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

Affecting Young Children’s Knowledge, Attitudes, and Behaviors for Ultraviolet Radiation Protection through the Internet of Things: A Quasi-Experimental Study

Prolonged exposure to ultraviolet (UV) radiation is linked to skin cancer. Children are more vulnerable to UV harmful effects compared to adults. Children’s active involvement in using Internet of Things (IoT) devices to collect and analyze real-time UV radiation data is suggested to increase their awareness of UV protection. This quasi-experimental pre-test post-test control group study implemented light sensors in a STEM inquiry-based learning environment focusing on UV radiation and protection in primary education. This exploratory, small-scale study investigated the effect of a STEM environment implementing IoT devices on 6th graders’ knowledge, attitudes, and behaviors about UV radiation and protection. Participants were 31 primary school students. Experimental group participants (n = 15) attended four eighty-minute inquiry-based lessons on UV radiation and protection and used sensors to measure and analyze UV radiation in their school. Data sources included questionnaires on UV knowledge, attitudes, and behaviors administered pre- and post-intervention. Statistically significant learning gains were found only for the experimental group (t14 = −3.64, p = 0.003). A statistically significant positive behavioral change was reported for experimental group participants six weeks post-intervention. The study adds empirical evidence suggesting the value of real-time data-driven approaches implementing IoT devices to positively influence students’ knowledge and behaviors related to socio-scientific problems affecting their health.

Sun-related knowledge and attitudes of primary and secondary schoolchildren in western Switzerland

Switzerland, particularly its western region, has the highest incidence of melanoma in Europe. Although the risk of melanoma increases with sun overexposure during childhood, sun-related knowledge and attitudes of Swiss children are scarcely documented. We report the first investigation of the knowledge of the danger of ultraviolet radiation, attitudes towards a suntan and parental influence of schoolchildren in western Switzerland. All fifth, eighth and eleventh graders (average ages of 9, 12 and 15, respectively) in the 18 primary (fifth grade, n=431) and secondary (eighth and eleventh grades, n=837) public schools of La Chaux-de-Fonds were surveyed during regular school classes. The response rate was 91% (1154/1268). Sun-related knowledge was high overall. Eight out of 10 children knew about the risk of skin cancer and recognized the most susceptible phototype. Knowledge increased significantly with age. Girls, older children, fair-skinned participants and those who preferred a tanned skin obtained the highest knowledge score. The main source of information on ultraviolet radiation and sun protection was their parents (76%), followed by the school (11%) and the media (9%). Multivariate logistic regression analyses identified higher sun-related knowledge, lower familial socioprofessional status and skin phototypes III-IV to be associated with a tan-seeking attitude. Parental sensitization (56%) and encouragement (61%) towards sun protection were more common among fair-skinned children and those of higher familial socioprofessional status. The high awareness of the risk of skin cancer among Swiss schoolchildren does not translate into appropriate attitudes. Community-wide intervention programmes involving parents, teachers, peers and primary care clinicians could be considered for Swiss prevention campaigns to improve children's sun behaviour and change their current pro-tan attitude.

Parents' knowledge, attitudes and beliefs regarding sun protection in children: a qualitative study

Background

Childhood is a critical period for sun protection, when the skin is particularly susceptible to the carcinogenic effects of ultraviolet radiation. Children are dependent upon parents to implement sun protective measures. Existing qualitative research exploring parents’ attitudes and beliefs underpinning children’s sun protection is from Australia, which has the highest melanoma incidence rates globally, and thus benefits from widespread sun protection awareness campaigns. Parents’ sun protective behaviour may, therefore, differ between Australia and the UK.

This study investigates the topic in a UK context, using qualitative methodology to gain detailed insights into a relatively under-researched area. The aim of the study was to explore parents’ knowledge and understanding of sun protection in children, and factors that motivate and challenge them in this area. Finally, it aimed to determine if and how ethnicity and skin type influence these attitudes and beliefs.

Methods

Twenty-two semi-structured individual interviews were carried out with parents of children aged 5 years or younger, recruited from local nurseries. Transcripts were analysed using thematic analysis.

Results

Four overarching themes emerged, each incorporating two to three sub-themes. ‘Attitudes towards children’s sun protection’ refers to the fact that parents considered sun protection to be important for children, a finding which was consistent between different skin types. ‘Sun protection practices’ brings together several protective behaviours adopted in children and, to a lesser degree, in parents, and their associated disadvantages. ‘Sun safety knowledge’ refers to parents’ awareness of the risks of sun exposure and the need for protection, and illustrates where gaps in knowledge exist, such as regarding the need for vitamin D, and the importance of vigilant sun protection even in the UK. Finally, ‘motivating and facilitating factors’ highlights motivations for sun protection in children, and factors that facilitate it in practice.

Conclusion

This study found parents to be motivated and concerned about children’s sun protection, irrespective of children’s ethnicity, and aware of appropriate protective behaviours. It indicates key challenges which could be targeted in future campaigns in order to improve sun protection in children and reduce uncertainty and anxiety regarding sun safety amongst parents.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5091-8) contains supplementary material, which is available to authorized users.

