Predicting children's sunscreen use: application of the theories of reasoned action and planned behavior

The risk of ultraviolet exposure for melanoma in Fitzpatrick skin types I-IV: A 20-year systematic review with meta-analysis for sunburns

Within the last two decades, no studies have comprehensively reviewed the risk of varying types of ultraviolet (UV) exposure on melanoma in fairer skinned individuals. Our research objective was to determine whether or not there was a change in the risk of UV exposure with development of melanoma in Fitzpatrick skin types I-IV based on more recent data over the past 20 years. We performed a systematic review from January 2002 to December 2021 analysing UV exposure and melanoma risk in Fitzpatrick type I-IV individuals. Out of 19,852 studies, 26 met inclusion criteria. Data spanned subjects from national and multinational cohorts (USA, Europe, Australia, Asia and South America). Twenty studies (77%, 20/26) identified a significant association between UV exposure and melanoma incidence. Sunburn was the most commonly assessed risk factor. Sunburn studies encompassed 3417 melanoma and found positive significant odds ratios (OR [95% CI]) in 11 out of 13 studies, ranging from 1.23 [1.01-1.49] to 8.48 [4.35-16.54]. Pooled analysis of the risk of melanoma with sunburn history found an unadjusted odds ratio of 1.66 [1.40-1.97] and adjusted odds ratio of 1.23 [1.04-1.46]. Cumulative sun exposure, measured as number of hours of sun exposure or calculated UV flux, was the second most common risk factor, encompassing 913 melanomas with positive significant ORs ranging from 1.1 [1.0-1.2] to 5.2 [2.1-12.5]. For other forms of UV exposure, a majority of studies showed an association with UV index (6/9), outdoor leisure activity (3/3) and left-sided laterality (1/1). Overall, UV exposure should continue to be considered a modifiable risk factor for melanoma in individuals of fairer skin.

Construcción del cuestionario de intención hacia el alcohol para niños mexicanos desde la Teoría de la Conducta Planeada

El incremento en el consumo de alcohol y la disminución en la edad de inicio requiere del desarrollo de propuestas preventivas dirigidas a población en edad más temprana, sustentadas teórica y empíricamente. La Teoría de la Conducta Planeada (TCP) constituye una base sólida para el desarrollo de propuestas de intervención en prevención de un comportamiento, para ello se debe conocer la intención que tiene el sujeto de realizarlo, siendo necesario evaluar sus creencias de comportamiento, normativas y de control, sobre la conducta de interés. Un medio para evaluar dichas creencias lo constituyen las escalas de medición. El objetivo de este trabajo es describir el proceso que se siguió para construir un instrumento, válido y confiable, que mide la intención de los niños para consumir bebidas con alcohol.

Investigating the role of implicit prototypes in the prototype willingness model

One useful theory to predict health behavior is the prototype-willingness model (PWM), which posits that people are more willing to engage in behavior to the extent that they have a positive view of the prototypical person who performs that behavior. The goal of the present research is to test whether adding an implicit measure of prototype favorability might improve explanatory power in the PWM. Two studies examined whether implicit prototype favorability uniquely predicted White women's intentions to engage in healthy sun behavior over the next 3-6 months, and their willingness to engage in risky sun behavior, should the opportunity arise. The results suggested that implicit prototype favorability, particularly implicit prototypes of those who engage in risky UV-related behaviors, uniquely predicted intentions to engage in healthy sun behavior and willingness to engage in risky sun behavior in the PWM.

A Sun Awareness Pilot Project in Texas

Skin cancer, the most common cancer in the United States today, is the most preventable. Sun overexposure results in approximately 90% of all skin cancer. Americans' lifetime risk of developing skin cancer is one-in-six. The purpose of this pilot project was to increase the level of sun protection knowledge and awareness in parents at their baby's 6-month immunization visit. This nonrandomized pretest, intervention, posttest study was modeled after Australia's Anti-Cancer Council “Slip! Slop! Slap!” campaign. Self-reported baseline data about parental sun protective measures for parents and their children were obtained from five pediatric clinics in Texas. Demographics, skin type, knowledge, attitudes, and beliefs about the sun and sun protection were investigated. Overall, parental sun protective knowledge and awareness increased; however, parents protected themselves more on average than they did their children. These findings should be a useful guide for future health education on prevention of skin cancers.

