A characterization of sun protection attitudes and behaviors among children and adolescents in the United States

Sun protection knowledge and behaviors of agricultural workers in Turkey: a cross-sectional study

BACKGROUND

Agricultural workers are at risk of developing skin cancer due to prolonged exposure to the sun during their daily work. This study was conducted to determine sun protection knowledge and behaviours of agricultural workers in Turkey.

METHODS

The cross-sectional study was conducted with 460 participants working in agriculture. The data were collected using a sociodemographic form, Skin Cancer and Sun Knowledge Scale and Sun Protection Behaviour Scale. The data were analysed using One Way ANOVA and Independent Samples t Test.

RESULTS

Participants mean total score on the Skin Cancer and Sun Knowledge Scale was 15.24 ± 2.47 (max-min 0-25) and the mean total score on the Sun Protection Behaviour Scale was 24.10 ± 4.46 (max-min 8-40). Statistically significant disparities were observed between the SCBS, SPBS and their sub-divisions along with the working period, age, marital status, gender, level of education, income status, skin type and agricultural working status of the participants (p < .05).

CONCLUSION

The study found that people working in the agriculture had inadequate sun protection behaviours and knowledge. Based on the study's results, it is proposed to create intervention programmes that specifically target single, male, middle-aged or older individuals with extended working hours and low levels of education and income.

The effects of sport, setting, and demographics on sunscreen use and education in young athletes

Participation in outdoor sports increases exposure to ultraviolet radiation, necessitating mitigation through sunscreen use. This prospective study examined the effects of sport, setting (practice vs. competition), gender, age and geographic location on sunscreen use and education among youth athletes in various sports. Six hundred and twelve athletes ≤18 years old completed an online survey on sunscreen education and use during competitions and practices. Regardless of sport, reported sunscreen use was higher during practices than competition (p < 0.0001). Sunscreen was used most by swimmers/divers (odds ratio: OR ≥ 1.9, p < 0.001) and least by American football players (OR ≤ 0.57, p ≤ 0.001). Coaches mentioned sunscreen use the most in track and field (OR 1.84, p = 0.001) and the least in American football (OR 0.67, p = 0.03). Athletes used sunscreen more if they were female (OR ≥ 1.9 1.38, p ≤ 0.06) and younger (age OR ≤ 0.88, p < 0.001). In conclusion, youth athletes differ in sunscreen use by sport and setting, highlighting the need for continued photoprotective education.

Sunscreen Safety and Efficacy for the Prevention of Cutaneous Neoplasm

Sunscreen is widely used for ultraviolet radiation protection. Studies validate sun protection factors (SPFs) to prevent ultraviolet (UV)-induced skin changes such as melanoma and squamous cell carcinoma (SCC). Few studies examine sunscreen's impact on endocrine and immune system dysregulation, the production of radical oxygen species, and whether the ingredients deteriorate under prolonged exposure. We present an investigation of sunscreen labels and how ingredients impact sun safety and human health. A review of the literature was conducted using Embase and PubMed to examine sunscreen safety, efficacy, and use to prevent UV-induced skin damage. Increasing sunscreen reapplication, wearing protective clothing, and limiting exposure can reduce the incidence of skin cancer. Inorganic sunscreens form barriers to block UV light, but without titanium dioxide (TiO2), they may not be advantageous due to their low UVA protection. Organic sunscreens absorb into the skin and provide a better feeling after application. Octocrylene and avobenzone are stable and provide UVA and UVB protection with minimal adverse effects. Oxybenzone is harmful to the neuroendocrine system and should be avoided. Titanium dioxide works for broad-spectrum UV protection and offers minimal adverse effects. Octocrylene and avobenzone are organic sunscreen ingredients that also provide a better feeling on the skin after application, which enables higher rates of use. Oxybenzone should be avoided.

