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

An evaluation of the amount, type and use of shade at public playgrounds in Guelph, Ontario, Canada

INTRODUCTION

The provision of shade at outdoor recreation sites such as playgrounds confers a variety of public health benefits. It can prevent overexposure to solar ultraviolet radiation, and, in turn, protect against skin cancer. Further, shade mitigates heat and may promote physical activity. In this study, we evaluate and describe the amount, type and use of shade at public playgrounds.

METHODS

Using a modified shade audit tool, shade audits were conducted to visually evaluate shade coverage at 85 city-operated playgrounds in Guelph, Ontario, Canada, in summer 2019.

RESULTS

The main play area of most playgrounds (68%) had no shade available. Although the areas surrounding playgrounds had more shade coverage than the main play areas, we also found minimal shade coverage (> 0% to 30%) in this area for many playgrounds (48%). All shade over main play areas was provided by trees (i.e. natural shade). Permanent, built shade structures were observed in the surrounding area of 13% of playgrounds. Shade coverage in the areas surrounding playgrounds was positively correlated with the number of individuals (rs = 0.259; p = 0.017), children (rs = 0.270; p = 0.012), and active individuals (rs = 0.253; p = 0.020) using the surrounding area. This suggests that individuals seek shade at playgrounds and may be more active in shaded areas.

CONCLUSION

Children have limited protective shade available to them at playgrounds. Future research is needed to determine how to best increase shade provision and to further explore the impact it has on playground usage, activity levels, temperature and UVR exposure.

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.

Attitudes, Beliefs, and Measures Taken by Parents to Protect Their Children from the Sun in Guangzhou City, China

Excessive sun exposure can cause sunburn, suntan, skin photoaging, and even skin cancer. Skin photoaging conflicts with the human pursuit of a young and beautiful appearance. Some research data indicate that the incidence of skin cancer in the Chinese has been increasing, although it remains lower than in whites. To estimate the prevalence of sun protection used on Chinese children aged 3-13 years and identify its predictors, a population-based cross-sectional questionnaire was given to 3684 parents/guardians of children in Guangzhou, China, of which 3083 questionnaires were returned. Of those returned, 35.5% of parents/guardians reported regularly using sun protection on their children and the primary reason cited was to prevent sunburn. Hats and handheld umbrellas were the most frequently used measures; sunscreen was less common, and when used, 48.8% of parents/guardians still reapplied sunscreen on their children every 2.0-3.0 h. Parental age, parents using sun protection measures themselves when outdoors, and the child's sex were factors associated with regular use of sun protection on children. These results suggest that sun protection campaigns targeted toward parents and children need to be conducted in Guangzhou, or throughout China, to strengthen awareness about sun protection and address any inadequate protocols of sun protection.

Increasing incidence of nutritional rickets: a population-based study in Olmsted County, Minnesota

OBJECTIVE

To determine temporal trends in incidence and risk factors of nutritional rickets in a community-based population.

PATIENTS AND METHODS

Rochester Epidemiology Project data were used to identify all children (aged <18 years) residing in Olmsted County, Minnesota, between January 1, 1970, and December 31, 2009, with diagnostic codes corresponding to rickets, vitamin D deficiency, hypovitaminosis D, rachitis, osteomalacia, genu varum, genu valgum, craniotabes, hypocalcemia, hypocalcemic seizure, and tetany. Record abstraction was performed to select individuals with radiographic confirmation of rickets. Age- and sex-matched controls were identified for the evaluation of risk factors. The main outcome measure was radiographic evidence of rickets without identifiable inherited, genetic, or nonnutritional causes. Incidence rates were calculated using Rochester Epidemiology Project census data.

RESULTS

Of 768 children with eligible diagnostic codes, 23 had radiographic evidence of rickets; of these, 17 children had nutritional rickets. All 17 children were younger than 3 years, and 13 (76%) were of nonwhite race/ethnicity. Clinical presentation included poor growth (n=12), leg deformity (n=8), motor delay (n=5), leg pain (n=3), weakness (n=3), and hypocalcemia or tetany (n=2). The incidence of nutritional rickets in children younger than 3 years was 0, 2.2, 3.7, and 24.1 per 100,000 for the decades beginning in 1970, 1980, 1990, and 2000, respectively (P=.003 for incidence trend). Nutritional rickets was associated with black race, breast-feeding, low birth weight, and stunted growth (P<.05 for all). Four of 13 patients (31%) who underwent 25-hydroxyvitamin D testing had values less than 10 ng/mL.

CONCLUSION

Nutritional rickets remains rare, but its incidence has dramatically increased since 2000. Not all cases of rickets can be attributed to vitamin D deficiency.

The Sun Exposure and Behaviour Inventory (SEBI): validation of an instrument to assess sun exposure and sun protective practices

BACKGROUND

Skin cancer is the most common cancer worldwide. Sun exposure is the most important risk factor for its development. The amount of exposure required to cause skin cancer has not been quantified, and the impact of sun protective practices is unknown.

OBJECTIVES

To develop a brief self-administered questionnaire to estimate past and current sun exposure, sun protective practices, and assess the questionnaire's reliability and validity.

METHODS

The study had three stages: (1) questionnaire formulation, (2) internal reliability and construct validity testing and questionnaire refinement, (3) test-retest and further internal reliability testing. The final Sun Exposure and Behaviour Inventory (SEBI) is composed of 15 questions assessing three domains; current sun behaviour, current sun exposure and prior sun exposure.

RESULTS

A total of 251 subjects completed Stage 2 testing and 57 completed Stage 3. Final Cronbach's α-scores ranged from 0.71 to 0.84 and k-scores demonstrated excellent to fair/good agreement, indicating acceptable internal consistency and test-retest reliability. Construct validity was evidenced by significantly higher prior sun exposure scores and lower current sun behaviour scores in subjects with a history of non-melanoma skin cancer.

LIMITATIONS

Self-reported questionnaires, though efficient and low cost, may be subject to recall error and bias. Further work remains to determine if the SEBI maintains its reliability and validity in different populations.

CONCLUSION

The SEBI is a brief self-administered questionnaire, which appears to be reliable and valid. It may provide useful measures of past and present sun exposure and current sun behaviour, which may be useful in studies of skin cancer incidence and risk modification.