Sun Protection as a Family Health Project in Families with Adolescents

This study examined sun protection in families with adolescents from an action-theoretical perspective. Interview data were collected from 20 families about their attitudes and behaviors around sunbathing and sun protection. The data support the understanding of project as joint goal-directed action over time as the basis on which these behaviors are organized in families. Families used the language of goal-directed action to discuss family sun protection. Differences between families with focused and diffuse sun-protection projects are identified. Sun protection in families as one part of an array of family goal-directed actions and projects has implications for health promotion.

Knowledge and practice of sun protection in schools in South Africa where no national sun protection programme exists

Interventions in primary schools that increase sun-protective behaviours and decrease ultraviolet radiation exposure, sunburn incidence and skin cancer risk can be effective. SunSmart School Accreditation Programmes (SSAP) are recommended. Prior to SSAP implementation in South Africa, we explored the feasibility of obtaining national baseline information and investigated possible associations between strategies regarding sun protection in schools and students' responses to a questionnaire. Principals from randomly selected urban government schools in all nine South African provinces completed a questionnaire and 679 students were surveyed. The mean sun-related knowledge and behaviour scores of students were 4 (range: 1-7) and 3 (range-0-8) out of 9, respectively. The mean school sun protection effort score was 4 out of 14. There were no statistically significant correlations between students' knowledge or behaviour scores and their school score. The World Health Organization recommends an SSAP to address policy, practice and curriculum changes to support sun protection of students. This cross-sectional study demonstrates the feasibility of, and need for, a larger baseline study with longitudinal, multi-variable follow-up which includes other influential factors, such as parent support. Such research could quantify the impact of the SSAP and identify which key factors influence the sun-related knowledge and behaviours of students.

Online discussion effects on intention to participate in genetic research: A longitudinal experimental study

OBJECTIVE

The National Human Genome Research Institute has emphasised community engagement and public dialogue in the U.S. on issues related to genetics. This study examines how online discussions among the U.S. public directly or indirectly influence psychosocial constructs of the Theory of Planned Behavior, including intention to take part in genetic research.

DESIGN

After completing the baseline questionnaire, participants (n = 3754) were randomly assigned to one of the following three groups: the discussion group, the pre-/post-only group and the End-of-Project group. The discussion group (n = 1824) was invited and participated in up to three online discussions, which were held from November 2008 to May 2009.

MAIN OUTCOME MEASURES

Behavioural intention, beliefs, attitudes, subjective norm and perceived behavioural control variables were assessed.

RESULTS

The most interesting finding was that those participating in online discussions had fewer negative beliefs about volunteering for genetic research, which in turn contributed to more positive attitudes, increased injunctive and descriptive norms and enhanced behavioural control. These relationships, then, were associated with higher intention to participate in genetic research.

CONCLUSION

These findings suggest that continuous public discussions seem to positively affect volunteer intention for genetic research through ameliorating fears of negative consequences.

Protective skin care behaviors in cancer survivors

PURPOSE

Research suggests that physicians neglect preventive care for cancer survivors. A survivor's self-motivation with respect to preventive care is unknown. Using protective skin care as a proxy, our aims were to characterize preventive care in cancer survivors and to identify factors associated with appropriate prevention.

METHODS

Using data from the 2009 U.S. Health Information National Trends Survey, we compared preventive skin care patterns in cancer survivors and non-cancer patients. Primary endpoints were the use of sunscreens, long-sleeved shirts, hats, and shade.

RESULTS

We identified 179 early cancer survivors (<5 years), 242 intermediate cancer survivors (5-10 years), 412 long-term cancer survivors (>10 years), and 5951 non-cancer patients. The use of sunscreens (60%), long-sleeved shirts (88%), hats (58%), and shade (68%) was suboptimal. Overall, cancer survivors were not more likely to adhere to preventive care (p = 0.89). A composite score showed a significant difference between the cancer survivor groups (p < 0.01) whereby intermediate survivors reported the best preventive practices.

CONCLUSIONS

A prior diagnosis of cancer does not appear to increase personal compliance with cancer prevention. Reasons for this poor engagement are not clear. Targeted strategies to increase self-motivation might improve preventive practices in cancer survivors.