Behaviorally segmented audiences for managing sunscreen chemical pollution risk in protected coastal natural resource areas

This audience segmentation of visitors at coastal parks in Hawaii and North Carolina addresses an emergent natural resource management concern and risk to aquatic ecosystems: sunscreen chemical pollution. Four audiences were identified that correspond to different behavioral profiles: sunscreen protection tourists, multimodal sun protection tourists, in-state frequent park visitors, and frequent beachgoers who skip sunscreen. The second-largest audience, sunscreen protection tourists, represents 29% of visitors at Cape Lookout National Seashore and 25% at Kaloko-Honokōhau National Historical Park. This group ranks of most concern for chemical pollution because they use sunscreen, but not typically mineral formulations or other methods such as protective clothing, and they have lower levels of sunscreen chemical issue awareness. The identification of similar audience segments across regions with differing cultural characteristics and sunscreen regulation status suggests the robustness of the model and its indicator variables, with implications for both environmental protection and public health. Further, coastal visitors' interest in enacting pro-environmental sun protection behaviors during their next park or beach visit indicates the potential for natural resource managers to holistically address risks in both domains through targeted interventions with audiences of most concern.

Sun protection behaviors among children aged 6-18 years old, the role of socioeconomic factors: A cross-sectional study

Background and Aims

Evaluation of sun protection behavior and related factors in children aged between 6 and 18 years in Isfahan, Iran.

Methods

This cross-sectional study was conducted at outpatient pediatric clinics affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during the summer of 2021. A checklist was designed, and the interviewer used that to gather the required information including children's demographic characteristics, families' socioeconomic data, and sun-protective behaviors in children.

Results

The mean ± standard deviation (SD) age of children was 10.54 ± 3.61. Among the study population, 63.7% of children were male. The most common skin phototypes were II and III (33.5% each). 83.8% of children used at least one method of sun protection (94.5% of girls, 77.6% of boys, p < 0.001). Wearing long-sleeved clothes was the most frequent UV-protection method (48%), while sunscreen application was the least prevalent method (28.1%). Sun protection behaviors were more frequent among urban children (86.7%, p = 0.009) and children with wealthy families (94%, p = 0.035). Sun protection methods were used by most of the children whose mothers applied sunscreen on a daily basis (90.2%, p = 0.002) and all of the children whose mothers held a master's degree or above (100%, p = 0.004).

Conclusion

Children's sun protection behavior is directly associated with demographic characteristics, families' socioeconomic level and maternal usage of sun protection measures. It is necessary to provide information and education about sun protection methods and the risks of excessive sun exposure to families and children, as well as facilitate their access to these.

Attitudes, Behaviors, and Risks of Sun Protection to Prevent Skin Cancer Amongst Children, Adolescents, and Adults

Skin cancer is the most common cancer diagnosis worldwide. Many factors are involved in the development of skin cancers, but ultraviolet (UV) light exposure is the most modifiable. Our lifetime cumulative UV exposure may be a result of poor sun protection practices in childhood and adolescence. Modifying the attitudes and behaviors of children can be done in the classroom, at recreational activities, and at home. A review of the literature was conducted using Embase and PubMed to examine the relationship between attitudes and behaviors as they relate to sun protection strategies. Well-developed, standardized sun protection educational programs are needed to instruct children and adolescents. Individualized counseling from physicians or online programs is needed to help parents increase sun-safe standards for their children. Many young women utilize indoor tanning beds frequently, but many instructional programs increased their tanning bed usage. Time should be allotted at schools, sports practices, camps, and other outdoor activities for sunscreen reapplication. Many parents and children report the media is their primary source of information about sun safety. Media outlets may positively change attitudes and behaviors when reporting about sun safety. Parents and children need individualized programs or counseling to reduce ultraviolet (UV) exposure and increase sun protection. At-risk populations need tailored instruction, but few strategies have worked to decrease UV exposure.

Correlation of skin cancer and actinic keratosis-related knowledge and sun protection behaviors and sunscreen use among a sample of Jordanian population

BACKGROUND

The incidence of skin cancer and actinic keratosis has increased worldwide. Measuring the public awareness, attitude, and knowledge about these diseases and the skin protection behaviors are highly important to undertake preventive measures.

