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Cluster Randomized Trial: Sun Protection Intervention 'Clever in Sun and Shade for Preschools'-Effectiveness and Dissemination. CHILDREN-BASEL 2021; 8:children8080651. [PMID: 34438542 PMCID: PMC8391804 DOI: 10.3390/children8080651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022]
Abstract
Skin cancer is one of the most common types of cancer and UV radiation is one of the main risk factors. Therefore, sun protection, especially in childhood, is strongly recommended. We examined the effectiveness of the ‘Clever in Sun and Shade for Preschools’ program (CLEVER) in promoting sun protection behavior among preschool staff (trial registration: DRKS00023468) and describe its dissemination. Within a cluster randomized trial with 24 preschools (n = 273 staff members) stating a high need for sun protection measures, an educational workshop for preschool staff and a project kit with materials applicable in preschool groups was provided. Staff members of preschools taking part in CLEVER report significantly stronger sun protection behavior to avoid the sun (effect size [ES] 0.70, 95% confidence interval [CI] 0.04 0.71, p < 0.05) and less perceived impediments to avoid the sun (ES −0.56, CI −0.82 −0.17, p < 0.01) after 12 months as well as higher self-efficacy to avoid the sun (ES 1.09, CI 0.39 1.07, p < 0.001) and to use sunscreen (ES 0.71, CI 0.03 0.88, p < 0.05) after 1 month. Compared to the control group, there was no significant effect on sunscreen use and further psychosocial outcomes. The effectiveness of CLEVER may be underrated due to a high drop-out rate. Within three years, an enhanced free-of-charge program kit, including a media-based workshop and materials, had reached over 4000 preschools, i.e., 7.1% of all daycare centers in Germany. The results show that CLEVER can strengthen sun protection, offer high-quality information at low cost, and is easily disseminable.
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Criado P, Ocampo-Garza J, Brasil A, Belda Junior W, Di Chiacchio N, de Moraes A, Parada M, Rabay F, Moraes Junior O, Rios R, da Silva C, Ferreira F, Mandelbaum S, Vasconcellos C. Skin cancer prevention campaign in childhood: survey based on 3676 children in Brazil. J Eur Acad Dermatol Venereol 2017; 32:1272-1277. [DOI: 10.1111/jdv.14740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/30/2017] [Indexed: 01/13/2023]
Affiliation(s)
- P.R. Criado
- Members of Brazilian Society Dermatology; São Paulo Brazil
- Full Researcher at Faculdade de Medicina do ABC; Santo André São Paulo Brazil
| | - J. Ocampo-Garza
- Dermatology Department; University Hospital ‘Dr. José Eleuterio González’; Universidad Autónoma de Nuevo León; Monterrey México
| | - A.L.D. Brasil
- Pediatrician of Social Service of the Industry-Regional Estate of São Paulo (SESI-SP in Portuguese); São Paulo Brazil
| | | | | | - A.M. de Moraes
- Members of Brazilian Society Dermatology; São Paulo Brazil
| | - M.B. Parada
- Members of Brazilian Society Dermatology; São Paulo Brazil
| | - F.O. Rabay
- Members of Brazilian Society Dermatology; São Paulo Brazil
| | | | - R.S. Rios
- Members of Brazilian Society Dermatology; São Paulo Brazil
| | - C.S. da Silva
- Members of Brazilian Society Dermatology; São Paulo Brazil
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Wan M, Hu R, Li Y, Wang Y, Xie X, Yue P, Guan L, Lai W. Attitudes, Beliefs, and Measures Taken by Parents to Protect Their Children from the Sun in Guangzhou City, China. Photochem Photobiol 2016; 92:753-9. [PMID: 27463620 DOI: 10.1111/php.12623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/24/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Miaojian Wan
- Department of Dermatology & Venerology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Rong Hu
- Skin Research Center, Landproof Testing Technology Co., Ltd, Guangzhou, Guangdong Province, China
| | - Ying Li
- Department of Dermatology, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong Province, China
| | - Yaning Wang
- Skin Research Center, Landproof Testing Technology Co., Ltd, Guangzhou, Guangdong Province, China
| | - Xiaoyuan Xie
- Department of Dermatology & Venerology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Pan Yue
- Department of Dermatology & Venerology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Lei Guan
- Skin Research Center, Landproof Testing Technology Co., Ltd, Guangzhou, Guangdong Province, China.
