more likely to counsel most patients; pediatricians located in the South and West and those who practice in hospital/clinic settings were least likely to counsel compared with those in other regions. Approximately half (53%) of pediatricians reported selectively counseling on the basis of patient characteristics The most important SP recommendation named was using a sunscreen with a sun protection factor > or =15. Only 38% of pediatricians rated SP as very important to their patients' health compared with other topics such as use of car seats (86%), nutrition (79%), immunization issues (76%), and smoking/avoidance of environmental tobacco smoke (74%). The most frequently named barrier to SP counseling was lack of time (58% reporting). CONCLUSIONS Although the majority of pediatricians believe that SC prevention is a worthy issue, only a minority reported providing routine SP counseling to most patients in every age group, and most ranked SP lower in importance than other issues. Interventions might include programs and materials to educate patients and pediatricians alike. To have an effect on increasing rates of SC and SC mortality, a broader public health approach is needed as a complement to pediatricians' counseling efforts.
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Affiliation(s)
- Sophie J Balk
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
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Abstract
BACKGROUND It has long been recognized that compliance with recommended sun safety practices is suboptimal, yet few investigations have explored the barriers that people face in practicing good sun safety. In this context, barriers can exist at the following three levels: knowledge of sun safety, acquisition of sun safety information, and implementation of specific sun protective measures. OBJECTIVE The investigation reported herein sought to elucidate barriers to sun safety that individuals face. Ultimately, this study aimed to qualify the possible barriers that lead to a misalignment of current recommendations and sun safety practices. METHODS The study design was observational, and the instrument used for data collection was a self-administered questionnaire. Thirty-four outpatients of the RK Schachter Dermatology Centre of Sunnybrook and Women's College Health Sciences Centre (SWCHSC), Toronto, Ontario, as well as 27 outpatients of the Sport Care facility of SWCHSC were enrolled in the study. They represent the target population of those who are at greater risk of developing sun-related skin lesions. Data were analyzed using standard parametric and nonparametric techniques. Comparisons were made between the two outpatient groups and between other groups within the sample. RESULTS In general, level of sun safety knowledge was fairly high, though compliance to sun safety measures was suboptimal in both populations. There were no significant differences regarding level of knowledge between the 2 outpatient groups. Deficiencies in knowledge centered around risk factors for skin cancer. Frequently cited barriers to sun safety include inconvenience (34% of respondents), forgetting to use sun safety measures (49%), a desire to be tanned (33%), and protective clothing being too hot to wear (56%). High compliers were notable for their great likelihood of being counseled by a physician about sun safety ( P < 0.025) and their slightly higher mean knowledge scores. CONCLUSIONS These data support that knowledge alone does not predict compliance and that sun awareness campaigns should be evaluated based on their ability to affect behavior.
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Affiliation(s)
- Andrea K Boggild
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Gritz ER, Tripp MK, de Moor CA, Eicher SA, Mueller NH, Spedale JH. Skin cancer prevention counseling and clinical practices of pediatricians. Pediatr Dermatol 2003; 20:16-24. [PMID: 12558840 DOI: 10.1046/j.1525-1470.2003.03004.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little is known about pediatricians' counseling and clinical practices to reduce skin cancer risk among their patients. Thus our objectives were to characterize skin cancer preventive counseling and clinical practices in a sample of pediatricians and identify correlates of these practices. Physicians practicing general pediatrics in Harris County, Texas, received a mail survey that assessed their sun protection recommendations and skin cancer preventive counseling and clinical practices. Pediatrician, patient, and medical practice variables were assessed as correlates. Most (76%) pediatricians routinely recommended sunscreen; however, relatively few (24%) suggested reapplying it after prolonged periods outside. About half routinely recommended protective clothing (53%), shade (47%), or limiting midday sun exposure (46%). Even fewer pediatricians routinely discussed skin cancer risk factors, passed out sunscreen samples, made educational materials available, took a family history of skin cancer, or documented risk factors in a patient's chart. More than half reported that they routinely performed full-body skin examinations during a first visit (65%) and annually (56%). Perceived barriers, perceived relevance of skin cancer prevention, and personal sun protection practices were important factors associated with professional practices in this sample. Interventions are needed to increase pediatricians' counseling and clinical practices to reduce skin cancer risk among patients.
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Affiliation(s)
- Ellen R Gritz
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston 77030-4009, USA.
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Davy L, Boyett T, Weathers L, Campbell RJ, Roetzheim RG. Sun protection counseling by pediatricians. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2002; 2:207-11. [PMID: 12014981 DOI: 10.1367/1539-4409(2002)002<0207:spcbp>2.0.co;2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE 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. STUDY DESIGN 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Leigh Davy
- University of South Florida, Tampa, FL 33612, USA
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