METHODS

To investigate skin cancer and actinic keratosis-related knowledge, sun protection behaviors, and sunscreen usage among Jordanians, a questionnaire was developed. The questionnaire was provided as a google form to individuals via social media and the data were analyzed using SPSS^® 23.

RESULTS

A total of 1277 individuals, aged 18-65 years filled the questionnaire. The median melanoma and actinic keratosis knowledge score were 7 (4-9) and 4 (0-9), respectively. The melanoma knowledge was higher among females, those with a medical background, a high level of education, and in the central region, whereas the AK knowledge was higher among those with a medical background. Overall, 75.9% of the participants used sunscreen at least often to prevent sunburn, uneven skin tone, or tanning, 72% were using sunscreen with an SPF of 30 at least. However, 45.3% and 49.2% of sunscreen users did not comply with application, and reapplication times, respectively. Moreover, 58.4% of participants applied less than the recommended amount of sunscreen.

CONCLUSION

Our study revealed that public awareness of actinic keratosis is low among Jordanians. Although it was found that a high proportion of Jordanians use sunscreens there are deficits in sunscreen practice indicating an urgent need to design effective interventions to increase awareness of actinic keratosis and correct use of sunscreen via health campaigns or healthcare professions.

Designing a Social Marketing-Based Intervention to Promote Sun-protective Behaviors among Urban Adolescent Boys: A Study Protocol

Background

Skin cancer is one of the most preventable diseases. The purpose of this study is to describe a social marketing-based intervention design protocol to promote sun-protective behaviors among adolescent boys living in urban areas in Yasuj, south west of Iran.

Methods

This study will be conducted based on six specific steps including a qualitative study, a systematic review, development of appropriate tools, a cross-sectional study, intervention designing, and a feasibility study. The main objective of the qualitative study is to elicit the views and opinions of adolescent boys, their parents, and teachers about sun-protective behaviors. In the second step, factors affecting sun-protective behaviors will be reviewed systematically. Based on the findings of the first and second steps, an appropriate model/theory of behavior change will be selected, and a standardized questionnaire will then be developed. In the fourth step, a cross-sectional survey will be conducted using the developed questionnaire to assess current sun-protective behavior practices.

Results

Findings of the first to fourth stages will provide a comprehensive picture of the issue and the affecting factors. During the fifth step, the structure and the content of the intervention package, as well as educational and promotional materials, will be developed and pre-tested. Finally, in the sixth step, a feasibility study will be conducted.

Conclusion

This study will provide practical information on the achieving of content and construct of a community-based social marketing intervention. This protocol reports on how to achieve audience-oriented insights for designing a tailored intervention aimed at promoting sun-protective behaviors among adolescent boys using social marketing.

Encouraging sun protection early in life: from a successful prevention programme in children to the identification of psychological barriers in adolescents

Children and adolescents have high rates of sunburn and high levels of ultraviolet radiation (UVR) exposure and are therefore at risk of developing skin cancer in later life. Minimizing UVR exposure in childhood and adolescence may be the most important component of skin cancer prevention efforts. Thus, age-adapted prevention campaigns, targeting children, adolescents and caregivers, are needed to change sun protection behaviour among individuals in these age groups. In the first part of this review, we describe the 'SunPass' programme, which was initiated in Germany in 2010 as the first nationwide educational intervention for sun safety designed to teach kindergarten children and their caregivers how to protect themselves from overexposure to the sun. Implemented in 55 kindergartens, this programme has been shown to be effective at improving sun protection behaviour (P < 0.001) and hat use (P = 0.029) among kindergarten children, as well as at improving shade practices and increasing demand for protective clothing (P < 0.001). Up to 40 000 children, 50 000 parents/grandparents and 2500 kindergarten caregivers took part in the SunPass programme in Germany from 2019 to June 2021. The programme has also been adapted and implemented in several other European countries and could be readily adapted for use elsewhere. In the second part of this review, we discuss the specific challenges faced by adolescents and consider how these issues may impact their sun protection behaviour. Adolescents have difficulties suppressing responses to reward-related cues and projecting themselves into the future. They also place a lot of importance on social acceptance and cosmetic appearance, and their higher risk of depression, addiction and impulsivity make them vulnerable to tanning addiction. These specificities need to be acknowledged by dermatologists, so they can adapt their therapeutic relationship and develop effective sun protection interventions for this generation.