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.

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.

SunSmart: evaluation of a pilot school-based sun protection intervention in Hispanic early adolescents

The incidence of melanoma is rising among Hispanic populations in the United States. The purpose of this study is to evaluate the impact of a pilot sun safety educational intervention conducted from 2006 to 2012 on Hispanic early adolescents in a high ultraviolet environment. Nineteen schools with high Hispanic enrollment were recruited from urban neighborhoods in Los Angeles. The analytic sample was restricted to students identifying as Hispanic or Latino (n = 777). A mixed effects linear model was used to test mean changes from pre- to posttest on students' sun protection knowledge, attitudes and behaviors. Significant improvements were observed across several cognitive outcomes related to sun protection, including knowledge of and attitudes toward sun protection and self-efficacy to wear sunscreen. However, changes in sun protective behaviors were not achieved. Although some improvements were observed, future studies should identify the factors that motivate sun protection in this population and develop tailored prevention strategies, as improving the sun safe behaviors of Hispanic youths may aid in reducing the risk of melanoma in adulthood in this population.

The impact of parental knowledge and tanning attitudes on sun protection practice for young children in Germany

Public health campaigns have improved knowledge on UVR-associated skin cancer risk and increased sun protection awareness. However, tanned skin is still a common beauty ideal. The relationship between knowledge, attitudes and protective behavior is not fully understood yet. A population-based survey was thus performed in the district of Erlangen involving 2,619 parents of 3- to 6-year old children. By means of a self-administered standardized questionnaire parental knowledge about risk factors for skin cancer, their attitudes towards tanning and details of protective measures taken for their children were assessed. The study analyzed specifically the impact of parental tanning attitudes on sun-protective measures for their children while controlling for parental knowledge about skin cancer risk factors. While parental knowledge was significantly (inversely) associated with agreement to the statement "Tanned skin is healthy skin", this was not the case for "Tanning makes me look better". Overall, tanning affirmative attitudes were inversely associated with protective measures taken for the children, whereas parental knowledge had a positive impact on sun protection at the beach only. Multivariable analyses provided evidence for an effect of parental attitude on protective behavior independent of parental knowledge. Tanning attitudes and tanned skin as the misguided ideal of beauty need to be addressed in future public health campaigns to enhance the effectiveness of preventive activities in changing sun protective behavior.

Scottish adolescents' sun-related behaviours, tanning attitudes and associations with skin cancer awareness: a cross-sectional study

OBJECTIVES

To describe Scottish adolescents' sun-related behaviours and tanning attitudes and assess associations with skin cancer awareness.

DESIGN

Cross-sectional study.

SETTING

20 state secondary schools in one Scottish local authority (Glasgow City).

PARTICIPANTS

2173 adolescents (females: 50.7%, n=1102) with a mean age of 12.4 (SD=0.55).

OUTCOME MEASURES

Sun-related behaviour (suntan, sunbathing, sunburn, sunscreen use, sunbed use), tanning attitudes, skin cancer-related symptom and risk factor awareness.

RESULTS

Adolescents reported poor sun-related practice: 51% of adolescents reported sunburn the previous summer of whom 38% indicated sunburn on more than one occasion. Skin cancer awareness was low: 45% recognised 'change in the appearance of a mole' as a cancer symptom, and 39% agreed that 'getting sunburnt more than once as a child' increased cancer risk. 42% and 26% of adolescents, respectively, reported that friends and family held protanning attitudes. Compared with males, females were statistically significantly more likely to: report sunbathing (p<0.001), use of lotions or oil to aid tanning (p=0.009) and sunburn (p<0.001); know that changes in the appearance of a mole was a skin cancer symptom (p=0.036) and sunburn more than once as a child was a skin cancer risk factor (p=0.005); perceive their friends to hold protanning attitudes (p<0.001) and indicate that a tan made them feel better about themselves (p<0.001), more attractive to others (p=0.011) and healthier (p<0.001).

CONCLUSIONS

Scottish adolescents had poor sun protection practice and low skin cancer awareness. Girls adopted riskier sun-related behaviour despite greater awareness of skin cancer-related risk. Urgent action is required to promote positive sun-related behaviour and increase skin cancer awareness among Scottish adolescents. However, further research is needed to inform the development of effective sun-safe interventions.

Self-reported sun-related knowledge, attitudes and behaviours among schoolchildren attending South African primary schools

BACKGROUND

Skin cancer and other adverse health effects result from excess solar ultraviolet radiation exposure. Sun protective practices are important interventions for skin cancer prevention, particularly when implemented early in life. Several international studies have assessed children's sun-related knowledge, attitudes and behaviours in school settings but never before in Southern Africa, where multiethnic populations exist.

PURPOSE

The purpose of this study is to describe the sun-related knowledge, attitudes and behaviours as self-reported by South African primary schoolchildren and consider the roles of sex and skin type.

METHODS

A randomly selected sample of 707 schoolchildren from 24 government, urban schools in all nine provinces of South Africa were surveyed regarding their sun-related knowledge, attitudes and behaviours.

