Sun-Protection Behaviors Used by Adults for Their Children -- United States, 1997

In the United States, the high incidence of skin cancer --including basal cell carcinoma, squamous cell carcinoma, and melanoma -- has been attributed primarily to sun exposure (1,2). To reduce exposures to the sun's harmful ultraviolet (UV) rays, the American Academy of Dermatology (AAD), the American Cancer Society, and other organizations have recommended sun-protection practices such as wearing protective clothing, avoiding sun exposure during the midday hours (when the sun's rays are the strongest), and using sunscreen (3,4). Such practices are especially important for infants and children because sun exposure during the early years of life appears to increase the risk for melanoma, the most serious form of skin cancer (1). To characterize sun-protection practices among children, AAD conducted a survey of parents with children aged less than or equal to 12 years during June-July 1997. This report summarizes the results of the survey, which indicate that three fourths of adults had their children use one or more measures to reduce exposure to UV rays.

Random-digit-dialing was used to compile a sample of households with children aged less than or equal to 12 years. Of 1872 households screened, 587 included a child aged less than or equal to 12 years. Of these households, 84 refused to participate in the survey, resulting in a sample size of 503 households. One adult per household was interviewed. Demographic characteristics were ascertained, and respondents were asked how often (always, usually, sometimes, or never) they had their child use specific measures to protect themselves from the sun. For households with more than one child aged less than or equal to 12 years, one child was randomly selected for reporting in the survey. For the analyses, "always" and "usually" were coded as positive responses and "sometimes" and "never" as negative responses. The statistical differences between the sun-protection behaviors and demographic variables were determined using Chi-square analyses.

Overall, 363 (74%) of 491 adults reported using one or more sun-protection behaviors for their children (Table_1). The sun-protection behavior most frequently reported was using a sunscreen with a sun-protection factor of greater than or equal to 15 (257 {53%} of 486), followed by seeking shade (150 {30%} of 499), wearing hats (133 {27%} of 502), and wearing shirts (42 {8%} of 501). Sun-protection behaviors overall were more frequently reported for fair-skinned children and for children of adults who were white than for darker-skinned children and for children of adults who were black. Sunscreen use in particular was more frequently reported for those same subgroups of children and for children with a family history of skin cancer. Women were more likely than men to report sunscreen use for their children. Although sunscreen use did not significantly change with the age of the child, the proportion of children using one or more sun-protection behaviors decreased with age.

Reported by: JK Robinson, MD, DS Rigel, MD, RA Amonette, MD, American Academy of Dermatology, Schaumburg, Illinois. Cancer Surveillance Br, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that a high proportion of parents, particularly parents of children at increased risk for skin cancer (e.g., those who are white, have fair skin, and who have a family history of skin cancer), use sun-protection measures for their children. The most frequently reported sun-protection behavior was sunscreen use. Other means of protection may be more difficult to promote among children, who may not want to wear hats or may be too hot to wear long sleeves.

The findings in this report are subject to at least two limitations. First, many households refused to be screened or had no adult respondent available; therefore, the results may not be representative of all U.S. children. Second, respondents' reporting of sun-protection behaviors may have been influenced by the desire to report in what was perceived to be a socially acceptable manner.

Several organizations, including AAD, the Skin Cancer Foundation, the American Cancer Society, the Food and Drug Administration, and CDC, have initiated educational efforts about sun protection. A recent study found an increased awareness among adults that sun exposure is dangerous, a decline in the belief that having a tan is healthy, and an increase in the reported use of sunscreen. However, study results also suggested an increase in adult UV ray exposure, as measured by increased reports of sunburning and regular use of tanning booths (5). Targeting health-education messages to children, young adults, and parents may result in further attitudinal and behavioral change in those who engage in high-risk behaviors. The desire to influence a child's behavior may further motivate adults to protect themselves while in the sun and to avoid sunburning. Sun-protection behaviors among children also may be enhanced by including educational components in school health curricula and by environmental measures, such as providing shade structures and scheduling outdoor activities before 10 a.m. or after 4 p.m.

References

1. Armstrong BK, English DR. Cutaneous malignant melanoma. In: Schottenfeld D, Fraumeni JF, eds. Cancer epidemiology and prevention. 2nd ed. New York, New York: Oxford University Press, 1996:1282-312.

2. Scotto J, Fears TR, Kraemer KH, Fraumeni JF. Nonmelanoma skin cancer. In: Schottenfeld D, Fraumeni JF, eds. Cancer epidemiology and prevention. 2nd ed. New York, New York: Oxford University Press, 1996:1313-30.

3. American Cancer Society. Cancer facts and figures -- 1997. Atlanta, Georgia: American Cancer Society, 1997. (report no. 97-300M-No. 5008.97).

4. Council on Scientific Affairs. Harmful effects of ultraviolet radiation. JAMA 1989;262:380-4.

5. Robinson JK, Rigel DS, Amonette RA. Trends in sun exposure knowledge, attitudes, and behaviors: 1986 to 1996. J Am Acad Dermatol 1997;37:179-86.

TABLE 1. Sun-protection behaviors reported by adults for their children, by selected
characteristics -- United States, 1997
=============================================================================================
                                               Children who use sunscreen,
                   Children who use sunscreen   clothing, hats, or shade
                   --------------------------  ---------------------------
Characteristic     No. *    (%)    (95% CI +)    No.   (%)     (95% CI)
--------------------------------------------------------------------------
Child's age (yrs)
   <= 2               51    (56)     (+/-10)     77    (83)     (+/- 8)
   3- 4               53    (60)     (+/-10)     69    (78)     (+/- 9)
   5- 7               55    (50)     (+/- 9)     80    (72)     (+/- 8)
   8-10               52    (49)     (+/- 9)     75    (69)     (+/- 9)
  11-12               46    (51)     (+/-10)     62    (69)     (+/-10)

Child's sex
  Boy                130    (52)     (+/- 6)    191    (76)     (+/- 5)
  Girl               127    (54)     (+/- 6)    172    (71)     (+/- 6)

Child's skin type
  Dark                30    (39)     (+/-11)     49    (64)     (+/-11)
  Olive               68    (55)     (+/- 9)     91    (73)     (+/- 8)
  Fair               111    (53)     (+/- 7)    157    (75)     (+/- 6)
  Very fair           48    (62)     (+/-11)     64    (83)     (+/- 8)

Sex of adult
 respondent
  Man                 62    (39)     (+/- 8)    110    (69)     (+/- 7)
  Woman              195    (59)     (+/- 5)    253    (76)     (+/- 5)

Race of adult
 respondent &
  White,             215    (59)     (+/- 5)    279    (76)     (+/- 4)
    non-Hispanic
  Black,              10    (18)          --     29    (52)          --
    non-Hispanic
  Other               29    (47)          --     51    (80)          --

Skin cancer
 in family
  Yes                 39    (75)     (+/-12)     40    (77)     (+/-11)
  No                 216    (50)     (+/- 5)    321    (73)     (+/- 4)

Total                257    (53)     (+/- 5)    363    (74)     (+/- 4)
--------------------------------------------------------------------------
* Numbers may not add to total because of nonresponse to some questions.
+ Confidence interval.
& Numbers for racial/ethnic groups other than white and black were too small for meaningful
  analysis.
=============================================================================================

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