Investigation on the Awareness and Behavior of Primary School Students on Sunscreen Use in Beijing

Objective

This study aims to understand primary school students’ behavior and awareness of sun exposure and sunscreen in Beijing, China.

Methods

A questionnaire survey was conducted of 232 students in grades 4–6 at a public primary school in Beijing, including 129 boys (55.6%) and 103 girls (44.4%). The contents of the questionnaire included awareness about ultraviolet rays, sun exposure, sunscreen habits, and the understanding and use of sunscreen.

Results

The majority of the subjects (75.0%) said they had never been sunburned, and 26.3% had never been tanned. Only 7.3% of the primary school students had a comprehensive and correct understanding that sunlight will burn, cause cancer, tan, and age the skin. Sunscreen (47.8%), sunshades (47.4%), sun hats (44.4%), avoiding going out at noon (37.5%), and sunglasses (30.2%) were the most frequently used sunscreen means. Furthermore, 47.8% of primary school students used topical sunscreen for light protection, higher than other measures. The proportion of girls using sunscreen at least once a day was more than boys.

Conclusion

Primary school students in Beijing, China, do not have a comprehensive understanding of ultraviolet rays, and there are deficiencies in protective behavior. Their awareness and use of sunscreen need to be improved.

Correlates Between Physical Activity and Sunburn Prevalence Among a Nationally Representative Sample of US High School Students, 2015-2017

BACKGROUND

Physical activity is associated with greater odds of sunburn in adults, increasing harmful sun exposure and skin cancer risk. The authors sought to investigate parallel associations between sunburn and physical activity among US high school students.

METHODS

The authors examined pooled cross-sectional data from the 2015 and 2017 Youth Risk Behavior Survey. A nationally representative sample of 21,894 US high school students who responded to the sunburn question was included.

RESULTS

Prevalence of sunburn was 56.6% between 2015 and 2017. Sunburn prevalence was higher in physically active students (88.3%; 95% confidence interval [CI], 86.7%-90.0%; P < .0001) and student athletes (63.0%; 95% CI, 59.4%-66.7%; P < .0001). Among male students who were vigorously physically active (≥5 d) or on ≥3 teams, the odds of sunburn were 2.33 (95% CI, 1.81-3.00; P < .0001) and 2.52 (95% CI, 1.96-3.23; P < .0001), respectively. Among female students who were vigorously physically active (≥5 d) or on ≥3 teams, the odds of sunburn were 1.65 (95% CI, 1.36-2.02; P < .0001) and 2.92 (95% CI, 2.07-4.13; P < .0001), respectively.

CONCLUSIONS

Many US high school students are affected by sunburn, and the odds of sunburn are elevated during physical activity and team sports participation. Efforts are needed to improve sun safety regulations, education, and resources for youth during school and physical activity.

The effectiveness of educational programmes in promoting sun protection among children under the age of 18: a systematic review and meta-analysis