The role of emotions in UV protection intentions and behaviors

Two studies examined the role of emotions, relative to cognitions, in predicting sun protection intentions and practices. In Study 1, 106 females were assessed for baseline sun protection, ultraviolet (UV) radiation exposure-related cognitions (perceived susceptibility to skin damage, self-efficacy for regular sunscreen use, perceived costs of sun protection use, perceived rewards of tanning), anticipated negative mood following future risky UV behavior, and future sun protection intentions. Self-reported sun protection behavior was then assessed in the same participants five weeks later. The results of Study 1 demonstrated that the extent to which participants' expected to experience negative feelings if they engaged in future risky UV behavior predicted their intentions to sun protect and their subsequent sun protection behaviors independent of their UV radiation exposure-related cognitions. In Study 2, in addition to the assessments collected in Study 1, participants were exposed to an appearance-based intervention that included visual images of their existing skin damage and were then assessed for their emotional reactions to the intervention. The results replicated those of Study 1 and, in addition, showed that negative emotional reactions to the intervention predicted future sun protection intentions and self-reported behaviors at follow-up, independent of the various cognitive factors that are central to prominent models of health behavior. These studies provide preliminary support for the development of expanded health behavior models that incorporate anticipated and experienced emotions.

Legally brown: using ethnographic methods to understand sun protection attitudes and behaviours among young Australians 'I didn't mean to get burnt--it just happened!'

Sun protection is not commonly perceived as an important issue by adolescents yet this behaviour would, if adopted, confer significant lifelong protection against skin cancer. Despite the world's highest skin cancer rates, Australia remains a culture which values sun seeking, tanning and outdoor activities. This qualitative study used ethnographic methods to produce insights into sun protection behaviours and attitudes of Australian adolescents aged 15 and 16 years. Applying the Theory of Planned Behaviour to the analysis, the study involving 51 adolescents revealed the complexity of the factors that influence sun protection behaviours, such as peers, lifestyle, environments, social norms and fashion. Sun protection was imbued with associations of negativity, dullness and irritation which was dissonant with adolescents' buoyant, dynamic and 'fun filled' experience of the sun. Key barriers to sun protection were found to stem from the perceived impact of sun protection behaviour on the peer dynamic, negative perceptions around what sun protection communicates about the user, the tone of existing sun protection communications and the spontaneous unplanned nature of the adolescent lifestyle. The paper concludes by discussing the implications for health promotion with this hard to reach group.

Social Cognitive Correlates of Young Adult Sport Competitors’ Sunscreen Use

Young adults participating in outdoor sports represent a high-risk group for excessive sun exposure. The purpose of this study was to identify modifiable social cognitive correlates of sunscreen use among young adult competitors. Participants aged 18 to 30 years who competed in soccer ( n = 65), surf-lifesaving ( n = 63), hockey ( n = 61), and tennis ( n = 48) completed a sun habits survey. Almost half ( n = 113) of the participants used sunscreen inadequately and 30% ( n = 70) reported not using sunscreen. In fully adjusted models, social cognitive attributes significantly ( p < .05) associated with inadequate sunscreen use (vs. nonuse) included skin cancer risk perceptions (OR = 0.6, 95% CI = 0.3, 1.0), perceived barriers to sunscreen use (OR = 0.5, 95% CI = 0.3, 0.9), and stronger personal norms for applying sunscreen (OR = 1.8, 95% CI = 1.0, 3.2). These findings provide insight into the attributes that enable or inhibit the use of sunscreen among young competitors and as a result may be useful in informing behavior change interventions within the sporting context.

Parents as health promoters: a theory of planned behavior perspective on the prevention of childhood obesity

Childhood obesity is a significant problem in the United States. A number of communication campaigns and interventions have been conducted to combat the problem, with parents being recognized as an important target audience. A critical aspect of involving parents in such campaigns is formative research on parents' perceptions of their role in preventing childhood obesity. To facilitate this process, a study was conducted in which parents (N = 201) responded to Theory of Planned Behavior (TPB) survey items as they relate to providing healthy foods and limiting unhealthy foods for their children. Results indicated support for TPB predictions. Additionally, the degree to which parents viewed providing healthy foods and limiting unhealthy foods as effective in preventing obesity (response efficacy) was predictive of parent tracking of children's unhealthy eating behavior. Finally, parent TV viewing behavior was related to perceived response efficacy of limiting children's TV viewing hours. Practical implications for communication practitioners are discussed.