RESULTS

Approximately 56% of students reported experience of sunburn last summer and 59% stated that they had got a suntan. Many students (64.5%) believed that one could protect oneself from getting skin cancer by avoiding getting sunburnt. Other means reported to do so by the students were to use sunscreen (65.4%), stay out of the summer sun (48.0%), cover up with clothing (45.5%) and eat the right foods (38.0%). Only about a quarter of the students (22.4%) wrongly agreed that it is safe to get sunburnt once or twice a year. Few students (8.7%) agreed that they like to have a suntan because they feel healthier and agreed that they think a suntan makes them feel more attractive to others (17.3%). Few also agreed that most of their friends (16.1%) and family (14.2%) think that a suntan is a good thing. Children reporting to have white/light brown skin (69.4%) were more likely to agree that they used sunscreen to protect themselves from getting sunburnt compared with children having brown/dark brown/black skin (54.8%) (P = 0.0005).

CONCLUSION

South African schoolchildren at urban government schools do have some knowledge about sun protection, and they do have some positive sun behaviours; however, the reported occurrence of sunburn, a risk factor for skin cancer, was relatively high. There were few differences in responses by sex and some differences by skin type. These findings are important for the development of appropriate sun protection programmes aimed at schoolchildren in South Africa and other countries with similar multi-ethnic populations.

The role of skin cancer knowledge in sun-related behaviours: A systematic review

Skin cancer is the most commonly diagnosed cancer in many Western countries. This systematic review provides a comprehensive overview of the relationship between skin cancer knowledge and sun-protective, exposure and tanning behaviours in the general population. A total of 34 studies, published in peer-reviewed journals over three decades, were reviewed and synthesised. Sun-protective behaviour was positively associated with skin cancer knowledge in most cases. Findings were inconsistent regarding other sun-related behaviours. Heterogeneity in measurement compromised the capacity to definitively link knowledge and sun-related behaviours. There is a need for development and utilisation of a standardised skin cancer knowledge scale, and guidelines are suggested.

Sun-protection habits of primary students in a coastal area of Greece

Aim. The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1) years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set to P ≤ 0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0–5 km away from the sea (urban area), 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.

Prospective study of sunburn and sun behavior patterns during adolescence

OBJECTIVES

Early childhood UV light radiation (UVR) exposures have been shown to be associated with melanoma development later in life. The objective of this study was to assess sunburn and changes in sunburn and sun behaviors during periadolescence.

METHODS

A prospective, population-based study was conducted in fifth-grade children (∼10 years of age) from Framingham, Massachusetts. Surveys were administered at baseline (September-October 2004) and again 3 years later (September-October 2007). Surveys were analyzed to assess prevalence of reported sunburn and sun behaviors and to examine changes in response over the follow-up period.

RESULTS

Data were analyzed from 360 participants who had complete information regarding sunburn at both time points. In 2004, ∼53% of the students reported having at least 1 sunburn during the previous summer, and this proportion did not significantly change by 2007 (55%, P = .79), whereas liking a tan and spending time outside to get a tan significantly increased (P < .001). In 2004, 50% of students reported "often or always" use of sunscreen when outside for at least 6 hours in the summer; this proportion dropped to 25% at the follow-up evaluation (P < .001).

CONCLUSIONS

With at least 50% of children experiencing sunburns before age 11 and again 3 years later, targeting children in pediatric offices and community settings regarding unprotected UV exposure may be a practical approach. Because periadolescence is a time of volatility with regard to sun behaviors, learning more about children who receive sunburns versus those who avoid them is a critical research task.

Associations between authoritative parenting and the sun exposure and sun protective behaviours of adolescents and their friends

Associations between the sun exposure and sun protective behaviours of adolescents and their friends were examined along with the role played by authoritative parenting and other family and peer socialisation factors. Four hundred and two adolescents (198 males, 204 females) participated in the research. It was found that these adolescents and their friends shared similar sun exposure and sun protective behaviours and had similar parenting backgrounds. Parental authoritativeness was positively associated with the use of sun protection, even after the effects of other familial and peer variables were controlled, but not with the time spent sunbathing which was associated with friends' behaviours. The theoretical and practical implications of these findings are discussed.

[Update on photoprotection in children]

Children are one of the population groups in which the photo-protection must be maximised. Firstly, because they take part in outdoor activities more often than adults. Secondly, because the principal risk factor for all types of skin cancer is ultraviolet radiation, and in particular, cumulative exposure during childhood. Hence, decreasing exposure to ultraviolet radiation in childhood has the potential to significantly lower the incidence of most forms of skin cancer. Photoprotection includes behavioural measures to protect the skin from sun exposure, e.g. sun protective clothes, hats, sunglasses, and sunscreens. It is necessary to provide information on aphotoprotection to parents, and, above all, to children, using educational campaigns to increase knowledge of photoprotection to help change attitudes towards sun exposure. Dermatologists and Paediatricians play a essential role in this educational work. In this article we review the latest information regarding paediatric sun protection, the new sunscreens, and the recent sun protection educational programs.