Childhood ultraviolet radiation exposure has a strong connection to the development of skin cancer in later life. Therefore, there have been numerous sun protection educational programmes targeted to this age group. However, the association between these have not been well established. This systematic review aims to summarize the evidence on, and assess, the effectiveness of educational programmes in improving sun protection among children under age-18. The protocol was prospectively registered in the PROSPERO database (CRD42020178264). Per PRISMA guidelines, bibliographic databases CENTRAL, OVID (EMBASE, MEDLINE, PsycINFO), LILACS, trial registries, grey literature and other sources were systematically searched for randomized controlled and clinical controlled trials published between database inception to 9 June 2020. Dual independent review of abstracts and full texts was performed. Eligible studies were assessed for methodological quality using the Cochrane risk-of-bias tool. The primary outcome was postintervention scores [standardized mean difference (SMD)] for sun protection (i) knowledge (ii) attitudes and beliefs (iii) behavioural intentions and behaviours. Sidik-Jonkman random effects meta-analysis, sensitivity and subgroup analyses were performed for specific outcomes (sunscreen and sun-safe hat use) which were sufficiently reported. 1350 publications were identified and 24 eligible trials, conducted across 8 different countries, with sufficient aggregate data were included. Small-to-moderate effects of educational programmes were observed across all sun protection outcomes of interest, but negligible effect sizes were demonstrated when specific outcomes were meta-analysed - sunscreen use, SMD 0.18 (95% CI 0.07-0.29; n = 8) and sun-safe hat use, SMD 0.08 (95% CI, 0.00-0.16; n = 6). A promising approach in the future may be to consider targeting children in secondary education with a digitally delivered interactive intervention. Current evidence, however, is insufficient to assess the effects of potential moderators and change in sun protection outcomes is likely not one-size-fits-all. Further research is warranted to direct intervention design and public policy.

Erythemal ultraviolet radiation exposure of high school rowers in Aotearoa/New Zealand

Athletes who compete in outdoor sports can receive potentially harmful levels of solar ultraviolet radiation (UVR). Rowing is a popular outdoor sport that takes place during the peak UVR season. Using electronic dosimeters attached to the shoulder strap of the rower's uniform, this study aimed to quantify the real-time solar UVR exposure experienced by high school rowers during competition. We measured personal UVR exposure (PE) during the time spent on the water in order to compete in a single rowing-race (race-time), when rowing administrators are responsible for athletes' wellbeing. Data collection took place in Aotearoa (New Zealand) at Lake Ruataniwha (44.28°S, 170.07°E), during two consecutive rowing seasons (December-February 2018-19 and 2019-20). Analysis of dosimeter data generated from 56 race-times over five regattas revealed a median personal UVR exposure (PE) of 1.15 standard erythemal dose (SED), where 1 SED is defined as an effective radiant exposure of 100 Jm^-2. Mean race-time was 46 min. Over two-thirds of race-times (69.6%) exceeded the Australian Radiation Protection and Nuclear Safety Agency recommendation of 1 SED being considered safe for most people in a day. An exposure of 1.5-3.0 SED produces perceptible erythema for people with light coloured skin and the lower parameter of 1.5 SED was exceeded in 14 (25.0%) of the race-times. By regatta, the median SED/h ranged from 0.96-2.40 and the median percentage of total concurrent ambient UVR ranged from 17 to 31%. Our results indicate that rowing is a high UVR sport and that races outside of peak UVR times also warrant the use of sun protection even when the UVI < 3. Given that acute and cumulative UVR exposure are recognised risk factors in the development of ocular diseases and skin cancers later in life, risk management guidelines for competitive school rowing will be incomplete until a long-term approach to well-being is considered and comprehensive sun protection measures adopted.

Associations between ultraviolet radiation, tree cover and adolescent sunburns

Background

Sunburn is the strongest risk factor for melanoma and non-melanoma skin cancers. Adolescent sunburns are related to higher risk of developing melanoma later in life. Little is known about the association of sunburns and shade, particularly tree cover, around adolescent homes and schools. This linkage study assessed associations of adolescent self-reported sunburns with ambient ultraviolet radiation (UV) and tree cover.

Methods

We analyzed a U.S. national sample of parent–child dyads (n = 1333) from the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study conducted by the National Cancer Institute. The outcome was adolescent sunburns reported for the previous 12 months. GIS buffers around geocoded home and school addresses were used to summarize UV and tree cover. A sensitivity analysis assessed different UV measures and tree cover buffer distances. Logistic regression models estimated the adjusted odds of any sunburns for five models: (1) no environmental variables; (2) spatial variables of latitude and longitude; (3) UV; (4) tree cover; and, (5) a combined model with UV and tree cover. Covariates included common sunburn-related items such as sun protective behaviors, socio-demographics, and latitude. Model residuals were assessed for spatial dependency and clustering.