Child sun protection: sun-related attitudes mediate the association between children's knowledge and behaviours

AIM

To describe and investigate the relationship among the sun-related knowledge, attitudes and behaviours of New Zealand primary schoolchildren and consider the roles of sex and school year level.

METHODS

A randomly selected, two-stage cluster sample of 488 children from 27 primary schools in five regions of New Zealand was surveyed regarding their sun-related knowledge, attitudes and behaviours. A scoring system was used to assign a knowledge, attitude and behaviour score to each child.

RESULTS

Although knowledge increased with school year level, there was a decline in sun protective attitudes and behaviours. There was little variation in knowledge, attitudes and behaviour between boys and girls, but sex-year level interactions were found for knowledge and behaviour. When considering children's knowledge, attitudes and behaviours simultaneously, knowledge was only significantly associated with behaviours when mediated by attitudes.

CONCLUSIONS

When targeting child sun protection and skin cancer prevention programmes, a focus on attitudes towards sun exposure and a suntan may prove beneficial in influencing sun-related behaviours.

The impact of an appearance-based educational intervention on adolescent intention to use sunscreen

During adolescence, there is a steady decline in the use of sun protection and increased use of indoor tanning lights. Previous health education efforts have changed knowledge but not these behaviors. Middle school students (n=113) received a single educational class that included personal viewing of skin changes visible under ultraviolet (UV) filtered light. Pre-/post-surveys assessed past, current and future intent to use sunscreen, as well as sun benefit and sun risk attitudes. Prior to the session, 42% were sunscreen non-users and 21% were consistent users. At post-test, one-third of students who had not previously intended to use sunscreen in the next month now intended to use it. Among students who had seen skin damage, 59% reported intention to use sunscreen in the next month versus 35% who did not see skin changes (P = 0.04). Viewing sun damage was an independent predictor of intent to use sunscreen in the next month (OR 2.9, P = 0.04), as was older age (OR 2.6, P = 0.04) and previous consistent sunscreen use (OR 6.1, P = 0.004). A brief educational intervention that emphasizes risk-to-appearance and personalizes the risks of UV exposure has the potential to influence early adolescent sun protection. Long-term studies of this approach are needed.

Associations between deprivation, attitudes towards eating breakfast and breakfast eating behaviours in 9–11-year-olds

Objectives

To examine school-level relationships between deprivation and breakfast eating behaviours (breakfast skipping and the healthfulness of foods consumed) in 9–11-year-old schoolchildren and to examine whether attitudes towards eating breakfast mediated these relationships.

Design

Cross-sectional survey.

Setting

One hundred and eleven primary schools in Wales.

Subjects

Year 5 and 6 pupils within the 111 primary schools. Measures were completed by 4314 children. Analysis was conducted at the group (school) level, with each school representing one group.

Results

Deprivation was positively associated with breakfast skipping and consumption of ‘unhealthy’ items (i.e. sweet snacks, crisps) for breakfast. A significant negative association was found between deprivation and consumption of ‘healthy’ items (i.e. fruit, bread, cereal, milk). Deprivation was significantly inversely associated with attitudes towards eating breakfast. The relationships between deprivation and (1) breakfast skipping and (2) consumption of ‘healthy’ items for breakfast were mediated by attitudes towards eating breakfast. The hypothesis that attitudes mediated the relationship between deprivation and consumption of ‘unhealthy’ breakfast items was unsupported.

Conclusions

Deprivation is associated with adverse breakfast eating behaviours amongst children aged 9–11 years, in terms of breakfast skipping and the quality of breakfasts consumed. Socio-economic differences in attitudes towards eating breakfast are apparent amongst this age group, and appear to relate to social gradients in breakfast eating behaviours. Research is needed to examine the causal nature of these trends and to elucidate factors underlying the development of socio-economic differences in eating-related cognitions.

Toward a Model of Prostate Cancer Information Seeking

Public health actions to improve African American men's ability to make informed decisions about participation in prostate cancer control activities have a greater likelihood of success when they are theory driven and informed by members of the target population. This article reports on formative research to evaluate the usefulness of the theory of reasoned action as a model to explain and predict prostate cancer information-seeking behavior by African American men. Fifty-two men participated in eight focus group interviews. Positive behavioral beliefs for obtaining prostate cancer information from physicians included increasing awareness of and obtaining accurate information about the disease, early detection and screening, and treatment. Negative beliefs included fear, distrust, and inconvenience. Significant others, peers, siblings, and religious leaders were identified as individuals who could influence this behavior. These findings provide additional insight into ways to reach and intervene with African American men to influence this important cancer control activity.

