Sun protection behaviours and the predictors of sunburn in young children

Sun behaviour and physical activity associated with autumn vitamin D status in 4–8-year-old Danish children

Objective

To explore determinants of serum 25-hydroxyvitamin D (s-25(OH)D) during autumn in young, Caucasian children not consuming vitamin D-fortified foods or supplements, and explore differences in sun behaviours between pre-school and school children.

Design

In September–October, s-25(OH)D was measured by LC–MS/MS; physical activity, sun behaviours and vitamin D intake were assessed with questionnaires.

Setting

Baseline data from the ODIN Junior trial at 55°N.

Subjects

Children aged 4–8 years (n130), of whom 96% gave blood samples.

Results

Mean s-25(OH)D was 56·8 (sd12·5) nmol/l and positively associated with fat-free mass index (P=0·014). Children being active 6–7 h/week had 5·6 (95% CI 1·1, 10·0) nmol/l higher s-25(OH)D than less active children (P=0·014). Children seeking shade sometimes or rarely/never had 7·0 (95% CI 1·2, 12·9;P=0·018) and 7·2 (95% CI 0·8, 13·6;P=0·028) nmol/l higher s-25(OH)D, respectively, than children always/often seeking shade. Pre-school children had more sun-safe behaviour than school children in terms of use of a hat, sunscreen and sunscreen sun protection factor (P<0·05). In school but not pre-school children, using a hat rarely/never was associated with 12·1 (95% CI 2·5, 21·7;P=0·014) nmol/l higher s-25(OH)Dv. always/often (Pinteraction=0·019). Vitamin D intake was not associated with s-25(OH)D (P=0·241).

Conclusions

Physical activity and sun behaviours are associated with s-25(OH)D in young children. Identifying factors influencing autumn s-25(OH)D is relevant to optimize levels before sun exposure diminishes. Strategies to reduce risk of inadequacy should consider risk of skin cancer and sunburn, and could include fortification and/or vitamin D supplementation.

The risks and benefits of sun exposure 2016

Public health authorities in the United States are recommending that men, women and children reduce their exposure to sunlight, based on concerns that this exposure will promote skin cancer. On the other hand, data show that increasing numbers of Americans suffer from vitamin D deficiencies and serious health problems caused by insufficient sun exposure. The body of science concerning the benefits of moderate sun exposure is growing rapidly, and is causing a different perception of sun/UV as it relates to human health. Melanoma and its relationship to sun exposure and sunburn is not adequately addressed in most of the scientific literature. Reports of favorable health outcomes related to adequate serum 25(OH)D concentration or vitamin D supplementation have been inappropriately merged, so that benefits of sun exposure other than production of vitamin D are not adequately described. This review of recent studies and their analyses consider the risks and benefits of sun exposure which indicate that insufficient sun exposure is an emerging public health problem. This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis. The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D.

Sun-protective behaviors in populations at high risk for skin cancer

Over 3 million new cases of skin cancer are diagnosed in the US annually. Melanoma, a subtype of skin cancer that can be fatal if the disease is not detected and treated at an early stage, is the most common cancer for those aged 25–29 years and the second most common cancer in adolescents and young adults aged 15–29 years. The primary carcinogen for the genesis of skin cancers is ultraviolet light from solar radiation and tanning beds. In spite of massive health campaigns to raise public awareness on ultraviolet radiation, sun-protective practices still fall behind. A plausible explanation is the lack of behavioral change in the populations at risk; in this review article, we examine sun-protective behavior in the four high-risk skin cancer groups: skin cancer survivors, individuals with a family history of melanoma, individuals with physical characteristics associated with skin cancer risk, and organ transplantation patients. Findings in the literature demonstrate that increased knowledge and awareness does not consequently translate into behavioral changes in practice. Behavior can differ as a result of different attitudes and beliefs, depending on the population at risk. Thus, intervention should be tailored to the population targeted. A multidisciplinary health team providing consultation and education is required to influence these much needed changes.

Children's skin cancer prevention: a systematic review of parents' psychosocial measures

CONTEXT

Parents' knowledge, attitudes, and beliefs may be influenced through intervention to increase children's sun protection. Little is known about measures of these psychosocial characteristics, including psychometric properties. This paper systematically reviews parents' psychosocial measures in children's skin cancer prevention studies.