Results

Overall, 44% of adolescents reported any sunburns in the previous 12 months. For the bivariate associations, lower categories of UV were associated with any reported sunburns (p-trend = 0.002). Home tree cover was not associated with any reported sunburns (p-trend = 0.08), whereas schools with lower categories of tree cover were associated with sunburns (p-trend = 0.008). The adjusted odds of any sunburns by UV tertiles, as a linear tread, was 0.89 (0.76–1.05) (p = 0.17); school tree cover was: 0.91 (0.78–1.07) (p = 0.25). Neither UV nor tree cover, in a combined model, were significant. Sensitivity analyses resulted in the optimal buffer size of 200 m for summarizing tree cover. Spatial dependence of residuals was not significant and clustering was significant for about 6% or less of the sample in each model.

Conclusions

We did not find significant relationships between UV or tree cover and adolescent sunburns, when adjusted by sunburn-related covariates. Better contextual data about where sunburns occurred is needed to identify environmental correlates of sunburn.

Children of the Sun: a historical look at how pediatric light therapy shaped attitudes and behaviors toward sunbathing

Today, parents are warned to protect their children from the sun's ultraviolet (UV) rays, the most preventable and leading cause of skin cancer. Yet, during the first half of the 20th century, the medical community widely extolled the health benefits of daily sunbaths for babies and children. What initially had begun as evidence-based medical therapies to prevent pediatric diseases, specifically tuberculosis and rickets, soon took on a life of its own as physicians, public health experts, and the general public embraced sunbathing and tanning as a means to ensure health and wellbeing for children and families. Here, we trace how specific medical therapies entered mainstream pediatric medicine and, converging with societal and cultural forces, shaped attitudes and behaviors towards sunbathing that still exist today. Understanding our complex history with the sun may shed light on the current peak of skin cancer incidence and future disease development. Moreover, it may help improve how we educate parents and children about sun safety by taking into account the current social and cultural context of medical practice and health communication.

Staying Safe This Summer

The arrival of summer brings more sunshine, more time outside, and more opportunities for recreation and play. Although these activities may look a little different this summer as a result of the coronavirus disease 2019 (COVID-19) pandemic, they also allow us to get outside, interact safely with others, and remain connected to our friends and communities. Along with fun activities and exercise, there also comes a need for heightened awareness of summertime safety. Because so many childhood activities occur during the summer, precautions must be taken to ensure the safety and health of our children. From appropriate sun protection and water safety to insect exposure and recreational precautions, it is important to review key safety points to ensure a happy and healthy season. As the COVID-19 pandemic is still very active, there will also be an added layer of complexity to staying safe this summer, including adapting activities to meet the guidelines of social distancing. This article addresses some of the most common dangers encountered during the summer months and offers protective measures to decrease risk and promote safety. [Pediatr Ann. 2020;49(7):e285-e289.].

The Potential of Ultraviolet Radiation Meters in Secondary Schools as a Sun Protection Intervention Mechanism for Adolescents

The aim of this pilot study was to assess whether the installation of ultraviolet radiation (UVR) meters in secondary schools has the potential to improve adolescents’ sun protection-related knowledge, attitudes, and behaviours and reduce their exposure to UVR during school hours. Data were collected from students at two schools via online pre- and post-intervention surveys, measurement of sunscreen usage, polysulfone UVR exposure badges, and photographs of the schoolyards to assess hat and shade use. Several operational issues limited the quantity and quality of data that could be collected, and findings were mixed. While there were no significant changes in either self-reported or observed sun protection behaviours, there were significant improvements in UVR knowledge among students at the intervention school, and reactions to the meter were highly favourable. Students reported consulting the meter regularly and using it to make decisions about their sun protection behaviours. Overall, the study results offer some support for the use of UVR meters in areas frequented by adolescents and provide insights into the process issues that are likely to need to be addressed when attempting to trial sun protection interventions in schools.