Motives of Belgian Adolescents for Using Sunscreen: The Role of Action Plans

The first objective of this study was to analyze the differences between adolescents who use sunscreen frequently and those who do not. The second objective was to explore the importance of specific action plans when planning sunscreen use. Data was gathered among 602 Belgian secondary school students. Frequent and infrequent users of sunscreen were compared on several determinants related with sunscreen use, and a regression analysis on sunscreen use was done. Frequent users of sunscreen measures had significantly higher scores on attitudes, social influence, self-efficacy, some awareness factors, intention, and action plans. The integrated model for exploring motivational and behavioral change (I-Change model) explained 57% of the total variance of using sunscreen every 2 hours. Frequent sunscreen use was most strongly predicted by action plans, followed by positive intentions to use sunscreen, wearing protective clothing, seeking shade, attitude toward sunscreen use, education, social influence, and exposure to the sun. Our results suggest that skin cancer prevention programs aimed at promoting sunscreen use need to emphasize the advantages of sunscreen to infrequent users and to increase feelings of self-efficacy. Moreover, support by friends and parents should be stimulated. Finally, developing specific action plans for the use of sunscreen should be promoted to more effectively translate general intentions into actual sunscreen use.

Youth solar ultraviolet radiation exposure, concurrent activities and sun-protective practices: a review

To assist standardization of procedures, facilitate comparisons, and help guide research efforts to optimally inform development of appropriately targeted interventions, there is a need to review methods used to quantify child and adolescent solar ultraviolet radiation (UV) exposure, related outdoor activities and sun-protective practices. This holistic approach is essential for comprehensive research that will provide all-inclusive, informative and meaningful messages for preventive measures of harmful UV exposure. Two databases were searched and 29 studies were retrieved, and these studies report measurement or assessment techniques documenting UV exposure patterns and related outdoor activities. Polysulfone film badges were the main measurement instrument used in 10 studies, with questionnaire, survey data, observation, a model, electronic dosimeters, biological dosimeters, colorimeter and UV colouring labels used in the remaining studies. Methods used to record activities included self-report, parental report, a logbook and observation. Measurement duration and unit of UV exposure varied in most studies, but a method common to 15 studies was measured UV exposure as a percentage of ambient UV. The studies reviewed do not provide sufficient information for the development and evaluation of targeted youth sun protection programs. Studies are required which document precise UV exposure, concurrent activities and sun protection usage for children and adolescents.

Connaissances, attitudes et comportements des adultes vis-à-vis du soleil en France

INTRODUCTION

The number of new skin cancers has constantly increased in France over the past two decades. The role of sun exposure can partly explain this phenomenon and justifies the development of information and prevention campaigns to change peoples' attitude towards sun bathing. To be effective, we need to know how much information and what attitudes the population currently has with regard to the sun. Although several studies in France have targeted children, little data is available regarding adults. This trial was aimed at pinpointing the knowledge, attitude and behavior of adults regarding sun exposure.

MATERIAL AND METHODS

Data were collected during a randomized multicenter study on the prevention and early diagnosis of cutaneous tumors, conducted in 26 Health Centers from 1998 to 2000. Standardized questionnaires were handed to those consulting to assess their knowledge, attitudes and behavior towards sun bathing. The population was composed of 41 143 adults aged over 30, consulting one of the 26 Health Check-up units. Analysis of the data was made using SAS v 6.12 and STATA 7.0 software. Logistic regression identified the explicative factors of knowledge and behavior. All the statistical analyses were considered significant above a threshold of alpha<5%.

RESULTS

A total of 33 021 persons filled-in the self-questionnaire. Forty-nine percent were women and 51% were men, with a mean age of 50 years. Geographically, 25% lived in the North-East, 16% in the North-West, 25 p.cent in the South-East and 34% in the South-West. Thirty percent claimed that they tanned without burning and 2% of the population studied had often suffered from sun burn, generally when they were adult. The risks related to sun burn were known, because 92% knew that the sun increased the risk of skin aging and 89% knew that it increased the risk of skin cancer. Regarding sun screens, knowledge was not so good; 42% thought that all products were the same and 53% that they allowed one to sun bathe longer. This knowledge was better in those with fair skins, in those who had a history of sun burn, in women and in those who lived in the northern areas of France. Conversely, knowledge decreased with age and was limited in those aged over 60. Regarding behavior, those with fair skin and who reddened under the sun without tanning, protected themselves more. The women declared they protected themselves more than the men, but they used less sun protective measures (clothing, hats...), other than sun screens, than men. Subjects aged over 60 protected themselves more than younger subjects. Lastly, a personal cutaneous history increased protective behavior, and those from northern France protected themselves more than those from the South.