EVIDENCE ACQUISITION

A search of standard databases conducted in 2008, updated in 2011, yielded 5797 unique citations. A study was eligible if (1) it was published between January 1980 and March 2011; (2) it was published in English; (3) it reported a psychosocial measure relevant to children's skin cancer prevention; and (4) the psychosocial measure was administered to parents, the majority of whom had children aged ≤12 years. Screening yielded 57 eligible studies. Data were analyzed in 2008 and 2011.

EVIDENCE SYNTHESIS

Most studies measured one (n=24) or two (n=18) psychosocial constructs; few (n=7) measured more than three. The most frequently measured constructs were knowledge (n=41); attitudes (n=22); perceived susceptibility/risk (n=11); self-efficacy (n=9); and perceived barriers (n=9). Most studies did not mention theory. Theoretic mechanisms underlying interventions were not examined. There was little description of measure validity. Reliability, usually internal consistency, was reported more often (n=19).

CONCLUSIONS

Few studies assessed more than two parent-related psychosocial constructs, so it was not possible to test theoretic models of parental influences on children's sun protection. Validated measures were lacking. There was conceptual overlap of measures because of the presence of analogous constructs across theories and assessment of multiple constructs within a single measure.

Sunburn in children and adolescents: associations with parents' behaviour and attitudes

AIMS

Sunburn in childhood is a known risk factor for melanoma and non-melanoma skin cancer. Based on a theoretical model, we tested the hypothesis that parental attitudes and behaviour are related to the risk of sunburn in their children.

METHODS

We analysed the association between behaviour in the sun and attitudes related to tanning among Danish parents and their children's risk for sunburn by logistic regression. Gender, educational level, and skin type of the responding parent were included as confounders and analyses were stratified for child age.

RESULTS

In children aged 7-12 and 13-17 years, the risk of sunburn increased when parents had experienced sunburn themselves, and also for 13-17 year olds if parents had a very positive attitude towards tanned skin. We found no association between parental attitudes and behaviour and the risk of sunburn in children aged 0-6 years.

CONCLUSIONS

Interventions to influence the attitudes and behaviour of parents could reduce their children's risk for excessive sun exposure and thereby their risk for melanoma and non-melanoma skin cancer. The results encourage preventive campaigns to focus on changing parental attitudes towards tanned skin and sun behaviour.

Epidemiology of vitamin D deficiency in children presenting to a pediatric orthopaedic service in the UK

BACKGROUND

Vitamin D deficiency may increase predisposition to a number of pediatric orthopaedic conditions and the prevalence of vitamin D deficiency is increasing in children in developed countries. The aim of this study was to determine the epidemiology of vitamin D deficiency and insufficiency in children presenting to a regional pediatric orthopaedic service. We also examined the relationships between vitamin D status, social deprivation, and ethnicity.

METHODS

Individuals of age 18 years and younger presenting to the regional pediatric orthopaedic service at Southampton, UK from 2008 to 2010 were investigated. Deprivation index scores were calculated from indices of deprivation.

RESULTS

A total of 187 children (97 male, 90 female, mean age 7.1 y) underwent serum 25-hydroxyvitamin D level measurement. Of them 82% were white British and 11% were of Asian ethnicity. The calculation of the total depravation index for the whole cohort showed 34 patients (18%) were in quartile 1 (most deprived), 54 (29%) in quartile 2, 49 (26%) in quartile 3, and 50 (27%) in quartile 4 (least deprived). Sixty patients (32%) had vitamin D insufficiency with 25-(OH) levels <50 nmol/L and 15 patients (8%) had vitamin D deficiency. No relationship was identified between vitamin D level and social deprivation score.

CONCLUSIONS

There is a need for awareness of the prevalence of vitamin D deficiency in the pediatric orthopaedic population presenting with bone pain and lower limb deformity before commencing "observation or orthopaedic surgical treatment."

LEVEL OF EVIDENCE

3.

New insights about infant and toddler skin: implications for sun protection

The skin is increasingly recognized as a component of the innate immune response, in addition to its role as a physical barrier. Although the deleterious effects of solar ultraviolet radiation (UVR), including immunosuppression and cutaneous tumorigenesis, are widely acknowledged, most studies to date have concentrated on adult skin. Despite the more sensitive nature of infant and toddler skin, little is known about its responses to UVR exposure, whether acute or long-term. Accumulating evidence suggests not only that the skin's barrier protection remains immature throughout at least the first 2 years of life but also that accumulation of UVR-induced changes in the skin may begin as early as the first summer of life. Such evidence not only affirms the importance of sun protection during the infant and toddler years but underscores the need for more research to establish evidence-based standards of care in this area. In this article we review recent studies in which differences between the skin properties of infants and young children and those of adults were compared, and we discuss the implications of these differences for sun-protection practices.