| | - Wei Lai
- Department of Dermatology & Venerology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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Haylett A, Chiang Y, Nie Z, Ling T, Rhodes L. Sunscreen photopatch testing: a series of 157 children. Br J Dermatol 2014; 171:370-5. [DOI: 10.1111/bjd.13003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A.K. Haylett
- Photobiology Unit; Dermatology Centre; Institute of Inflammation and Repair; University of Manchester; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Manchester M6 8HD U.K
| | - Y.Z. Chiang
- Photobiology Unit; Dermatology Centre; Institute of Inflammation and Repair; University of Manchester; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Manchester M6 8HD U.K
| | - Z. Nie
- Photobiology Unit; Dermatology Centre; Institute of Inflammation and Repair; University of Manchester; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Manchester M6 8HD U.K
| | - T.C. Ling
- Photobiology Unit; Dermatology Centre; Institute of Inflammation and Repair; University of Manchester; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Manchester M6 8HD U.K
| | - L.E. Rhodes
- Photobiology Unit; Dermatology Centre; Institute of Inflammation and Repair; University of Manchester; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Manchester M6 8HD U.K
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Klostermann S, Bolte G. Determinants of inadequate parental sun protection behaviour in their children--results of a cross-sectional study in Germany. Int J Hyg Environ Health 2013; 217:363-9. [PMID: 23988730 DOI: 10.1016/j.ijheh.2013.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Unprotected sun exposure especially during childhood is a risk factor for skin cancer. A combined use of sun protection measures is recommended to protect children. However, the prevalence and determinants for combined use have been scarcely studied in children. The objective of this study was to identify determinants of parental sun protection behaviour. METHODS A cross-sectional survey was performed in five regions in Bavaria (Germany) during school entrance health examination (2010/2011). Parents of 4579 children (47% female, aged 5-6 years) completed a self-administered questionnaire (response 61%). RESULTS Most children were regularly protected with single measures (shade (69%), clothes (80%), hat (83%), sunscreen (89%), sunglasses (20%)). However, regarding regular and combined use, >50% of children were inadequately protected. Larger family size, lower household equivalent income, darker skin and sunburn history were associated with inadequate use of different sun protection measures. The less frequent use of one sun protection measure was associated with less frequent use of the others. Child's sex, migration background, parental education and sun exposure showed inconsistent results regarding the different sun protection outcomes. CONCLUSION Based on our results a regular, combined and correct use of multiple sun protection for children should be promoted independent of sociodemographic characteristics. Priority of shade, clothes and hat before sunscreen should be clarified.
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Affiliation(s)
- Swaantje Klostermann
- Department of Occupational and Environmental Epidemiology, Bavarian Health and Food Safety Authority, Germany
| | - Gabriele Bolte
- Department of Occupational and Environmental Epidemiology, Bavarian Health and Food Safety Authority, Germany; Department of Social Epidemiology, Institute for Public Health and Nursing Research, University of Bremen, Germany.
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Batista T, Fissmer MC, Porton KRDB, Schuelter-Trevisol F. Avaliação dos cuidados de proteção solar e prevenção do câncer de pele em pré-escolares. REVISTA PAULISTA DE PEDIATRIA 2013; 31:17-23. [DOI: 10.1590/s0103-05822013000100004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 10/09/2012] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Investigar os cuidados dos pais com a pele de seus filhos, especialmente quanto ao uso do filtro solar e de métodos físicos de proteção solar. MÉTODOS: Estudo transversal com pré-escolares de Tubarão, Santa Catarina, Brasil. Após sorteio de escolas das redes pública e privada e mediante a autorização da direção das entidades, os pais ou responsáveis foram convidados a participarem do estudo. Os questionários foram autoaplicáveis. O instrumento continha dados sobre características demográficas e socioeconômicas, uso de filtro solar, uso de barreiras físicas de proteção solar, além dos horários em que a criança ficava exposta ao sol. Para verificar a associação entre as variáveis de interesse, foram utilizados os testes do qui-quadrado de Pearson ou exato de Fisher, sendo significante p<0,05. RESULTADOS: Foram estudadas 361 crianças, sendo 228 (63,2%) matriculadas na rede pública de ensino. A cor branca da pele foi predominante (78,8%). Do total, 16 (4,4%) faziam uso do filtro solar todos os dias do ano e 253 (70,1%) usavam barreiras físicas de proteção solar. Crianças de pele branca usavam mais filtro solar do que as negras, principalmente no verão (p=0,001), e costumavam reaplicar o produto (p=0,04). Foi encontrada uma associação positiva entre renda familiar elevada e uso de filtro solar (p<0,001). A reaplicação do filtro solar também esteve associada com crianças que frequentavam escolas da rede privada (p=0,01). CONCLUSÕES: Os achados revelam que o uso de filtro solar em pré-escolares é incorreto e insuficiente.
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Tripp MK, Vernon SW, Gritz ER, Diamond PM, Mullen PD. Children's skin cancer prevention: a systematic review of parents' psychosocial measures. Am J Prev Med 2013; 44:265-73. [PMID: 23415124 DOI: 10.1016/j.amepre.2012.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 09/11/2012] [Accepted: 10/22/2012] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Mary K Tripp
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA.
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Behrens CL, Thorgaard C, Philip A, Bentzen J. Sunburn in children and adolescents: associations with parents' behaviour and attitudes. Scand J Public Health 2013; 41:302-10. [PMID: 23392996 DOI: 10.1177/1403494813476158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Christine L Behrens
- Danish Sun Smart Campaign, Department of Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark.
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Li J, Uter W, Pfahlberg A, Gefeller O. Parental perspective on sun protection for young children in Bavaria. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:196-202. [DOI: 10.1111/j.1600-0781.2011.00598.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Non-hereditary photodermatoses with well-known trigger factors and idiopathic light eruptions occur quite frequently during childhood and are at least temporarily associated with a marked impairment of quality of life in affected patients and their parents. Thus, it is crucial that the involved specialties are familiar with acquired UV-associated disorders in order to guarantee a quick diagnosis and effective therapy. Additionally, the recurrence of photodermatoses associated with potentially severe long-term complications has to be prevented. This requires a stringent prophylaxis that can only succeed after age-adapted instruction of the patient and parents.
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Affiliation(s)
- H Ott
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Aachen, Pauwelsstrasse 30, 52074 Aachen.
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