DISCUSSION

This analysis of 33 021 adults aged over 30 shows the good global knowledge of the consequences of sun bathing, but also the lack of knowledge on the interest of using external sun protection and the role of physical means of protection. Attitudes varied depending on gender, age and phototype and also depending on the area where they lived. Despite good knowledge, the most frequent behavior of adults aged over 30 is still not appropriate with differences depending on age, gender and area, which must prompt more appropriate targeting of prevention campaigns according to the populations concerned.

Skin cancer prevention: behaviour and motives of Dutch adolescents

Skin cancer incidence is rising in the Netherlands and prevention programmes are needed. We analysed sun protection behaviours and beliefs in 500 adolescents aged 15-20 years using the Integrated Model for Change. The results show that adolescents with the fairest skin type exposed themselves significantly less to the sun, but had more burns than groups with a darker skin type. Sunscreen was the most commonly used method by adolescents to protect themselves and 77% of adolescents frequently used this strategy. Sunscreen use was also higher in females than in males. Wearing protective clothing (34%) and seeking shade between 1200 and 1500 h (26%) were less popular and used by adolescents in our study. Frequent use of sunscreen was most strongly predicted by positive intentions to use sunscreen, parental support, a positive attitude towards using sunscreen, support of friends and perceiving skin cancer risks. Wearing protective clothing was predicted most strongly by parental support, having a positive attitude towards wearing protective clothing, seeking shade, support of friends, high self-efficacy levels, low exposure to the sun and being male. Seeking shade was most strongly predicted by a positive attitude towards seeking shade, support of friends, using protective clothing, high self-efficacy, parental support, a negative attitude towards tanning, and perceiving skin cancer risks. Implications for Dutch skin cancer prevention programmes are that the efficacy and advantages of all protective methods need to be outlined more clearly in health education programmes on skin cancer prevention.

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.

Skin cancer prevention: education and public health issues

OBJECTIVES

To examine current public health initiatives related to skin cancer prevention and early detection, and public education issues.

DATA SOURCES

Review articles, research reports, web sites, and government reports.

CONCLUSIONS

Skin cancer remains a major public health problem. Efforts to decrease the morbidity and mortality associated with skin cancer are gradually shifting toward primary prevention. Primary prevention efforts should not only be limited to using sunscreen, but should also focus on reductions in ultraviolet light exposure. Secondary prevention efforts include professional skin examinations and skin self-examination. Tertiary efforts focus on the prevention and detection of additional primary skin cancers.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can influence the public to practice primary, secondary, and tertiary prevention strategies for skin cancer.

Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age

BACKGROUND

Adolescence is a high-risk period for the development of melanoma and nonmelanocytic skin cancers later in life. This study examines the prevalence and correlates of sun-protection practices among U.S. youth.

METHODS

During July-October, 1998, a national, population-based telephone survey was conducted (N = 1,192 paired interviews of youth and their parents). Weighted prevalence and adjusted prevalence odds ratios and 95% confidence intervals were estimated. Multiple logistic regression analyses examined associations between sociodemographics, attitudes, and other modifiable correlates to specific behaviors.

RESULTS

Routinely practiced sun-protection behaviors among youth on sunny days were wearing sunglasses (32%) or long pants (21%), staying in the shade (22%), and applying sunscreen (31%). Fifty-eight percent used a sunscreen with SPF > or =15 when at the beach or pool. Age, sex, and sun sensitivity were associated with substantial variation in some sun-protection behaviors. Factors associated with specific sun-protection behaviors included a lower appeal to tanning, a higher perceived benefit of sun protection, and information from family and friends about sun protection.

CONCLUSION

Effective sun protection is practiced by less than one-third of U.S. youth. This baseline survey will help to monitor progress in skin cancer prevention in this critical age group in the future.