Sun behaviour in Canadian children: results of the 2006 National Sun Survey

Childhood sun exposure is a particularly important determinant of skin cancer, yet little data are available for children. This paper describes sun behaviour among Canadian children for the summer of 2006. As part of the Second National Sun Survey (NSS2), 1,437 parents reported on the time spent in the sun, and the frequency of sun protection behaviours and sunburning for one of their children aged 1 to 12 years. Analysis was carried out using complex survey procedures in SAS and STATA. The majority of children (94%) spend at least 30 minutes in the sun on a typical summer day; however, regular sun protection is only commonly reported for young children (1 to 5 years) and involves covering their heads and wearing sunscreen (85%). The frequency of other protective behaviours is much lower, and sun protection decreases with age. Older children are also twice as likely to spend extended time in the sun and to get a sunburn. Among older children, boys are more likely to cover their heads and girls are more likely to wear sunscreen. Regular sun protection among Canadian children is low, given their sun exposure. Heavy reliance on sunscreen is consistent with previous reports and indicates that other measures, such as seeking shade and wearing protective clothing, need to be promoted. Riskier sun behaviour among older children may reflect decreased parental control, as well as changing attitudes and peer pressure, and highlights the importance of adult role models and targeted interventions for this age group.

Predictors of vitamin D status and its association with parathyroid hormone in young New Zealand children

BACKGROUND

Despite increased awareness of the adverse health effects of low vitamin D status, few studies have evaluated 25-hydroxyvitamin D [25(OH)D] status in young children.

OBJECTIVES

We aimed to assess vitamin D status on the basis of 25(OH)D and its relation with parathyroid hormone (PTH) and to identify possible predictors of 25(OH)D status in young children living in a country with minimal vitamin D fortification.

DESIGN

Serum 25(OH)D and PTH concentrations were measured in a cross-sectional sample of children aged 12-22 mo [n = 193 for 25(OH)D, n = 144 for PTH] living in Dunedin, New Zealand (latitude: 45 degrees S). Anthropometric, dietary, and sociodemographic data were collected.

RESULTS

The majority of children sampled in the summer (94%; 47 of 50) had 25(OH)D >50 nmol/L; however, nearly 80% of children sampled in the winter (43 of 55) had serum concentrations < or =50 nmol/L. In season-adjusted multivariate analysis, breastfeeding and higher levels of education were independently associated with lower 25(OH)D concentrations, whereas male sex and cigarette-smoke exposure were positively associated with 25(OH)D (all P < 0.05). Fractional polynomial regression was used to describe the nonlinear relation between serum PTH and 25(OH)D (P < 0.001). When 25(OH)D concentrations were >60-65 nmol/L, a plateau in PTH was evident.

CONCLUSIONS

Seasonal variation in 25(OH)D concentration implies that postsummer vitamin D stores were insufficient to maintain status >50 nmol/L year-round. Examination of the predictors of 25(OH)D in our model shows few modifiable risk factors, and thus effective dietary strategies may be required if future research determines that children with 25(OH)D concentrations <50 nmol/L are at significant health risk. This trial was registered at www.actr.org.au as ACTRN12605000487617.

Sun protection at elementary schools: a cluster randomized trial

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.

Sun safety: what are the health messages?

Solar ultraviolet radiation (UVR) is a human carcinogen. The UK and the worldwide incidence of cutaneous (skin) melanoma are rising. It is now the second most common cancer in 15-34 year-olds in the UK, increasing by 49% in 1991—2000. The UK government prioritized skin cancer in 1992 in their public health strategy The Health of the Nation, and set the target for reducing the yearly rise in skin cancer incidence by 2005. In 1998 in the Saving Lives: Our Healthier Nation strategy, targets were set to reduce the death rate from cancer, including skin cancer, by 20% by 2010. As a consequence of these targets, since the mid-1990s public health campaigns to reduce sun exposure and skin cancer incidence in the UK have used specific interventions for at-risk groups and the mass media to reach the general population. Evidence indicates a shift in knowledge, with further work required to increase change in behaviour and attitudes.

