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

Abstract

Children and adolescents may be vulnerable to increased ultraviolet radiation exposure and greater risk for subsequent sun-related pathologies. This study examined the demographic, geographic, and phenotypic factors influencing sun exposure and protective behaviors among children and adolescents living in the United States. A cross-sectional survey on perceived sun exposure and protective behaviors was administered at three sports medicine clinics in California, Colorado, and Hawaii. Responses were measured with a 5-item frequency scale: Never, Rarely (25% of the time or less), Sometimes (50% of the time), Often (75% of the time or more), and Always. Sun protective behavior was examined using univariate and multivariate analyses. In total, 860 surveys were collected (52% female, 48% male; mean age 12.7 years). Females reported significantly greater frequency of using sunscreen (p = 0.001), staying in the shade or using an umbrella while in the sun (p = 0.004), and tanning (p < 0.001). Age was inversely associated with sunscreen use frequency (p < 0.001); the percentage of participants who reported always wearing sunscreen decreased as age increased. Participants in Hawaii reported using sunscreen less frequently than those in California and Colorado (p < 0.001). These results identify high-risk populations such as males, older adolescents, and Hawaii's youth who may not be practicing frequent sun protective behaviors. While it is important for youth to stay active, they must also be reminded to adopt protective behaviors while outdoors to prevent unnecessary sun damage and lower the risk of sun exposure complications.

Associations between ultraviolet radiation, tree cover and adolescent sunburns

“…The results from Aim 3 highlight the potential spatial variation in the associations between sunburns, covariates, behaviors and environments. Recent research reported adolescent sunscreen use, sun protective clothing use, and intentional sun exposure varied between three U.S. states [ 44 ]. For example, adolescents in Hawaii reported using sunscreen less frequently than those in California or Colorado [ 44 ].…”

“…Recent research reported adolescent sunscreen use, sun protective clothing use, and intentional sun exposure varied between three U.S. states [ 44 ]. For example, adolescents in Hawaii reported using sunscreen less frequently than those in California or Colorado [ 44 ]. Sun protective behaviors and sunburns also varied between urban and rural areas in Texas adults, with rural residents more likely to report using sunscreen with a higher sun protection factor (SPF), yet also report having had more sunburns during adolescence compared to urban residents [ 45 ].…”

“…The national sample allowed variation in environmental contexts, socio-demographics, and behaviors. For example, adolescent sun protective behaviors vary between some U.S. states [ 44 ], so using a national sample allowed for more generalizable results than a study located in a specific city, state or region. Another strength was the geocoded home and school locations, which allowed estimates of local tree cover.…”

“…Another strength was the geocoded home and school locations, which allowed estimates of local tree cover. Few other studies have assessed sunburns and tree cover with this level of detail, with most assessing either sunburns and behaviors [ 18 , 19 , 21 , 44 ] or tree cover and potential UV exposure [ 6 , 23 , 25 – 27 ]. While our measure of sunburns was broad (over previous 12 months), we leveraged ambient UV, important sun protective behaviors, and other covariates to explore the role of tree cover with sunburns.…”

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

“…While the prevalence of use of sun protection behaviours in adolescence varies across different countries [11][12][13][14], overall enactment levels remain suboptimal [14][15][16]. This is especially the case amongst teenagers, with compliance with sun protection recommendations decreasing during adolescence [15,[17][18][19]. Teenagers have been described as particularly difficult to target due to reduced parental oversight, a desire to exert independence, increasing concern about appearance, a common desire for a tan, concerns about the opinions of peers, and increased risk-taking, all of which can result in low motivation to comply with sun protection recommendations [13,15,[20][21][22].…”