An associate health problem is vitamin D deficiency, which is prevalent across certain UK population groups. The main childhood health problem associated with vitamin D deficiency is the development of rickets, with evidence indicating those at high risk are exclusively breastfed dark-skinned infants, the elderly, those with dark skin pigmentation, and certain cultural groups that cover their bodies in clothing. Adolescents are the group with the highest incidence of low vitamin D status in the UK, with children of Asian descent at higher risk than Caucasian children. Increasing the outdoor activity levels of children in winter and during the cooler hours in summer is one way of increasing safe sun exposure. It is imperative to educate the general public on the risk of vitamin D deficiency, and offer advice on safe sun exposure, dietary sources of vitamin D, and dietary supplements. More research is required on recommendations for daily vitamin D supplements to determine optimal vitamin D levels in different population groups. There also needs to be reliable and accessible evidence on the links between vitamin D deficiency and lack of sun exposure, with sun safe messages adjusted accordingly.

Solar UVR Exposure, Concurrent Activities and Sun-Protective Practices Among Primary Schoolchildren

Comprehensive measures of ultraviolet radiation (UVR) exposure, concurrent activities and sun-protective practices are needed to develop and evaluate skin cancer prevention and sun protection interventions. The UVR exposures of 345 primary schoolchildren at 23 schools around New Zealand were measured using electronic UVR monitors for 1-week periods over 12 weeks in 2004 and 2005. In addition, ambient UVR levels on a horizontal surface were measured on-site at each school. Children completed activity diaries during the period UVR measurements were made and provided information on their indoor and outdoor status and clothing and sun protection worn. Mean total daily UVR exposure (7:00-20:00 h NZST + 1) at the body location where the UVR monitors were worn was 0.9 SED (standard erythemal dose, 1 SED = 100 J m(-2)). This was 4.9% of the ambient UVR on a horizontal surface. Mean time spent outdoors was 2.3 h day(-1). Differences in children's UVR exposure could be explained in part by activity, where outdoor passive pursuits were associated with higher UVR exposure rates than outdoor active and outdoor travel pursuits. Compared with older children, the activities of younger children, although labeled the same, resulted in different UVR exposures, either as a result of reporting differences or a real difference in UVR exposure patterns. UVR exposure rates were generally higher on weekdays compared with the weekend, confirming the important role of school sun protection and skin cancer prevention programs. High UVR exposure activities included physical education, athletics and lunch break.

Student–parent agreement in self-reported sun behaviors

OBJECTIVE

We sought to describe agreement between parent proxy and student self-reported sun behaviors and sun protective practices in adolescents aged 10 to 14 years.

METHODS

We conducted a cross-sectional pilot study of students (n = 52) from two classrooms, grades 6 and 7, at a school system in Framingham, Mass. Data were collected using self-administered questionnaires. Students were asked to report their sun behaviors and sun protective practices. Proxy measures were obtained by asking parents to report sun behaviors and practices of their children. Agreement was measured using weighted kappa analysis for ordinal data. Mean differences (95% confidence intervals) were calculated.

RESULTS

The response rate for student/proxy pairs was 96% (n = 50). Agreement between student and proxy was good for skin color, sunscreen use, number of sunburns in the past summer, and application of sunscreen while in other outdoor places (range kappa = 0.52-0.73). Lowest agreement was found for questions relating to wearing a shirt, wearing a hat, sitting in the shade, and frequency of parental sunscreen application to the students' backs (range kappa = 0.08-0.28). Mean differences in responses between student and proxy respondents were relatively small ranging from -0.39 to +0.25.

CONCLUSIONS

The lack of a gold standard in the assessment of sun exposure and related sun protective practices limits the ability to validate these exposure measures in skin cancer studies. The assessment of sun exposure behaviors is especially problematic when relying on a child's ability to accurately recall these exposures. Parent proxy measures are often used as surrogate measures and for validation purposes. We found low to moderate student/proxy agreement in this pilot study suggesting that adolescents can effectively recall their recent sun behaviors and protective practices when compared with parent proxy measures.

Sun-safe practices in U.S. youth and their parents: role of caregiver on youth sunscreen use

BACKGROUND

There is a limited understanding of the social influences, such as the role of parents on youth sun-safe practices, that may reduce the risk of developing skin cancer later in life.

METHODS

This study examined the degree of correlation in sun-safe practices between youth and their parents and assessed independent parental factors of youth sunscreen use in a 1998 cross-sectional, population-based telephone survey of U.S. youth (11- to 18-year-olds) and their parents/caregivers (N=1192 pairs of youth and parents).

RESULTS

Sunscreen-use practices between youth and their parents were significantly correlated, albeit small. Youth were significantly more likely to use sunscreen frequently if their parents applied it frequently on themselves. Multivariate analysis revealed three independent parental factors associated with frequent youth sunscreen use: Their parent reported to insist frequently that the child uses sunscreen (adjusted prevalence odds ratio [aPOR]=2.4, 95% confidence interval [CI], 1.6-3.8); parent reported no difficulty with protecting their child from the sun (aPOR=1.4, 95% CI, 1.1-1.9); and parent's own frequency of sunscreen use (aPOR=1.3, 95% CI, 0.9-1.8).

CONCLUSIONS

Sun-safe practices were correlated between parent-child pairs and parental factors exerted a positive role on youth sunscreen-use frequency. These data may guide further sociobehavioral and intervention research for the design of skin cancer prevention programs in schools and communities to improve levels of sun-safe practices.

Sun protection counseling by pediatricians

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.

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 (approximately 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.

Predictors of sunburn among Canadian adults

BACKGROUND

Data from the 1996 National Survey on Sun Exposure & Protective Behaviors (4,023 respondents) were analyzed to identify independent predictors of sunburn among adult Canadians.

METHODS

Multivariate models predicting sunburn odds were developed using unconditional logistic regression. Backward elimination model selection was used to identify independent predictors of sunburn.

RESULTS

Nonbehavioral characteristics found to predict sunburn were younger age, male sex, light skin color, nonblack hair color, and birthplace in North America or Europe. Behavioral predictors of sunburn included high awareness of the UV Index, working outdoors in the summer, longer leisure time in the sun, forgetfulness about protecting oneself from the sun, and seeking a tan. Sun avoidance between 11 AM and 4 PM was associated with lower odds of sunburn, while seeking shade when outside and use of protective clothing showed nonsignificant associations with lower sunburn odds. Sunscreen use was found to have a nonsignificant positive association with sunburn.

CONCLUSIONS

These findings highlight risk factors to be considered in the targeting of sunburn reduction strategies to high-risk groups and suggest that sun avoidance, seeking shade, and use of protective clothing may be effective in preventing sunburn.

Sunburn and sun protection among New Zealand adolescents over a summer weekend

OBJECTIVE

To examine predictors of sunburn and sun protection practices during summer weekends within a sample of NZ adolescents.

METHOD

Phone interviews were conducted with 203 participants aged 12-17 years. Questions were asked about behaviour from 11am to 4pm during the previous weekend.

RESULTS

Less than half of the sample outside during peak radiation hours wore sunscreen and only a quarter wore hats. Sunburn was experienced by 31% of adolescents and was associated with spending longer times outside and use of sunscreen without reapplication. Wearing a sunhat was predicted by being younger and male, while sunscreen use was predicted by being female.

CONCLUSIONS

There is a lack of appropriate sun protection among many NZ adolescents, and correspondingly high rates of sunburn. Possible opportunities to address this are through increasing the efficacy of sunscreen and sun hat use, and creating outdoor environments that support sun avoidance.

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.

Factors associated with sunburn in white children aged 6 months to 11 years

OBJECTIVE

To determine the sunburn experience and factors associated with sunburn among white children aged 6 months to 11 years.

METHODS

Telephone interviews were conducted with parents and primary caretakers of children, selected by random, stratified sampling, in the contiguous United States in the summer of 1998. Information was gathered on demographic characteristics of parents and children, and children's sunburn experience during the past year, protection from sun exposure, and hours per week spent outdoors. The proportion of children experiencing sunburn in the past year was calculated. Multivariate logistic regression analyses were conducted to determine factors associated with sunburn. Information for 1052 white children was available for the analyses.

RESULTS

An estimated 42.6% of U.S. white children experienced one or more sunburns within the past year (95% CI 38.2-47.0). Sunburn was less common among children who ever wore hats (adjusted OR 0.59, 95% CI 0.40-0.87) and more common among children who did not always wear sunscreen (OR for using sunscreen sometimes compared with always, 2.25; 95% CI 1.31-3. 86). Sunburn was also more common among children with sun-sensitive skin and older children.

CONCLUSIONS

A large proportion of U.S. white children experience sunburns. Parents and children may benefit from education about protection from sun exposure.